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Mitochondrial dysfunction and oxidative stress: cause and consequence of epileptic seizures.

Mitochondrial dysfunction has been implicated as a contributing factor in diverse acute and chronic neurological disorders. However, its role in the epilepsies has only recently emerged. Animal studies show that epileptic seizures result in free radical production and oxidative damage to cellular proteins, lipids, and DNA. Mitochondria contribute to the majority of seizure-induced free radical production. Seizure-induced mitochondrial superoxide production, consequent inactivation of susceptible iron-sulfur enzymes, e.g., aconitase, and resultant iron-mediated toxicity may mediate seizure-induced neuronal death. Epileptic seizures are a common feature of mitochondrial dysfunction associated with mitochondrial encephalopathies. Recent work suggests that chronic mitochondrial oxidative stress and resultant dysfunction can render the brain more susceptible to epileptic seizures. This review focuses on the emerging role of oxidative stress and mitochondrial dysfunction both as a consequence and as a cause of epileptic seizures.

Animals↗

Consequences of impaired data quality on information retrieval in electronic patient records.

OBJECTIVES: To assess the quality of specific information in electronic patient records and the consequences of sub-optimal data quality on automated information retrieval. METHODS: Patient records were evaluated with respect to accuracy of data relevant for retrieval according to a source-oriented, time-oriented and concept-oriented view of the record. Retrieval effectiveness was estimated using various methods based on record structure, text based retrieval and combinations of these. RESULTS: 98.1% of record documents were consistent regarding author, 99.8% regarding department of origin and 90.9% regarding document date. Document type was definitely not consistent in 8% of the documents. Estimated recall was 97% with 50% precision for document retrieval on the basis of date, and varying from 31 to 100% for retrieval based on document type. Retrieval based on manually supplied semantic tags performed better than simple string-based methods and improved when combined with string-matching mechanisms. CONCLUSIONS: Data attributes central for automated document retrieval in electronic patient records showed variable accuracy, with potentially negative consequences for basic record navigation. Text-based retrieval was inferior to methods based on data representing record structure. Quality of specific information elements suffered from lack of precise definitions and adequate mechanisms for quality assurance.

Information Storage and Retrieval↗

Rate, predictors, and consequences of hemodynamic depression after carotid artery stenting.

OBJECTIVES: We sought to determine the frequency, predictors, and consequences of hemodynamic depression (HD) after carotid artery stenting (CAS). BACKGROUND: Hemodynamic depression has been reported after carotid artery stenting CAS and carotid endarterectomy (CEA). METHODS: We retrospectively analyzed data on 500 consecutive CAS procedures performed over a 5-year period. Hemodynamic depression was defined as periprocedural hypotension (systolic blood pressure <90 mm Hg) or bradycardia (heart rate <60 beats/s). Univariate and multivariate binary logistic regression models were used to determine the predictors and consequences of HD and persistent HD. RESULTS: The mean age of the patients was 70.5 +/- 10 years, and 69% were men. Hemodynamic depression occurred during 210 procedures (42%), whereas persistent HD developed in 84 procedures (17%). Features that independently predicted HD included lesions involving the carotid bulb (odds ratio [OR] 2.18 [range 1.46 to 3.26], p < 0.0001) or the presence of a calcified plaque (OR 1.89 [range 1.25 to 2.84], p < 0.002). Prior ipsilateral CEA was associated with reduced risk of HD (OR 0.35 [range 0.20 to 0.60], p < 0.0001). Patients who developed persistent HD were at a significantly increased risk of a periprocedural major adverse clinical event (OR 3.05 [range 1.35 to 5.23], p < 0.02) or stroke (OR 3.34 [range 1.13 to 9.90], p < 0.03). CONCLUSIONS: Hemodynamic depression is common after CAS, particularly in patients with a calcified plaque in the carotid bulb, but is easily treated with conventional methods. Patients who develop persistent HD are at an increased risk of periprocedural major adverse clinical events and stroke.

Aged↗

Knowledge of dietary restrictions and the medical consequences of noncompliance by patients on hemodialysis are not predictive of dietary compliance.

