Medical hypotheses
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The disorders of Alzheimer's disease, vascular dementia and normal pressure hydrocephalus are all causes of dementia in the elderly population. It is often the case that it is clinically very difficult to tell these diseases apart. ⋯ It is proposed the manifestation of the dementia in any one patient is dependant on the way that the pulsations interact with the brain and its venous and perivascular drainage. This interaction is predominately dependant on the compliance of the craniospinal cavity and the chronicity of the increased pulse wave stress.
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Normal pressure hydrocephalus, Alzheimer's disease and syringomyelia appear to be completely unrelated diseases, however, they share a reduction in subarachnoid space compliance as part of their pathophysiology. This paper discusses the physiology of pulsatile fluid flow and its relationship to compliance/impedance. Unlike continuous or non-pulsatile flow where the vessel resistance and pressure gradient are the major determinants of the volume of fluid flowing, when the fluid flow in a vessel pulsates then the vessel compliance/impedance becomes important. ⋯ Therefore, there is an increase in outflow vessel impedance. The venous blood, CSF and interstitial brain/spinal cord fluid all have significantly pulsatile flow and an increase in the impedance of the fluid outflow in each disease would limit the volume of these fluids as they attempt to cross the subarachnoid space. It is hypothesised that a reduction in the efficiency of the outflow of venous blood, CSF and interstitial brain/spinal cord fluid would lead to the accumulation of CSF in NPH, cord fluid in syringomyelia and delay the excretion of beta amyloid via the interstitial drainage pathways in AD.
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Bone marrow-derived hematopoietic stem cells (HSC) can exhibit tremendous differentiation activity in numerous non-hematopoietic organs. This enigmatic process is called as 'stem cell plasticity' (SCP). HSC may promote structural and functional repair in several organs such as heart, liver, brain, and skeletal muscle via the SCP. ⋯ Activation of the local myocardial RAS after injury may be related to homing and engraftment of the HSC to the cardiac tissue. Regenerating myocardial tissue may exert regulatory functions on circulating or resident HSC via the locally active RAS. Understanding the exact molecular basis of SCP in relation to local tissue RAS could offer new frontiers in the better management of ischemic cardiac diseases.
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Simultaneous consideration of the influence of the different types of carbohydrates and fats in human diets on mortality rates (especially the diseases of aging), and the probable retardation of such diseases by caloric restriction (CR) leads to the hypothesis that restriction of foods with a high glycemic index and saturated or hydrogenated fats would avoid or delay many diseases of aging and might result in life extension. Many of the health benefits of CR might thereby be available to humans without the side effects or unacceptability of semi-starvation diets.
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Respiratory muscle fatigue after prolonged mechanical ventilation of the lungs is a common occurrence. This is probably due to disuse atrophy. The standard technique used to overcome this problem is to gradually wean the patient from the respirator over the course of several days or weeks. ⋯ dependence on the respirator, length of intubation time, risk of complications and length of stay in the ICU would be considerably reduced.