Alzheimer's disease: Innate immunity gone awry?

Inflammation is an immune activity designed to protect the host from pathogens and noxious agents. In its low-intensity form, presence of an inflammatory process must be inferred from appropriate biomarkers. Occult neuroinflammation is not just secondary to Alzheimer's disease (AD) but may contribute to its pathogenesis and promote its progression.

Biomarkers, ketone bodies, and the prevention of Alzheimer's disease.

Sporadic Alzheimer's disease (spAD) has three successive phases: preclinical, mild cognitive impairment, and dementia. Individuals in the preclinical phase are cognitively normal. Diagnosis of preclinical spAD requires evidence of pathologic brain changes provided by established biomarkers.

A new way to produce hyperketonemia: use of ketone ester in a case of Alzheimer's disease.

Background: Providing ketone bodies to the brain can bypass metabolic blocks to glucose utilization and improve function in energy-starved neurons. For this, plasma ketones must be elevated well above the ≤ 0.2 mM default concentrations normally prevalent.

Ketone body therapy: from the ketogenic diet to the oral administration of ketone ester.

Ketone bodies (KBs), acetoacetate and β-hydroxybutyrate (βHB), were considered harmful metabolic by-products when discovered in the mid-19th century in the urine of patients with diabetic ketoacidosis. It took physicians many years to realize that KBs are normal metabolites synthesized by the liver and exported into the systemic circulation to serve as an energy source for most extrahepatic tissues. Studies have shown that the brain (which normally uses glucose for energy) can readily utilize KBs as an alternative fuel.

The mitochondrial permeability transition pore provides a key to the diagnosis and treatment of traumatic brain injury.

The pathological consequences of traumatic head injury result largely from the opening of the mitochondrial permeability transition pore (mPTP). The mPTP opens due to a decrease in brain phosphorylation energy resulting in a further decrease in brain ATP production and a measurable increase in brain heat generation and temperature. The increase in brain temperature can be measured transcranially by near infrared spectroscopy which can be used to diagnose traumatic brain injury (TBI) and to monitor treatment.

Opioids for cancer pain: the challenge of optimizing treatment.

During 2007, 11.7 million US men and women of all ages suffered from some form of invasive cancer. During their illness, at least 70% (8.

Gout: epitome of painful arthritis.

Arthritic pain and disability are at or near the top of the list of reasons adult patients seek medical attention. At least 47.8 million US residents have arthritis.

Subsyndromal depression in the elderly: underdiagnosed and undertreated.

Major depressive illness is present in about 5.7% of US residents aged>or=65 years, whereas clinically significant nonmajor or "subsyndromal" depression affects approximately 15% of the ambulatory elderly. Risk of developing subsyndromal depression increases as elderly people get older.

The escalating pandemics of obesity and sedentary lifestyle. A call to action for clinicians.

Obesity and sedentary lifestyle are escalating national and global epidemics that warrant increased attention by physicians and other health care professionals. These intricately linked conditions are responsible for an enormous burden of chronic disease, impaired physical function and quality of life, at least 300,000 premature deaths, and at least $90 billion in direct health care costs annually in the United States alone. Clinicians are on the front line of combat, yet these conditions receive minimal attention during a typical office visit.

Ketones: metabolism's ugly duckling.

Ketones were first discovered in the urine of diabetic patients in the mid-19th century; for almost 50 years thereafter, they were thought to be abnormal and undesirable by-products of incomplete fat oxidation. In the early 20th century, however, they were recognized as normal circulating metabolites produced by liver and readily utilized by extrahepatic tissues. In the 1920s, a drastic "hyperketogenic" diet was found remarkably effective for treatment of drug-resistant epilepsy in children.

Nutritional assessment of hospital patients: New methods and new opportunities.

Recently, two new methods (total body electrical conductivity [TOBEC] and bioelectrical impedance analysis [BIA]) have become available for the rapid, safe, and convenient estimation of total body water in hospital patients. Despite these clear advantages, the clinical usefulness of the TOBEC and BIA methods in patient diagnosis and care is likely to be restricted by illness-related changes in the hydration of the lean body and in the distribution of water between the intracellular and extracellular water compartments. If these methods can be refined so as to permit their measurement of extracellular water as rapidly as they now measure total body water, the ability of clinicians to assess and monitor the nutritional and metabolic status of their hospital patients will be greatly enhanced.