Longevity Health and Wellness Protocol

Grow Younger Blood

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The Longevity Revolution And Its Implications

Perhaps two of the greatest human achievements to have occurred from prehistoric to more recent times, and, particularly, in the last two centuries, are the increase in the human population worldwide and the extension of human longevity. Thanks to improved living conditions stemming from advances in agricultural practices and advances in industry and technology, the human population today has reached an unprecedented size (1-3). Living conditions have greatly improved due to Never in human history have so many humans lived longer In the United States, for example, the percentage of Americans aged 65 and older, relative to the entire U.S. population, rose from 4 in 1900 to 8 in 1950 and to 13 in 1990, and these increases are even greater in the population statistics of other countries (Chapter 2). Indeed, because of this longevity revolution that owes much to improvements in technology and extraordinary advances in biomedicine, industrialized countries are now faced with a large...

Human Longevity in the Past and the Present

There are two important sets of questions about historical trends. First, how long do people live, why is longevity increasing, and how long will we live in the future Second, given that we are living longer, are we mostly gaining healthy years of life or are we living longer but doing worse We know a lot more about the first question, partly because death is much easier to define and measure than health or functional status. In the United States, for example, there have been health FIGURE 1 Life expectancy at birth by sex, France 1806-2004. Source From Refs. 2,5.

Trends in Life Expectancy

Life expectancy has been increasing, not just in industrialized societies but also around the world. The rise in life expectancy at birth probably began before the industrial era before national mortality statistics were first assembled in Sweden around 1750. As noted earlier, e0 was b During recent decades the two major exceptions to the worldwide increase in life expectancy have been a stagnation and even reversal of earlier progress in parts of Africa, due to the AIDS epidemic, and in parts of the former Soviet block (especially Russia) due to social disruptions and instability. probably in the 20s during the Middle Ages and earlier. By 1750, Sweden (and probably other parts of northwestern Europe) had attained an e0 of 38, so the upward trend in longevity appears to have begun before the industrial era. Over the next century or more, there was a slow and irregular increase in life expectancy. After about 1870, however, the increase became stable and more rapid. During the first...

Learning and Longevity

Learning has emerged as a factor in prolonging life and reducing disability and disease in old age (Box 2). Epidemiologic studies have reported that there is a positive correspondence between life expectancy and amount of schooling one receives (95,96). The benefit of education persists when active life expectancy or life free of disabilities is compared to total life expectancy or life with disabilities and this finding is irrespective of sex and race. As Katzman (97) quotes, Scholars grow wiser with age, but the noneducated become foolish. A higher level of education seems also to be associated with a lower prevalence of AD (98). In a long-term investigation, started in l986 and continuing today (the Nun Study), 678 Catholic nuns are being studied for the relationship between their writing proficiency at a young age and continuing in middle and old age, and their longevity and incidence of dementia (99). Reports to date indicate that those with the higher writing proficiency at a...

Theoretical Model of Longevity Extension in Social Species

Improved health and increased longevity in societies sets in motion a self-perpetuating system of longevity extension. This positive feedback relationship is based on the demographic tenet that (all else being equal) increased survival from birth to sexual maturity reduces the number of children desired by parents (15). Because of the reduced drain of childbearing and child rearing, parents with fewer children remain healthier longer and thus raise healthier children. The higher survival rate of these children fosters yet further reductions in fertility. Greater longevity of parents also increases the likelihood that they can contribute as grandparents to the fitness of both their children and their grandchildren. And, the self-reinforcing cycle continues. (17), prolonged expectancy for working life span must have made people more ready to accept the risks and costs of seeking their fortunes in distant places and in new occupations. The positive feedback of gains in longevity on...

Selective Longevity

The duration of life (longevity), the onset of aging, and the rate of mortality significantly differ among animal and plant species. In eukaryotes, the life span varies from a few days' duration in yeast cells (in Saccharomyces, mean chronological life span is 6 to 30-40 days, depending on environment and nutrients) to a duration of 5000 years in the California bristlecone pine (Pinus longaeva). In vertebrates, aging and death, assumed to occur in all species, were originally attributed to species-specific genetic programs. However, the early view of a rigid, genetically preprogrammed life span is gradually being replaced by one of greater plasticity in response to environmental modifications (Chapters 1 and 5). It is now possible to envision that aging may be retarded by a combination of appropriate genetic and environmental modifications. Accordingly, the life spans of sexually reproducing species may be categorized according to rapid, gradual, or negligible rates of senescence...

Other Regulatory Patterns

Not all ethylene-sensitive flowers are climacteric and produce elevated levels of ethylene during senescence. For example, the daffodil flower is ethylene-sensitive, non-climacteric, and produces only minimal amounts of ethylene throughout its maturation and senescence. Furthermore, repeated treatments of the flower with 1-MCP result in only a very modest increase in longevity which suggests that ethylene is not the primary regulator of its senescence. It appears therefore, that the absence of climacteric ethylene production or respiration is no signature for ethylene insensitivity or vice versa. It seems likely that the relationships among flower senescence, respiration, ethylene production and ethylene sensitivity need to be defined for each new species studied.

Tests of the Theories

At the foundation of the evolutionary theories of senescence are the theoretical predictions of Medawar (1952). He suggested that in a natural environment a population would experience a high level of random, age-independent, mortality due to harsh environmental conditions. As a result, there is an ever-decreasing proportion of individuals that survive to reproduce at older ages. Harmful genes whose time of expression is beyond the natural range of life span for a particular species, can accumulate in a population with little or no check because the effect of mortality from external causes will be to reduce the force of selection in each successive portion of the life span. As a result, natural selection is ineffective at preventing an accumulation of deleterious genes that affect late-ages because they have a minimal impact on the population. Medawar concluded that aging is the result of the cumulative expression of deleterious genes in individuals that live longer than the average...

Genes Controlling Vegetative Growth Regeneration and Monocarpic Senescence

Monocarpic senescence is the degeneration leading to death of the whole plant at the end of the reproductive phase in monocarpic plants. As a prerequisite to or as a part of monocarpic senescence, vegetative growth ceases, so the plant can no longer regenerate its assimila-tory structures. Eventually, the existing leaves and other parts senesce, and the plant dies (Nooden, 1988b). The mutations that make plants live longer do so mainly by extending their regenerative ability (Nooden and Penney, 2001). The shift to clonal growth is also an example of life-extending growth. Whereas genes in the above categories are expressed mainly at the cell and organ level, this group is expressed more at the organ and whole plant levels. Given the important role of correlative controls in whole plant senescence, it is expected that factors that alter those controls likewise influence monocarpic senescence. In many monocarpic plants, the reproductive structures, especially the fruits, control...


One of the limitations of gerontological studies, in all species, has been sample size (Finch, 1990). Survivorship curves based on small sample sizes can provide estimates of life expectancy at birth, but it is not possible to estimate mortality rates late in life because so few individuals remain alive at older ages. Moreover, in field experiments there is a high rate of random mortality affecting survival at all ages. With a large sample size, it will be possible to attain a more accurate understanding of the inherent changes in mortality at different ages. It is important to emphasize that data on age-specific mortality, not just life span data, are needed to understand the evolution of senescence. Plant species show a wide range of variation in their life spans, ranging from a few weeks, for some ephemeral annuals, to over 1,000 years for many conifer species. The presence of senescence cannot be inferred from life span measures for several reasons. First, evidence for senescence...

Arguments Against Population Screening

Opponents of screening point to the potential for side effects from treatment, the possibility that some men will be treated unnecessarily, the economic burden on the health care system and the lack of definitive scientific evidence that the screening will reduce overall disease-specific mortality.19 Indeed, many men with prostate cancer do not die of the disease, whereas many other patients die of the disease despite our best efforts. No foolproof markers are currently available to differentiate these two groups. Therefore, a key objection to screening is that such efforts may uncover many cancers that, if left undetected, would never have caused morbidity or mortality conversely, some cancers will cause death despite being detected by screening. Some observers have further recommended that screening should be avoided in men older than 70 or 75 years of age so as to reduce the detection of such 'incidental cancers' that are unlikely to affect life expectancy.

