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PubMed2005

Use of percutaneous endoscopic gastrostomy feeding tubes and functional recovery in stroke rehabilitation: a case-matched controlled study.

OBJECTIVE: To compare the morbidity, mortality, and functional recovery of patients who require percutaneous endoscopic gastrostomy (PEG) placement for the management of dysphagia after stroke. DESIGN: Retrospective case-matched controlled study. SETTING: Acute stroke rehabilitation inpatient unit. PARTICIPANTS: Patients (N=193) who were admitted for stroke rehabilitation with a PEG tube in place from January 1, 1993, to December 31, 2002, were matched with 193 case controls without PEG. Patients and controls were within 90 days of stroke onset, and were matched for age, sex, type of stroke, FIM instrument score, duration from onset to stroke unit admission, and year of admission. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Length of rehabilitation hospital stay, improvement in FIM scores, FIM efficiency score, need for transfer back to acute care hospital, diagnosis for which transfer was required, final discharge destination, and survival status. RESULTS: Significant differences were found between the 2 groups, PEG versus control, respectively, in the following variables: FIM efficiency (.42+/-.57 vs .56+/-.55, P =.016); need for transfer back to acute hospital (58/193 vs 23/193, P =.001); and survival status dead/alive (14/179 vs 3/190, P =.006). Nonsignificant differences were as follows: length of rehabilitation hospital stay (46.9+/-24.8d vs 43.3+/-19.7d, P =.11), improvement in total FIM score from admission to discharge (16.9+/-17.9 vs 21.0+/-15.5, P =.72), and final discharge destination home/institutional care (96/83 vs 101/89, P =.93). Pneumonia was the most frequent reason for transfer to acute care for patients with PEG. CONCLUSIONS: Patients who meet criteria for admission to a stroke rehabilitation unit and who have a PEG in place are at increased risk for medical complications and death. Those who survive, however, show similar functional recovery and rate of home discharge as case-matched controls.

Aged↗
PubMed2005

Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better?

UNLABELLED: Horn SD, DeJong G, Smout RJ, Gassaway J, James R, Conroy B. Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better? OBJECTIVE: To examine associations of patient characteristics, rehabilitation therapies, neurotropic medications, nutritional support, and timing of initiation of rehabilitation with functional outcomes and discharge destination for inpatient stroke rehabilitation patients. DESIGN: Prospective observational cohort study. SETTING: Five U.S. inpatient rehabilitation facilities. PARTICIPANTS: Post-stroke rehabilitation patients (N=830; age, >18 y) with moderate or severe strokes, from the Post-Stroke Rehabilitation Outcomes Project database. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Discharge total, motor, and cognitive FIM scores and discharge destination. RESULTS: Controlling for patient differences, various activities and interventions were associated with better outcomes including earlier initiation of rehabilitation, more time spent per day in higher-level rehabilitation activities such as gait, upper-extremity control, and problem solving, use of newer psychiatric medications, and enteral feeding. Several findings part with conventional practice, such as starting gait training in the first 3 hours of physical therapy, even for low-level patients, was associated with better outcomes. CONCLUSIONS: Specific therapy activities and interventions are associated with better outcomes. Earlier rehabilitation admission, higher-level activities early in the rehabilitation process, tube feeding, and newer medications are associated with better stroke rehabilitation outcomes.

Activities of Daily Living↗
PubMed2004

Evaluation of functional improvement in older patients with cognitive impairment, depression and/or delirium admitted to a geriatric convalescence hospitalization unit.

