Geriatric Assessments Can Predict Functional Outcome and Mortality after Urological Tumor Surgery.

Introduction: Older patients undergoing major urological tumor surgery are at severe risk of functional deterioration, complications, and mortality. We prospectively evaluated geriatric assessment tools and developed a novel easy-to-use assessment tool for clinical use.

Methods: In 159 patients, geriatric assessment tools were used prior to cystectomy, prostatectomy, and renal tumor surgery, and their peri- and postoperative courses were recorded.

Frail Older Individuals Maintaining a Steady Standing Position: Associations Between Sway Measurements with Frailty Status Across Four Different Frailty Instruments.

Objective: An analysis of the relationships between static equilibrium parameters and frailty status and/or severity across four different frailty measures.

Design: Cross-sectional analysis.

Setting: Geriatric wards of a general hospital.

Predictability of a modified Mini- Nutritional- Assessment version on six-month and one-year mortality in hospitalized geriatric patients: a comparative analysis.

Recently we introduced a modified Mini Nutritional Assessment (MNA) Short Form (MNA-SF) and Long Form (MNA-SF) with operationalization of the 'mobility' and 'neuropsychological problems' items of the MNA using scores on Barthel Index mobility item and Mini Mental State Examination and Geriatric Depression Scale scores. We have now evaluated the abilities of this modified MNA-SF and MNA-LF to predict mortality in comparison with the standard MNA-SF and MNA-LF and the Nutritional Risk Screening 2002 (NRS 2002) and the Malnutrition Universal Screening Tool (MUST). A prospective analysis was performed in 240 hospitalised geriatric patients aged ≥ 65 years.

Changes of a frailty index based on common blood and urine tests during a hospital stay on geriatric wards predict 6-month and 1-year mortality in older people.

Background: We aimed to evaluate the abilities of a 21-item frailty index based on laboratory blood and urine tests (FI-Lab21) assessed at different points in time, ie, at admission to hospital (FI-Lab21) and before discharge from hospital (FI-Lab21), and the change of the FI-Lab21 during the hospital stay to predict 6-month and 1-year mortality in hospitalized geriatric patients.

Methods: Five hundred hospitalized geriatric patients aged ≥65 years were included in this analysis. Follow-up data were acquired after a period of 6 months and 1 year.

Operationalizing a frailty index using routine blood and urine tests.

Background: Uncomplicated frailty instruments are desirable for use in a busy clinical setting. The aim of this study was to operationalize a frailty index (FI) from routine blood and urine tests, and to evaluate the properties of this FI compared to other frailty instruments.

Materials And Methods: We conducted a secondary analysis of a prospective cohort study on 306 patients aged ≥65 years hospitalized on geriatric wards.

Comparing the predictive accuracy of frailty, comorbidity, and disability for mortality: a 1-year follow-up in patients hospitalized in geriatric wards.

Background: Studies evaluating and comparing the power of frailty, comorbidity, and disability instruments, together and in parallel, for predicting mortality are limited.

Objective: This study aimed to evaluate and compare the measures of frailty, comorbidity, and disability in predicting 1-year mortality in geriatric inpatients.

Design: Prospective cohort study.

Significance of frailty for predicting adverse clinical outcomes in different patient groups with specific medical conditions.

Frailty is a major health burden in an aging society. It constitutes a clinical state of reduced physiological reserves that is associated with a diminished ability to withstand internal and external stressors. Frail patients have an increased risk for adverse clinical outcomes, such as mortality, readmission to hospital, institutionalization and falls.

Haemoglobin and vascular function in the human retinal vascular bed.

Objective: Haemoglobin is a potential nitric oxide (NO) scavenger. Haemoglobin is associated with blood viscosity and the red blood cell free layer width of microvessels that impact on shear stress in the microcirculation. We hypothesized that haemoglobin modulates retinal vascular function.

Effects of manidipine vs. amlodipine on intrarenal haemodynamics in patients with arterial hypertension.

Aims: Intraglomerular pressure is one of the main drivers of progression of renal failure. Experimental data suggest that there are important differences between calcium channel blockers (CCBs) in their renal haemodynamic effects: manidipine reduces, whereas amlodipine increases intraglomerular pressure. The aim of this study was to investigate the effects of manidipine and amlodipine treatment on intragomerular pressure (P(glom)) in patients with mild to moderate essential hypertension.

Impaired increase of retinal capillary blood flow to flicker light exposure in arterial hypertension.

We hypothesized that the increase of retinal capillary blood flow (RCF) to flicker light exposure is impaired in subjects with arterial hypertension. In 146 nondiabetic untreated male subjects with (n=50) or without (n=96) arterial hypertension, RCF was measured before and after flicker light exposure noninvasively and in vivo using scanning laser Doppler flowmetry. In addition, in a subgroup of 28 subjects, the change of RCF to flicker light exposure was again assessed during parallel infusion of nitric oxide synthase inhibitor N-monomethyl-L-arginine (L-NMMA).

Reversibility of the effects of aliskiren in the renal versus systemic circulation.

Background And Objectives: Renal hemodynamic effects of inhibitors of the renin-angiotensin system can increase the risk of acute kidney injury under certain conditions. The BP-lowering effects of the renin inhibitor aliskiren are sustained 3-4 weeks after withdrawal. In this study, the reversibility of the renal hemodynamic effects of aliskiren was tested.

Postchallenge hyperglycemia is closely related with early vascular damage in overweight and obese patients.

Objective: There is ongoing discussion on how best to screen for diabetes mellitus. Previous studies suggest that an abnormal oral glucose tolerance test (OGTT) is better than fasting glucose levels in predicting cardiovascular mortality, which is largely determined by macrovascular complications in type 2 diabetes. We examined the relationship between screening methods for diabetes and indices of vascular damage in young individuals at high risk of type 2 diabetes.

