Measure Of Reserve Research Articles

Serum anti-Müllerian hormone in subfertile women.

The correlation between ovarian reserve and infertility remains unclear. Albeit poorly predictive of pregnancy success in in vitro fertilization cycles, serum anti-Müllerian hormone (AMH) has been acknowledged as a surrogate measure of ovarian reserve and is commonly evaluated in women seeking pregnancy. Disentangling whether low serum AMH affects natural fecundity is clinically important, as this information helps physicians in providing appropriate counseling to women and may impact on management strategies. This was a nested case-control study from a prospective cohort of pregnant women undergoing first trimester screening for aneuploidies. Cases were subfertile women having tried to become pregnant for 12-24 months. Controls were subsequent age-matched fertile women. Inclusion criteria for both cases and controls were: (i) age > 18 years, (ii) natural conception, (iii) regular menstrual cycles (24-35 days). We used quantitative detection of serum AMH and interviews with the women. The main outcome measure was the proportion of women with serum AMH < 1.1 ng/mL. Seventy-six subfertile women and 76 matched fertile controls were selected. In the two study groups, there were 11 (15%) and 15 (20%) women with serum AMH < 1.1 ng/mL, respectively (p = 0.52). The crude odds ratio for subfertility in women with low serum AMH was 0.69 [95% confidence interval (CI) 0.29-1.62]. The adjusted odds ratio was 0.85 (95% CI 0.35-2.10). The median (interquartile range) serum concentration of AMH in subfertile and control women was 2.6 (range 1.6-4.0) and 2.8 (range 1.4-4.3) ng/mL, respectively (p = 0.91). Low serum AMH is not associated with female subfertility.

The comparison of the effects of single-dose methotrexate and salpingectomy on ovarian reserve in terms of the anti-Mullerian hormone level measurement

Ectopic pregnancy constitutes 1-2% of all pregnancies and has 6% maternal mortality rate. Both surgical treatment and methotrexate (MTX) administration for ectopic pregnancy is still controversial in terms of ovarian reserve protection. Anti-mullerian hormone (AMH) is the best current available measure of ovarian reserve for different clinical conditions. (ref). To the best of our knowledge there is not any study dealing with the long term effects of these two treatment methods on AMH levels. Therefore we aimed to compare the effects of single-dose MTX and salpingectomy on ovarian reserve in fertile women with ectopic pregnancy in the long term. Cross-sectional study. A total of 181 patients have been included into the study; 101 of them had received single-dose MTX or salpingectomy treatment for ectopic pregnancy in the last 12 to 18 months. Patients who have underwent salpingostomy, tubal milking, fimbriectomy and other tuba-ovarian surgery were excluded from the study. Patients in the salpingectomy group did not receive MTX. Their AMH, follicle stimulating hormone (FSH), estrogen and antral follicle counts were evaluated. The duration of time passed between application of treatment and the measurement of AMH levels for MTX and salpingectomy groups were 15.43 ± 1.77 and 14.91 ± 1.84, respectively (p=0.144). The average age was similar in both groups (p=0.094). None of the three groups displayed a significant difference in terms of FSH, E2 levels and antral follicle counts (p=0.393, p=0.117, p=0.528, respectively).There were no statistically significant difference in AMH levels in all groups (2.96 ± 0.85, 2.82 ± 0.77 and 2.68 ± 0.59 for control, MTX and salpingectomy groups respectively, P=0.147). (Table reference:aData are expressed as mean ± SD. AMH= Anti-mullerian hormone, FSH= Follicle stimulating hormone, E2= Estrogen, AFC= Antral follicle count. Neither single-dose MTX nor salpingectomy does have any detrimental effects on ovarian reserve for the treatment of ectopic pregnancy in terms of serum AMH levels and does alter antral follicle counts in the long term.Tabled 1Comparison of age, measures of ovarian reserve and smoking status.Control(n=80)Methotrexate(n=56)Salpingectomy(n=45)pAge (years)a27.15 ± 3.4927.18 ± 2.9728.33 ± 3.010.094AMH(ng/mL)a2.96 ± 0.852.82 ± 0.772.68 ± 0.590.147FSH(mIU/mL)a6.87 ± 1.797.23 ± 1.417.10 ± 1.330.393E2(pg/mL)a44.61 ± 13.9445.41 ± 13.9540.11 ± 7.630.117AFCa10.25 ± 1.8710.10 ± 1.929.84 ± 2.010.528Smoking (user/total)17/8011/5610/450.949 Open table in a new tab