Cognitive impairment, depression and delirium are problems of high prevalence in older patients. The geriatric convalescence unit (GCU) is a hospitalization facility offering an interdisciplinary geriatric intervention program that may be more appropriate for these patients. This study intended to analyze the functional improvement (FI) in older patients with cognitive impairment, depression and/or delirium admitted to a GCU. A group of 107 patients received specific nurse care, habitually performed in GCU and they also were included in a rehabilitation program. Cognitive impairment, depression and delirium were diagnosed according to standardized protocols. The analyzed variables were: age, functional status (Barthel index) before admission (BBA), at admission (BA) and at discharge(BD), diagnostic categories, cognitive function (mini mental state examination: MMSE) and post-discharge destination. The corrected Heinemann index (CHI) was used to evaluate FI obtained during GCU-stay, where CHI = 100 x (BD-BA)/(BBA-BA), and the efficiency index(El) was used to analyze the relationship between FI and the length of stay in the GCU,where El = (BD-BA)/(days in GCU). According to CHI, patients were divided in three groups. Group I: CHI = 0 or negative (patients who lost functional capacity during hospitalization,those who died or were transferred to hospital owing to acute deterioration. Group II: CHI < 35 % (high FI). Mean age was 77.6 +/- 9.1 years, the diagnostic categories were: fractures/orthopedics 49 (45.7 %), neurological 27(25.2 %), pulmonary/cardiologic 6 (5.6 %) and other cases 25 (23.3 %). Mean MMSE and BA scores were 16.9 +/- 9.4 and 29.6 +/- 18.9, respectively. Post-discharge destinations were:63 patients (58.8 %) returned home, 28 (26.1 %) were definitively institutionalized, 11 (10.2%) died and finally 5 (4.6 %) were transferred to acute care hospital. In-Group I, there were 35 patients (32.7 %) with a mean value of the El = 0.12 +/-1.1; in Group II, 13 (12.1 %) and 0.26 +/- 0.38; in Group III, 59 (55.1 %) and 0.94 +/- 0.97, respectively. In spite of the presence of cognitive impairment, depression and/or delirium, a high proportion of patients (67.2 %)obtained a significant improvement in their functional capacity.35 % (moderate FI). Group III: CHI >/=

Aged↗
PubMed2004

Validation of a modified version of the Gijon's social-familial evaluation scale (SFES): the "Barcelona SFES Version", for patients with cognitive impairment.

The aim was to validate an abbreviated version of the Gijon's social-familial evaluation scale (SFES) (Barcelona-SFES version), on patients with cognitive impairment. A group of 34 patients with cognitive impairment, admitted to an intermediate-long-term-care facility, were analyzed. Mean age was 80.2 +/- 7.4 years. Gijón's SFES was abbreviated and only the first three item groups corresponding to family conditions, social contacts and assistance from the social network were selected. Barcelona-SFES version had a range score between 3 to 15 points, in which low scores identify older patients who live with their family, have good contacts, and participate in community activities. In contrast, high scores identify older persons who live alone and have poor social support and little participation with community activities. Three social risk categories were established according to the Barcelona-SFES score: low social risk (>/= 7 points), intermediate social risk (8-9 points) and high social points). Validation criteria used in the present study were: predictive value of Barcelona-SFES score of post-discharge destination (home or institution), and patient's (or family's) request for a definitive institutionalization in a nursing home. There were 9 patients with low social risk (26.4 %), 8 with intermediate social risk (23.5 %) and 17 with high social risk (50 %). A significant relationship between Barcelona-SFES scores and post-discharge destination was found. Eighty percent of patients discharged to an institution(nursing and residential homes), they had high social risk SFES scores (>/= 10) Also, a significant correlation was found between the number of patients for which a definitive institutionalization request was performed and the Barcelona-SFES scores. Fifteen (88.2 %) of the 18 patients for whom the request was done, were in the high social risk group. The lowest scores from SFES were predictive of home discharge, while the highest scores were predictive of a definitive institutionalization.

Aged↗
PubMed2005

Body mass index and outcomes after left ventricular assist device placement.

