scholarly journals The Role of Autophagy for the Regeneration of the Aging Liver

2020 ◽  
Vol 21 (10) ◽  
pp. 3606
Author(s):  
Fengming Xu ◽  
Chuanfeng Hua ◽  
Hans-Michael Tautenhahn ◽  
Olaf Dirsch ◽  
Uta Dahmen
Keyword(s):  
Liver Regeneration ◽  
The Elderly ◽  
Surgical Removal ◽  
Remnant Liver ◽  
Hepatic Tumors ◽  
Curative Surgery ◽  
Increased Risk ◽  
High Incidence ◽  
Patients At Risk

Age is one of the key risk factors to develop malignant diseases leading to a high incidence of hepatic tumors in the elderly population. The only curative treatment for hepatic tumors is surgical removal, which initiates liver regeneration. However, liver regeneration is impaired with aging, leading to an increased surgical risk for the elderly patient. Due to the increased risk, those patients are potentially excluded from curative surgery. Aging impairs autophagy via lipofuscin accumulation and inhibition of autophagosome formation. Autophagy is a recycling mechanism for eukaryotic cells to maintain homeostasis. Its principal function is to degrade endogenous bio-macromolecules for recycling cellular substances. A number of recent studies have shown that the reduced regenerative capacity of the aged remnant liver can be restored by promoting autophagy. Autophagy can be activated via multiple mTOR-dependent and mTOR-independent pathways. However, inducing autophagy through the mTOR-dependent pathway alone severely impairs liver regeneration. In contrast, recent observations suggest that inducing autophagy via mTOR-independent pathways might be promising in promoting liver regeneration. Conclusion: Activation of autophagy via an mTOR-independent autophagy inducer is a potential therapy for promoting liver regeneration, especially in the elderly patients at risk.

Cerebral amyloid angiopathy–associated intracerebral hemorrhage: pathology and management

2012 ◽  
Vol 32 (4) ◽  
pp. E7 ◽  
Author(s):  
Prachi Mehndiratta ◽  
Sunil Manjila ◽  
Thomas Ostergard ◽  
Sylvia Eisele ◽  
Mark L. Cohen ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Cerebral Amyloid Angiopathy ◽  
Management Strategies ◽  
Case Series ◽  
The Elderly ◽  
Postoperative Hemorrhage ◽  
Amyloid Angiopathy ◽  
Increased Risk ◽  
Cerebral Amyloid

Amyloid angiopathy–associated intracerebral hemorrhage (ICH) comprises 12%–15% of lobar ICH in the elderly. This growing population has an increasing incidence of thrombolysis-related hemorrhages, causing the management of hemorrhages associated with cerebral amyloid angiopathy (CAA) to take center stage. A concise reference assimilating the pathology and management of this clinical entity does not exist. Amyloid angiopathy–associated hemorrhages are most often solitary, but the natural history often progresses to include multifocal and recurrent hemorrhages. Compared with other causes of ICH, patients with CAA-associated hemorrhages have a lower mortality rate but an increased risk of recurrence. Unlike hypertensive arteriolar hemorrhages that occur in penetrating subcortical vessels, CAA-associated hemorrhages are superficial in location due to preferential involvement of vessels in the cerebral cortex and meninges. This feature makes CAA-associated hemorrhages easier to access surgically. In this paper, the authors discuss 3 postulates regarding the pathogenesis of amyloid hemorrhages, as well as the established clinicopathological classification of amyloid angiopathy and CAA-associated ICH. Common inheritance patterns of familial CAA with hemorrhagic strokes are discussed along with the role of genetic screening in relatives of patients with CAA. The radiological characteristics of CAA are described with specific attention to CAA-associated microhemorrhages. The detection of these microhemorrhages may have important clinical implications on the administration of anticoagulation and antiplatelet therapy in patients with probable CAA. Poor patient outcome in CAA-associated ICH is associated with dementia, increasing age, hematoma volume and location, initial Glasgow Coma Scale score, and intraventricular extension. The surgical management strategies for amyloid hemorrhages are discussed with a review of published surgical case series and their outcomes with a special attention to postoperative hemorrhage.

