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Dementia and osteoporosis in a geriatric population: Is there a common link?

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World Journal of Orthopedics 2017年第5期8卷 412-423页

作者： Candice L Downey Adam Young Emily F Burton Simon M Graham Robert J Macfarlane Eva-Maria Tsapakis Eleftherios Tsiridis University of Leeds School of Medicine Department of Anaesthetics Pinderfields Hospital Department of Trauma and Orthopaedics the Royal Liverpool University Hospital Academic Department of Orthopaedics and Trauma Aristotle University Medical School

AIM To determine the existence of a common pathological link between dementia and osteoporosis through reviewing the current evidence base. METHODS This paper reviews the current literature on osteoporosis and dementia in order to ascertain evidence of a common predisposing aetiology. A literature search of Ovid MEDLINE(1950 to June 2016) was conducted. The keywords "osteoporosis", "osteoporotic fracture", "dementia" and "Alzheimer's disease"(AD) were used to determine the theoretical links with the most significant evidence base behind them. The key links were found to be vitamins D and K, calcium, thyroid disease, statins, alcohol and sex steroids. These subjects were then searched in combination with the previous terms and the resulting papers manually examined. Theoretical, in vitro and in vivo research were all used to inform this review which focuses on the most well developed theoretical common causes for dementia(predominantly Alzheimer's type) and *** Dementia and osteoporosis are multifaceted disease processes with similar epidemiology and a marked increase in prevalence in elderly populations. The existence of a common link between the two has been suggested despite a lack of clear pathological overlap in our current understanding. Research to date has tended to be fragmented and relatively weak in nature with multiple confounding factors reflecting the difficulties of in vivo experimentation in the population of interest. Despite exploration of various possible mechanisms in search for a link between the two pathologies, this paper found that it is possible that these associations are coincidental due to the nature of the evidence available. One finding in this review is that prior investigation into common aetiologies has found raised amyloid beta peptide levels in osteoporotic bone tissue, with a hypothesis that amyloid beta disorders are systemic disorders resulting in differing tissue manifestations. However, our findings were that t

关键词： Osteoporosis Fracture Dementia Thyroid disease Alzheimer’s disease Elderly Vitamin D Vitamin K Calcium Statins Alcohol Sex steroids

Inequalities in care in patients with acute myocardial infarction

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World Journal of Cardiology 2015年第12期7卷 895-901页

作者： Shabnam Rashid Alexander Simms Phillip Batin John Kurian Chris P Gale Department of Cardiology Leeds General Infirmary Department of Cardiology Pinderfields General Hospital Department of Cardiology Bradford Royal Infir-mary Department of Cardiology University of Leeds

Coronary heart disease is the single largest cause of death in developed countries. Guidelines exist for the management of acute myocardial infarction(AMI),yet despite these,significant inequalities exist in the care of these patients. The elderly,deprived socioeconomic groups,females and non-caucasians are the patient populations where practice tends to deviate more frequently from the evidence base. Elderly patients often had higher mortality rates after having an AMI compared to younger patients. They also tended to present with symptoms that were not entirely consistent with an AMI,thus partially contributing to the inequalities in care that is seen between younger and older patients. Furthermore the lack of guidelines in the elderly age group presenting with AMI can often make decision making challenging and may account for the discrepancies in care that are prevalent between younger and older patients. Other patients such as those from a lower socioeconomic group,i.e.,low income and less than high school education often had poorer health and reduced life expectancy compared to patients from a higher socioeconomic group after an AMI. Lower socioeconomic status was also seen to be contributing to racial and geographical variation is the care in AMI patients. Females with an AMI were treated less aggressively and had poorer outcomes when compared to males. However even when females were treated in the same way they continued to have higher in hospital mortality which suggests that gender may well account for differences in outcomes. The purpose of this review is to identify the inequalities in care for patients who present with an AMI and explore potential reasons for why these occur. Greater attention to the management and a better understanding of the root causes of these inequalities in care may help to reduce morbidity and mortality rates associated with AMI.