BACKGROUND: Although extremes of body mass index (BMI) are associated with decreased survival after cardiac transplantation, its association with outcomes after left ventricular assist device (LVAD) implantation is not known. This issue is especially important as LVADs are now approved as destination therapy for advanced heart failure patients who are not transplant candidates. In this study, we assess the association between BMI and outcomes after LVAD implantation. METHODS: A total of 222 patients who underwent LVAD placement (190 bridge-to-transplant [BTT] and 32 destination therapy) were divided into four groups based on BMI (kg/m2) quartiles (group 1, <22.9; group 2, 22.9 to 26.3; group 3, 26.4 to 29.4; and group 4, >29.4) and were compared for outcomes. RESULTS: Eighty-four patients died on LVAD support. Six- and 12-month survival on LVAD for the four groups was 35%, 60%, 65%, and 73%, and 26%, 34%, 50%, and 66% (both p < 0.01), respectively. Similar trends were seen for the composite endpoint of survival on LVAD and within 30 days posttransplant among BTT patients. Infectious, neurological, respiratory, or bleeding complications were not related to BMI. Patients with higher BMI tended to have a greater risk of reoperations (43%, 49%, 53%, and 61%, p = 0.06) and renal complications (16%, 33% 23%, 43%, p = 0.03). Age and history of thoracotomy were independently associated with mortality whereas higher BMI was not. Survival was worst for patients with lowest BMI. CONCLUSIONS: Higher BMI did not adversely affect survival after LVAD implantation and therefore relative obesity should not be considered a contraindication for LVAD placement. Further work is needed to understand and manage risks for low BMI patients.

Adult↗
PubMed2005

Protein transport from the late Golgi to the vacuole in the yeast Saccharomyces cerevisiae.

The late Golgi compartment is a major protein sorting station in the cell. Secreted proteins, cell surface proteins, and proteins destined for endosomes or lysosomes must be sorted from one another at this compartment and targeted to their correct destinations. The molecular details of protein trafficking pathways from the late Golgi to the endosomal system are becoming increasingly well understood due in part to information obtained by genetic analysis of yeast. It is now clear that proteins identified in yeast have functional homologues (orthologues) in higher organisms. We will review the molecular mechanisms of protein targeting from the late Golgi to endosomes and to the vacuole (the equivalent of the mammalian lysosome) of the budding yeast Saccharomyces cerevisiae.

Endosomes↗
PubMed2005

Activation of nuclear factor-kappaB (NFkappaB) identifies a high-risk subset of hormone-dependent breast cancers.

Activation of nuclear factor-kappaB (NFkappaB) has been linked to the development of hormone-independent, estrogen receptor (ER)-negative human breast cancers. To explore the possibility that activated NFkappaB marks a subset of clinically more aggressive ER-positive breast cancers, NFkappaB DNA-binding was measured in ER-positive breast cancer cell lines and primary breast cancer extracts by electrophoretic mobility shift assay and ELISA-based quantification of specific NFkappaB p50 and p65 DNA-binding subunits. Oxidant (menadione 100 microMx30 min) activation of NFkappaB was prevented by pretreatment with various NFkappaB inhibitors, including the specific IkappaB kinase (IKK) inhibitor, parthenolide (PA), which was found to sensitize MCF-7/HER2 and BT474 but not MCF-7 cells to the antiestrogen tamoxifen. Early stage primary breast cancers selected a priori for lower ER content (21-87 fmol/mg; n=59) and known clinical outcome showed two- to four-fold increased p50 and p65 NFkappaB DNA-binding over a second set of primary breast cancers with higher ER content (>100 fmol/mg; n=22). Breast cancers destined to relapse (13/59) showed significantly higher NFkappaB p50 (but not p65) DNA-binding over those not destined to relapse (46/59; p=0.04). NFkappaB p50 DNA-binding correlated positively with several prognostic biomarkers; however, only NFkappaB p50 DNA-binding (p=0.04), Activator Protein-1 DNA-binding (AP-1; p<or=0.01) and urokinase-type plasminogen activator expression (uPA; p=0.0014) showed significant associations with metastatic relapse and disease-free patient survival. These clinical findings indicate that high-risk ER-positive breast cancers may be prognostically identified by increased NFkappaB p50 DNA-binding, and support preclinical models suggesting that therapeutic inhibition of NFkappaB activation may improve the endocrine responsiveness of high-risk ER-positive breast cancers.

Biomarkers, Tumor↗
PubMed2004

Input from the presubiculum to dendrites of layer-V neurons of the medial entorhinal cortex of the rat.

