Diuretic lounge and the impact on hospital admissions for treatment of decompensated heart failure.

BACKGROUND: Heart failure is a prevalent condition associated with frequent and costly hospital admissions. Hospitalizations are primarily related to worsening fluid retention and often require admission for decongestion with intravenous diuretics. OBJECTIVE: To assess the safety of an outpatient intravenous diuresis service for heart failure patients, and its impact on emergency admissions and the cost of treatment. METHODS: We conducted a prospective observational cohort registry study on patients referred to the diuretic lounge at our acute hospital between May 2017 and April 2018. RESULTS: We analysed 245 patients treated in the diuretic lounge, of which 190 (77.6%) avoided hospitalization or any adverse events during the 60 days of follow up (77.6% vs. 22.4%; P < 0.001). The diuretic lounge service resulted in a significant decrease in emergency heart failure admissions compared to the previous 12 months (823 vs. 715 per annum; 68.6 ± 10.1 vs. 59.6 ± 14 per month; P = 0.04), and a numerical reduction in readmission rates (17.3% vs. 16.2%). The 13.1% decrease in admissions lead to financial savings of £315 497 per annum and £2921 per admission avoided. During the same time period, at the other acute hospital site in our trust, where no diuretic lounge service is available, the number of admissions did not significantly change (457 vs. 450 per annum; 37.5 ± 7.0 vs. 38.1 ± 7.6 per month; P = 0.81). CONCLUSION: Ambulatory administration of intravenous diuretics reduces emergency admissions and is a safe and cost-effective alternative to treat acute decomposition in heart failure patients.

Registry report of the prevalence of ECG abnormalities and their relation to patient characteristics in an asymptomatic population.

BACKGROUND: Cardiovascular disease is the leading cause of morbidity and mortality in developed countries. Many patients do not experience symptoms before a first major cardiovascular event. Resting electrocardiogram (ECG) may help identify asymptomatic individuals with a high risk of cardiovascular disease. OBJECTIVE: We sought to determine the prevalence of ECG abnormalities in an apparently symptom-free adult population within a prospective registry. METHODS: The registry consisted of 4739 consecutive apparently healthy individuals [age 62.8 ± 6.2 (SD) years; 54% female], referred by their General Practitioners between 2009 and 2013. Patient demographics, and clinical data were obtained, alongside blood tests and a resting ECG. RESULTS: ECG abnormalities were present in 1509 (31.8%) subjects and were commoner with increasing age (F = 0.161, p = 0.01), systolic (F = 0.134, p = 0.01) and diastolic (F = 0.44, p = 0.01) blood pressure and waist circumference (F = 0.53, p = 0.01). Left ventricular hypertrophy (LVH) was the most common abnormality (n = 281) and was positively associated with systolic (F = 0.12, p = 0.01) and diastolic blood pressure (F = 0.99, p = 0.01) and male gender (X2 = 60.5, p < 0.01). All ECG abnormalities (except for LVH) were associated with an increasing age, while right bundle branch block (F = 0.041, p = 0.01) and atrial fibrillation (n = 29; F = 0.036, p = 0.05) were associated with the presence of diabetes mellitus (n = 211). Only left bundle branch block (n = 50) was associated with angina (F = 0.05, p = 0.01). CONCLUSIONS: Unrecognized cardiac abnormalities are common in middle-aged men and women with no overt symptoms. ECG offers the potential to identify these abnormalities and provide earlier intervention and treatment, and possibly improve cardiovascular outcome.

INPP4B overexpression and c-KIT downregulation in human achalasia.

