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Weak control of inflammation by genes, linked to Alzheimer’s development

A team of researchers from the University of Cambridge has studied data from healthy human brain tissue, revealing a signature of proteins in specific areas of the brain that could dictate vulnerability to damage in Alzheimer’s. The findings help to explain the characteristic spread of damage across the brain that is observed in the disease and the findings could help to inform future drug discovery efforts. The results are published on 10 August in the journal Science Advances.

Alzheimer’s disease is characterised by the abnormal build-up of two proteins in the brain called amyloid and tau. Initially, the damage inflicted by both proteins is confined to specific areas of the brain – particularly those involved in controlling memory and navigation. Over time, the damage caused by these proteins spreads across the brain, affecting new areas and causing symptoms to worsen and diversify. This spread of damage is not random and for many years researchers have observed a predictable pattern of spread between particularly vulnerable areas of the brain. But researchers have long questioned why these areas are most susceptible to Alzheimer’s.

The Cambridge team suggested that one explanation for this vulnerability could lie in the pattern of proteins expressed in a particular brain area. If a region of the brain expresses a signature of proteins, which are inherently more prone to clumping together, then it could be more susceptible to the damage triggered when the amyloid and tau proteins start to build up.

To explore their hypothesis they used data from existing databases to compare the levels of almost 20,000 genes and corresponding proteins from 500 different brain areas taken from six healthy people aged 24 to 57 years. They gave a vulnerability score to each brain region that was higher if that area expressed more proteins that were prone to clumping together. They then looked to see whether these protein signatures corresponded to the areas of the brain known to be most susceptible to damage in Alzheimer’s.

The scientists found a link between areas of the brain known to be vulnerable to damage in Alzheimer’s and specific signatures of genes and proteins in those areas. The gene signature corresponded to proteins that either clump together with amyloid and tau, or influence the brain’s ability to clear the two culprit proteins. He and his colleagues conducted a transcriptome-wide microarray analysis of more than 500 healthy brain tissues from the Allen Brain Atlas and characterized the progression of disease using Braak staging. After developing their vulnerability score, the researchers noted that brain regions where Alzheimer’s disease is typically first noticed had elevated expression levels of proteins that co-aggregate in plaques and tangles.

But as these co-aggregating proteins were still present at fairly high levels across the brain, the researchers also examined the role of the protein homeostasis components that regulate them. These components, they found, are typically expressed at lower levels in vulnerable tissues, suggesting a role for them in amyloid and tau deposition.

“Vulnerability to Alzheimer’s disease isn’t dictated by abnormal levels of the aggregation-prone proteins that form the characteristic deposits in disease, but rather by the weaker control of these proteins in the specific brain tissues that first succumb to the disease,” Vendruscolo added.

The vulnerable tissues also exhibited lower expression of genes associated with autoimmune response, which lends further credence to theories that inflammation plays a role in Alzheimer’s disease development.

The researchers repeated their tissue vulnerability analysis for aggregation sets linked to amyotrophic lateral sclerosis, ALS, finding a significant difference between the scores for each disease.

Vendruscolo and his colleagues then used single-cell human mRNA data to zoom in on cells most vulnerable to aggregation by evaluating the levels of amyloid beta and tau in various brain cell types. Their relative expression was highest in neurons, the researchers reported.

“The results of this particular study provide a clear link between the key factors that we have identified as underlying the aggregation phenomenon and the order in which the effects of Alzheimer’s disease are known to spread through the different regions of the brain,” co-author Christopher Dobson, also at Cambridge, said in the statement. ”


Connie’s notes: Reading, using the brain more, exercise, sleep, whole foods and being out in the sun (Vit D helps in absorption of calcium and magnesium) help in slowing the progression of Alzheimer’s (as we age, we move less, our body function slowly, so we need to energize our body more).

Preventable hospitalizations among racial groups, 2003

In 2003, racial and ethnic dis-parities existed in the rates of preventable hospitalizations, with blacks generally having the highest rates and Hispanics the second highest rates.

