Alzheimer's disease (AD) has become a global health issue as the population ages. There is no effective treatment to protect against its occurrence or progression. Some argue that the lack of treatment response is due to delays in diagnosis. By the time a diagnosis of AD is made, neurodegenerative changes are at the stage where very few neurons can be salvaged by medication. The AD research community has developed the idea of mild cognitive impairment (MCI) in an attempt to find predementia patients who might benefit from potentially therapeutic drugs that have proven ineffective in the past. However, MCI is heterogeneous in terms of its underlying pathology and practicality for predicting dementia. This article first reviews the conceptual evolution of MCI as the borderland between normal aging and dementia, and then proposes that built environment and sociocultural context are two key elements in formulating a diagnosis of dementia. Dementia is more than a biomedical term. Cognitive impairment is considered a dynamic outcome of how an individual interacts with cognitive challenges. To focus on amyloid deposition as a single etiology for AD does not adequately capture the social implications and geriatric aspects of dementia. Moreover, MCI is nosologically questionable. Unlike a diagnosis of AD, for which a prototype has been well established, MCI is defined by operational criteria and there are no cases seen as typical MCI. Biofluid and imaging markers are under active development for early detection of amyloid deposition and neurofibrillary tangles in the brain, whereas vascular risks, chronic medical diseases, and polypharmacy continue to add to the complexity of dementia in old age. The paradigm of dementia care policy may shift to early diagnosis of AD pathology and comprehensive care for chronic diseases in the elderly population.

Although evidence shows that urodynamic study may not improve outcomes, it can be used to evaluate men with lower urinary tract symptoms (LUTSs) which have not been adequately delineated and treated. In young men with LUTS not responding to treatment based on clinical examination, or elderly men with LUTS and incontinence, a complete urodynamic evaluation is mandatory to understand the pathophysiology underlying LUTS, such as bladder outlet obstruction (BOO), detrusor overactivity, and detrusor underactivity. Preoperative urodynamic study-proven BOO is a predictor of a successful surgical outcome. An urodynamic study should be performed when patients with LUTS are planning to undergo surgical treatment for benign prostatic obstruction.

Lower urinary tract symptoms (LUTS) are highly prevalent in the aging population, particularly in men. Historically, prostate enlargement was thought to be responsible for most cases of male LUTS. Several risk factors for the development of benign prostate enlargement/hyperplasia (BPE/BPH) have been identified, including age, genetics, hormones, growth factors, inflammation, and lifestyle factors. However, as our knowledge continues to evolve, male LUTS are no longer managed entirely in a prostate-centric fashion. In this article, we review current concepts in the epidemiology, etiology, and pathophysiology of BPE/BPH and male LUTS.

Objective: We report here the human leukocyte antigen (HLA) allelic variety and haplotype composition in a cohort of the Taiwanese Chinese population and their patterns of linkage disequilibria on HLA-B: HLA-C alleles and HLA-DRB1: HLA-DQB1 alleles at a high-resolution level. Materials and Methods: Peripheral whole blood from 11,423 Taiwanese Chinese unrelated individuals was collected in acid citrate dextrose. Genomic DNA was extracted using the QIAamp DNA Blood Mini Kit. The DNA material was subjected to HLA genotyping for HLA-A,-B,-C,-DRB1, and-DQB1 loci using a commercial polymerase chain reaction-sequence-based typing (PCR-SBT) kit, the SeCore^® A/B/C/DRB1/DQB1 Locus Sequencing kit. High-resolution allelic sequencing was performed as previously described. Results: The number of individual HLA-B alleles detected was greater than the number of alleles recognized in the both the HLA-A and-DRB1 loci. Several novel alleles were discovered as a result of employing the SBT method and the high number of donors tested. In addition, we observed a genetic polymorphic feature of association between HLA-A and-B, HLA-B and-C, and HLA-DRB1 and-DQB1 alleles. Further, the homozygous haplotype frequencies of HLA-A and-B; HLA-A,-C, and-B; HLA-A,-C,-B, and-DRB1; and HLA-A,-C,-B,-DRB1, and-DQB1 in Taiwanese Chinese population are presented. Conclusion: As increasing number of HLA alleles are being discovered, periodic HLA profile investigation in a given population is essential to recognize the HLA complexity in that population. Population study can also provide an up-to-date strategic plan for future needs in terms of compatibility measurement for HLA matching between transplant donors and patients.