BACKGROUND: Achalasia is a rare motility disorder characterized by myenteric neuron and interstitial cells of Cajal (ICC) abnormalities leading to deranged/absent peristalsis and lack of relaxation of the lower esophageal sphincter. The mechanisms contributing to neuronal and ICC changes in achalasia are only partially understood. Our goal was to identify novel molecular features occurring in patients with primary achalasia. METHODS: Esophageal full-thickness biopsies from 42 (22 females; age range: 16-82 years) clinically, radiologically, and manometrically characterized patients with primary achalasia were examined and compared to those obtained from 10 subjects (controls) undergoing surgery for uncomplicated esophageal cancer (or upper stomach disorders). Tissue RNA extracted from biopsies of cases and controls was used for library preparation and sequencing. Data analysis was performed with the "edgeR" option of R-Bioconductor. Data were validated by real-time RT-PCR, western blotting and immunohistochemistry. KEY RESULTS: Quantitative transcriptome evaluation and cluster analysis revealed 111 differentially expressed genes, with a P ≤ 10-3 . Nine genes with a P ≤ 10-4 were further validated. CYR61, CTGF, c-KIT, DUSP5, EGR1 were downregulated, whereas AKAP6 and INPP4B were upregulated in patients vs controls. Compared to controls, immunohistochemical analysis revealed a clear increase in INPP4B, whereas c-KIT immunolabeling resulted downregulated. As INPP4B regulates Akt pathway, we used western blot to show that phospho-Akt was significantly reduced in achalasia patients vs controls. CONCLUSIONS & INFERENCES: The identification of altered gene expression, including INPP4B, a regulator of the Akt pathway, highlights novel signaling pathways involved in the neuronal and ICC changes underlying primary achalasia.

Downregulation of neuronal vasoactive intestinal polypeptide in Parkinson's disease and chronic constipation.

BACKGROUND: Chronic constipation (CC) is a common and severe gastrointestinal complaint in Parkinson's disease (PD), but its pathogenesis remains poorly understood. This study evaluated functionally distinct submucosal neurons in relation to colonic motility and anorectal function in PD patients with constipation (PD/CC) vs both CC and controls. METHODS: Twenty-nine PD/CC and 10 Rome III-defined CC patients were enrolled. Twenty asymptomatic age-sex matched subjects served as controls. Colonic transit time measurement and conventional anorectal manometry were evaluated in PD/CC and CC patients. Colonoscopy was performed in all three groups. Colonic submucosal whole mounts from PD/CC, CC, and controls were processed for immunohistochemistry with antibodies for vasoactive intestinal polypeptide (VIP) and peripheral choline acetyltransferase, markers for functionally distinct submucosal neurons. The mRNA expression of VIP and its receptors were also assessed. KEY RESULTS: Four subgroups of PD/CC patients were identified: delayed colonic transit plus altered anorectal manometry (65%); delayed colonic transit (13%); altered manometric pattern (13%); and no transit and manometric impairment (9%). There were no differences in the number of neurons/ganglion between PD/CC vs CC or vs controls. A reduced number of submucosal neurons containing VIP immunoreactivity was found in PD/CC vs controls (P<.05). VIP, VIPR1, and VIPR2 mRNA expression was significantly reduced in PD/CC vs CC and controls (P<.05). CONCLUSIONS AND INFERENCES: Colonic motor and rectal sensory functions are impaired in most PD/CC patients. These abnormalities are associated with a decreased VIP expression in submucosal neurons. Both sensory-motor abnormalities and neurally mediated motor and secretory mechanisms are likely to contribute to PD/CC pathophysiology.

Preparation, characterization and sorption properties for phosphates of hematite, bentonite and bentonite-hematite systems.

Hematite was prepared using Fe(NO3)3*9H2O. Bentonite was first saturated with sodium and then was transformed to the hydrogen form. The bentonite-hematite (b-h) system was prepared by the mixing of hematite and bentonite at pH 6.0, and a hematite-coated bentonite surface was created. The physical and chemical properties of the above solids were studied from the information given by X-ray, IR and NMR spectra and by measurement of specific surface and point of zero charge. The results of the above study show that the bentonite-hematite system is not a physical mixture of hematite and bentonite. Hematite moved into bentonite's interlayer space, coating these planes throughout. Consequently, Al-substitution and structural H2O/OH displacement of hematite took place. The system has a specific surface, less than bentonite and greater than hematite, while its p.z.c. is higher than bentonite and lower than hematite. Adsorption experiments of phosphates at different concentrations and pH were carried out and the constant capacitance model was used to describe phosphate adsorption by hematite, bentonite and the bentonite-hematite system. The model is characterized by a ligand exchange mechanism based on the assumption that the charge is attributed both on adsorbate and adsorbent, and is proven to successfully describe the adsorption of phosphate on these materials along with the effect of varying pH values. Ma-Za 1 and Ma-Za 2 (two computer programs) were used for this purpose. The model successfully gave a description (both quantitative and qualitative) of the adsorption of phosphate anions across the pH range (3.8-9.0). Furthermore, it can be successfully applied in systems as the bentonite-hematite system by utilizing the surface protonation-dissociation constant of hematite. The model, when applied in such systems, procreates the exact shape of the adsorption isotherms for the entire pH range of 3.8-9.0. The constant capacitance model was able to describe phosphorous adsorption on hematite and the bentonite-hematite system. The accurate fit of the model to phosphorous adsorption on hematite and the bentonite-hematite system suggests that inner sphere surface complexation is the appropriate adsorption mechanism for these materials.