  • The disparities were greatest for hospitalizations for chronic conditions such as diabetes, hypertension, and asthma. Compared with non-Hispanic whites, rates of admission for these conditions were about 3 to 5 times greater among blacks, and approximately 2 to 3 times greater among Hispanics.
  • Compared with non-Hispanic whites, blacks had higher rates of preventable hospitalizations for 15 of 17 indicators, and Hispanics had higher rates of preventable hospitalizations for 14 of 17 indicators.
  • Asians were less likely than non-Hispanic whites to be ad-mitted for preventable hospitali-zations, with 9 of 17 indicators being lowest in Asians.
  • Blacks had the highest rates of preventable hospitalizations for all indicators related to diabetes and circulatory diseases. Hospi-talization rates for hypertension and for diabetes without compli-cations were 5 times higher for blacks than for non-Hispanic whites. Hospitalization rates for pediatric asthma, adult asthma, perforated appendix, dehydra-tion, and low birth weight were also highest among blacks.
  • Hispanics had the highest rates of admission for elderly asthma, pediatric gastroenteritis, and urinary tract infection.
  • Admissions for asthma among patients 65 and older were 1.8 times more likely for Asians than for non-Hispanic whites—the only indicator where hospitaliza-tion rates were higher in Asians.

This Statistical Brief is based on PQI Version 2.1, revision 3. This PQI version includes measures for hospital admission rates for the following 16 ambulatory care-sensitive conditions:

– Lower-extremity amputations among patients with diabetes (a specific, serious, long-term complication of diabetes)

– Diabetes, long-term complications (i.e., chronic conditions such as renal, visual, neurological, and circulatory disorders, including lower-extremity amputations)

– Diabetes, short-term complications (i.e., acute conditions such as diabetic ketoacidosis, hyperosmolarity, and coma)

– Uncontrolled diabetes without complications

– Angina without procedure

– Hypertension

– Congestive heart failure

– Pediatric asthma

– Adult asthma

– Chronic obstructive pulmonary disease

– Pediatric gastroenteritis

– Perforated appendix

– Urinary tract infections

– Dehydration

– Bacterial pneumonia

– Low-birth weight

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ER visits in the USA, 2011

ER visits 111.JPG

http://www.hcup-us.ahrq.gov/reports/statbriefs/statbriefs.jsp

In 2011, there were about 421 visits to the emergency department (ED) for every 1,000 individuals in the population.

■ More than five times as many individuals who visited an ED were discharged as were admitted to the same hospital.

■ Among patients younger than 18 years, the most common reasons for admission to the hospital after an ED visit were acute bronchitis (infants younger than 1 year), asthma (patients aged 1–17 years), and pneumonia (infants and patients aged 1–17 years).

■ For adults aged 45–84 years, septicemia (infection in the bloodstream) was the most frequent reason for admission to the hospital after an ED visit.

■ Medicare was the primary payer for more than half of ED visits that resulted in admission to the same hospital.

■ The most common reasons for ED visits resulting in discharge were fever and otitis media (infants and patients aged 1–17 years), superficial injury (all age groups except infants), open wounds of the head, neck, and trunk (patients aged 1–17 years and adults aged 85+ years), nonspecific chest pain (adults aged 45 years and older), and abdominal pain and back pain (all adult age groups except those aged 85+ years).

■ Rural areas had a higher rate of ED visits resulting in discharge compared with urban areas.

 

Costs for hospital stay in the USA

Of the $377.5 billion aggregate hospital inpatient costs in 2012, 46 percent was for Medicare-covered stays and 16 percent was for Medicaid-covered stays. Thus, patients covered by government payers accounted for at least 62 percent of all hospital costs.

■ More than half of Medicare-covered and uninsured stays were medical (55 percent and 54 percent, respectively). More than half of stays covered by private insurance were surgical (52 percent).

■ Maternal and neonatal stays constituted 27 percent of costs for Medicaid, 15 percent of costs for private insurers, and 4 percent of costs for uninsured patients.

■ Mean hospital costs in 2012 were highest for surgical stays ($21,200)—2.5 times the mean costs for medical stays ($8,500) and nearly five times the mean costs for maternal and neonatal stays ($4,300).

■ Patients aged 45–64 and 65–84 years had the highest mean hospital costs in 2012 ($12,900 and $13,000, respectively), but patients under age 18 had the highest growth in mean costs between 2008 and 2012 (more than 6 percent annually).

■ Among payers of hospital stays, Medicare had the highest mean hospital costs in 2012 ($12,200), but between 2008 and 2012 mean Medicare costs grew at the lowest annual rate (0.9 percent).

■ Average annual growth in aggregate hospital costs slowed from 5.2 percent in the 2003–2008 time period to 2.1 percent in the 2008–2012 time period.

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