Significance Of Physiology In Human Aging

In these early years of the twenty-first century, however, aging is being regarded anew as a positive and potentially rewarding process, free of the stigma it has had in the past of inevitable decline in health and productivity. With the introduction of the concepts of successful or healthy aging, many researchers are shifting attention from a primary focus on the diseases of old age to the possibility of strengthening normal functional competence at the molecular, cellular, and organ systems levels over the life span (8-10). During the life span, according to Hayflick, the level of physiologic capacity reached at the age of reproductive success in living things is taken as the determinant of their potential longevity Considerable advances have been made in prolonging life expectancy and in preventing and treating many diseases, and similar advances may be expected in the future.

Organization Of The Chapters

Any consideration of the aging process cannot ignore psychological, social, and economic components, and this is particularly so for the geriatrician, who must deal with the patient from a holistic perspective. Although such factors are vital to a full understanding of this phase of life, an in-depth exploration of their contribution is beyond the scope of this book the reader will be referred to appropriate publications for further study.

Studies in Age Related Cognition

Secondary memory, memory for nonverbal material, span of attention, the capacity to divide attention among competing sources of stimulation, and two motor tasks requiring psychomotor integrity. This study found a gradual, progressive decline in cognitive functioning but found that the decline did not reach statistically significant levels. The decline was general, suggesting that it may have been a function of reduced attention rather than more discrete losses. This finding appears to be consistent with the notion that crystallized intellectual or abstract processes are well maintained across time. There were suggestions that speed of information processing is a sensitive measure of the aging process. It is possible, however, that the tasks selected for this study did not discriminate between younger and older aging adults because the tasks may be more reliable for assessing brain injuries and psychologically impaired persons, who were not included in the population studied....

Example from the literature

Slevin et al. (1990) asked 106 consecutive patients with solid tumours to complete questionnaires about their willingness to receive chemotherapy. They were told that the more-intensive regimen was likely to have considerable side-effects and drawbacks, such as severe nausea and vomiting, hair loss, frequent tiredness and weakness, frequent use of drips and needles, admission to hospital, decreased sexual interest, and possible infertility. They were given different scenarios, such as (a) small (1 ) chance of cure, (b) no cure, but chance of prolonging life by three months, and (c) 1 chance of symptom relief only. All patients knew they were about to commence chemotherapy, and thus considered the questions seriously. Cancer nurses, general practitioners, radiotherapists, oncologists and sociodemographicallv matched controls were asked the same questions.

The Mental Health Care System And Its Components

Decisive improvement in the health of most nations, reflected in continued reductions in infant mortality and increases in life expectancy, began to occur in the second half of the 19th century. The progress was triggered by the detection of asepsis and by research results in the field of

Sammy SaabSteven Huy Han and Paul Martin

HRS occurs in approximately 10 of hospitalized cirrhotic patients. Diagnostic criteria for HRS are shown in Table 3.3. Currently, two distinct forms of hepatorenal syndrome are recognized. Type I HRS is defined as a rapid deterioration in renal function, with virtually all patients expiring within 10 weeks of onset. In contrast, type II HRS is insidious, with a life expectancy of several months. The major clinical consequence of HRS type II is the development of refractory ascites. Before a diagnosis of HRS can be established, other specific causes of renal dysfunction must be excluded, such as obstruction, volume depletion, glomerulonephritis, acute tubular necrosis, and drug-induced nephrotoxicity. A urinary catheter, renal ultrasound, and fluid challenge are useful in this setting. The recent use of nephrotoxic drugs (NSAIDs, aminoglycosides) is ruled out by history.

Selfefficacy and health

In a 2002 article, Bandura explained the benefits for health promotion and disease prevention By managing their health habits, people can live longer, healthier, and slow the process of aging. To stay healthy, people should exercise, refrain from smoking, reduce the amount of dietary fat, keep blood pressure down, and develop effective ways of coping with stressors. Of course, most people know about the benefits of healthy lifestyle habits. Turning that knowledge into action is not always easy, though. High perceived self-efficacy helps people have the confidence to make needed changes and the determination to stick with them.

Maximum Average Life Span

Let us consider whether there might be an upper limit to the average life span that could be achieved by a large human population. Average life span, or life expectancy at birth, refers to how long people live on average in a population. In the United States, life expectancy is currently around 75 years for men and 80 years for women (34). Accordingly, these numbers describe the average length of life that can be anticipated, given the mortality conditions of today. For example, baby boys born this year will live an average of 74 years, assuming that age-specific death rates (Fig. 4a) do not change in the future. Just as occurs today, some of these newborns will die in infancy from congenital ailments, some will be killed in car accidents as young adults, and some will succumb in old age to cancer or heart disease.

Cardiac transplantation

I Idiopathic cardiomyopathy, ischaemic heart disease, graft atherosclerosis, congenital cardiac disease, valvular cardiac disease, myocarditis. Recipient criteria End-stage heart disease with a life expectancy of < 1 year (New York Heart Association Class III or IV). Failure of conventional medical and surgical treatment. No other significant systemic illness and no evidence of infection. Emotionally stable with good compliance for immunosuppressive therapy. A The heart has four chambers right and left atria and the respective ventricles. The SVC and the IVC open into the upper and lower parts of the right atrium respectively. The pulmonary artery begins at the upper part of the right ventricle passing upwards, posteriorly and to the left branching into the left and right pulmonary arteries. Four pulmonary veins open into the posterior wall of the left atrium. The aorta starts at the base of the left ventricle running anteriorly and upwards to form the ascending aorta. I Pre-op...

Mental Disorders and Public Health

Mental disorders have received little priority in the developing world. Demographic transition and improved measures to combat infectious diseases are leading to a change in the pattern of disease in many poor countries 10 . In Chile, for example, life expectancy is now over 70 years and, along with many other areas of the world, the burden of disease is largely produced by non-communicable diseases familiar to those in the West. These changes will contribute to the growing importance of depression and other mental disorders in world health.

Learning from History

The historical rise of human longevity is the result of a complex set of changes beginning several centuries ago. Prior to the 1930s, most of this decline was due to factors other than medical therapy (57), and is generally attributed to improvements in cFor example, a segment of ABC's 20 20 (broadcast on 16 January 1998) reported that this discovery would lead to the development of anti-aging drugs within 5 to 10 years, and one researcher interviewed on camera predicted healthy life spans of several hundred years. The finding itself was reported in Science magazine (54). It seems reasonable to expect that future mortality trends in wealthy nations will resemble past changes. Although the focus of our efforts will evolve, the net effect on death rates will probably be similar. For this reason, extrapolation is the preferred means of predicting the future of human mortality. This strategy rides the steady course of past mortality trends, whereas popular and scientific discussions of...

Comparative Physiology Of Aging

In humans, increases in life expectancy in the past century have been ascribed overwhelmingly to reductions in environmental causes of mortality that are extrinsic to the aging process. Longevity in evolutionary terms is difficult to reconcile with the findings, in recent decades, that, in humans, both mortality and disability rates have dropped for all older men and women, across virtually all social classes and ethnic groups, and in most developed and developing countries. It is possible that other factors, in addition to physical fitness and reproductive capability, may be subject to positive selection such as the grandparents hypothesis, that is, the important contribution of the grandparents in raising the young (Chapters 2 and 5). Comparison of life spans of several species (selective longevity) may show some differences in longevity and allow us to draw some relationships between the life span and the selected physiologic characteristics (physiological correlates of longevity).