Cardiovascular Disease

2018 ◽  
Author(s):  
Mara Caroline ◽  
Ryan Bradley ◽  
Mimi Guarneri
Keyword(s):  
Cardiovascular Disease ◽  
Elderly Population ◽  
Cardiovascular Health ◽  
The Elderly ◽  
Nutrient Deficiencies ◽  
Comorbid Conditions ◽  
Increased Risk ◽  
Increased Susceptibility

The older population is challenging to treat for numerous reasons, including comorbid conditions and increased susceptibility to adverse drug reactions, limiting medical therapy. They are at increased risk for loneliness and depression, which strongly impacts their cardiovascular outcomes, and they also have different values, usually prioritizing quality of life over mortality objectives. Finally, the elderly are underrepresented in cardiovascular clinical trials, thus limiting the applicability of guideline recommendations. This chapter emphasizes the importance of a comprehensive assessment of individual circumstances when assessing cardiovascular health in the elderly population. The chapter focuses on the role of nutrition, resiliency, and exercise for the prevention and treatment of cardiovascular disease. Nutrient deficiencies commonly seen with cardiovascular drugs are also discussed, as well as specific integrative strategies for optimizing dyslipidemia, atrial fibrillation, and heart failure in this population.

An Update on Carotid Stent Trials and Perspectives

2009 ◽  
Vol 4 (1) ◽  
pp. 92
Author(s):  
Stefan Bertog ◽  
Marius Hornung ◽  
Jennifer Franke ◽  
Nina Wunderlich ◽  
Horst Sievert ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
The Elderly ◽  
Symptomatic Carotid ◽  
Stent Restenosis ◽  
Asymptomatic Patients ◽  
Symptomatic Carotid Stenosis ◽  
Increased Risk ◽  
Risk Patients

The presence of carotid artery stenosis is associated with an increased risk of stroke. Carotid endartectomy (CEA) has been demonstrated to reduce the stroke risk in standard-risk patients with symptomatic carotid stenosis as well as in asymptomatic patients, provided that the operative risk is low. The role of percutaneous carotid intervention is less clear. There are no trials that compare percutaneous carotid intervention with medical management. Although trial results comparing CEA with carotid artery stenting (CAS) are variable and/or controversial, some trials have demonstrated promising results and have fostered enthusiasm for the performance of ongoing trials comparing CAS with CEA. This article focuses on the results of completed trials and outlines ongoing and planned trials that aim to clarify the role of CAS in patients with carotid stenosis. In addition, potential unresolved problems associated with CAS, such as CAS in the elderly, in-stent restenosis and distal embolisation, are discussed.

Significant role of middle hepatic vein in remnant liver regeneration of right-lobe living donors

2003 ◽  
Vol 75 (9) ◽  
pp. 1598-1600 ◽  
Author(s):  
Masahiro Kido ◽  
Yonson Ku ◽  
Takumi Fukumoto ◽  
Masahiro Tominaga ◽  
Takeshi Iwasaki ◽  
...  
Keyword(s):  
Liver Regeneration ◽  
Hepatic Vein ◽  
Significant Role ◽  
Middle Hepatic Vein ◽  
Living Donors ◽  
Remnant Liver ◽  
Right Lobe

scholarly journals Can Met-PET/CT Predict Sporadic Multiglandular Hyperparathyroidism? Report of a Case and Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Andreas Hillenbrand ◽  
Johannes Lemke ◽  
Doris Henne-Bruns ◽  
Ambros J. Beer ◽  
Vikas Prasad
Keyword(s):  
Posterior Mediastinum ◽  
Parathyroid Glands ◽  
Preoperative Localization ◽  
Surgical Removal ◽  
Increased Risk ◽  
Pet Ct ◽  
Parathyroid Adenomas ◽  
Patients At Risk ◽  
Ectopic Parathyroid ◽  
Met Pet