The entorhinal cortex (EC) and the hippocampus are reciprocally connected. Neurons in the superficial layers of EC project to the hippocampus, whereas deep entorhinal layers receive return connections. In the deep layers of EC, pyramidal neurons in layer V possess apical dendrites that ascend towards the cortical surface through layers IIII and II. These dendrites ramify in layer I. By way of their apical dendrites, such layer-V pyramidal cells may be exposed to input destined for the superficial entorhinal neurons. A specific and dense fiber projection that typically ends in superficial entorhinal layers of the medial EC originates in the presubiculum. To investigate whether apical dendrites of deep entorhinal pyramidal neurons indeed receive input from this projection, we injected the anterograde tracer PHA-L in the presubiculum or we lesioned the presubiculum, and we applied in the same experiments the tracer Neurobiotin trade mark pericellularly in layer V of the medial EC of 17 rats. PHA-L labeled presubiculum axons in the superficial layers apposing apical segments of Neurobiotin labeled layer-V cell dendrites were studied with a confocal fluorescence laserscanning microscope. Axons and dendrites were 3D reconstructed from series of confocal images. In cases in which the presubiculum had been lesioned, material was investigated in the electron microscope. At the confocal fluorescence microscope level we found numerous close contacts, i.e. appositions of boutons on labeled presubiculum fibers with identified dendrites of layer-V neurons. In the electron microscope we observed synapses between degenerating axon terminals and spines on dendrites belonging to layer-V neurons. Hence we conclude that layer-V neurons receive synaptic contacts from presubiculum neurons. These findings indicate that entorhinal layer-V neurons have access to information destined for the superficial layers and eventually the hippocampal formation. At the same time, they have access to the hippocampally processed version of that information.

Animals↗
PubMed2005

Dynein anchors its mRNA cargo after apical transport in the Drosophila blastoderm embryo.

Molecular motors actively transport many types of cargo along the cytoskeleton in a wide range of organisms. One class of cargo is localized mRNAs, which are transported by myosin on actin filaments or by kinesin and dynein on microtubules. How the cargo is kept at its final intracellular destination and whether the motors are recycled after completion of transport are poorly understood. Here, we use a new RNA anchoring assay in living Drosophila blastoderm embryos to show that apical anchoring of mRNA after completion of dynein transport does not depend on actin or on continuous active transport by the motor. Instead, apical anchoring of RNA requires microtubules and involves dynein as a static anchor that remains with the cargo at its final destination. We propose a general principle that could also apply to other dynein cargo and to some other molecular motors, whereby cargo transport and anchoring reside in the same molecule.

Animals↗
PubMed2005

Malnutrition determined by the patient-generated subjective global assessment is associated with poor outcomes in acute stroke patients.

BACKGROUND & AIMS: The extent of malnutrition in hospitalised stroke patients and its influence on outcomes including hospital complications, length of stay and discharge destination are important issues. The aim of this study was to determine the nutritional status of patients admitted to an acute stroke unit and the association between nutritional status and health outcomes. METHODS: Nutritional status was determined prospectively using the scored patient generated subjective global assessment (PG-SGA) in patients (n=73) admitted to an acute stroke unit within 48 h of admission to an Australian private hospital. Outcome data were collected by retrospective audit. RESULTS: On admission, 19.2% of patients were malnourished and this was associated with a significantly greater PG-SGA score (15 vs. 5) and lower body weight (59.8 kg vs. 75.8 kg) compared to well-nourished patients. In terms of health outcomes, malnourished patients had longer length of stay (13 vs. 8 days), increased complications (50% vs. 14%), increased frequency of dysphagia (71% vs. 32%) and enteral feeding (93% vs. 59%). No association was found between nutritional status and serum albumin level or discharge destination. CONCLUSIONS: Malnutrition on admission to hospital after acute stroke is associated with poor outcomes including increased length of stay and increased prevalence of dysphagia and complications. The scored PG-SGA is a nutrition assessment tool that allows quick identification of malnourished stroke patients.

Aged↗
PubMed2005

Aflatoxin occurrence in foodstuff supplied to dairy cattle and aflatoxin M1 in raw milk in the North of Paraná state.

Moulds occur in a great variety of foods, including the concentrated and roughage destined for animal feeding, and can produce mycotoxins under certain conditions. The ingestion of mycotoxin AFB(1) by dairy cattle leads to the biotransformation of that substance, which is eliminated via milk as AFM(1), and also causes damage to human health. The present study aimed to analyze the presence of aflatoxins in foodstuff destined for dairy cattle and in the milk produced by these animals. The contamination of the foodstuff by aflatoxins happened mainly in the feeds and the silages did not present contamination by aflatoxins. Out of the 42 samples of milk analyzed, 10 (24%) were contaminated by AFM(1), and 3 (7%) were above the 0.5 microg/l limit.