Interpretation of Reports on Korean British and Japanese American

Similarly, aged populations (> 50 years old) in Western countries exhibited relatively little association between TC and CHD, while cancer and or all-cause mortality tended to be inversely associated with TC (Austrian VHM& PP Study and Framingham Study, Studies on elderly people shown in table 8). It should be noted that high TC is not a risk factor for general populations over 40-50 years old during which atherogenesis is in progress, and that high TC is a predictor of low cancer mortality and longevity among these populations.

Explanations for Difference in Prevalence by Gender

Some authors have suggested that there is a response bias such that women are more likely to give a positive response when asked about all symptoms, including those of depression and anxiety. There is evidence that women are more likely than men to report physical symptoms as well as psychological ones, despite the fact that women live longer. A study in Recife, Brazil, also found a bias in that women were more likely to report symptoms on the Symptom-Reporting Questionnaire (SRQ) than on a psychiatric interview, when compared with men 65 . However, even in that study women had a higher prevalence of common mental disorders with the psychiatric interview. It would seem unlikely that response bias could account for the whole observed difference between men and women.

Public Health and Corrections

Public health is the art and science of preventing disease and injury, prolonging life, and promoting health through the organized efforts of society. Public health practice informs and empowers individuals and communities, and creates healthy environments through the use of evidence-based strategies and accountability mechanisms. The balance of health risks and health gains is the essential issue in considering the public health impacts of prisons (Glaser & Greifinger, 1993).

Prevalence and Impact

Dementia may occur at all ages, but its incidence increases with advanced age. Dementia is most frequent in those older than seventy-five. There are an estimated 600,000 cases of advanced dementia in the United States, and milder degrees of altered mental status are very common in the elderly. The prevalence of dementia increases from 1 percent at age sixty to 40 percent at age eighty-five. The expense of long-term care at home or in a nursing facility has been estimated at 40 billion per year for people age sixty-five and older. The prevalence of dementia is expected to continue to increase as a result of increased life expectancy and an aging population of baby boomers. Many of the problems caused by dementia are due to memory loss.

Are There any Limitations for Advising a Low Anterior Resection and to Whom Should an APR be Recommended

Many experienced surgeons would probably advise against a low anterior resection for anaplastic tumours, and otherwise bulky and or fixed tumours, reserving the operation for mainly local and limited growths, and those with low-grade malignancy. An APR may also be preferable for old age, particularly for those with a short life expectancy and those with a serious contemporary disease (diabetes, cardiac or pulmonary insufficiency etc.). In these patients an ultralow rectal resection - with square stapling of the anorectal remnant, omitting the perineal dissection - would be justified, considerably reducing the operative trauma and post-operative morbidity.

Practical Preimplantation Genetic Diagnosis

With progress in treatment of genetic disorders, PGD will have an increasing impact on the decision of the affected and well-treated patients to reproduce. For example, the life expectancy has been significantly improved for such common conditions as CFTR and thalassemias, which presently may be treated radically by stem cell transplantation. In each of such cases, the strategy depends on whether the affected partner is male or female, because testing may be entirely based on oocytes if the male partner is affected, in contrast to embryo testing when the female partner is affected. We have performed PGD for couples with affected partners with both of these conditions, presented below.

The Developmentally Disabled Population

Between 200,000 and 500,000 people in the United States over the age of sixty may have some form of developmental disability. Some of these individuals present special problems as they age. Those with epilepsy appear to be at greater risk for osteoporosis, while those with Down syndrome seem to begin the aging process earlier than others.

Experimentally Induced Aging and Disease in Animals

The use of animals, isolated organs, tissues, and cells, has led, and continues to lead, to a better understanding of the aging process. This use is regulated by specific rules governing the choice of the most appropriate model to answer each specific question (Chapter 1). Within this context, cause effect relationships between disease and aging have been variously explored, depending on the hypotheses entertained by different investigators. Most often, intentionally induced disease has been used to accelerate the onset and course of aging processes to test therapeutic measures that might prevent or slow disease and aging. Some attempts have focused on segmental aging, that is, induction of aging in a selected organ, tissue, or cell type to mimic specific aspects of aging. Examples of these experimental approaches include genetic manipulation, increased free radical accumulation, inoculation of slow viruses, interference with nervous and endocrine functions, induction of wear-and-tear...

Age and Ecological Validity in Other Domains of Cognition

One of the skills that is particularly important in PM is planning. Planning consists of both mental formulation of a method to carry out a task, and accurate execution of the formulated plan. There are age-related declines in the ability to formulate and execute plans in novel tasks (e.g., Gilhooly, Phillips, Wynn, Logie, & Della Sala, 1999). Where a planning task is set in a more familiar environment, no age differences are found (Garden et al., 2001 Lachman & Burack, 1993 Phillips et al., 2006). In relation to problem solving, many authors have argued against the use of traditional psychometric problem-solving tasks such as IQ tests to study aging. However, there are many measurement problems associated with assessing more ecologically valid problem solving, such as how to score such tasks (Berg & Klaczynski, 1996), and this has fuelled contradictory results. Influential work in this field (e.g., Denney, 1989) concludes that (a) older people perform better on more everyday...

Radical Prostatectomy Versus Surveillance

Presently, the Scandinavian Prostate Cancer Group and the US Prostate Cancer Intervention Versus Observation Trial (PIVOT) are two large prospective randomized controlled studies comparing radical prostatectomy and watchful waiting as treatment modalities for localized prostate cancer.14 Until the results of these studies are available, prostate cancer remains the second leading cause of cancer death in men with a 50 suggested death rate in men who are diagnosed with a moderately well-differentiated disease and a life expectancy of 15 years or more.15 We believe that younger males would be best served by surgery, since they are at risk of their disease

Consequences Of Cellular Senescence And Cell Death

Cellular senescence and cell death may play a role in aging or age-related pathology by two distinct means. First, because both processes are important for suppressing cancer, they are longevity-assurance mechanisms mechanisms that postpone the onset of aging phenotypes or age-related disease in this case, cancer. On the other hand, as dysfunctional senescent cells accumulate in renewable tissues, and apoptosis depletes cells from postmitotic tissues, both processes may contribute to aging phenotypes. This apparent paradox the ability to be beneficial early in life, but detrimental late in life is consistent

Reduced Genome Maintenance

Genome maintenance systems are important longevity-assurance mechanisms, and that the cellular responses to damage (senescence and cell death) can contribute to aging phenotypes. But have these mouse models taught us anything beyond the general importance of genome maintenance for longevity assurance A recent mouse model has provided an important insight.

InsulinIGF1 Signaling

Mice that are constitutively deficient in growth hormones and IGF-1 suffer from dwarfism, compromised fertility, and other problems (163). However, mouse models in which there is a more modest reduction in IGF-1 signaling, for example, mice in which only one copy of the IGF-1 receptor was genetically inactivated, are phenotypically normal yet long lived (164). In this case, however, life span extension was also modest (16-33 ). Likewise, genetic manipulations that selectively eliminate the insulin receptor in adipose tissue increase longevity, but again only modestly (< 20 ) (165). Thus, blunting the insulin IGF-1 pathway increases longevity in mice, as it does in simpler organisms, although to a significantly lesser extent.

Mitochondrial and Energy Production

A surprising number of mutations or partial gene disruptions that extend the longevity of simple organisms, especially nematodes, compromise or reduce mitochondrial function (166,167). In mammals, however, compromised mitochondrial function generally shortens life span (168,169). Moreover, in both in vivo and cell culture studies, it also increases the susceptibility to cellular senescence and apoptosis (170,171). However, recent findings suggest that subtle perturbations to mitochondrial function and energy production can modestly extend life span in mouse models. For example, within a cohort of outbred mice, animals with relatively higher mitochondrial uncoupling produce lower levels of reactive oxygen species and are relatively longer lived (172). Likewise, a partial reduction in CKL-1, a mitochondrial protein that is important for the synthesis of the mobile electron carrier ubiquinone, modestly increases the life span of both nematodes and mice (173). Recently, a transgenic mouse...