OBJECTIVE: To investigate whether knowledge of the diet and medical consequences of noncompliance influences dietary compliance among patients on hemodialysis. DESIGN: An interviewer-administered questionnaire assessed patients' knowledge of foods restricted in their diet (four separate scores for knowledge of foods restricted for: potassium, phosphorus, sodium, and fluid); overall knowledge of restricted foods (one composite knowledge score); and knowledge of medical complications of dietary noncompliance (one composite knowledge score). Patients' mean monthly serum phosphorus and potassium and weight charts provided an estimate of dietary compliance. SUBJECTS/SETTING: Seventy-one of the eligible 82 patients on hemodialysis at Nottingham City Hospital, Nottingham, UK, participated in the study (87% response rate). STATISTICAL ANALYSES: Chi(2) tests determined associations between dietary compliance and knowledge scores. RESULTS: More than one third of patients were noncompliant with at least one dietary restriction. Phosphorus dietary restrictions were the most commonly abused and potassium the least. Patients' knowledge of the medical consequences of noncompliance was poorer than knowledge of renal dietary restrictions (mean scores 29.4%; 74.7%). There was no association between compliance with potassium or sodium/fluid restrictions and knowledge of these dietary restrictions. However, patients with better knowledge about phosphorus were less likely to be compliant (P=.03). Patients with better knowledge about the medical complications of noncompliance were less likely to be compliant for phosphorus (P=.002) and sodium/fluid (P=.008) restrictions. APPLICATIONS: These findings question the value of current dietary education techniques in motivating patients to comply with dietary restrictions. Instead of the more traditional approach of information-giving, effective educational methods that focus on motivating patients to comply with dietary restrictions are needed to improve compliance.

Adult↗

Social anxiety, depressive symptoms, and post-event rumination: affective consequences and social contextual influences.

Using a self-presentation perspective, we hypothesized that during social interactions in which social attractiveness could be easily appraised by others, more socially anxious individuals would be more prone to ruminate and rumination would have more adverse emotional consequences. After assessing social anxiety and depressive symptoms, unacquainted college students participated in 45-min structured social interactions manipulated to induce personal self-disclosure or mimic superficial, small-talk. Affective experiences were assessed immediately after and 24h after social interactions. Results found that social anxiety was associated with negative post-event rumination more strongly among those with elevated depressive symptoms. Further, at higher levels of social anxiety, post-event rumination was associated with increases in NA following personal disclosure interactions and decreases in NA following small-talk interactions. Individuals with more depressive symptoms experienced increases in NA following small-talk interactions, but not personal disclosure interactions. Contrary to expectation, positive relations between social anxiety and rumination were not mediated by self-presentation concerns during interactions. Fitting with relevant theory, findings implicated symptom and social contextual variables that moderate the affective consequences of rumination.

Adult↗

Predictors and consequences of pneumonia in critically ill patients with stroke.

OBJECTIVE: Ascertain the incidence, predictors and consequences of early (within 48 hours of admission) and nosocomial pneumonia among critically ill patients with stroke. METHODS: Medical records of critically ill patients with acute stroke were reviewed. Predictors and consequences of pneumonia were determined with analysis of variance. RESULTS: 55 patients, aged 33 to 91 (median 74) years, were admitted. The stroke was located at the brainstem in 14 (26.4%) patients. Nine patients (16.4%) had early pneumonia and additional 17 patients (30.9%) developed nosocomial pneumonia. Patients with brain-stem stroke were more likely to develop early pneumonia (p =.04). Nosocomial pneumonia incidence was higher in patients who failed swallowing evaluation (RR = 6.3, 95% CI: 0.9-43.0) and in those who were intubated (58.6% v 0%, p =.00008). Also, nosocomial pneumonia was associated with longer duration of mechanical ventilation and prolonged hospital stay. Nineteen patients (34.5%) died at the hospital. They were more likely to be older (median 77 versus 69 years, p =.03) with higher admission acuity of illness. CONCLUSION: Pneumonia complicated stroke in 47% of critically ill patients and adversely impacted the duration of mechanical ventilation and overall length of hospital stay. Aggressive preventive measures are needed to reduce pneumonia occurrence in stroke patients.