关键词： Coronary artery disease Dual antiplatelet therapy Inequalities Guidelines Myocardial infarction

三叉神经头痛和面神经疼痛综合征与自主神经功能障碍相关

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世界核心医学期刊文摘（神经病学分册） 2005年第11期1卷 14-15页

作者： Al-Din A.S. Mir R. Davey R. 高中宝 Neurosciences Department Pinderfields General Hospital Wakefield United Kingdom

Trigeminal autonomic cephalgias (TACs) include a spectrum of primary headache syndromes associated with cranial autonomic dysfunction. Other types of headache and facial pain syndromes can be associated with marked localized facial or ear autonomic changes. We report on a group of patients suffering from episodic migraine with cranial autonomic features, patients with different presentations of the ‘red ear syndrome’(RES), cluster headache with prominent lower facial involvement and crossover cases. In our experience crossover between TACs and migraine, RES and cluster headache is not uncommon. We propose that all these conditions belong to the same group and a unifying causative mechanism is proposed.

关键词：疼痛综合征偏头痛患者神经障碍

Small bowel obstruction presenting with a rectal haematoma

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World Journal of Gastrointestinal Surgery 2010年第12期2卷 402-404页

作者： Omar A Mownah Zaed Z Hamady Mark J Rogers Syed G Shah Deven H Vani Department of Colorectal Surgery Pinderfields General HospitalWakefieldWest Yorkshire Department of Gastroenterology Pinderfields General Hospital WakefieldWest Yorkshire

We report on a case of an 85-year old man with an unusual presentation of small bowel obstruction. A palpable mass on digital rectal examination was subsequently visualised endoscopically with the appearance of a haematoma. The presence of a rectal mass as a presenting sign for small bowel obstruction is highly unusual and unreported in the literature.

关键词： Small bowel obstruction Rectal mass Haematoma

Risk stratification for ST segment elevation myocardial infarction in the era of primary percutaneous coronary intervention

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World Journal of Cardiology 2014年第8期6卷 865-872页

作者： Richard A Brogan Christopher J Malkin Philip D Batin Alexander D Simms James M McLenachan Christopher P Gale Leeds Institute of Cardiovascular and Metabolic Medicine Division of Epidemiology and BiostatisticsUniversity of LeedsLeeds LS2 9JTUnited Kingdom York and Hull Medical School University of YorkYorkYO10 5DDUnited Kingdom Department of Cardiology Leeds Teaching Hospital NHS TrustLeeds LS2 9JTUnited Kingdom Department of Cardiology Pinderfields General HospitalMid Yorkshire NHS TrustWakefield WF5 9LZUnited Kingdom Department of Cardiology York Teaching Hospital NHS Foundation TrustYork YO10 5DDUnited Kingdom

Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for non ST segment elevation myocardial infarction(NSTEMI) with the decision on revascularisation dependent on perceived clinical risk. Risk stratification for STEMI has no recommendation. Statistical risk scoring techniques in NSTEMI have been demonstrated to improve outcomes however their uptake has been poor perhaps due to questions over their discrimination and concern for application to individuals who may not have been adequately represented in clinical trials. STEMI is perceived to carry sufficient risk to warrant emergency coronary intervention [by primary percutaneous coronary intervention(PPCI)] even if this results in a delay to reperfusion with immediate thrombolysis. Immediate thrombolysis may be as effective in patients presenting early, or at low risk, but physicians are poor at assessing clinical and procedural risks and currently are not required to consider this. Inadequate data on risk stratification in STEMI inhibits the option of immediate fibrinolysis, which may be cost-effective. Currently the mode of reperfusion for STEMI defaults to emergency angiography and percutaneous coronary intervention ignoring alternative strategies. This review article examines the current risk scores and evidence base for risk stratification for STEMI patients. The requirements for an ideal STEMI risk score are discussed.

关键词： ST segment elevation myocardial infarction Risk stratification Primary percutaneous coronary intervention Harm Risk scores