Integrated Care Models for Managing and Preventing Frailty: A Systematic Review for the European Joint Action on Frailty Prevention (ADVANTAGE JA).

Frailty requires concerted integrated approaches to prevent functional decline. Although there is evidence that integrating care is effective for older people, there is insufficient data on outcomes from studies implementing integrated care to prevent and manage frailty. We systematically searched PubMed and Cochrane Library database for peer-reviewed medical literature on models of care for frailty, published from 2002 to 2017. We considered the effective and transferable components of the models of care and evidence of economic impact, where available. Information on European Union-funded projects or those registered with the European Innovation Partnership on Active and Healthy Ageing, and grey literature (including good practices) were also considered. We found 1,065 potential citations and 170 relevant abstracts. After excluding reports on specific diseases, processes or interventions and service models that did not report data, 42 full papers met the inclusion criteria. The evidence showed that few models of integrated care were specifically designed to prevent and tackle frailty in the community and at the interface between primary and secondary (hospital) care. Current evidence supports the case for a more holistic and salutogenic response to frailty, blending a chronic care approach with education, enablement and rehabilitation to optimise function, particularly at times of a sudden deterioration in health, or when transitioning between home, hospital or care home. In all care settings, these approaches should be supported by comprehensive assessment and multidimensional interventions tailored to modifiable physical, psychological, cognitive and social factors.

Ethanolic extract of Casearia sylvestris Sw exhibits in vitro antioxidant and antimicrobial activities and in vivo hypolipidemic effect in rats / Extrato etanólico de Casearia sylvestris Sw apresenta atividade antioxidante e antimicrobiana in vitro e efeito hipolipemiante em ratos

ABSTRACT: The Casearia sylvestris Sw (Flacourtiaceae) is a shrub that occurs in forests of Southern Brazil; its leaves are widely used in folk medicine as a depurative, analgesic, anti-inflammatory and antiulcerogenic agent. The objective of this study was to perform the phytochemical description and to evaluate the pharmacological activities (antimicrobial, antifungal, antioxidant and toxicity) of the ethanolic extract (EE) of C. sylvestris Sw. In addition, we also evaluated the effect of the EE of C. sylvestris Sw on the glucose levels and lipid profile in blood serum of rats submitted to a model of streptozotocin-induced diabetes. Material and Methods: In vitro assay: the detection of chemical groups was done through chemical reactions with the development of color or precipitate and by chromatographic profile; the antioxidant activity was measured by the method of reduction of DPPH free radical (2,2-diphenyl-1-picrylhydrazyl); the Minimum Inhibitory Concentration was evaluated by the broth microdilution method, and the Minimum Bactericide Concentration and the Minimum Fungicide Concentration were performed in Petri dishes; the cytotoxic activity was measured by the Artemia salina test. In vivo assay: diabetic and non-diabetic rats were treated with EE of C. sylvestris Sw (300 mg/kg) for 45 days, and the glycaemia and lipid profile were analyzed. Results: The EE showed a Lethal Dose50 of 724.76 μg.mL-1 and important antioxidant, fungicide and fungistatic activities. The EE showed better antimicrobial activity regarding the microorganisms Staphylococcus aureus, Escherichia coli and Salmonella setubal. Conclusion: The EE of C. sylvestris Sw produces a significant decrease in triglycerides, total cholesterol and VLDL levels without any significant alteration in the glycaemia. The EE of C. sylvestris Sw presents antioxidant and antimicrobial activities and it exhibits a potent hypolipidemic effect.

RESUMO: Casearia sylvestris Sw (Flacourtiaceae) é uma planta comumente encontrada em florestas do sul do Brasil; suas folhas são amplamente utilizadas na medicina popular como depurativa, analgésica, anti-inflamatória e anti ulcerogênica. O objetivo deste estudo foi apresentar uma descrição fitoquímica e da atividade farmacológica (antimicrobiana, antifúngica, antioxidante e toxicidade) do extrato etanólico (EE) da C. Sylvestris Sw. Adicionalmente, procurou-se avaliar o efeito do EE da C. Sylvestris Sw sobre os níveis séricos de glicose e perfil lipídico de ratos submetidos a um modelo de diabetes induzida por estreptozotocina. A detecção de grupos químicos foi realizada por reações químicas de coloração ou precipitação, e também por cromatografia; a atividade antioxidante foi mensurada pelo método de redução do DPPH (2,2-difenil-1-picril-hidrazil); a concentração mínima inibitória foi realizada pela técnica de micro-diluição, e concentração mínima bactericida e concentração mínima fungicida foram realizadas em placa de Petri; enquanto a atividade citotóxica foi conduzida pelo teste da Artemia salina. Nos ensaios in vivo, ratos diabéticos e não-diabéticos foram tratado com EE da C. Sylvestris Sw (300mg/kg) por 45 dias, e os níveis glicêmico e perfil lipídico foram medidos. A dose Letal50 do EE foi de 724.76 μg.mL-1; mostrando importante atividades antioxidante, fungicida e fungistática e melhor atividade antimicrobiana contra Staphylococcus aureus, Escherichia coli e Salmonella setubal. O EE da C. Sylvestris Sw promoveu diminuição significativa nos níveis de triglicerídeos, colesterol total e VLDL; porém sem efeito significativo nos níveis glicêmicos. O EE da C. Sylvestris Sw, além de apresentar atividade antioxidante e antimicrobiana; possui também potente efeito hipolipidêmico.