Aged↗

Adverse clinical consequences of neodymium:YAG laser treatment of posterior capsule opacification.

PURPOSE: To evaluate the clinical consequences of complications from neodymium:YAG (Nd:YAG) laser capsulotomy for posterior capsule opacification (PCO) over the lives of cataract patients. SETTING: CHU de Caen, Caen, France. METHODS: A model was constructed to estimate the lifetime clinical consequences of postoperative PCO treated by Nd:YAG laser capsulotomy. The probability of death was modeled from French mortality tables as a polynomial function of sex and age. The probability of becoming blind was modeled as a function of age from data in the literature. The incidence of Nd:YAG complications came from the literature. The rate of Nd:YAG capsulotomy over time was modeled as a survival curve using data from a cohort of 3335 patients. RESULTS: Over 9 years in a 70-year-old population, switching from an IOL with a 20% Nd:YAG capsulotomy rate at 3 years to an IOL with a 5% rate would avoid 1 chronic intraocular pressure increase requiring medical follow-up in every 54 surgeries, 1 case of glaucoma in every 237 surgeries, 1 case of cystoid macular edema in every 265 surgeries, and 1 retinal detachment in every 265 surgeries. A 3-year clinical study would only capture one-third to one-half of long-term adverse events of Nd:YAG capsulotomy. CONCLUSION: Reducing PCO and the associated use Nd:YAG laser capsulotomy may contribute to preserving visual acuity in patients over their lifetimes.

Aged↗

The impact of economic activity in Asturias on greenhouse gas emissions: consequences for environmental policy within the Kyoto Protocol framework.

Climate change is one of the major worldwide environmental concerns. It is especially the case in many developed countries, where the greenhouse gas emissions responsible for this change are mainly concentrated. For the first time, the Kyoto Protocol includes an international agreement for the reduction of the net emissions of these gases. To fulfil this agreement measures designed to reduce or limit current emissions have to be brought into force. Consequently, fears have arisen about possible consequences on competitiveness and future development of manufacturing activities and the need for support mechanisms for the affected sectors is obvious. In this paper, we carry out a study of the emissions of gases responsible for climate change in Asturias (Spain), a region with an important economic presence of sectors with intensive emissions of CO(2), the chief greenhouse gas. To be precise, in the first place, the volumes of direct emissions of the said gases in 1995 were calculated, showing that the sectors most affected by the Kyoto Protocol in Asturias are iron and steel and electricity production. Secondly, input-output analysis was applied to determine the direct and indirect emissions and the direct, indirect and induced emissions of the different production sectors, respectively. The results derived from the direct and indirect emissions analysis and their comparison with the results of the former allow us to reach some conclusions and environmental policy implications.

Air Pollution↗

Deep wound infection after proximal femoral fracture: consequences and costs.

The purpose of this study was to assess the impact of deep wound infection after surgery for proximal femoral fracture (PFF) on the patient in terms of mortality and social consequences, and on the National Health Service in terms of financial burden. Sixty-one cases of PFF over a six-year period were complicated with deep surgical wound infection. These cases were compared with a matched control group of 122 patients without infection. Infected cases had greatly increased hospital stay (P<0.001), were 4.5 times less likely to survive to discharge (P=0.002), and if they survived, were three times less likely to return to their original residence (P=0.05). The total cost of treatment per infected case was 24,410 pound sterling compared with 7210 pound sterling for controls (P<0.001). Meticillin-resistant Staphylococcus aureus (MRSA) infection increased admission length and cost compared with non-MRSA infection (P=0.02). Deep wound infection after PFF is a devastating and costly complication for both the patient and the healthcare services. The cost consequences should be considered when allocating resources to trauma services to ensure adequate provision to minimize infection risks and to accommodate treatment costs in this vulnerable group.

Aged↗

Structural and energetic consequences of mutations in a solvated hydrophobic cavity.