Comparative Demography of Life Span

The literature contains descriptions of only a small number of life span correlates, including the well known relationship between life span and both body mass and relative brain size (1,5-8), and the observation that animals that possess armor (e.g., beetles, turtles) or capability of flight (e.g., birds, bats) are often long lived (9). But, major inconsistencies exist within even this small set of correlates. For example, there are several exceptions regarding the relationship of extended longevity and large body size (e.g., bats are generally small but most of their species are long lived) and this positive relationship may be either absent or reversed within orders. Likewise, the observation that flight ability and extended longevity are correlated does not provide any insight into why within-group (e.g., birds) differences in life span exist, nor does it account for the variation in longevity in insects where adults of the majority of species can fly. An alternative approach for...

Life Span Patterns Humans and Primates

Estimates based on regressions of anthropoid primate subfamilies or limited to extant apes indicate a major increase in longevity between Homo habilis (52-56 years) to Homo erectus (60-63 years) occurring roughly 1.7 to 2 million years ago. The predicted life span for small-bodied Homo sapiens is 66 to 72 years (14). From a catarrhine (Old World monkeys and apes) comparison group, a life span of 91 years is predicted when contemporary human data are excluded from the predictive equation. For early hominids (family of bipedal primate animals comprising recent man, his ancestors, and related forms) to live as long or longer than predicted was probably extremely rare the important point is that the basic Old World primate design resulted in an organism with the potential to survive long beyond a contemporary mother's ability to give birth. This suggests that postmenopausal survival (Chapter 10) is not an artifact of modern life style but may have originated between 1 and 2 million years...

Somatic Mutation and DNA Damage

The broad concept of this category of aging theories is that the integrity of the genome is the controlling factor in the aging process and therefore that either mutations (changes in the polynucleotide sequence that remain uncorrected) or DNA damage (chemical alterations in the double-helical structure that are not fully repaired) underlies the aging process and determine its rate. The theory that aging occurs due to either somatic mutation or DNA damage belongs to the class of stochastic theories of aging that assumes that an accumulation of environmental insults eventually reaches a level incompatible with life, primarily because of genetic damage. Somatic mutation occurs in day-to-day cell replication (43). It is generally concluded that there is currently little evidence to support the notion that either somatic mutation or DNA damage underlies the diseases and dysfunctions of aging.

Alternatives To Allogeneic Transfusion

Preoperative blood donation is still the standard of care in many institutions in the USA today. The first autologous transfusion was described in 1874.48 With this technique, patients get their own blood, which is the safest form of transfusion. With predonation, patients are reducing their exposure to allogeneic blood. During RRP without predonation, the patient allogeneic transfusion rate is 60-70 ,17 but only 5-20 of patients who predonated blood required allogeneic transfusion. Nevertheless, predonation recently has undergone some critical reappraisal. In many centers, blood loss during RRP is steadily decreasing. Improved surgical technique has further contributed to diminished blood loss to the point that autologous predonation has become unnecessary.49 Also reappraisal of the trigger points for transfusion has diminished the overall need for blood during RRP. This surgery is usually performed in patients whose life expectancy is at least 10 years and significant comorbidity is...

Cellular Aging Additional Theories Wearand Tear Theory

This theory postulates that ordinary insults and injuries of daily living accumulate and thus decrease the organism's efficiency (e.g., loss of teeth leads to starvation). Although there is little question that some wear and tear plays a role in mortality risk and individual life span, this theory has been rejected by most gerontologists as a more general explanation for aging because (i) animals raised in protected environments still age (ii) many of the minor insults that accumulate are essentially time dependent and thus cannot logically serve as an underlying causal mechanism of the aging process and (iii) the theory is outdated inasmuch as cellular and molecular advances point toward more specific mechanisms.

Radiation Therapy Equivalent Option Or Inferior Therapy

One of the most vexing controversies in urologic oncology has been determining the appropriate management for patients with early-stage prostate cancer. Despite, or perhaps because of, rapid technological advances in the diagnosis staging and treatment of localized prostate cancer, the optimal curative treatment for this disease has been disputed. Owing to the lack of a well-designed randomized prospective trial with long-term biochemical, disease-specific and overall survival data, the patient diagnosed with organ-confined disease is subject to the heated debate on the comparative merits of the two definitive therapies - radical prostatectomy and external beam radiotherapy. In an attempt to resolve this dilemma, the American Urological Association (AUA) convened the Prostate Cancer Clinical Guidelines Panel in 1989.1 To estimate survival rates for patients choosing between radical prostatectomy, external beam radiotherapy, brachytherapy or surveillance, a comprehensive survey and...

Pathophysiology Of Aging

It is useful to think of the aging process in physiological, not chronological terms. That being said, a chronological definition is often used to stratify the aging population into three groups young old, age 65-75 years old, age 75-85 years and old old, age > 85 years. Nearly all of the research that describes pharmacokinetics and pharmacodynamics in older individuals has been obtained from study of the young old, that is, individuals < 75 years old. Therefore, the validity of extrapolating these findings to the older age groups may be questioned. In contrast, the data describing adverse drug events in older as compared to younger patients are obtained from patient

Chromosomal Abnormalities in Molar Pregnancy

A partial hydatidiform mole (PHM) is produced when two sperm fertilize a normal ovum. PHMs can also arise from fertilization of an ovum by a single sperm that subsequently undergoes chromosomal duplication. In either case, the resulting cell is triploid (i.e., the kary-otype is 69, XXX or 69, XYY). In this situation, both trophoblastic and fetal tissues can develop, and very rarely a fetus with triploidy can survive to term, although the postnatal life expectancy is extremely short. Approximately 16 of spontaneous abortions show triploidy.

Palliation for Local Symptoms in Patients

Self-expanding metal stents are useful to avoid a colostomy in selected patients with incurable rectal cancer and a limited life expectancy. The median technical and clinical success rates are 90-100 and 84-94 . A considerable number of patients will require surgical palliation because of failure of stent treatment (stent migration, pain, incontinence, fistu-lae, reobstruction) and in cases of low rectal cancer, patients might suffer tenesmus 90, 91 . In these cases and when the predominant symptom is rectal bleeding, endoscopic Nd-Yag Laser ablation is particularly indicated. Other indications for laser therapy are rectal obstruction and mucous discharge. It is feasible and has low complication rates it requires repeated sessions 92 .

Congenital Immune Deficiency Due to a Cellular or Humoral Immune Deficiency

Severe combined immune deficiency (SCID) is a rare T-cell disorder, which usually presents within the first months of life. In addition, B-cell function is mostly compromised, leading to both cell-mediated and humoral deficiencies. Life expectancy will generally be short however, if these patients reach travelling age, travel should be discouraged because of disseminated or persistent infection after live attenuated vaccines. This has been described after BCG and oral polio vaccination, but the same can be expected after oral typhoid vaccine and yellow fever vaccine.

Before Being Diagnosed

In 1980, my wife became aware of prostate cancer having an impact on the longevity of African-American males lives after age 50. I was in my mid-forties at that time and aware of her concern. I promised her that I would start having regular physical examinations. I made an appointment and went to see my medical physician, who administered the different tests for a complete physical, blood pressure, cholesterol and general body functions. This examination found me to be in good physical health.

Recognition of failure

It is easy to replace a failed restoration without considering the implications of failure, which are often underestimated. Situations such as sub-standard treatment, incorrect diagnosis (initially or of failure) or provision of restorations with a short life expectancy will all result in more frequent intervention. Quite simply, the implications of failure relate to cost, both in terms of economic implications as well as harm to the tooth.