Does cognitive reserve moderate the association between mood and cognition? A systematic review

SummaryThe evidence regarding the association between mood and cognitive function is conflicting, suggesting the involvement of moderating factors. This systematic review aimed to assess whether cognitive reserve moderates the association between mood and cognition in older people. Cognitive reserve was considered in terms of the three key proxy measures – educational level, occupation, and engagement in cognitively stimulating leisure activities – individually and in combination. Sixteen studies representing 37,101 participants were included in the review. Of these, 13 used a measure of education, one used a measure of occupation, two used a measure of participation in cognitively stimulating activities, and one used a combination of these. In general, cognitive reserve moderated the association between mood and cognition, with a larger negative association between mood and cognition in those with low cognitive reserve than in those with high cognitive reserve. Further research utilizing multiple proxy measures of cognitive reserve is required to elucidate the associations.

Elecsys(®) AMH Assay: A Review in Anti-Müllerian Hormone Quantification and Assessment of Ovarian Reserve.

The Elecsys(®) AMH assay is an in vitro, fully automated assay indicated for the quantification of anti-Müllerian hormone (AMH) in human serum/lithium-plasma, which (in conjunction with other clinical and laboratory findings) can help to determine ovarian reserve. The assay is highly sensitive and precise, with a broad linear range, and correlates well with manual AMH assays and transvaginal sonographic assessment of antral follicle count, but has the benefit of being less variable. The Elecsys(®) AMH assay also has a shorter testing time than some other AMH assays and was shown to provide a reproducible measure of ovarian reserve in women of reproductive age in a large prospective cohort study, demonstrating its usefulness in this setting.

Abstract 203: Cardiomyocyte T-tubule Membrane Turns Over, Releasing BIN1 Containing Microparticles into Blood

Bridging integrator 1 (BIN1) is a cardiac muscle protein that folds cardiomyocyte T-tubule membrane. BIN1 is intrinsic to cardiac health, and is reduced in acquired heart failure. Interestingly, we have found that BIN1 is also blood available, and that plasma BIN1 correlates with cardiac function, suggesting cardiac origin of plasma BIN1. We found that low plasma BIN1 correlates with failing muscle and predicts ventricular arrhythmia. However, the paradigm does not exist for an intracellular membrane associate cardiomyocyte protein to be homeostatically turned over into blood. In this study, using a mouse model with cardiac specific deletion of Bin1 gene, we identified with biochemical techniques that plasma BIN1 levels directly correlate with cardiac tissue BIN1 levels, indicating cardiac origin. Furthermore, investigations using both super-resolution fluorescent imaging and flow cytometry analysis revealed that adult ventricular cardiomyocytes constantly release BIN1 into blood via membrane microparticle production. Microparticles are small membrane vesicles shed from plasma membrane of a variety of cell types including platelets, leukocytes, and endothelial cells. Using super-resolution three-dimensional stochastic optical reconstruction microscopy (3D-STORM), we found similar to the blood cells, isolated adult mouse cardiomyocytes release Annexin V positive microparticles with diameters ranging between 0.1 to 1.0 μm. These microparticles also carry BIN1 protein. Flow cytometry was also used to detect and quantify microparticles &lt;1.0 μm in size from medium bathing a pure population of adult mouse cardiomyocytes. BIN1 microparticle release is proportional to actin stability and amount of T-tubule membrane folds. Compared to wild type cardiomyocytes, microparticle release is significantly reduced from myocytes with heterozygous deletion of Bin1 gene. These data indicate that cardiomyocyte membrane undergoes dynamic turnover, releasing T-tubule folds into blood as microparticles. Furthermore, plasma BIN1 can be used as a direct measure of cardiomyocyte health and reserve.