The structural and energetic consequences of modifications to the hydrophobic cavity of interleukin 1-beta (IL-1beta) are described. Previous reports demonstrated that the entirely hydrophobic cavity of IL-1beta contains positionally disordered water. To gain a better understanding of the nature of this cavity and the water therein, a number of mutant proteins were constructed by site-directed mutagenesis, designed to result in altered hydrophobicity of the cavity. These mutations involve the replacement of specific phenylalanine residues, which circumscribe the cavity, with tyrosine, tryptophan, leucine and isoleucine. Using differential scanning calorimetry to determine the relative stabilities of the wild-type and mutant proteins, we found all of the mutants to be destabilizing. X-ray crystallography was used to identify the structural consequences of the mutations. No clear correlation between the hydrophobicities of the specific side-chains introduced and the resulting stabilities was found.

Calorimetry, Differential Scanning↗

Pain catastrophizing and consequences of musculoskeletal pain: a prospective study in the Dutch community.

UNLABELLED: By elaborating on previous prospective and cross-sectional research, the primary aim of this study was to examine in the general community whether pain catastrophizing predicts the development of chronic pain complaints and other consequences of pain. The following health index values were examined as consequences of pain: specialist consultation, use of pain medication, and absenteeism. It was also examined whether these relationships were moderated by the number of pain problems and by pain intensity. The results demonstrated a generally low level of catastrophizing and a small but significant effect of catastrophizing on the development of chronic pain complaints. With respect to the health index values, no significant effects of catastrophizing were found, nor were the relationships between catastrophizing and chronicity and the health index values moderated by the number of pain problems or by pain intensity. PERSPECTIVE: Because in the general community the level of catastrophizing is low, its role in the development of future pain problems is probably limited in this type of setting. More practically, the Pain Catastrophizing Scale, used to measure pain catastrophizing, is probably of limited use as a screening instrument in the general community. The disappointing results may indicate that, depending on the specific setting (eg, clinical, outpatient, or community) the role of pain catastrophizing is either more or less prominent.

Adult↗

Comprehensive assessment of peri-operative fatigue: development of the Identity-Consequence Fatigue Scale.

OBJECTIVE: Fatigue is one of the complaints most widely reported during peri-operative periods. However, despite its prevalence, the aetiology of this fatigue remains poorly understood. Recent meta-analysis suggests that the limited applicability of existing fatigue measures is contributing to the current lack of understanding. This research therefore sought to use a rigorous analytic process to develop a comprehensive measure of fatigue suitable for use with recovering surgical patients. METHODS: Content analysis was undertaken to investigate the structure of 55 items initially generated. Self-report questionnaires were then distributed to surgical out-patients, and the 177 responses analysed using principal components analysis. Once item selection was finalized, the convergent and discriminant validity of the new measure was assessed. RESULTS: The new measure, the Identity-Consequence Fatigue Scale (ICFS), has 28 items and five subscales. All subscales show high internal reliability, and reentry of deleted items showed that the finalized items form a robust component structure. Discriminant validity analysis confirmed that all ICFS subscales are distinctive from depression and anxiety. Convergent validity analysis confirmed the extent to which the ICFS assesses Fatigue-Consequences is a unique feature of the new measure. CONCLUSION: The ICFS has a clear and stable structure that offers more comprehensive assessment of fatigue than provided by the measures most widely used in postsurgical fatigue (PSF) literature to date.

Adult↗

Placental ischaemia is a consequence rather than a cause of pre-eclampsia.

