We sought to determine whether there are structural and metabolic changes in the brains of older adults with cognitive complaints yet who do not meet MCI criteria (i.e., preMCI). We compared the volumes of regional lobar gray matter (GM) and medial temporal lobe structures, including the hippocampus, entorhinal cortex (ERC), fusiform and parahippocampal gyri, and metabolite ratios from the posterior cingulate in individuals who had a Clinical Demetia Rating (CDR) of 0.5, but who did not meet MCI criteria (preMCI, N = 17), patients with mild cognitive impairment (MCI, N = 13), and cognitively normal controls (N = 18). Controls had more ERC, fusiform, and frontal gray matter volume than preMCI and MCI subjects and greater parahippocampal volume and more posterior cingulate N-acetylaspartate (NAA)/myoinosotil (mI) than MCI. There were no significant differences between MCI and preMCI subjects on any of these measures. These findings suggest there are neurodegenerative changes in the brains of older adults who have cognitive complaints severe enough to qualify for CDR = 0.5 yet show no deficits on formal neuropsychological testing. The results further support the hypothesis that detection of individuals with very mild forms of Alzheimer's disease (AD) may be facilitated by use of the CDR, which emphasizes changes in cognition over time within individuals rather than comparison with group norms.
We present the first known cases of successful implantation of the Perceval sutureless bioprosthetic valve in the pulmonary position in two high-risk endocarditis patients.
Cambodia has recently seen the dawn of a new era in medical practice. Total hip replacement (THR) operations are now available for those who require these services. Post-operative rehabilitation is the crux of a successful hip replacement programme. In this article, the authors discuss their experiences in rehabilitating THR clients in Cambodia, and introduce what they think is the country's first specific protocol for rehabilitation of post-THR clients. In 2007, the Children's Surgical Centre became one of the first providers to offer THRs in Cambodia. From the start, physiotherapists have provided postoperative rehabilitation but, to date, there has been no official protocol to address the specific challenges for THR rehabilitation in this part of the world. Multiple social and cultural factors mean that established protocols from the developed world are not wholly suited to the needs of Cambodian clients. Bearing in mind the lower literacy levels, poverty, language barriers, specific cultural and economic needs of the clients and the unique forms of transportation in Asia, the authors have developed a programme, including a guide with simple Khmer instructions, customised pictures, and a separate client education sheet. The results seen among the THR clients seem promising-there is scope in the future to assess longer term outcomes of THR clients in Cambodia.
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