Androgen Deprivation Linked to Cognitive Impairment

Men treated with androgen-deprivation therapy for advanced prostate cancer appear to be at risk for cognitive decline within 6 months of starting therapy, investigators found in a controlled comparison study. The results suggest that discussions of the risks and benefits of androgen-deprivation therapy (ADT) should include the possibility of cognitive problems, said Brian D. Gonzalez, PhD, and colleagues from the Moffitt Cancer Center in Tampa. “Clinicians may also consider inquiring about changes in cognitive functioning that may have occurred after starting ADT and refer patients for assessment and treatment as needed,” they wrote in the Journal of Clinical Oncology. Because there is, at best, mixed evidence of potential cognitive changes in men undergoing ADT, the investigators conducted cognitive assessments of 58 men within 21 days of starting on ADT and at 6 and 12 months. They compared the results with those of age- and education-matched controls, including 84 with prostate cancer treated with prostatectomy alone and 88 men without prostate cancer. They used a battery of neuropsychological tests, including validated measures of verbal memory, visual memory, attention, executive function, and cognitive reserve. They compared mean cognitive performance scores using mixed models and cognitive impairment using generalized estimating equations. They found that there were no differences at any time point in either mean-level cognitive performance nor impaired cognitive performance between the prostatectomy-only controls and the controls without prostate cancer. Therefore, the two groups were combined into a single, larger control cohort. The men who received ADT were not different from controls at baseline in terms of impaired cognitive performance, but over time they had significantly higher rates of impaired cognitive performance relative to controls, and at both the 6-month and 12-month intervals, Dr. Gonzalez and his associates reported (J Clin Oncol 2015;33:2021-7). Age, baseline cognitive reserve, depression, fatigue, and the presence of hot flashes did not moderate the effects of ADT on change in impaired cognitive performance. The authors noted that their findings contradict those of a previous study (J Clin Oncol 2010;28:5030-37), in which investigators found no evidence of higher rates of impaired performance either overall or on specific tests between ADT-treated men and controls over 12 months. They said that the earlier study, however, relied on less stringent criteria of impairment. “Interestingly, both studies found evidence suggesting that practice effects (i.e., improvement over time as function of repeated exposure to same tests) were limited primarily to control groups,” they wrote. Dr. Gonzalez reported having no conflicts of interest to disclose. Neil Osterweil is a Frontline Medical News freelance writer based in Boston.

Treatment: special conditions: Co-existing heart disease: coronary artery disease, myocardial infarction, heart failure

Behavioral performance and hemodynamic changes in the prefrontal cortex (PFC) represent cerebrovascular reserve and may indicate functional deficits related to essential hypertension. Fifteen stage 1 hypertensive and normotensive males (19–55 years) were compared on four tests of working memory (digit span and auditory consonant trigrams), and accompanying hemodynamic changes measured by functional near infrared spectroscopy (fNIRS). With participants blindfolded, the four tests were randomized while fNIRS was used to monitor bilateral PFC changes in oxyhemoglobin (O2Hb), deoxyhemoglobin (HHb), total hemoglobin (tHb), and hemoglobin difference. The hypertensive group demonstrated significant impairment in performance on the working memory tests with a trend of decreased efficiency performance scores (tests score/O2Hb and tHb changes). Significant correlations were noted in the hypertensive group between test performance and changes in O2Hb and tHb in both the left and right PFC. These findings suggest that fNIRS combined with cognitive testing may provide important measures of cerebrovascular reserve in essential hypertension.

Hemodynamic changes in the prefrontal cortex during working memory in essential hypertension

Behavioral performance and hemodynamic changes in the prefrontal cortex (PFC) represent cerebrovascular reserve and may indicate functional deficits related to essential hypertension. Fifteen stage 1 hypertensive and normotensive males (19–55 years) were compared on four tests of working memory (digit span and auditory consonant trigrams), and accompanying hemodynamic changes measured by functional near infrared spectroscopy (fNIRS). With participants blindfolded, the four tests were randomized while fNIRS was used to monitor bilateral PFC changes in oxyhemoglobin (O2Hb), deoxyhemoglobin (HHb), total hemoglobin (tHb), and hemoglobin difference. The hypertensive group demonstrated significant impairment in performance on the working memory tests with a trend of decreased efficiency performance scores (tests score/O2Hb and tHb changes). Significant correlations were noted in the hypertensive group between test performance and changes in O2Hb and tHb in both the left and right PFC. These findings suggest that fNIRS combined with cognitive testing may provide important measures of cerebrovascular reserve in essential hypertension.