The aetiology or pre-eclampsia remains unknown, but it is widely accepted that the disorder is placental in origin. Failed trophoblast invasion of the maternal spiral arteries is accepted to be a central pathogenetic mechanism. However, the concept of failed trophoblast invasion is based on an assumption rather than direct scientific observation and there are other likely explanations for this phenomenon. The criteria for disease causation, such as the Bradford-Hill criteria are central to the ascertainment of causal relationships in modern medicine and these criteria are used here to assess the relationship between the placenta and pre-eclampsia. There is a strong association between pre-eclampsia and small (rather than large) placentas and an appropriate dose-response relationship does not exist. Failed trophoblast invasion of the spiral arteries is not specific to pre-eclampsia and occurs in other pregnancy complications and in up to 40% of biopsies from normal pregnancies and the relationship between placental ischaemia and pre-eclampsia is very inconsistent. A placental cause for pre-eclampsia is not consistent with the pathogenesis of other pregnancy complications like gestational diabetes mellitus. If pre-eclampsia was a disease of trophoblast origin, the risk of the disease should be determined by trophoblast rather than maternal factors. However, evidence from assisted reproduction shows that the risk of a woman developing pre-eclampsia is almost entirely dependent on maternal factors and independent of the embryo from which the placenta develops. There is currently no plausible proven mechanism by which the placenta causes pre-eclampsia. The syndrome typically gets worse, and can arise de-novo after the placenta has been removed, calling into question the role of the placenta in its causation. Uterine artery ligation in humans, unlike in animal experiments, is not associated with an increased incidence of pre-eclampsia, calling into question the role of poor utero-placental perfusion in the cause of the disease in humans. The signals that initiate maternal adaptive responses during pregnancy come from or through the placenta into the maternal milieu but as is the case with gestational diabetes mellitus, are not necessarily the cause of maternal disease. Pre-eclampsia causes renal, hepatic, myocardial, cerebral and adrenal ischaemia--that is ischaemia in all highly vascular organs. Placental ischaemia, like ischaemia in all other organs, is a consequence rather than a causal factor in the development of the syndrome and this has profound consequences for research strategies.

Female↗

DNA-protein crosslinks: their induction, repair, and biological consequences.

The covalent crosslinking of proteins to DNA presents a major physical challenge to the DNA metabolic machinery. DNA-protein crosslinks (DPCs) are induced by a variety of endogenous and exogenous agents (including, paradoxically, agents that are known to cause cancer as well as agents that are used to treat cancer), and yet they have not received as much attention as other types of DNA damage. This review summarizes the current state of knowledge of DPCs in terms of their induction, structures, biological consequences and possible mechanisms of repair. DPCs can be formed through several different chemistries, which is likely to affect the stability and repair of these lesions, as well as their biological consequences. The considerable discrepancy in the DPC literature reflects both the varying chemistries of this heterogeneous group of lesions and the fact that a number of different methods have been used for their analysis. In particular, research in this area has long been hampered by the inability to chemically define these lesions in intact cells and tissues. However, the emergence of proteomics as a tool for identifying specific proteins that become crosslinked to DNA has heralded a new era in our ability to study these lesions. Although there are still many unanswered questions, the identification of specific proteins crosslinked to DNA should facilitate our understanding of the down-stream effects of these lesions.

DNA↗

Organizational bullying among nursing faculty: A systematic review of consequences, contributing factors, and interventions.

BACKGROUND: Organizational bullying among nursing faculty is a systemic and pervasive issue with profound psychological, professional, and institutional consequences. Despite increasing awareness, the literature remains fragmented, and a comprehensive synthesis is lacking. METHODS: This systematic review followed PRISMA guidelines and examined empirical studies on organizational bullying among nursing faculty, with no date restrictions applied. A structured search across five databases (PubMed, Scopus, Web of Science, CINAHL, and Embase) identified studies that met inclusion criteria related to the consequences, contributing factors, and interventions. The Mixed Methods Appraisal Tool (MMAT) was used to assess study quality. RESULTS: Fifteen studies meeting the quality threshold were included. Organizational bullying was consistently associated with psychological distress (e.g., anxiety, depression, burnout, suicidal ideation), professional disengagement, and intent to leave. Contributing factors were categorized into structural and organizational (e.g., hierarchical power imbalances, toxic workplace culture), managerial and HR-related (e.g., lack of leadership support, poor reporting mechanisms), and individual/social (e.g., gender or ethnic discrimination, early-career vulnerability). Intervention strategies identified included policy reforms, leadership training, supportive reporting systems, and psychological support services, though evidence on their effectiveness remains limited. CONCLUSIONS: Organizational bullying in nursing academia is a serious and multifaceted challenge with detrimental effects on individuals and institutions. Addressing it requires a comprehensive, evidence-based approach that includes structural reforms, leadership development, and psychosocial support systems. Academic institutions must prioritize the creation of safe, inclusive, and respectful environments to retain faculty and sustain the quality of nursing education.

Faculty, Nursing↗

Neuronal, glial and synaptic remodeling in the adult hypothalamus: functional consequences and role of cell surface and extracellular matrix adhesion molecules.