Reconstruction of the Calvarium

There are obviously many ways to reconstruct the calvarium rib grafts, split calvarial grafts, methyl methacrylate or other bone substitute, titanium mesh. The choice of technique will depend on the factors outlined above as well as on the availability of suitable donor bone. Generally, in the oncology patient this reconstruction will involve soft tissue cover as well as bone. In these situations the same choices are available and in my practice the latissimus muscle with split thickness skin graft is the first choice. In certain patients wound closure can be achieved with flap cover alone without bony reconstruction. This is usually the choice in older patients with limited life expectancy and in whom the risk of significant trauma to the skull is unlikely or can be minimized,

Supplemental Security Income

Although it is not known how many individuals enrolled in the SSI programs for adults and children were born preterm, preterm birth and its possible adverse long-term health outcomes generate public costs through the SSI program. These public costs can extend far into the future for any child born preterm, potentially for the entire life course. The latter may span many decades, as average the life expectancy is 77 years for children born in 2005.

Prostatespecific Antigenactivated Prodrugs

As the average life expectancy in the Western world increases, so does the incidence of prostate cancer. The extracellular serine protease prostate-specific antigen (PSA) is a prostate cancer-associated enzyme. PSA is produced by prostate glandular cells, whereas in the circulation this enzyme is inactivated. As a result, enzymatically active PSA is present only in prostate cancer tissue.

Management of antibody deficiency

Most patients with suspected PID should be referred to a clinical immunologist with access to modern immunological tests. For severely affected patients, a combination of immunoglobulin replacement and periodic or prophylactic antibiotics (e.g. ciprofloxacin or a rotating regimen of amoxycillin, doxycycline and a quinolone) are required, but mild cases can often be managed with antibiotics alone. Most severely affected patients are given monthly intravenous immunoglobulin (400 mg kg) or weekly subcutaneous infusions (100 mg kg), the latter being recommended for infants and young children with difficult venous access. Morbidity and life expectancy depend on the type of immunodeficiency and the degree of organ damage at diagnosis for example patients with XLA diagnosed early before there is

Insulinlike Growth Factor

Cancer were diagnosed in this cohort. A total of 152 of them provided plasma for IGF analyses. Then 152 age-matched controls were selected and plasma IGF was measured using an enzyme-linked immunosorbent assay. In a univariate analysis, IGF-1 was significantly related to prostate cancer risk (P 0.006). Comparing top to bottom quartiles, IGF-1 was now associated with a relative risk of 4.32, and an inverse association between IGFBP-3 and prostate cancer risk emerged. No significant difference was noted among men with high grade stage disease versus low grade stage cancers. The association appeared to be somewhat stronger for older men, but significant positive trends were noted for both older and younger men, using a cut-point at the age of 60. IGF-2 was not related to risk of prostate cancer. Overall, these studies show a 2-3-fold increase in the risk of developing cancer when IGF-1 is in the higher quartiles. Subsequently, Djavan etal.52 evaluated prospectively the value of IGF-1 and...

Variant sickle cell syndromes Sickle cell trait

Sickle cell trait (HbAS) is a benign condition that has no haema-tological manifestations and is associated with normal growth and life expectancy. Sickle cell trait affects 8-10 of African-Americans and up to 25-30 of the population in West Africa. Upon electrophoresis, the ratio of HbA-HbS is 60 40, owing to the greater affinity of a-globin chains for PA-globin chains. Impaired urine-concentrating ability and haematuria can occur, and an increased incidence of urinary tract infection is observed in pregnant women with sickle cell trait. A slight risk of sudden death during military training has been reported, and splenic infarction is possible at very high altitudes. Genetic counselling should be provided to individuals with sickle cell trait.

Physiological Evidence of the Disease Process in the Brain

Psychiatric Rehabilitation

An MRI scan provides images of the tissue, structure, and spaces (ventricles and sulci) in the brain. In the MRI scans shown in Figure 2.1, the lighter gray areas are the brain tissue cells, or neurons, and the darker gray areas are the ventricles. The ventricles are large fluid-filled enclosures and the sulci are the spaces or folds in the brain's cortex. These are part of the normal anatomy or structure of the brain. Normally, ventricles and sulci become enlarged as part of the aging process. In the MRI scans pictured in Figure 2.1, note that the person with schizophrenia, on the right, has less brain tissue and enlarged ventricles compared to the peer of the same age, on the left.

Physical Rehabilitation as a Model for Psychiatric Rehabilitation

Several authors have suggested that the rehabilitation of persons with physical disabilities provides an apt and instructive model or analogy for understanding the rehabilitation of persons with psychiatric disabilities (e.g., Anthony, Cohen, & Farkas, 2002 Deegan, 1988). An obvious benefit of this comparison is that rehabilitation from physical injury or disease is a relatively common and acceptable phenomenon in modern society. Sports figures recovering from injuries sustained on the playing field and aging public figures recovering from heart attacks or strokes are frequent subjects of media coverage. In addition, as medicine improves, life expectancy increases, making it more likely that a family member, friend, or acquaintance will develop a physical handicap.

Prehistoric and Preindustrial Eras

For mortality data derived from subpopulations, there is also an issue of whether the data are representative of some larger population. Who gets buried in a society, and who gets a tombstone Which societies have regular burial practices, as opposed, say, to burning their dead What kinds of populations have complete genealogical records from a particular time period Thus, for many reasons, all estimates of mortality or longevity from the preindustrial period (roughly, before 1750) should be viewed with caution. Of the many sources of bias in these estimates, there are both positive and negative factors, which tend to balance each other to some extent (17). They are inaccurate and or unrepresentative by amounts that cannot be well quantified. Although these historical estimates may be either too high or too low, they provide us nonetheless with a useful description of the general contours of the history of human longevity. For example, most scholars agree that life expectancy at birth...

Research on Direct Effects of PIs on Bees

In our own studies on the direct effects of PIs on bees we have used newly-emerged adult bees,15-17 because ingestion of a PI expressed in pollen is most likely to affect an adult bee via a disruption of protein digestion, and because it is only during these first few days of adulthood that honeybees consume and need to digest significant amounts of this food. We found that, when fed to these young bees, four different serine endopepti-dase inhibitors have a dose-dependent effect on bee longevity and that protease activity levels in the midgut of these bees are significantly altered by many of the PI treatments.15-17 We have found that bovine pancreatic trypsin inhibitor (BPTI) and soybean Kunitz trypsin inhibitor (SBTI, or SKTI) significantly reduce the longevity of bees fed these PIs ad lib in sugar syrup at 10, 5 or 1 mg ml, but not at 0.1 or 0.01 mg ml.15,16 We also determined the in vivo activity levels of three midgut endopeptidases (trypsin, chymot-rypsin and elastase) and the...

Optimism vs Pessimism

Another source of optimism about future mortality rates lies in the potential application of existing technologies (e.g., nutritional supplements, reductions in smoking) or the unusual longevity of certain groups such as Mormons and Seventh Day Adventists (52,53). Such discussions may be a good way to improve health behaviors, but they are not so good at informing predictions, largely because this same sort of advocacy influenced past trends as well. For purposes of prediction, we need to ask whether future positive reforms in lifestyle are likely to be implemented faster or more effectively than were similar reforms in the past. More pessimistic scenarios of the future course of human longevity are based on notions of biological determinism or arguments about practicality, yielding the now-familiar claim that life expectancy at birth cannot exceed 85 years (21,55). Sometimes, evolutionary arguments are invoked in support of the notion that further extension of the human life span is...

Telomeres and Premature Aging

Among the first mouse models to show multiple signs of accelerated aging was the telomerase knockout mouse. These mice completely lack telomerase activity owing to a germ-line disruption in the gene encoding the essential telomerase RNA component, mTR (147). Interestingly, mTR- - mice are asymptomatic for the first three to four generations. Subsequent generations, however, are shorter lived and prematurely develop hair loss and graying, ulcerative skin lesions, delayed wound healing, reduced fertility, reduced stress resistance, and increased cancer. As noted earlier, mice have telomeres that are much longer than humans. It is notable, then, that the reduced longevity and fitness of mTR- - mice were not manifest until the mouse telomeres had substantially shortened to lengths more typical of those found in aged human tissues. Thus, this model demonstrates a critical role for telomere function not only in suppressing cancer, but also in ensuring many other aspects of organismal...