The use of a monolithic column to improve the simultaneous determination of four cephalosporin antibiotics in pharmaceuticals and body fluids by HPLC after solid phase extraction--a comparison with a conventional reversed-phase silica-based column.

The use of a monolithic column (Chromolith, SpeedROD RP-18e, by Merck) was studied on the determination of cephalosporin antibiotics. Results were compared with those from a previously developed analytical method using conventional silica-based analytical column. A rapid, accurate and sensitive method has been developed and validated for the quantitative simultaneous determination of four cephalosporins: Cephalexine and Cephadroxil (first generation), Cefaclor (second generation) and Cefotaxim (third generation) in pharmaceuticals as well as in human blood serum and urine. Hydroflumethiazide (HFM) (3,4-dihydro-6(trifluoromethyl)-2H-1,2,4-benzothiadiazine-7-sulfonamide-1,1-dioxide) was used as an internal standard at a concentration of 1.5 ng/microL. A rectilinear relationship was observed up to 5 ng/microL for the four compounds. Analysis time was less than 4 min. The statistical evaluation of the method was examined by means of within-day repeatability (n=8) and day-to-day precision (n=8) and was found to be satisfactory with high accuracy and precision results. The method was applied to the determination of the cephalosporins in commercial pharmaceuticals and in biological fluids: human blood serum after solid phase extraction and urine simply after filtration and dilution. Recovery of analytes in spiked serum samples was in the range from 88.7 to 107.8%, while for urine samples recovery was from 98.0 to 105.6%. By comparing the figures of merit for the monolithic column and the silica-based one, regarding the determination of the four cephalosporins investigated in the present study, the outstanding efficiency of the monolithic column can be noticed.

Copper adsorption and Si, Al, Ca, Mg, and Na release from clinoptilolite.

Copper adsorption onto clinoptilolite (natural zeolite), Al/Si dissolution, and Mg, Ca, and Na release from the substrate were the subjects of the investigation described here. Experimental variables were Cu and electrolyte concentrations and solution pH. Copper adsorption was found to increase with increased pH and with decreased electrolyte concentration. Large amounts of K were also adsorbed from electrolyte. Since solution pH was assumed as a variable, the effects of [H(+)] differentiation on Cu adsorption and on Al/Si dissolution were also examined. Al dissolution was affected mainly by electrolyte concentration, whereas Si dissolution was affected mainly by adsorbed Cu amount. It was assumed that the release of Mg, Ca, and Na occurs through ion-exchange reactions with solution K(+), because their release is affected more by electrolyte concentration than by adsorbed Cu. From the study of FTIR spectra for various samples used in the present investigation, we observed that the removal of framework Si/Al shifts the band which was attributed to O-T-O stretching vibration toward higher frequency. Significant changes were observed for the bands assigned to Si-OH-Al bridges and to monomeric and polymeric hydrogen bonds at the region between 3650 and 3200 cm(-1). It is proposed that the Cu species caused the destruction of H-bonded structures, whereas K adsorbed species were located at exchangeable sites after an ion-exchange process between K and Ca, Mg, and Na from the zeolite's surface. An expansion of the zeolite framework was detected from XRD patterns under acid conditions.

[Dietary restriction and oral administration of antioxidant and omega-3: what are the effects on the clinical variables in a group of obese women?]. / La dietoterapia ipocalorica bilanciata personalizzata ed il trattamento con integratori a base di antiossidanti e omega-3 (quali gli effetti sulle variabili cliniche di outcome in un gruppo di donne in sovrappeso?)