Social cognition is not associated with cognitive reserve in older adults

Social and general cognitive abilities decline in late life. Those with high cognitive reserve display better general cognitive performance in old age; however, it is unknown whether this is also the case for social cognition. A total of 115 healthy older adults, aged 60–85 years (m = 44, f = 71) were assessed using The Awareness of Social Inference Test (TASIT-R; social cognition), the Lifetime of Experiences Questionnaire (LEQ; cognitive reserve), and the Wechsler Abbreviated Scale of Intelligence (WASI-II; general cognitive ability). The LEQ did not predict performance on any TASIT-R subtest: Emotion Evaluation Test (β = -.097, p = .325), Social Inference – Minimal (β = -.004, p = .972), or Social Inference – Enriched (β = -.016, p = .878). Sensitivity analyses using two alternative cognitive reserve measures, years of education and the National Adult Reading Test, supported these effects. Cognitive reserve was strongly related to WASI-II performance. Unlike general cognitive ability, social cognition appears unaffected by cognitive reserve. Findings contribute to the emerging understanding that cognitive reserve differentially affects individual cognitive domains, which has implications for the theoretical understanding of cognitive reserve and its brain correlates. Cognitive measures unbiased by cognitive reserve may serve as best indicators of brain health, free of compensatory mechanisms.

Could cognitive estimation ability be a measure of cognitive reserve?

Could cognitive estimation ability be a measure of cognitive reserve?

Cardiorespiratory Fitness, Oxygen Uptake Efficiency Slope And Endothelial Function In Male Adolescents

PURPOSE: VO2 max defined as the point at which oxygen uptake reaches a plateau despite further increase in work rate, is an objective measure of an individual’s cardiorespiratory fitness (CRF). Due to its effort dependency, a true plateau in VO2 during incremental exercise is seldom attained particularly in chronic disease and pediatric populations. The oxygen uptake efficiency slope (OUES) is as an objective and effort independent submaximal measure of cardiopulmonary reserve. Children with high CRF have higher OUES values than those with low CRF. Furthermore, high CRF during adolescence is associated with a healthier cardiovascular profile. The purpose of this study was to examine the relation between OUES and endothelial function (EF) in healthy male adolescents with low, moderate and high CRF. METHODS: Low fit (n=14, VO2max = 43.2±5.3, mL·kg1·min-1), moderate fit (n=16, VO2max = 53.8±3.3, mL·kg1·min-1) and high fit (n=18, VO2max = 63.7±4.0 mL·kg1·min-1) healthy asymptomatic males (mean age 15.8 ± 0.5;) participated in the study. High-resolution ultrasonography was used to assess endothelial dependent (EDD) and endothelial independent dilation (EID) in response to brachial artery flow mediated dilation and glyceryl trinitrate. VO2max was measured using open circuit spirometry during an incremental treadmill test. OUES was determined by plotting VO2 (ml·min-1) against the logarithm of VE (L·min-1) and calculating the slope of this linear relation through single regression analysis. RESULTS: EDD and VO2max were significantly lower in the low fit than the moderate and high fit group. There was no between group difference in EID. Maximal OUES was higher in the high fit than the moderate (p<0.01) and low fit (p<0.05) group. There was a significant positive relation between maximal OUES and percentage change (r=0.33, p<0.01) and absolute change in EDD (r=0.44, p<0.01). VO2 max was also significantly related to percentage change (r=0.67, p<0.001) and absolute change in EDD (r=0.73, p<0.001) CONCLUSION: VO2 max and maximal OUES are significantly related to both absolute and percent change in EDD in adolescent males.

Patient selection for elective revascularization to reduce myocardial infarction and mortality: new lessons from randomized trials, coronary physiology, and statistics.

