The complexity of center of pressure (COP) dynamics, as quantified using multiscale entropy (MSE), during TPCA-1 datasheet quiet standing is lower in older adults, especially those with falls. We hypothesized that COP dynamics from frail elderly individuals demonstrate less complexity than those from nonfrail elderly

controls; complexity decreases when performing a dual task; and postural complexity during quiet standing is independent of other conventional correlates of balance control, such as age and vision.

Methods. We analyzed data from a population-based study of community-dwelling older adults. Frailty phenotype (nonfrail, prefrail, or frail) was determined for 550 participants (age 77.9 +/- 5.5 years). COP excursions were quantified for 10 trials of 30 seconds each. Participants concurrently performed a serial subtraction task in half of the trials. Complexity of balance dynamics was quantified using MSE. Root-mean-square sway amplitude was also computed.

Results. Of the 550, 38%

were prefrail and 9% were frail. Complexity of the COP dynamics in the anteroposterior Torin 1 purchase direction was lower in prefrail (8.78 +/- 1.91 [mean +/- SD]) and frail (8.38 +/- 2.13) versus nonfrail (9.20 +/- 1.74) groups (p <.001). Complexity reduced by a comparable amount in all three groups while performing the subtraction task (p <.001). Quiet standing complexity was independently associated with frailty after adjusting for covariates related to balance while sway amplitude was not.

Conclusion. Cognitive distractions during standing may further compromise balance control in frail individuals, leading to an increased risk of falls.”
“A 57-year-old man presents with fever, chills, and new lumbar back pain 2 weeks after undergoing a prostate biopsy because of an increased prostate-specific antigen level. His temperature is 39.7 degrees C; he has an enlarged, tender prostate and lumbar spine tenderness. His white-cell count is 9100 per cubic millimeter, and the C-reactive protein level is 343 mg per liter. Urine and blood cultures reveal multidrug-resistant, extended-spectrum

beta-lactamase-producing PIK3C2G Escherichia coli susceptible to imipenem. How should he be evaluated and treated?”
“Background. Cardiac autonomic dysfunction has been associated with cognitive impairment, but the underlying pathogenesis is complex and cerebral white matter lesions (WMLs) might be implicated.

Methods. Time and frequency heart rate variability (HRV) and visual rating of WMLs were carried out in 42 patients with mild cognitive impairment.

Results. After adjustment for relevant demographic and clinical characteristics, including left ventricular mass, reduced HRV indices of parasympathetic (root mean square of successive difference of RR intervals, RMSSD) and sympathetic modulation (low-frequency [LF] power) were associated with increased WML score (RMSSD: B -0.30, 95% CI -0.52 to -0.08, p =.01; LF: B -0.24, 95% CI -0.46 to -0.02, p =.05).