Objective: To test the feasibility of establishing a senior volunteer cohort and describe vascular risks, cognitive function, and brain aging indices in a pilot study. Materials and Methods: We enrolled 40 senior volunteers from the Tzu Chi Foundation and other organizations in Hualien in 2014–2015. We conducted in-person interviews to collect information on demographic features, physical fitness, dietary habits, comorbidities, and narratives of aging. Vascular risks including blood pressure, body mass index (BMI), serum glucose level, and lipid profile were examined. Each participant underwent a comprehensive battery of neuropsychological tests and structural brain magnetic resonance imaging (MRI). Descriptive statistics and tabulation were applied to characterize this pilot cohort. Results: There were more volunteers from the Tzu Chi Foundation (n = 25) than other organizations. The mean age was 66.7 years (standard deviation = 5.1) and there was a female predominance (M:F = 13:27). The mean number of comorbid chronic diseases was 2.1 and the mean BMI was 24.5. Most participants (77.5%) engaged in outdoor walking activities every week. Nutrient intake in vegetarians (n = 18) did not differ from nonvegetarians except for lower Vitamin B12 levels (mean = 0.9 μg). All participants but one scored 26 or above in the Mini–Mental State Examination (mean = 28.4). Among the other cognitive tests, only one task related to inhibition and switching abilities was at the low average level. The mean values of vascular risk markers were within the normal ranges. The most common genotype of apolipoprotein E was μ3/μ3 (n = 32). The quality of MRI was sufficient for volumetric analysis. Conclusion: It is feasible to establish a volunteer-based cohort to study brain aging in Taiwan. The senior volunteers were physically active and cognitively healthy. Vascular risks were well distributed among these participants. Future longitudinal study will allow us to observe changes in these markers over time and provide dynamic evidence about vascular health and cognitive aging.

Objective: Pregnant women infected with malaria represent a significant obstetric problem, especially in the face of antimalarial resistance. This cross-sectional study investigated the prevalence of malaria parasitemia, associated risk factors as well as the antimalarial resistance pattern of Plasmodium isolates from pregnant women attending four selected secondary health facilities in Kaduna State, Nigeria. Materials and Methods: Blood samples were collected from 353 pregnant women attending selected hospitals. Malaria microscopy and parasite density count were conducted based on standard protocols. Antimalarial susceptibility test (using chloroquine, artesunate, artether, and sulfadoxine-pyrimethamine), and hemoglobin concentrations were determined using schizont maturation assay and methemoglobin method, respectively. Multiple-drug resistance (MDR) was defined by resistance against ≥3 antimalarial drugs. Results: The overall prevalence of plasmodiasis was 22.4%. Out of those infected, 5.2% was found to be anemic. Malaria parasitemia was significantly associated with parity, residential area, age of women, and use of preventive measures against malaria (P < 0.05) but not with hemoglobin concentration, occupation, and trimester of pregnancy (P > 0.05). Malaria parasites from the pregnant women exhibited the highest resistance against chloroquine, 75 (94.9%) followed Artemether, 30 (37.9%) then sulfadoxine-pyrimethamine, 29 (36.7%) and least resistant to artesunate, 28 (35.4%). The prevalence of MDR was 40.5% (32/79). Conclusion: The prevalence of malaria was relatively high due to inadequate and/or ineffective preventive measures adopted by pregnant women. More so, significant isolates of Plasmodium falciparum exhibited MDR against antimalarial agents tested.

Objective: Despite its possible role in knee arthroplasty, the proximal-distal condylar length (PDCL) of the femur has never been reported in the literature. We conducted an anatomic study of the proximal aspect of the medial femoral condyle to propose a method for measuring the PDCL. Materials and Methods: Inspection of dried bone specimens was carried out to assure the most proximal condylar margin (MPCM) as the eligible starting point to measure the PDCL. Simulation surgery was performed on seven pairs of cadaveric knees to verify the clinical application of measuring the PDCL after locating the MPCM. Interobserver reliability of this procedure was also analyzed. Results: Observation of the bone specimens showed that the MPCM is a concavity formed by the junction of the distal end of the supracondylar ridge and the proximal margin of the medial condyle. This anatomically distinctive structure made the MPCM an unambiguous landmark. The cadaveric simulation surgical dissection demonstrated that the MPCM is easily accessed in a surgical setting, making the measurement of the PDCL plausible. The intraclass correlation coefficient was 0.78, indicating good interobserver reliability for this technique. Conclusion: This study has suggested that the PDCL can be measured based on the MPCM in a surgical setting. PDCL measurement might be useful in joint line position management, selection of femoral component sizes, and other applications related to the proximal-distal dimension of the knee. Further investigation is required.