As stated in American College of Cardiology/American Heart Association Guidelines, randomized trials have not demonstrated that elective percutaneous coronary intervention (PCI) reduces myocardial infarction (MI) or mortality over medical treatment. Even the Fractional Flow Reserve Guided PCI Versus Medical Therapy in Stable Coronary Disease (FAME 2) trial showed no statistically significant benefit of PCI over the deferred group by traditional intention-to-treat, nonbenchmark analysis starting at randomization that includes procedure-related events. Benchmark analysis in FAME 2 beginning 1 week after PCI removed procedure-related events that counterbalanced subsequent reduced MI and mortality compared with the deferred group. Meta-analysis of the literature on risk of events related to fractional flow reserve (FFR), including FFR Versus Angiography in Multivessel Evaluation (FAME), and other physiological measures of severity reveal an underappreciated, powerful interdependence among physiological severity of stenosis, diffuse coronary artery disease (CAD), event rates, sample size, and statistical certainty of differences. This analytic review synthesizes an evidenced-based, quantitative hypothesis and potential solution to this issue based on hard data from the literature by coauthors of diverse cardiovascular disciplines in trial design, biostatistics, invasive procedures, coronary physiology, fluid dynamics, coronary pathology, and quantitative imaging. Our synthesis elucidates a dual hypothesis for failure of elective PCI in stable CAD to reduce MI or mortality and novel trial design for selecting patients for whom PCI will likely reduce these events. First, a large burden of global diffuse CAD carries a high risk of coronary events unmitigated by PCI of a focal stenosis. Second, focal stenosis severity in previous randomized revascularization trials has been too modest without objectively quantified sufficient severity to observe benefit of PCI. In previous trials, mixture of diffuse coronary disease and intermediate stenosis may not incur high enough risk for potential benefit by PCI for sample size of reported trials. Greater quantitative severity with …

Perceived frailty and measured frailty among adults undergoing hemodialysis: a cross-sectional analysis.

BackgroundFrailty, a validated measure of physiologic reserve, predicts adverse health outcomes among adults with end-stage renal disease. Frailty typically is not measured clinically; instead, a surrogate—perceived frailty—is used to inform clinical decision-making. Because correlations between perceived and measured frailty remain unknown, the aim of this study was to assess their relationship.Methods146 adults undergoing hemodialysis were recruited from a single dialysis center in Baltimore, Maryland. Patient characteristics associated with perceived (reported by nephrologists, nurse practitioners (NPs), or patients) or measured frailty (using the Fried criteria) were identified using ordered logistic regression. The relationship between perceived and measured frailty was assessed using percent agreement, kappa statistic, Pearson’s correlation coefficient, and prevalence of misclassification of frailty. Patient characteristics associated with misclassification were determined using Fisher’s exact tests, t-tests, or median tests.ResultsOlder age (adjusted OR [aOR] = 1.36, 95%CI:1.11-1.68, P = 0.003 per 5-years older) and comorbidity (aOR = 1.49, 95%CI:1.27-1.75, P < 0.001 per additional comorbidity) were associated with greater likelihood of nephrologist-perceived frailty. Being non-African American was associated with greater likelihood of NP- (aOR = 5.51, 95%CI:3.21-9.48, P = 0.003) and patient- (aOR = 4.20, 95%CI:1.61-10.9, P = 0.003) perceived frailty. Percent agreement between perceived and measured frailty was poor (nephrologist, NP, and patient: 64.1%, 67.0%, and 55.5%). Among non-frail participants, 34.4%, 30.0%, and 31.6% were perceived as frail by a nephrologist, NP, or themselves. Older adults (P < 0.001) were more likely to be misclassified as frail by a nephrologist; women (P = 0.04) and non-African Americans (P = 0.02) were more likely to be misclassified by an NP. Neither age, sex, nor race was associated with patient misclassification.ConclusionsPerceived frailty is an inadequate proxy for measured frailty among patients undergoing hemodialysis.

Frailty, mycophenolate reduction, and graft loss in kidney transplant recipients.

