Cardiovascular Disease in Elders: Is It Inevitable?

Cardiovascular disease is the major cause of death and disability in America. The burden of cardiovascular disease is higher in elders than in younger populations, presumably because of life-long exposure to risk factors such as hypertension, smoking, abnormal blood lipids, lack of exercise, and/or obesity. Many assume that it is too late to attempt to modify risk factors in elders because behavior is so difficult to change. The purpose of this article is to argue that cardiovascular risk factor modification is effective in elders and should be vigorously pursued for the good of individuals, families, communities, and societies.     

肺原位腺癌手术与随访之争议解析

《WHO胸部肿瘤分类(第5版)》中的肺肿瘤分类目录把肺原位腺癌从腺癌目录中移出, 归类到腺体前驱病变。肺磨玻璃结节临床考虑原位腺癌时,如何进行临床决策更易造成偏差, 到底是随访还是手术值得思考, 过度诊疗和误诊误治同时存在。应充分理解肺原位腺癌的特性, 以较好的心态去应对, 从生物学及社会心理学两方面考虑, 不能治愈了一个肺癌, 但多了一个肺癌患者。建议在医患共同决策的前提下进行个体化方案制定, 使患者尽早回归社会, 最大可能使患者获益。

     

El tiempo de tránsito del pulso: un índice de cambios en la presión arterial

Resumen

Los propósitos de este trabajo fueron: primero, evaluar el grado con el cual el tiempo de tránsito del pulso (TTP) covería con la presión sistólica; segundo, estimar la influencia del período de preeyección sobre el TTP; tercero, probar un índice de reactividad en la presión arterial, y cuarto, estudiar el decremento en la actividad cardiovascular a lo largo del tiempo.

Los resultados revelan una alta correlación entre el TTP y la presión sistólica (¯=—. 866), aunque el TTP probablemente no sólo refleje cambios de la presión arterial, sino también del período de preeyección.

La respuesta ante una tarea de aritmética mental, en contraste con una linea base de relajación, se mostró como un buen índice de la reactividad en la presión sistólica.

El cuarto propósito no pudo realizarse por no producirse el decremento esperado en la actividad cardiovascular.     

基于胃肠激素观点的高血压发病机制思考

本文基于胃肠激素的特点及其与目前高血压发病机制研究较集中的几个关键环节的联系,分析了肾素一血管肾张素一醛固酮系统、肥胖、2型糖尿病、胰岛素抵抗、精神应激等与胃肠激素的相关性,提出遗传与环境因素可能通过胃肠激素途径影响血压,胃肠激素变化可能为高血压发病机制之一。     

抗血管生成靶向药物相关性高血压

高血压是抗血管生成靶向药物最常见的副作用之一,其机制和管理受到重视。本文就靶向药物导致高血压的机制进行了探讨,考虑可能与抗血管生成药物的作用靶点有关,即影响了血管内皮生长因子的功能所致;介绍临床如何进行高血压管理并建议在抗血管生成靶向药物使用过程中规范地监测、控制血压,开展相关研究。     

医师知识结构和思维方式与肺血栓栓塞症诊断

肺血栓栓塞症是常见的临床病症,因其临床表现多样,易发生误诊漏诊而导致较高的病死率。但“凡事预则立,不预则废”,充分掌握肺血栓栓塞症的知识、以正确的思维方式引导临床诊疗可以有效减少和避免误诊漏诊。     

Hypertension and cognitive function

Previous research indicates that blood pressure may impact a variety of cognitive functions, including short-term memory, abstract reasoning, visual-spatial abilities, and attention (Boller, Vrtunski, Mack, & Kim, 1977; Elias, Robbins, Schultz, & Pierce, 1990; Franceschi, Tancredi, Smirne, Mercinelli, & Canal, 1982; Mazzucchiet al., 1986). However, studies which have assessed the cognitive functioning of hypertensive adults have offered conflicting results, particularly when hypertension levels were in the mild range (e.g., Bolleret al., 1977; Eliaset al., 1990; Elias, Wolf, D'Agostino, Cobb, & White, 1993; Farmeret al., 1987, 1990; Franceschiet al., 1982; Pérez-Stable, Coates, Halliday, Gardiner, & Hauck, 1992; Schmidtet al., 1991; Waldstein, Ryan, Manuck, Parkinson, & Bromet, 1991). A number of factors may contribute to the inconsistent findings in this area. Researchers have employed a wide range of neuropsychological instruments to assess varying domains of cognitive function. Sample sizes in some studies have been too small to ensure sufficient power. Finally, studies have employed varying methodological control over potential confounding factors such as concurrent medical conditions, alcohol abuse, psychiatric disorders, or antihypertensive medication. This study compared male veterans with blood pressures in the mildly hypertensive range (n=166) to normotensive veterans (n=176) on neuropsychological measures of verbal fluency, visual-spatial ability, verbal and visual memory, dexterity, attention, and executive functions. Results revealed that, after controlling for differences in education and income, there was no relationship between mild hypertension and combined measures of cognitive performance. The present findings suggest that mild hypertension alone has little effect on cognitive function in adults.     

The relaxation word of the day: A simple technique to measure adherence to relaxation

A new procedure of assessing adherence to home practice of relaxation is presented. The technique involved the subject identifying one of four possible relaxation words of the day at the end of a taped relaxation session. The method was employed to assess the relationship between adherence to relaxation and decline of blood pressure during a 10-session/8-week relaxation program involving 17 hypertensive subjects. No statistically significant relationship was found on either a short-term or a long-term basis. An advantage of the assessment technique is that it appears easily integrated into the overall therapeutic objective for relaxation therapy; a disadvantage is that the subject needs to comply not only with the relaxation schedule but also with the monitoring procedure.This research study was funded by NIH Grant HL27159.