The adult hypothalamo-neurohypophysial system (HNS) undergoes activity-dependent morphological plasticity which modifies astrocytic coverage of its oxytocinergic neurons and their synaptic inputs. Thus, during physiological conditions that enhance central and peripheral release of oxytocin (OT), adjacent somata and dendrites of OT neurons become extensively juxtaposed, without intervening astrocytic processes and receive an increased number of synapses. The morphological changes occur within a few hours and are reversible with termination of stimulation. The reduced astrocytic coverage has direct functional consequences since it modifies extracellular ionic homeostasis, synaptic transmission, and the size and geometry of the extracellular space. It also contributes indirectly to neuronal function by permitting formation of synapses on neuronal surfaces freed of astrocytic processes. Overall, such remodeling is expected to potentiate activated neuronal firing, especially in clusters of tightly packed neurons, an anatomical arrangement characterizing OT neurons. This plasticity connotes dynamic cell interactions that must bring into play cell surface and extracellular matrix adhesive proteins like those intervening in developing neuronal systems undergoing neuronal-glial and synaptogenic transformations. It is worth noting, therefore, that adult HNS neurons and glia continue to express such molecules, including polysialic acid (PSA)-enriched neural cell adhesion molecule (PSA-NCAM) and the glycoprotein, tenascin-C. PSA is a large, complex sugar on the extracellular domain of NCAM considered a negative regulator of adhesion; it occurs in large amounts on the surfaces of HNS neurons and astrocytes. Tenascin-C, on the other hand, possesses adhesive and repulsive properties; it is secreted by HNS astrocytes and occurs in extracellular spaces and on cell surfaces after interaction with appropriate ligands. These molecules have been considered permissive factors for morphological plasticity. However, because of their localization and inherent properties, they may also serve to modulate the extracellular environment and in consequence, synaptic and volume transmission in a system in which the extracellular compartment is constantly being modified.

Animals↗

Do bimanual isometric push efforts in humans stop as a consequence of postural muscle exhaustion?

The purpose of this study was to explore whether global efforts stop as a consequence of postural muscle exhaustion. To this end, seated adults were asked to exert 75% maximal voluntary contractions bimanual push efforts until exhaustion. A dynamometer was used to measure the horizontal force exerted on a bar (Fx) and a custom-designed force plate measured the antero-posterior displacement of the centre of pressure (Xp). Electromyograms were picked up by bipolar surface electrodes from the primum movens (serratus anterior) and four postural muscles (trapezius superior, erectores spinae, rectus abdominis, rectus femoris). Root mean square and mean power frequency were calculated over 2-s intervals and compared to corresponding Fx and Xp values. It was shown that the effort stops as a consequence of exhaustion of postural muscles (rectus abdominis and rectus femoris), and not of the primum movens. It is concluded that postural muscles make a major contribution to global efforts, in that they allow compliance to biomechanical requirements, that is, to preserve the distance between the centre of pressure and the centre of gravity, which must be proportional to the external force.

Arm↗

Loss of reflex tearing: an expected consequence of juvenile nasopharyngeal angiofibroma.

OBJECTIVE: To report the loss of reflex tearing after surgical treatment of juvenile nasopharyngeal angiofibroma (JNA). STUDY DESIGN AND SETTING: A retrospective case series of 8 patients with surgical extirpation of JNA from 1995 to 2003 in a major teaching hospital setting was studied for symptomatic xerophthalmia. RESULTS: One patient was lost to follow-up. Four of the remaining 7 patients reported a dry ipsilateral eye after surgical treatment of JNA. CONCLUSION: The location of the pterygopalatine ganglion and its associated fibers in the pterygopalatine fossa is directly adjacent to the location of origin of JNA. Lacrimal innervation passes through the pterygopalatine ganglion. Given the extensive nature of advanced JNA and mandate for complete surgical excision, lacrimal dysfunction should be considered an expected consequence of surgery. SIGNIFICANCE: The loss of reflex tearing has not been reported as a consequence of JNA or its surgical treatment. EBM RATING: C.

Adolescent↗