Background. Primary hyperparathyroidism (pHPT) is a common endocrine disorder of the parathyroid glands. In most cases pHPT is caused by single gland disease, but about 10% of patients suffer from sporadic multiglandular disease (MGD). Patients with MGD, especially with ectopic parathyroid adenomas, have an increased risk for persistence/recurrence after surgery. Normally, sporadic MGD cannot be diagnosed preoperatively by parathyroid scintigraphy. We analyzed the potential of positron emission tomography/computed tomography (Met-PET/CT) to predict MGD. Methods and Case Presentation. We reviewed the literature, if preoperative Met-PET/CT could predict MGD in patients with pHPT. Further, we present a 71-year-old female with ectopic MGD. Preoperative localization via Met-PET/CT showed MGD with two areas suspected to be enlarged parathyroid glands (left lateral to the thyroid lobe and posterior mediastinum). Both diagnostic findings were extirpated and parathormone dropped into normal levels. Results. We identified four additional manuscripts, referring to MGD and Met-PET/CT with divergent results. Preoperative localization diagnostics using Met-PET/CT may not necessarily identify MGD. In most cases, Met-PET/CT localized only one adenoma and localizes larger adenomas more reliably than smaller adenomas. Conclusion. Identifying patients at risk of MGD preoperatively remains challenging. We found MET-PET/CT seems to predict MGD in patients with large size and high weight PTH adenomas. For ectopic parathyroid adenomas, accurate preoperative localization is the key to successful surgical removal. Met-PET/CT appears to have great potential in soft-tissue analysis of complex anatomical regions and can predict ectopic parathyroid adenomas.

Hypoprothrombinemia Associated with Cefmetazole

1997 ◽  
Vol 31 (2) ◽  
pp. 180-184 ◽  
Author(s):  
Gail A Breen ◽  
Wendy L St Peter
Keyword(s):  
At Risk ◽  
Vitamin K ◽  
Clinical Symptoms ◽  
The Elderly ◽  
International Normalized Ratio ◽  
Fresh Frozen Plasma ◽  
Endstage Renal Disease ◽  
Populations At Risk ◽  
Increased Risk ◽  
Patients At Risk

Objective To report a case of hypoprothrombinemia associated with the use of cefmetazole sodium, define patients at risk for this adverse effect, and identify options to prevent this problem. Case Summary A malnourished patient with endstage renal disease received cefmetazole following a below-the-knee amputation of the right leg. Three days later, a prothrombin time (FT) and an international normalized ratio (INR) were obtained and were markedly elevated from baseline; however, the patient had no clinical symptoms of bleeding. Cefmetazole was discontinued. Vitamin K and fresh frozen plasma were administered. The PT and INR normalized within 24 hours and remained normal throughout the remainder of hospitalization. Discussion The incidence of hypoprothrombinemia associated with cefmetazole reported in the literature is conflicting and not consistent. There are three proposed mechanisms of cephalosporin-associated hypoprothrombinemia, two of which involve the N-methylthiotetrazole (NMTT) chain. The most plausible mechanism is NMTT inhibition of vitamin K epoxide reductase in the liver. Patients at an increased risk for this adverse event include those with low vitamin K stores, specifically patients who are malnourished, with low albumin concentrations and poor food intake. The elderly and patients with liver or renal dysfunction are examples of populations at risk. Conclusions Hypoprothrombinemia may occur with cephalosporins and is especially problematic with those containing an NMTT side chain. Clinicians need to identify patients at risk for developing antibiotic-associated hypoprothrombinemia, monitor them closely, and give vitamin K as prophylaxis accordingly.

Disruption of the Middle Hepatic Vein is not Crucial for Liver Regeneration of the Remnant Liver After Right Hemihepatectomy for Hepatic Tumors

2006 ◽  
Vol 13 (12) ◽  
pp. 1560-1568 ◽  
Author(s):  
Daisuke Morioka ◽  
Kuniya Tanaka ◽  
Hitoshi Sekido ◽  
Ken-ichi Matsuo ◽  
Mitsutaka Sugita ◽  
...  
Keyword(s):  
Liver Regeneration ◽  
Hepatic Vein ◽  
Middle Hepatic Vein ◽  
Remnant Liver ◽  
Hepatic Tumors ◽  
Right Hemihepatectomy

scholarly journals Reduction of Chronic Hyperinsulinemia (Insulin Resistance) for the Prevention and Treatment of Cancerous Disease: The Crucial Role of Caloric Restriction

2020 ◽  
Vol 5 (3) ◽  
Keyword(s):  
Insulin Resistance ◽  
Dynamic Change ◽  
Cancer Recurrence ◽  
Curative Surgery ◽  
Epithelial Cancers ◽  
Incident Cancer ◽  
Increased Risk ◽  
Promote Tumour Development ◽  
Insulin Like Growth Factors