Mycophenolate mofetil (MMF) side effects often prompt dose reduction or discontinuation, and this MMF dose reduction (MDR) can lead to rejection and possibly graft loss. Unfortunately, little is known about what factors might cause or contribute to MDR. Frailty, a measure of physiologic reserve, is emerging as an important, novel domain of risk in kidney transplantation recipients. We hypothesized that frailty, an inflammatory phenotype, might be associated with MDR. We measured frailty (shrinking, weakness, exhaustion, low physical activity, and slowed walking speed), other patient and donor characteristics, longitudinal MMF doses, and graft loss in 525 kidney transplantation recipients. Time-to-MDR was quantified using an adjusted Cox proportional hazards model. By 2 years after transplantation, 54% of frail recipients and 45% of nonfrail recipients experienced MDR; by 4 years, incidence was 67% and 51%. Frail recipients were 1.29 times (95% confidence interval [95% CI], 1.01-1.66; P = 0.04) more likely to experience MDR, as were deceased donor recipients (adjusted hazard ratio [aHR], 1.92; 95% CI, 1.44-2.54, P < 0.001) and older adults (age ≥ 65 vs <65; aHR, 1.47; 95% CI, 1.10-1.96, P = 0.01). Mycophenolate mofetil dose reduction was independently associated with a substantially increased risk of death-censored graft loss (aHR, 5.24; 95% CI, 1.97-13.98, P = 0.001). A better understanding of risk factors for MMF intolerance might help in planning alternate strategies to maintain adequate immunosuppression and prolong allograft survival.

MP16-12 CORRELATION BETWEEN SURGEONS' AND PATIENTS' SUBJECTIVE AND OBJECTIVE PERCEPTIONS OF FRAILTY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2015MP16-12 CORRELATION BETWEEN SURGEONS' AND PATIENTS' SUBJECTIVE AND OBJECTIVE PERCEPTIONS OF FRAILTY Daniel Canter, Louis Revenig, Yuan Liu, Sungjin Kim, Kenneth Ogan, and Viraj A. Master Daniel CanterDaniel Canter More articles by this author , Louis RevenigLouis Revenig More articles by this author , Yuan LiuYuan Liu More articles by this author , Sungjin KimSungjin Kim More articles by this author , Kenneth OganKenneth Ogan More articles by this author , and Viraj A. MasterViraj A. Master More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.819AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Surgical decision-making relies on subjective judgments by the physician and patient despite the availability of objective assessment tools. In this study, we sought to examine the concordance between an individual patient and his/her surgeon on the patient's “fitness” for surgery. We then correlated these ratings with the patient's objective frailty scores (FS). METHODS Patients were prospectively enrolled prior to surgery. In addition to Fried's 5 component frailty scale, patients were also asked to rate their ability to withstand the physical stress of the scheduled intended surgery using a visual analog scale. The operating surgeon then independently also rated his/her assessment of the patient's ability to withstand surgery in a blinded manner using a similar visual analog scale. Correlation among surgeons' and patients' assessments and patients' frailty score were assessed using the Spearman correlation coefficient. RESULTS 203 patients were included in this study. The mean age of our study population was 61.6 + 11.7 years with the majority of patients in this study being white (67%) and male (60.6%). A patient's self-assessment showed no correlation with their age (Spearman Correlation = 0.083, p-value = 0.239), however the surgeons' ratings of their patients showed a positive correlation with patient age (SC= 0.334, p = < 0.001). Patients' scores were positively correlated with their FS (SC = 0.338, p = < 0.001), although surgeons' ratings showed a stronger correlation (SC = 0.405, p = < 0.001). However, when stratified by age group, the positive correlation and predictive ability were lost (p-value = 0.198), indicating a subjective bias to rating patients frail based on age alone. CONCLUSIONS Although age is an established risk factor, our data demonstrate surgeons may mistakenly use it as a surrogate for an objective measure of physiologic reserve. Conversely, patients tended to overestimate their ability to withstand the intended stresses of surgery, regardless of age, neglect the effect of age on surgical fitness, possibly leading to unrealistic expectations of their recovery. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e172 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Canter More articles by this author Louis Revenig More articles by this author Yuan Liu More articles by this author Sungjin Kim More articles by this author Kenneth Ogan More articles by this author Viraj A. Master More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

013. Complementary role of 6-minutes walking test (6MWT) in the assessment of functional status of patients with chronic obstructive pulmonary disease (COPD)

Background Despite its limited repeatability, spirometry is the most widely used method of assessment of the pulmonary ventilation. However, it is not a safe measure of the functional reserve of chronic obstructive pulmonary disease (COPD) patients with multiple comorbidities. Consequently, a stress test that would include cardiovascular and neuromuscular variables would be a useful complimentary test.