Theoretical models and psychodermatology

Contextualing a review of any discipline requires that the discipline be placed within a theoretical and historical framework, and this approach is appropriate for psychodermatology. By the 1950s, the incidence of contagious diseases had declined rapidly and non-contagious diseases were on the increase. These included diseases that are related to lifestyle variables such as lung cancer and heart disease. Improved hygiene, vaccines and general medical treatment led to longer-life expectancy and the effects of health-compromising behaviours such as smoking, drinking, alcohol and poor diet had a growing effect on health. As a consequence of the limitations of the biomedical model and the change in disease statistics, researchers in the fields of health, psychology and medicine had begun to focus on the biopsychosocial model, a model that posits the fundamental assumption that health and illness are consequences of the interplay between psychological, biological and social factors (Engel,...

Rectangularization or Mortality Compression

It was once asserted that this process of rectangularization reflected the existence of biological limits affecting human longevity (21). This notion of limits to the human life span enjoys little empirical support, as discussed below. Nevertheless, the historical process of rectangularization was both real and extremely significant. It is perhaps best thought of as a compression of mortality, as documented in the middle panel of Figure 4. As the average level of longevity has increased, so has our certainty about the timing of death. One measure of this variability is the interquartile range of deaths in the life table or the age span of the middle 50 of deaths over the life course. In the 1750s, in Sweden, the life table interquartile range was about 65 years, so that deaths were spread out widely across the age range. The distribution of age at death became more and more compressed over the next two centuries until the life table interquartile range was around 15 years in...

Reports on Japanese General Populations Showing Lower Mortalities from Cancer and All Causes in the Higher Total

Conclusion Contrary to generally accepted understandings, high TC and obesity (data not shown here) were not the risk factors, but rather low TC and leanness were the risk factors for longevity in this population (translated). Our comments These results indicated that high TC was a beneficial factor, not a risk factor, for various kinds of diseases and longevity in this general population. It should be noted that the highest TC group included all with a TC value > 251 mg dl. Although the mortality data were not adjusted for possible confounding factors, similar conclusions were derived from other studies (fig. 30 , 32-35).

Maximum Individual Life Span

Limits to average life span, or life expectancy at birth, are one issue. When people discuss limits to the human life span, however, they often have another idea in mind the upper limit to an individual life span. Instead of asking how long we can live on average, we might ask how long one lucky individual can hope to live. This concept is actually much easier to understand than the notion of an upper limit to life expectancy. Who is the oldest person who has ever lived Even if we can never have a definitive answer to this question, we can at least imagine the existence of such a person. Maybe he or she (probably she) is still alive today. Or, maybe she lived hundreds of years ago but vanished without leaving a trace no birth certificate, no census record, and not even a newspaper article about her incredible feat of longevity. Should we believe people who claim to be extremely old without proper documentation Certainly, we should believe them, since there is no point in calling...

Evaluation Of The Kidney Transplant Recipient 411 General Indications

Once the irreversibility of the process is clear, patients must be free of active infection (acute or chronic), active inflammatory glomerulonephritis (such as in active systemic lupus erythematosus SLE ), active uncontrolled psychiatric disorder, and untreated malignancy). In addition, the patient must have a reasonable life expectancy after transplant and must be physiologically able to tolerate the transplant procedure. ESRD patients are prone to develop sequelae of arteriosclerosis and coronary artery disease (CAD), due in part to the higher incidence of hypertension and DM. The workup outlined here should also aim at excluding the consequences of other end-organ damage from these causes. High levels of sensitization to donor tissues also precludes transplantation due to a high incidence of hyperacute rejection and graft loss. This is further explained later in this chapter. Finally, patients must be compliant, without active addiction (alcohol and or...

Three Types of Hazard Functions Curves Described

Not doubts that measures of short-term treatment effects (remission or response rates) are presenting great interest to provide more efficient treatments. However, for all diseases with unfavorable prognosis, to which pertains hemoblasto-sis, life expectancy is the most important feature. The irrevocable decision about the choice between two different treatment options is usually based on survival functions comparison. Unfortunately, this analysis is not able to reveal critical periods in disease course with distinct maximum mortality rates. Clearly, this information is very important for clinicians efforts to distinguish time intervals when patients should be specially carefully monitored. A retrospective study of the overall survival function among patients with multiple myeloma (MM), acute nonlymphoblastic leukemia (ANLL) and chronic myeloprolypherative disorders (CMPD), treated in our hospital, was performed. These data were complemented with results for the hazard...

New statistical approaches in HEALTH

The DALY is proving a useful tool, for ranking diseases and conditions and to estimate the cost-effectiveness of interventions by comparing the cost of averting a DALY. More work is required to refine and simplify it. Refinements of the DALY have been developed to emphasize specific aspects of the burden of disease. For example, disability-adjusted life expectancy (DALE) measures the number of years lived without disability.

Preoperative Counseling

Medical and family history, etc. is completed with special attention to comorbid factors, prior cancers, smoking habits, etc. that may affect their longevity. A life expectancy of 10 or more years for a surgical candidate is an accepted figure. Patients over age 70 are occasionally considered for surgery, if highly motivated and with evidence of family longevity. Patients with comorbid factors often require consultation from medical colleagues for assessment on optimization for surgery.

Epidemiological patterns of

These countries are undergoing rapid demographic and epidemiological change infant, child and maternal mortality rates are declining, fertility rates are high but falling, life expectancy is rising parasitic and infectious diseases are still prevalent but chronic degenerative diseases and non-communicable diseases associated with modern lifestyles and ageing populations are increasing. In some cases, countries carry a double burden they are acquiring modern health problems whilst traditional ones persist. infant, child and maternal mortality rates are low life expectancy at birth is high cancer, cardiovascular, neurological and mental disorders, degenerative diseases, and problems associated with the changed lifestyle and behaviour are common.

The Role of the Reticular Activating and the Limbic Systems

The reticular activating system, formed of an afferent and efferent network of interconnecting neurons distributed in the core midbrain, controls conscious alertness and, thus, makes sensory, motor, and visceral perception possible. Changes in sleep patterns with aging may be related to alterations in the level of alertness as manifested by the EEG changes discussed above and shifts in neurotransmitters, primarily serotonin (60,61) (Chapter 6). Serotonin appears to function as an inhibitory neurotransmitter that modulates the effects of light on circadian rhythmicity and regulates several cyclic hormonal secretions (62,63). It is also the precursor of the pineal hormone melatonin, which, in some, has potent sedative and hypnotic (sleep-inducing) activity (Chapter 12). Insomnia, frequent in the elderly, may depend on several factors superimposed on the aging process. Anxiety, depression, and stress that often affect sleep, are prevalent among many elderly and may account for some of...

Mortality Decline Among the Elderly

The most significant trend now affecting longevity in industrialized societies is the decline of death rates among the elderly. Until the late 1960s, death rates at older ages had declined slowly, if at all. Traditionally, rates of mortality decline were much higher at younger than at older ages. Since about 1970, however, there has been an aging of mortality decline, meaning that some of the most rapid declines in death rates are now occurring at older ages (23,24). Thus, the decade of the 1960s marks a turning point, from an earlier era of longevity increase due primarily to the decline of acute infectious disease among juveniles to a more recent era involving the decline of chronic degenerative disease among the elderly.

Summary of Historical Trends

A compact summary of major trends in human longevity in industrialized countries is presented in Tables 3. Amidst the incredible detail available in historical mortality statistics, we cannot help but discern two major epochs before 1960 and after 1970. The driving trend in the former period was a rapid decline of mortality due to infectious disease, which had an impact across the age range but certainly a much larger effect at younger ages. The sharp reduction in infant and child mortality led to a rapid increase in average life span and a marked reduction in the variability of age at death. It did not, however, have a major impact on maximum life span, which rose very slowly due to the more gradual improvement in death rates at older ages. TABLE 3 Summary of Major Trends in Human Longevity in Industrialized Countries Average life span (life expectancy at birth) From the mid-1950s to the late 1960s, mortality trends in industrialized countries seemed to stabilize. Then, just before...