Gene’s expression changes with nutrition and physical activity and hormones signaling like insulin. A Western lifestyle may increase cancer risk through alterations in the metabolism of insulin and insulin-like growth factors. The anabolic signals by insulin or IGF-I can promote tumour development by inhibiting apoptosis, and by stimulating cell proliferation. There is dynamic change in gene expression in response to nutritional availability [1]. A clear association between adiposity, physical inactivity and Western diet, and the risk of incident cancer, cancer recurrence and mortality after “curative” surgery is increasing. Insulin Resistance Status characterized by hyperinsulinemia is associated with an excessive increased risk for a number of malignancies. An increasing clinical, biological and epidemiological evidence sustain that Insulin-IGFs System has been implicated in breast, prostate, pediatric, colon-recto and gynecological cancers, including sarcomas, epithelial cancers, multiple myeloma and melanoma. Chronic hyperinsulinaemia may be a cause of cancers of the colon, pancreas, endometrium, breast, prostate, ovarium, and possibly of the lung, and may predispose strongly to melanoma development; reducing the hormone-vitamin D anticancerigen action [2].

Control of tissue carnitine contents: Effects of partial hepatectomy and liver regeneration on carnitine concentrations in liver and extrahepatic tissues of the rat

1985 ◽  
Vol 5 (1) ◽  
pp. 47-55 ◽  
Author(s):  
Timothy J. French ◽  
Anthony W. Goode ◽  
Paul S. Schofield ◽  
Mary C. Sugden
Keyword(s):  
Liver Regeneration ◽  
Partial Hepatectomy ◽  
Surgical Removal ◽  
Remnant Liver ◽  
Liver Mass ◽  
Liver Remnant ◽  
Extrahepatic Tissues

The liver is the sole site of carnitine biosynthesis in the rat. However, the first 24 h after the surgical removal of two-thirds of the liver mass are not associated with depletion of carnitine either in the liver remnant or in a number of extrahepatic tissues with relatively short turnover times of carnitine (<24 h; heart, spleen, kidney). Dietary carnitine was not supplied. The results suggest that the capacity of the remnant liver for carnitine biosynthesis is sufficient to maintain tissue carnitine contents. Liver regeneration influenced the relative proportions of hepatic free and acylated carnitines in a manner compatible with changes in fat disposition in the proliferating tissue.

scholarly journals The role of vitamins in the diet of the elderly I. Fat-soluble vitamins

2017 ◽  
Vol 10 (1) ◽  
pp. 127-145
Author(s):  
J. Csapó ◽  
Cs. Albert ◽  
J. Prokisch
Keyword(s):  
Elderly People ◽  
Bone Fractures ◽  
The Elderly ◽  
Normal Diet ◽  
Vitamin Deficiencies ◽  
Increased Risk ◽  
The One ◽  
Partial Deficiency ◽  
Fat Soluble Vitamins

AbstractFollowing a discussion on the daily energy and protein requirements of elderly people, the authors will go on to talk about vitamin needs and the role of the four fat-soluble vitamins (A, D, E, and K). They point out that vitamin requirements in old age do not essentially differ from adult people’s, but they must take account of the fact that the body’s vitamin stores might get filled up, which may reduce vitamin needs, on the one part, but the altered physiological processes may increase them, on the other. Regarding the case of fat-soluble vitamins, reduced fat absorption, decreased vitamin storage capacity of the liver, reduced dietary intake, partial deficiency of digestive enzymes, and absorption disorders in the intestines may all lead to vitamin deficiencies. Problems may also arise due to multiple vitamin overdose developed either as a consequence of overconsumption of vitamin tablets or because the body’s vitamin stores are constantly filled up to maximum capacity. Positive and negative changes resulting from the consumption of several times the daily dose recommendations are covered as well. The authors show that A, D, E, or K vitamin deficiency occurs very rarely in the case of a normal diet; however, great care must be taken in order to meet vitamin D and, simultaneously, calcium requirements so that to avoid osteoporosis and an increased risk of bone fractures in elderly people. The paper discusses the fat-soluble vitamin needs of the elderly and, where necessary, specifies the requirements for men and women separately, while also touching upon those foodstuffs and methods that can contribute to the optimal satisfaction of the elderly people’s vitamin needs.

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