Aflatoxin B1↗
PubMed2006

Reaching hard-to-reach migrants by letters: an HIV/AIDS awareness programme in Nepal.

We assessed the impact of an HIV/AIDS programme for Nepalese migrants to India that involved writing letters. The programme created opportunities for sending HIV/AIDS-related messages to the migrants in India, and encouraging them practicing safer sex. Initially, they received the messages only from the programme, but later from their colleagues, spouses or other family members. They discussed the messages in groups, disseminated them, and sought more knowledge in their destinations. These findings indicated that using letters could be an effective way to reach inaccessible migrants at their destinations, and help them to improve their HIV/AIDS-related knowledge, and safer sex practices.

Adolescent↗
PubMed2005

Rupture of inlet graft of the HeartMate System: a case report.

As the implantation of left ventricular assist devices (LVADs) as destination therapy for patients with heart failure increases in frequency, device durability and malfunction present an increasing concern. Complications such as inflow valve regurgitation, outflow valve distortion, and problems with power cable or pump motors place the LVAD recipient at increased risk for morbidity and mortality. To offset the risk of complications related to the inflow cannula, modifications to the valve conduit were made to the SNAP VE device in November 2002. These modifications were intended to improve durability with cycle performance of up to 6 times longer than the old inflow valve during in vitro testing. We describe here a patient who sustained disruption of the Dacron inlet graft after implantation of the Heart-Mate XVE System as a destination therapy.

Aged↗
PubMed2006

Spatial and temporal expression of N-ethylmaleimide-sensitive factor gene in the nervous system of the cotton bollworm, Helicoverpa armigera.

N-ethylmaleimide-sensitive factor (NSF) is a component required for vesicular transport and release of neurotransmitters or neurohormones in the constitutive secretory pathways. Here, the spatial and temporal expression of NSF gene was investigated in Helicoverpa armigera (Helar). Reverse transcription-polymerase chain reaction analysis reveals that Helar-NSF is transcribed preferentially in the nervous system of H. armigera. Using in situ hybridization, the Helar-NSF mRNA is further localized in the superficial layer or deep layer cells of the brain, subesophageal ganglion (SG) and other ganglia. The developmental profiles of Helar-NSF show that both mRNA and protein in pupal brain-SG complexes are significantly higher in nondiapause-destined individuals than in diapause-destined individuals. The expression patterns are consistent with those of two neurohormones, prothoracicotropic hormone (PTTH) and diapause hormone (DH). These data suggest a central function of Helar-NSF in developmental process through regulating neurohormone release.

Animals↗
PubMed2006

Assessment of the impact of cattle testing strategies on human exposure to BSE agents in Japan.

In Japan, cattle screening tests for BSE are conducted at slaughterhouses for surveillance purposes and as a meat safety measure, but the public health impacts of such testing and the subsequent removal of positive animals from the food chain have not been quantitatively assessed. We evaluated the influence of removing specified risk materials and the alternation of age limits for testing cattle at the slaughterhouse on human exposure to the BSE agent in Japan by constructing a probabilistic risk model. A stochastic model using Monte Carlo simulation was constructed in order to estimate the BSE infectivity destined for the food chain from a single BSE-infected animal at slaughter. The impact of different testing strategies and risk material removal were then compared. Murine intra-cerebral ID50 (m.i.c. ID50) units were used as units for BSE infectivity. Sensitivity analysis was conducted for key input variables by changing values within plausible ranges. The expected fraction of BSE-infected cattle presented for slaughter that would be detected by screening tests was 20%, even if all slaughtered cattle were tested. The removal of risk materials reduced the median value estimate of infectivity destined for human consumption by 95%. Cattle screening tests reduced the infectivity further, but reduction efficacy did not differ among the various testing strategies. Sensitivity analysis indicated that the characteristics of BSE infectivity accumulation during the incubation period, extension of the incubation period, and lowering the detection limit of screening tests had no significant impact on relative infectivity reduction, which remained stable irrespective of testing strategy or changes in these parameters. This study suggests that the impact of changing the age limit for testing cattle on beef safety is small, provided that the removal of risk materials is conducted properly.