Objective: It is well established that patients with metabolic syndrome (MetS) demonstrate elevated levels of serum leptin. The aim of this study is to identify fasting serum leptin as an independent marker of MetS in geriatric diabetic patients. Materials and Methods: Sixty-four patients over 65 years old with type 2 diabetic mellitus (T2DM) were assessed for MetS based on the diagnostic criteria of the International Diabetes Federation. Fasting blood samples including serum leptin concentrations were obtained from the participants. Leptin levels were determined using a commercial enzyme immunoassay. Results: Forty-five (70.3%) of the 64 geriatric T2DM patients enrolled in this study were found to have MetS. This group of participants compared with those in the non-MetS group had higher serum levels of leptin (P = 0.004), triglycerides (P = 0.005), fasting glucose (P = 0.049), glycated hemoglobin (P = 0.016), white blood cells (P = 0.003), C-reactive protein (CRP, P = 0.028), insulin (P < 0.001), higher homeostatic model assessment insulin resistance values (HOMA1-IR and HOMA2-IR, both P < 0.001), a higher body weight (P = 0.024), body mass index (P < 0.001), body fat mass (P < 0.001), waist circumference (P < 0.001), systolic blood pressure (BP) (P < 0.001), diastolic BP (P < 0.001), percentage of women (P = 0.011), prevalence of hypertension (P = 0.042), and a lower level of serum high-density lipoprotein cholesterol (P = 0.001). Univariate linear analysis of the clinical variables associated with the fasting serum leptin level revealed that height (P = 0.020) had a negative correlation, while body fat mass (P < 0.001) and logarithmically transformed CRP (log-CRP, P < 0.001) had positive correlations with serum leptin levels. Multivariate forward step-wise linear regression analysis of the variables significantly associated with fasting serum leptin levels showed that body fat mass (P < 0.001) and log-CRP (P = 0.001) were independent predictors of these values. Conclusion: Serum leptin is positively correlated with MetS. It serves as an independent marker of MetS in elderly patients with T2DM.

Arachnoid cyst is a benign, congenital space-occupying brain lesion, which has been found in patients with schizophrenia. The association between arachnoid cyst and schizophrenia remains controversial, but the location of the arachnoid cyst may give rise to a specific symptom presentation in schizophrenia. We present a 31-year-old woman with an established diagnosis of schizophrenia coexisting with a large cerebellar arachnoid cyst who presented mainly with delusions of control. This cerebellar arachnoid cyst and schizophrenia may have been found together coincidentally or brain dysfunction due to this cerebellar arachnoid cyst may have caused or contributed to the appearance of psychotic symptoms. The patient had an unsteady gait accompanied by delusions of control, and she showed a poor response to high-dose olanzapine treatment, suggesting the arachnoid cyst was associated with her schizophrenic symptoms. The cyst was over the right posterior fossa with cerebellum compression, which may have caused abnormality in the cerebellar–parietal network resulting in her delusions of control. This case indicates that there might be relationships between cerebellar lesions, schizophrenia, and delusions of control.

Pneumomediastinum is the presence of air within the mediastinum. It is usually caused by a respiratory tract disorder, esophageal erosion, bowel perforation, or gastrointestinal tract endoscopic procedure. Pneumomediastinum following urological endoscopic surgery is very uncommon. Here, we report an unusual case of pneumomediastinum in a 55-year-old female following percutaneous nephrolithotomy for renal and ureteral stones. The patient recovered well with supportive treatment with oxygen.

Symmetrical peripheral gangrene (SPG) is characterized by sudden onset of peripheral, frequently symmetrical, gangrene in the absence of major vascular occlusive disease. We report a case of four limb SPG caused by septic shock with disseminated intravascular coagulation (DIC) that had been treated with inotropes. This case shows that SPG may be present as a complication of sepsis due to systematic derangement that affects a wide range of organ systems, including coagulation and microcirculation. Early recognition and prompt management of sepsis and optimization of the process of weaning off the inotropes at the earliest opportunity are necessary to avoid SPG.