Influence of blood flow on arteriolar wall-to-lumen ratio in the human retinal circulation in vivo.

Objective: We hypothesized that blood flow impacts on arteriolar wall-to-lumen ratio and that vasodilatory capacity is negatively related to arteriolar wall-to-lumen ratio in the human retinal vascular bed.

Methods: The study cohort comprised 141 non-diabetic untreated male patients with (n=52) or without (n=89) arterial hypertension but without evidence for cardiovascular disease. Retinal capillary blood flow (RCF) before and after exposure to flicker light and to infusion of nitric oxide (NO) synthase inhibitor N-monomethyl-L-arginine (L-NMMA), and parameters of retinal arteriolar morphology, e.

New software analyses increase the reliability of measurements of retinal arterioles morphology by scanning laser Doppler flowmetry in humans.

Objective: The investigation of the retinal arterioles offers the unique opportunity to analyze in vivo arteriolar remodeling in arterial hypertension in humans. We analyzed the reliability of assessing retinal arteriolar morphology with our new version of the software analyses for scanning laser Doppler flowmetry.

Method: In the test-retest reliability study, 10 eyes of 10 healthy persons were measured during 5 days under routine laboratory conditions with the Heidelberg Retinal Flowmetry.

Basal nitric oxide activity is an independent determinant of arteriolar structure in the human retinal circulation.

Objective: Experimental data indicate that nitric oxide might play a role in structure and remodeling of peripheral small arteries and arterioles. We hypothesized that retinal arteriolar structure is modulated by basal nitric oxide activity.

Methods: The study cohort comprised 97 male untreated patients with normal and elevated blood pressure but without clinical evidence for cardiovascular disease.

Folic acid treatment normalizes NOS-dependence of vascular tone in the metabolic syndrome.

Obese subjects with the metabolic syndrome (MS+) are more prone to microvascular complications than obese subjects without the metabolic syndrome (MS-). Excessive vascular nitric oxide (NO) production has been demonstrated in MS+ compared to MS-, perhaps driven by increased inflammation or oxidative stress. We tested whether in MS+, folic acid (FA) treatment could normalize NO synthase (NOS)-dependence of vascular tone in the retina and kidney.

Measurement of kidney perfusion by magnetic resonance imaging: comparison of MRI with arterial spin labeling to para-aminohippuric acid plasma clearance in male subjects with metabolic syndrome.

Background: Magnetic resonance imaging with arterial spin labeling (MRI-ASL) is a non-invasive approach to measure organ perfusion. We aimed to examine whether MRI-ASL kidney perfusion measurements are related to measurements of renal plasma flow (RPF) by para-aminohippuric acid (PAH) plasma clearance and whether changes of kidney perfusion in response to treatment with telmisartan can be detected by MRI-ASL.

Methods: Twenty-four patients with metabolic syndrome and an estimated creatinine clearance according to Cockroft and Gault of > or =60 ml/min were included in the study.

Rosuvastatin does not affect intrarenal hemodynamics in patients with hypercholesterolemia.

Background: It has been proposed that hyperlipidemia contributes to the progression of renal diseases, and conversely, that treatment with statins decreases the progressive decline of renal function. Increased glomerular pressure has been found to cause endothelial dysfunction of glomerular capillaries. However, the potential renoprotective effects of statin treatment have not been fully elucidated and so far no study has analyzed the effects of statin treatment on intrarenal hemodynamics.

Wall-to-lumen ratio of retinal arterioles is related with urinary albumin excretion and altered vascular reactivity to infusion of the nitric oxide synthase inhibitor N-monomethyl-L-arginine.

Objective: We hypothesized that wall-to-lumen ratio (WLR) of retinal arterioles might serve as an in-vivo parameter of vascular damage. To test this hypothesis we examined whether WLR of retinal arterioles is related with increased urinary albumin excretion and altered vascular reactivity to infusion of the nitric oxide synthase inhibitor N-monomethyl-L-arginine (L-NMMA).

Methods: Thirty-nine never-treated male patients aged 18-65 years with a body mass index at least 25 kg/m(2) and without diabetes mellitus or secondary or stage 3 arterial hypertension were examined.

Gender is related to alterations of renal endothelial function in type 2 diabetes.

Background: Gender has been shown to affect endothelial function of the forearm circulation in patients with type 2 diabetes, but data on the renal circulation are lacking. We hypothesized that renal vascular nitric oxide (NO) availability is higher, and oxidative stress lower, in female compared to male patients with type 2 diabetes.

Methods: In 41 male and 39 female patients with type 2 diabetes, renal plasma flow (RPF) was determined by constant infusion input clearance at baseline and following infusion of the NO synthase inhibitor N(G)-monomethyl-L-arginine (L-NMMA, 4.

Wall-to-lumen ratio of retinal arterioles and arteriole-to-venule ratio of retinal vessels in patients with cerebrovascular damage.

Purpose: There is evidence that generalized retinal arteriolar narrowing, which can be measured by the arteriole-to-venule ratio (AVR) of retinal vessels, predicts cerebrovascular events. The wall-to-lumen ratio (WLR) and wall cross-sectional area (WCSA) of retinal arterioles reflect structural arteriolar parameters. The primary objective was to test the association between WLR and AVR in a distinct cohort of patients with cerebrovascular damage.

Renal vascular endothelial function in hypertensive patients with type 2 diabetes mellitus.

Background: Basal nitric oxide (NO) activity has a pivotal role in the regulation of glomerular hemodynamics, and in animal experiments, its alteration has been associated with morphological changes characteristic of diabetic nephropathy.

Study Design: Prospective observational-study during a mean follow-up of 2.1 years.