Tetrahydrobiopterin as a Therapeutic Target

BH4 deficiency in hph-1 mice did not reproduce the severe pulmonary hypertension with plexiform lesions seen in humans 43 even after exposure to hypoxia, and the mice appear to have a normal life expectancy. Other recently published genetic mouse models of pulmonary hypertension have also failed to recapitulate this extreme phenotype 5,51,87 . Even in mice overexpressing S100A4 Mts1, only 5 of aging mice develop plexiform arteriopathy 27 . These observations imply that additional pathways need to be invoked for the full pathogenic expression of the human disease and reinforce the idea for combination therapy in the treatment of pulmonary hypertensive patients.

Extrapolation of Mortality Trends

Third, these gains in longevity are the result of a complex array of changes (improved standards of living, public health, personal hygiene, and medical care), with different factors playing major or minor roles in different time periods. Even accepting this argument, there is still a question of what to extrapolate. Demographers tend to view death rates as the fundamental unit of analysis in the study of mortality patterns, because these rates are estimates of the underlying force of mortality or the risk of death at any moment in a person's lifetime. These risks change over age and time and vary across social groupings (by sex, race, education, income, etc.). Life expectancy and the expected maximum age at death (for a cohort of a given size) can be expressed as a mathematical function of death rates by age. Thus, the usual strategy is to extrapolate age-specific death rates into the future and then to use the results of such an extrapolation to compute forecasts of life expectancy...

Programming of Later Obesity Risk

Childhood obesity is now considered a global epidemic in view of the alarming increase in its prevalence and severity, not only in affluent but also in less privileged childhood populations worldwide 11-13 . Serious short -and long-term consequences of childhood obesity arise in terms of damage to quality of life, performance, health and life expectancy. In addition, the size of the obesity epidemic is estimated to create huge costs for society due to loss of productivity and ensuing costs for health care and social security. Faced with the size of the problem, widely available and effective medical management of children who are already obese is needed, but at present the results of available treatment concepts are far less than satisfactory, and costs are high 14 . A recent Cochrane review on interventions for treating obesity in children found that no conclusions on the effects of treatment strategies and their components can be drawn with confidence 15 . Thus, in the present...

Reconstructive Technique

Mandibular reconstruction has evolved over the past 2 decades to become a very reliable though complex technique. The main reason for this advance has been the incorporation of microsurgical techniques and the development of reliable flaps for reconstruction. The concept of maintaining quality of life has become particularly important in the overall care and treatment of cancer patients. Thus, even patients with a very limited life expectancy are routinely reconstructed if it is expected that their quality of remaining life would be significantly enhanced. The high success rate of head and neck reconstructive procedures has allowed for significant improvement in both functional and aesthetic results and has completely changed the conceptual approach to mandibular reconstruction. Only patients who are medically unfit to tolerate a long operation or have a grave prognosis are excluded as candidates for resection and immediate reconstruction.

Mild Cognitive Impairment

Tion as is contained in the entire Encyclopedia Britannica, or 100 trillion bits of information. The circuitry in one human brain is probably sixty times the complexity of the entire United States telephone system. Given this complexity, even the daily estimated loss of 100,000 brain cells from the aging process may leave human beings capable of sound cognitive functioning well into old age.

Psychosomatics and the Future

By eliminating many of the diseases that used to be epidemic, especially those which killed people early in life, medical science has increased the average life expectancy of Americans by about thirty years since the beginning of the twentieth century. Eliminating the psychological factors that cause psychosomatic disorders holds promise for another increase in average life expectancy in the next few decades. Heart disease, cancer, and strokes are the top three killer diseases in the United States, and each has a powerful psychosomatic component. The reduction in human suffering and the economic benefits that can be gained by controlling nonfatal psychosomatic disorders are equally promising.


During the inflammation process, activated macrophages release various hydrolytic enzymes and reactive oxygen and nitrogen species that may contribute to tissue damage. Chemokines, plasma enzyme mediators (bradykinen, fibrinopeptidases), opsonins, leukotrienes, and prostaglandins are all mediators that have some role in the inflammatory process.2 The normal prostate is populated by a T-cells, B-cells and macrophages, with the T-cells being evenly distributed throughout the interstitium and between the epithelial cells.13,14 There is some indication that the number of T-cells increases with age,12 which correlates with the incidence of prostate inflammation during the aging process. In contrast, bacterial abacterial chronic prostatitis shows histological evidence of aggregation of numerous lymphocytes, plasma cells, macrophages, and neutrophils within the prostatic substance. Chemokines act as chemoattractants, which activate lymphocytes and other immune modulators into neighboring...


As noted earlier, trends in mortality among the elderly are the main factor behind the continued increase in life expectancy in developed countries. Furthermore, the main components of mortality at these ages are CVD and cancer. These two causes have been in decline during recent decades for reasons that are complex and not entirely understood. It is clear that there are multiple causes involved in bringing down death rates due to CVD and cancer. Medical science has played a part, but so have changes in diet and personal habits as well as community efforts and economic changes that have reduced the spread of infectious agents. It is important to keep this complex causality in mind when speculating about future trends in human mortality.

Disuse and Aging

Many changes that accompany aging coincide with those associated with physical inactivity and they are generally recognized as effects of disuse. Thus, bed rest as a consequence of disease may be superimposed on aging changes and further accelerates the aging process. Studies of long-term space travel have revealed that weightlessness in space also induces changes resembling those of aging and physical inactivity. The relationship between disuse (due to bed rest, insufficient exercise, or lack of gravity) and aging has some practical implications because the same practices of prevention and rehabilitation may apply to both.

Aging And Disease

Aging is associated with increased incidence and severity of diseases, accidents, and stress. Deleterious factors, not themselves lethal, may, from an early age, gradually predispose the individual to functional losses or to specific diseases in later life. The epidemiology of aging is that branch of medical sciences that deals with the incidence, distribution, and control of disease in a population. The major objectives of epidemiological aging-related studies are to identify diseases at their onset, or even before, they become manifest, and to develop public health and medical strategies to prevent, postpone, or moderate them (59). The choice and outcome of these strategies have been, for many years now, a subject of debate. Although the increasing longevity of the elderly would reasonably predict an expansion of morbidity, several investigators have proposed an opposed and more optimistic view of compression of morbidity. According to the hypothesis of compression of morbidity,...


The treatment of choice in patients with microgastria, if no other life-threatening anomalies are present, is gastric augmentation (Menon et al. 2003), classically a Hunt-Lawrence pouch (a double-lumen jejunal pouch anastomosed to the greater curvature of the stomach with a distal Roux-en-Y jejunos-tomy). Prolonged medical management of gastroesophageal reflux in these patients is not beneficial, since the stomach size will not increase significantly over time (Blank and Chisholm 1973). Operating at an early stage is indicated to allow normal growth and development. Life expectancy is determined mostly by the associated anomalies, being the most frequent cause of death (Mouiton et al. 1994).


Plastics have come under attack in recent years due to their high visibility in the solid waste crisis. Nondegradable plastics packaging is blamed for shortening the life expectancy of commercial landfills, increasing the operational cost, contaminating the environment, and posing a threat to animal and marine life. Plastics account for approximately 15-17 of the 19 billion food-packaging market, and it is predicted to increase to 50 by the year 2000 2 . Nearly 10 of the plastics used in packaging are used as coatings on other materials, including paper 2 . Increasing legislative and economic imperatives and public perception of paper being. natural and plastics being foreign have led to the explosive drive to recycle plastics packaging or to make it biodegradable.