Abattoirs↗
PubMed2006

Studies on Aspergillus section Flavi isolated from maize in northern Italy.

In 2003, for the first time in Italy, significant problems arose with colonization and contamination of maize destined for animal feed with Aspergillus section Flavi and aflatoxins (AFs). This resulted in milk and derived products being contaminated with AFM(1) at levels above the legislative limit. There was little knowledge and experience of this problem in Italy. The objectives of this research were thus to study the populations of Aspergillus section Flavi in six northern Italian regions and obtain information on the relative role of the key species, ability to produce sclerotia, production of the main toxic secondary metabolites, aflatoxins and cyclopiazonic acid, and tolerance of key environmental parameters. A total of 70 strains were isolated and they included the toxigenic species A. flavus and A. parasiticus. A. flavus was dominant in the populations studied, representing 93% of the strains. Seventy percent of strains of Aspergillus section Flavi produced AFs, with 50% of strains also producing cyclopiazonic acid. Sixty-two percent of A. flavus strains and 80% of A. parasiticus were able to produce sclerotia at 30 degrees C. Using 5/2 agar, only 1 strain developed S sclerotia and 19 L sclerotia. With regard to ecological studies, growth of Aspergillus section Flavi was optimal at between 25 and 30 degrees C, while AFB(1) production was optimal at 25 degrees C. Regarding water availability (water activity, a(w)), 0.99 a(w) was optimal for both growth and AFs production, while the only aflatoxin produced in the driest condition tested (0.83 a(w)) was AFB(1). This information will be very useful in identifying regions at risk in northern Italy by linking climatic regional information to levels of fungal contamination present and potential for aflatoxin production in maize destined for animal feed. This would be beneficial as part of a prevention strategy for minimising AFs in this product.

Aflatoxins↗
PubMed2004

Prediction of gestational hypertension or intrauterine fetal growth restriction by mid-trimester 24-h ambulatory blood pressure monitoring.

OBJECTIVES: To investigate clinical impact of 24-h ambulatory blood pressure monitoring (ABPM) on the prediction of hypertensive disorders of pregnancy and IUGR. METHODS: ABPM was performed in 334 normotensive non-proteinuric nulliparous women at 20 weeks' gestation. Arterial blood pressure patterns were analyzed by chronobiometry. RESULTS: Women who developed idiopathic IUGR (21) or PIH (33) showed a 24-h diastolic blood pressure mean significantly higher than the controls (69.2+/-1.8 mmHg and 73.5+/-6.2 vs. 62.2+/-1.5). Women with subsequent IUGR also showed a modification in BP rhythm. The most effective cut-off levels of 24-h diastolic blood pressure mean proved to be 67 for IUGR and 68 for hypertension. CONCLUSIONS: ABPM in the second trimester reliably predicts idiopathic IUGR and PIH. Both patients destined to develop gestational hypertension and those destined to develop IUGR show similar elevations in 24-h diastolic mean at 20 weeks' gestation.

Adult↗
PubMed2006

End-to-end security in telemedical networks--a practical guideline.

The interconnection of medical networks in different healthcare institutions will be constantly increasing over the next few years, which will require concepts for securing medical data during transfer, since transmitting patient related data via potentially insecure public networks is considered a violation of data privacy. The aim of our work was to develop a model-based approach towards end-to-end security which is defined as continuous security from point of origin to point of destination in a communication process. We show that end-to-end security must be seen as a holistic security concept, which comprises the following three major parts: authentication and access control, transport security, as well as system security. For integration into existing security infrastructures abuse case models were used, which extend UML use cases, by elements necessary to describe abusive interactions. Abuse case models can be constructed for each part mentioned above, allowing for potential security risks in communication from point of origin to point of destination to be identified and counteractive measures to be directly derived from the abuse case models. The model-based approach is a guideline to continuous risk assessment and improvement of end-to-end security in medical networks. Validity and relevance to practice will be systematically evaluated using close-to-reality test networks as well as in production environments.

Access to Information↗