Role of amyloid-β CSF levels in cognitive deficit in MS

Multiple sclerosis (MS) is the most common neurological disease of the young adults. Although being long considered as a pure white matter (WM) disease, growing evidence indicates that in MS the gray matter (GM) is affected as well, and that GM pathology correlates with cognitive function deterioration in MS. Indeed, MS is increasingly recognized to cause cognitive deficits since its early stages. Therefore, the identification of a biomarker with good diagnostic and prognostic power is of great importance for monitoring and preventing cognitive impairment in MS patients. A possibility arises from the combination of two different measures of neuronal injury: the levels of amyloid-β1-42 in cerebrospinal fluid (CSF), which have been found associated with cognitive decline in Alzheimer disease (AD); the brain synaptic plasticity, which is a measure of cognitive reserve and can be explored safely in humans by means of transcranial magnetic stimulation.In this review, we discuss the relevance of amyloid-β1-42 in MS disease and its link to long-term potentiation (LTP), which is the most studied form of synaptic plasticity, providing evidence for their combined use in cognitive assessment in MS patients.

Frailty and Mortality in Kidney Transplant Recipients

We have previously described strong associations between frailty, a measure of physiologic reserve initially described and validated in geriatrics, and early hospital readmission as well as delayed graft function. The goal of this study was to estimate its association with postkidney transplantation (post-KT) mortality. Frailty was prospectively measured in 537 KT recipients at the time of transplantation between November 2008 and August 2013. Cox proportional hazards models were adjusted for confounders using a novel approach to substantially improve model efficiency and generalizability in single-center studies. We precisely estimated the confounder coefficients using the large sample size of the Scientific Registry of Transplantation Recipients (n = 37 858) and introduced these into the single-center model, which then estimated the adjusted frailty coefficient. At 5 years, the survivals were 91.5%, 86.0% and 77.5% for nonfrail, intermediately frail and frail KT recipients, respectively. Frailty was independently associated with a 2.17-fold (95% CI: 1.01-4.65, p = 0.047) higher risk of death. In conclusion, regardless of age, frailty is a strong, independent risk factor for post-KT mortality, even after carefully adjusting for many confounders using a novel, efficient statistical approach.

Education mitigates age-related decline in N-Acetylaspartate levels.

BackgroundGreater educational attainment is associated with better neurocognitive health in older adults and is thought to reflect a measure of cognitive reserve. In vivo neuroimaging tools have begun to identify the brain systems and networks potentially responsible for reserve.MethodsWe examined the relationship between education, a commonly used proxy for cognitive reserve, and N-acetylaspartate (NAA) in neurologically healthy older adults (N = 135; mean age = 66 years). Using single voxel MR spectroscopy, we predicted that higher levels of education would moderate an age-related decline in NAA in the frontal cortex.ResultsAfter controlling for the variance associated with cardiorespiratory fitness, sex, annual income, and creatine levels, there were no significant main effects of education (B = 0.016, P = 0.787) or age (B = −0.058, P = 0.204) on NAA levels. However, consistent with our predictions, there was a significant education X age interaction such that more years of education offset an age-related decline in NAA (B = 0.025, P = 0.031). When examining working memory via the backwards digit span task, longer span length was associated with greater education (P < 0.01) and showed a trend with greater NAA concentrations (P < 0.06); however, there was no age X education interaction on digit span performance nor a significant moderated mediation effect between age, education, and NAA on digit span performance.ConclusionsTaken together, these results suggest that higher levels of education may attenuate an age-related reduction in neuronal viability in the frontal cortex.

Testing and interpreting measures of ovarian reserve: a committee opinion

Currently there is no uniformly accepted definition of decreased ovarian reserve (DOR), as the term may refer to three related but distinctly different outcomes: oocyte quality, oocyte quantity, or reproductive potential. Available evidence concerning the performance of ovarian reserve tests is limited by small sample sizes, heterogeneity among study design, analyses and outcomes, and the lack of validated outcome measures.