Diabetes mellitus is an important public health problem worldwide, and more than 75 of patients who have had diabetes mellitus for more than 20 years will have some form of retinopathy. Diabetic retinopathy correlates with the duration of diabetes thus, with increasing life expectancy, diabetic retinopathy and the ensuing blindness will tend to increase.

P53 Mutant Mice

As discussed earlier, p53 is a potent tumor suppressor and important for the senescence and apoptotic responses to damage. It might be expected, then, that hyperactive p53 would confer superior protection from cancer. Further, since cancer is a major age-related pathology in mice, as it is in humans, hyperactive p53 might also increase longevity. Several mouse models have been developed to test these ideas, all with surprising results.

Delayed Aging

Because many of these mutations act in conserved pathways, analogous mutations have been studied in mammals, principally mice. A consistent finding in mice is that, whereas some mutations do indeed extend longevity, for the most part, the life span extensions are much more modest and rarely exceed a 40 increase. It is beyond the scope of this chapter to review all the mouse models of extended longevity that have been created and studies, but a few are discussed below.

Stress Resistance

Indirectly controlling the level of cellular oxidative stress (177). Cells from mice that lack p66SHC expression are resistant to oxidative stress, evident as a marked reduction in the level of apoptosis. Moreover, the mice themselves live about 30 longer than wild-type control mice (176). Future research will very likely create additional mouse models in which stress-protective proteins such as chaperones are overexpressed to test the idea that stress resistance and longevity are as directly linked in mammals as they are in simple model organisms.


And reliable data exist on familial patterns of susceptibility and, although a number of gene variants have been associated with the conditions, the results are inconsistent among studies. The problem with HAPH is that it is a chronic but not acute illness, with a very slowly developing onset and challenging clinical diagnostics. When the clinical features are established, the parents of the subject usually have been passed and children are too young to be diagnosed. Unfortunately the life expectancy among mountain dwellers is very short and infant mortality is too high, which makes it very difficult to tag the familial patterns of the trait. Generally, it must be remembered that family data for environmentally-related illness can be difficult to obtain and that genetic analysis of HAPH is in its infancy. Many of the studies cited in this paper only relate to a few candidate genes out of the tens of thousands in the human genome and only a few tens of polymorphisms out of millions...

Tumour Type

In view of the distressing disturbances during the first post-operative year, a sphincter-saving operation involving a low anastomosis has very doubtful merits when life expectancy is short. Thus, in a patient with a low rectal carcinoma and distant metastasis, a well functioning abdominal colostomy probably offers a better quality of life. Moreover,


There were even more startling projections by the United Nations International Population Division (1996). They projected life expectancy in the 'developed' countries to reach 81 years by 2050. For less developed countries, this would still reach 76 years. However, this increase in the global elderly population would be proportionally offset by a decrease in fertility rate, now under way, from 1.7 births woman down to 1.4 in the Western world. This is below the replacement rate. For Second World regions, the rate of about 3.3 births woman would decline to 1.6. Even in the least developed (Third World) countries, 5 births woman would fall to 2 by 2050. Thus, the whole world would actually start to 'depopulate' in 40 years. The social and healthcare impact of these demographics in the USA and globally will lead to an increased demand for better medicines directed at a healthy old age. This elderly population have more income than average per capita income. In addition, with more time on...

U Introduction

We are currently witnessing a remarkable shift in the way physiologists think about aging of the CNS. The view formulated at the beginning of the twentieth century was of severe and inexorably progressive deterioration of structure, biochemistry, and function (e.g., the dire threat of dementia with longer life expectancy) (1). It is now considered that normal brain function can persist into old age with adaptive, compensatory, and learning capabilities occurring at all ages (2-7). Extension of mental and neurologic competence in old age is a characteristic of successful aging (Chapter 3) (Box 1).


However, we have to keep in mind that the resources available for ophthalmology are diminishing as life expectancy increases and new treatments for various macular and retinal diseases become available. This expanding spectrum includes invasive and noninvasive, but expensive, treatment modalities. All this may force us to reconsider how to spend the limited resources for the increasing number of patients.

N References

Maturation and longevity in relation to cranial capacity in hominid evolution. In Tuttle RH, ed. Primate Functional Morphology and Evolution. Mouton The Hague, 1975 417-442. 36. Sjobeck M, Dahlen S, Englund E. Neuronal loss in the brainstem and cerebellum part of the normal aging process A morpho-metric study of the vermis cerebelli and inferior olivary nucleus. J Gerontol 1999 54(9) B363-B368.

What Is Osteoporosis

Both men and women will thus lose bone mineral density as a natural consequence of the aging process however, men will lose less bone density with aging.5 Overall, men will lose about 15-45 of trabecular bone and 5-15 of cortical bone, as compared to women who will lose 30-50 and 25-30 , respectively.9 This loss of trabecular bone in both men and women explains the increase in fractures seen and why, although hip fractures occur in both sexes, it is twice as common in women.5,9 Additional risk factors include lifestyle decisions, such as smoking and excessive alcohol consumption, inactivity and low calcium intake.


As the average reproductive age of the patients from whom the oocytes were obtained was approximately 38.5 years, the observed genomic instability in mitotic divisions of the apparently balanced zygotes following meiosis II rescue may be age-related. Although the mechanism by which the age factor may lead to these changes is not known, the underlying mechanisms of the aging process involve increasing errors in the mitotic machinery of dividing cells and chromosomal abnormalities. It was also suggested that deviations in the cytoplasmic organization, such as mitochondrial distribution, may reduce mei-otic competence of oocytes and predispose the embryos to common cleavage abnormalities 23, 39-41 . The relationship between these cytoplas-mic changes and the nuclear organization during maturation and fertilization of oocytes may

The Menopause

The menopause is defined by the World Health Organization as the point in time of permanent cessation of menstruation due to loss of ovarian function. Clinically, the menopause is characterized by persistent amenorrhea for a period of twelve months. Laboratory findings in the menopause generally reveal low serum estradiol levels with elevated follicle stimulating hormone (FSH) levels. The specific levels may vary depending on the assay used. The perimenopause, or climacteric, is defined as the period of diminishing ovarian function preceding the menopause to one year following the final menses, generally lasting between 2 and 8 years. Currently, the average age of menopause in the United States is approximately 51 years and the average life expectancy is approximately 80 years. Consistent with this, almost one half of the average woman's life is spent in the post-menopausal period.

Cost Of Treatment

Radical prostatectomy remains the primary initial form of treatment for men less than 70 years of age. Rates of radical prostatectomy rose rapidly in the early 1990s in response to a rapid rise in the incidence of the disease.3 By 1994, aggressive screening with prostate specific antigen (PSA) had tapped the prevalent pool of undetected cases within the population. In addition, more rational age-specific screening strategies were adopted. These two phenomena led to an overall drop in the incidence rate. Rates of radical prostatectomy dropped in step with the declining incidence. At the same time, a number of studies began to demonstrate little survival benefit for men with less than a 10-year life expectancy.4-7 While overall rates of radical prostatectomy have declined, rates for men less than 65 years old have steadily risen since 1990.3

Economics of failure

It is axiomatic that there is an economic cost implication in provision of any treatment, whether this cost is met by individual patients or is state funded. There are financial implications in treatment of failed restorations and also in preventing failure, and this should be transparent at the outset of treatment to both operator and patient. The relationship between initial cost and longevity is not always obvious, and in some cases a more costly initial treatment option may prove to be more cost effective in the long term4.

Anti Aging Made Easy

Anti Aging Made Easy

When it comes to reducing wrinkles, you really have to take your needs seriously. There are a number of factors that play a role in the health and well being of your skin. It is often hard to understand how products work and why they may not work even if they promise to do so. If you are considering wrinkle creams and a regimen of facelifts, you may go broke in the process. Before you do all of that, consider going through a process of determine the very best solution for your needs.

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