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Re: Cytokines and Postoperative Delirium in Older Patients Undergoing Major Elective Surgery
GERIATRICS
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Biomarkers and Nutrimetabolomic Laboratory, Nutrition and Food Science Department, XaRTA, INSA, Pharmacy School, University of Barcelona and Ingenio-CONSOLIDER Program, FUN-C-FOOD, Barcelona, Spain, Department of Medicine, Institute of Gerontology and Geriatrics, Perugia University, Perugia, Geriatric Unit, Azienda Sanitaria Firenze, Florence, and Geriatrics and Geriatric Emergency Room, IRCCS-INRCA, Ancona, Italy, Biomarkers Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France, and Intramural Program, National Institute on Aging, Baltimore, Maryland J Gerontol A Biol Sci Med Sci 2015; 70: 1141e1147. doi: 10.1093/gerona/glv026
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25838546 Editorial Comment: Frailty is a geriatric syndrome that is associated with increased vulnerability in multiple clinical domains. The causes of frailty are complex and multifactorial. This study examined the potential link between nutritional status and frailty with an emphasis on dietary polyphenols. These compounds include carotenoids, vitamins E and D and bioflavonoids, and appear to have antioxidant and anti-inflammatory properties. Using a large, cross-sectional, population based study cohort, the levels of urinary polyphenols were compared with measures of frailty in 811 community dwelling people 65 years or older in Italy. The Mediterranean diet tends to be rich in polyphenols, and this group provided a unique population in which to study this question. The results demonstrated an inverse relationship between urinary polyphenol levels and degree of frailty. Sense of physical exhaustion and slowed gait were the frailty parameters most closely linked to decreased measured levels of urinary polyphenols. The cross-sectional study design precluded determination of absolute causality but the results raise interesting questions about the relationship between these variables. Future prospective nutritional research targeting this question will be required to enhance our understanding of this process, including the potential benefits of polyphenol rich foods as a mechanism to slow progression of the frailty phenotype. Tomas L. Griebling, MD, MPH
Re: Cytokines and Postoperative Delirium in Older Patients Undergoing Major Elective Surgery S. M. Vasunilashorn, L. Ngo, S. K. Inouye, T. A. Libermann, R. N. Jones, D. C. Alsop, J. Guess, S. Jastrzebski, J. E. McElhaney, G. A. Kuchel and E. R. Marcantonio Department of Medicine, Harvard Medical School, Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, and Departments of Medicine and Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, UConn Center on Aging, University of Connecticut Health Center, Farmington, Connecticut, and Advanced Medical Research Institute of Canada, Sudbury, Ontario, Canada J Gerontol A Biol Sci Med Sci 2015; 70: 1289e1295. doi: 10.1093/gerona/glv083
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26215633 Editorial Comment: Delirium is a serious potential complication that often occurs postoperatively in geriatric patients. The etiology is generally thought to be multifactorial, and prevention is considered a key element in care of older adults. This study examined the potential relationship between inflammatory cytokines as biomarkers for risk of delirium in a cohort of 566 older adults undergoing major surgery. A nested, matched control study was performed to account for variables such as patient age and gender, type of surgery, baseline cognitive status, vascular comorbidity and apolipoprotein E, which is a genetic risk factor for dementia. The overall incidence of delirium was 24%, and those who demonstrated this condition by postoperative day 2 had significantly increased levels of interleukin-6 compared to controls. Patients with delirium also had increased interleukin-2 levels in the immediate postoperative period compared to controls, and this finding continued longitudinally through multiple subsequent time points. With time levels of other cytokines, including vascular endothelial growth factor and tumor necrosis factor-alpha, also differed between those who did and did not show delirium. These data suggest that there is a link between inflammatory cytokines and the risk of delirium in the elderly surgical population. This finding may help lead to future development of preoperative or perioperative screening tests using these biomarkers to help reduce the incidence or severity of delirium postoperatively in older adults. Tomas L. Griebling, MD, MPH
Dochead: Urological Survey
LIT 5.4.0 DTD JURO13735_proof 14 May 2016 4:19 pm EO:
