Geriatric Medicine – An Evidence-Based Approach 4th Edition PDF

Geriatric Medicine



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Preface

Since the publication of the third edition of Geriatric Medicine. extraordinary advances have occurred in the science of aging and the potential for biomedical research to give us answers to many. if not most. of the age-related disorders that threaten the quality of life in older years. At the most basic level. the successful mapping of the human genome was declared complete in the fall of 2000. Understanding the map of the human genome is as important as understanding the map of genomcs of important laboratory species. ranging from the microscopic worms and fruitflics used in most classic genetic studies to rodents such as laboratory mice. and eventually to primates. on which much of the research on the aging human brain is done. The genetic maps of all of these species, including our own. does not answer clinical questions but it does open the door to dramatic, rapid. and efficient answers to questions about the genetic polymorphisms related to diseases in humans. The telomerase story also unfolded since the third edition. Telomerase is an enzyme responsible for maintaining the telomeres—the redundant DNA portions at the end of chromosomes—whose shortening seems to be linked directly to cell senescence. apop-tosisand the control over cell death. which.at the level of the individual cell.seems to be linked to the decline of organ function andeventuallyaging and death within the organ-ism.lhe potential for genetic manipulations by which telomerase maintains and restores telomere length within individual tissue cultures gives great promise for potential approaches to restoring function lost through degenerative diseases, such as macular degeneration and other disorders related to epithelial aging. In addition. the mainte-nance of telomeres has been intriguingly associated with the malignant immortality of cancer cells-andyet it appears possible to prevent degeneration without creati ng uncon-trolled growth or malignancy. Understanding this single genetic mechanism may give us clues not only to degenerative neurological and epithelial disease. but also perhaps to canoe r.anot her age-related human disease. Scientists have also discovered that stem cells from embryonic and adult tissues can potentially create new tissues and new organs. Perhaps most excitingly, it appears that brain cells themselves can be replaced through this mechanism.Thus.stcm cell research holds promise for treatment of ALzheimer’sand Parkinson’s disease-as well as for potentially growing new functioning organs that could be used for transplantation with much reduced risk of rejection because they are genet-ically fashioned to match the recipient’s immune status.


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