BACKGROUND: Obesity is now recognized as a major risk factor for many pathologies. The state of obesity is associated with an increase in reactive oxygen species; persistent overconsumption of calories in the obese may be exposing them to excessive damage besides maintaining the state of obesity. It is possible that dietary modification and association with assumption of antioxidant and omega-3 oral integration contributes to a reduction in reactive oxygen species generation and a corresponding reduction in indexes of oxidative damage, including lipid peroxidation. METHODS: Given this back-ground, the pro/anti-oxidant balance, biochemical parameters and the body composition were studied in two groups of obese women: a first group of 10 obese women were studied before and after eight weeks of dietary restriction and a second group of 12 obese women were studied before and after eight weeks of dietary restriction and oral administration of antioxidant and omega-3. RESULTS: In summary, as regards the preliminary results of clinical outcome parameters, interestingly enough the glycemic levels fall markedly in association with both dietary restriction and oral integration with antioxidant and omega-3. Another important finding of this study is that of calcium levels and phase angle (measured by impedenzometry) increase in the group treated with dietary restriction and oral administration of antioxidant and omega-3. CONCLUSIONS: Studies that aimed to explore whether oxidative status predicts clinical outcome would provide important details on the putative link between oxidative status and state of obesity.

Infections in traumatic brain injury patients.

Traumatic brain injury (TBI) victims are considered to be at high risk for infection. The purpose of this cohort study was to delineate the rates, types and risk factors for infection in TBI patients. Retrospective surveillance of infections was conducted for all TBI patients, aged ≥18 years, cared for at the Department of Neurosurgery of the University Hospital of Heraklion, Greece, between 1999 and 2005. A total of 760 patients (75% men) with a median age of 41 years were included. Most (59%) were injured in a motor vehicle accident. One third of them underwent a surgical procedure. Two hundred and fourteen infections were observed. The majority were infections of the lower respiratory tract (47%), followed by surgical site infections (SSI) (17%). Multivariate analysis showed that SSI development was independently associated with the performance of ≥2 surgical procedures (OR 16.7), presence of concomitant infections, namely VAP (OR 5.7) and UTI (OR 8.8), insertion of lumbar (OR 34.5) and ventricular drains (OR 4.0), and cerebrospinal fluid (CSF) leak (OR 3.8). Development of meningitis was associated with prolonged hospitalization (OR 1.02), especially >7 days ICU stay (OR 25.5), and insertion of lumbar (OR 297) and ventricular drains (OR 9.1). There was a notable predominance of Acinetobacter spp. as a VAP pathogen; gram-positive organisms remained the most prevalent in SSI cases. Respiratory tract infections were the most common among TBI patients. Device-related communication of the CSF with the environment and prolonged hospitalization, especially in the ICU setting, were independent risk factors for SSIs and meningitis cases.

The Policy of our Clinic in Early Escharectomy in Burns of the Hand.

Early escharectomy in deep partial- and full-thickness burns of the hand has proved to have an advantage over late surgical treatment. It provides an improved functional and cosmetic result. Hand deformities, the need for secondary reconstructive procedures, and morbidity are significantly reduced. In our clinic we prefer to use early escharectomy in all full-thickness burns of the hand unless the patient's condition prevents it or unless the extent of the burns in the rest of the body would prevent improvement in the general outcome.

Phosphate Adsorption on Hematite, Kaolinite, and Kaolinite-Hematite (k-h) Systems As Described by a Constant Capacitance Model

The constant capacitance model was used to describe phosphate adsorption on hematite, kaolinite, and a kaolinite-hematite system (k-h). The model assumes a ligand exchange mechanism and considers the charge on both adsorbate and adsorbent. The model is shown to provide a quantitative description of phosphate adsorption on these, including the effect of varying pH values. The computer program Ma-Za 2, a program that fits equilibrium constants to experimental data using an optimization technique, was used to obtain optimal values for the anion surface complexation constants on hematite, kaolinite, and a kaolinite-hematite system, while the PC program Ma-Za 1 in Q-Basic language was used for the application of the constant capacitance model. The model represented adsorption of phosphate anions well over the entire pH range studied (3.8-9.0). The main advantage of the model is its ability to represent changes in anion adsorption occurring with changes in pH. Extension of the model to describe phosphate adsorption in a mixed system, such as the kaolinite-hematite system, using the surface protonation-dissociation constant of hematite was qualitatively successful. In mixed system the model reproduced the shape of the adsorption isotherms well over the pH range 3.8-9.0. However, phosphate adsorption was overestimated. The hematite and the kaolinite-hematite system were synthesized and identified by X-ray, NMR, and FT-IR spectroscopy.