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115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176
Biomarkers and Nutrimetabolomic Laboratory, Nutrition and Food Science Department, XaRTA, INSA, Pharmacy School, University of Barcelona and Ingenio-CONSOLIDER Program, FUN-C-FOOD, Barcelona, Spain, Department of Medicine, Institute of Gerontology and Geriatrics, Perugia University, Perugia, Geriatric Unit, Azienda Sanitaria Firenze, Florence, and Geriatrics and Geriatric Emergency Room, IRCCS-INRCA, Ancona, Italy, Biomarkers Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France, and Intramural Program, National Institute on Aging, Baltimore, Maryland J Gerontol A Biol Sci Med Sci 2015; 70: 1141e1147. doi: 10.1093/gerona/glv026
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25838546 Editorial Comment: Frailty is a geriatric syndrome that is associated with increased vulnerability in multiple clinical domains. The causes of frailty are complex and multifactorial. This study examined the potential link between nutritional status and frailty with an emphasis on dietary polyphenols. These compounds include carotenoids, vitamins E and D and bioflavonoids, and appear to have antioxidant and anti-inflammatory properties. Using a large, cross-sectional, population based study cohort, the levels of urinary polyphenols were compared with measures of frailty in 811 community dwelling people 65 years or older in Italy. The Mediterranean diet tends to be rich in polyphenols, and this group provided a unique population in which to study this question. The results demonstrated an inverse relationship between urinary polyphenol levels and degree of frailty. Sense of physical exhaustion and slowed gait were the frailty parameters most closely linked to decreased measured levels of urinary polyphenols. The cross-sectional study design precluded determination of absolute causality but the results raise interesting questions about the relationship between these variables. Future prospective nutritional research targeting this question will be required to enhance our understanding of this process, including the potential benefits of polyphenol rich foods as a mechanism to slow progression of the frailty phenotype. Tomas L. Griebling, MD, MPH
Re: Cytokines and Postoperative Delirium in Older Patients Undergoing Major Elective Surgery S. M. Vasunilashorn, L. Ngo, S. K. Inouye, T. A. Libermann, R. N. Jones, D. C. Alsop, J. Guess, S. Jastrzebski, J. E. McElhaney, G. A. Kuchel and E. R. Marcantonio Department of Medicine, Harvard Medical School, Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, and Departments of Medicine and Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, UConn Center on Aging, University of Connecticut Health Center, Farmington, Connecticut, and Advanced Medical Research Institute of Canada, Sudbury, Ontario, Canada J Gerontol A Biol Sci Med Sci 2015; 70: 1289e1295. doi: 10.1093/gerona/glv083
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26215633 Editorial Comment: Delirium is a serious potential complication that often occurs postoperatively in geriatric patients. The etiology is generally thought to be multifactorial, and prevention is considered a key element in care of older adults. This study examined the potential relationship between inflammatory cytokines as biomarkers for risk of delirium in a cohort of 566 older adults undergoing major surgery. A nested, matched control study was performed to account for variables such as patient age and gender, type of surgery, baseline cognitive status, vascular comorbidity and apolipoprotein E, which is a genetic risk factor for dementia. The overall incidence of delirium was 24%, and those who demonstrated this condition by postoperative day 2 had significantly increased levels of interleukin-6 compared to controls. Patients with delirium also had increased interleukin-2 levels in the immediate postoperative period compared to controls, and this finding continued longitudinally through multiple subsequent time points. With time levels of other cytokines, including vascular endothelial growth factor and tumor necrosis factor-alpha, also differed between those who did and did not show delirium. These data suggest that there is a link between inflammatory cytokines and the risk of delirium in the elderly surgical population. This finding may help lead to future development of preoperative or perioperative screening tests using these biomarkers to help reduce the incidence or severity of delirium postoperatively in older adults. Tomas L. Griebling, MD, MPH
Dochead: Urological Survey
LIT 5.4.0 DTD JURO13735_proof 14 May 2016 4:19 pm EO:
177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238