Spanish Society of Medical Oncology consensus on the use of erythropoietic stimulating agents in anaemic cancer patients

Treatment of anaemia is a very important aspect in the management of cancer patients. In order to carry out a consensus process about the use of erythropoietic stimulating agents (ESAs) in cancer patients, the Spanish Society of Medical Oncology (SEOM) elaborated a working group which coordinated a panel of medical oncology specialists. This working group has reviewed the main issues about the use of ESAs. In addition a consensus meeting was held in Madrid on 25 April 2007. The following conclusions were made: Since ESA treatment increases the haemoglobin (Hb) level and decreases the red blood cell (RBC) transfusion requirements, ESAs should be used within the approved indications in patients undergoing chemotherapy treatment, beginning at a Hb level below 11 g/dl and maintaining it around 12 g/dl, with iron supplements if necessary. Neither increasing the ESA dose in nonresponders nor the use of ESAs in the treatment of chronic cancer-related anaemia is recommended (AU)

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Índice analítico de la revista La Enciclopedia (1885-1887) / Analytic index of La Enciclopedia journal (1885-1887)

Durante el trienio de 1885 a 1887 circuló en La Habana una de las publicaciones periódicas cubanas de mayor prestigio entre todas las que, dedicadas a la Medicina y a sus disciplinas afines, se editaron en el período colonial. Esa publicación, titulada La Enciclopedia, guarda en sus páginas numerosos trabajos generados por prestigiosas personalidades de la época, con un contenido de alto valor histórico y científico, por lo que su colección constituye hoy día una genuina reliquia bibliográfica. Este artículo contiene un índice analítico del total de 516 trabajos publicados en La Enciclopedia durante los tres años exactos que se mantuvo en circulación para divulgar los resultados de la labor intelectual cubana en materia médica, farmacéutica, física, química y de las ciencias naturales en general. En este índice analítico se brinda, en primera instancia, la relación cronológica de todos esos trabajos, agrupados en una sección a la que se ha dado el nombre de sección bibliográfica. A continuación de ésta aparece la llamada Sección de autores, donde se pueden encontrar, en orden alfabético, los nombres de los firmantes de los trabajos y, seguidamente, la sección temática en la cual se registran, en una ordenación también alfabética, las materias, asuntos o temas específicos que se trataron en cada trabajo.

From 1885 to 1887, it circulated in Havana one of the most prestigious Cuban periodicals among all the ones devoted to Medicine and related disciplines that were published in the colonial period. This publication, entitled La Enciclopedia, which includes in its pages numerous works of high scientific and historic value generated by well-known personalities of that time, is a collection that constitutes nowadays a genuine bibliographical relic. This article contains an analytic index of 516 works published in La Enciclopedia during the three exact years that it circulated to spread the results of the Cuban intellectual work on chemistry, physics, pharmacy, medicine and natural sciences, in general. In this analytic index, a chronologic relation of all those works, grouped in a section entitled Bibliographical Section, is offered in the first place. Secondly, it appears the Authors Section, where the names of those who signed the works can be found in alphabetical order and, next, the Thematic Section in which the subjects or specific topics that were dealt with in each work are registered in an alphabetical order, too.

Intraoperative human vagus nerve compound action potentials.

OBJECTIVE: Although electrical stimulation of vagus nerve is used widely for treatment of epilepsy the electrophysiological properties of human vagus nerve are not well characterized. Our objective was to measure compound action potentials of human vagus nerve fiber groups intraoperatively by stimulation using a commercially available generator and electrode system (Neurocybernetic Prosthesis System, NCP). MATERIAL AND METHODS: During NCP implantation we recorded compound action potentials evoked by stimulating the left vagus nerve through the NCP bipolar lead. Current intensities were varied from 0.25 to 3.0 mA. RESULTS: Vagus nerve compound action potential components conducting in the A, Adelta, and C velocity ranges could be elicited using either the NCP pulse generator or by a standard evoked potential instrument. A fiber potentials were recordable in all nerves, and were activated by very low stimulus currents. Adelta and C fibers were less reliably elicited, with C fibers requiring the highest currents. CONCLUSIONS: Three clearly identified fiber populations can be identified using therapeutic electrical stimulation of the human vagus. Intraoperative measurements of NCP-induced action potentials may potentially provide a marker for therapeutic stimulation and better insight into mechanisms of vagus nerve stimulation (VNS) efficacy.

Revision and removal of stimulating electrodes following long-term therapy with the vagus nerve stimulator.

BACKGROUND: A significant concern about vagus nerve stimulation therapy has been the disposition of the spiral stimulating electrodes once treatment is considered ineffective or is no longer desired. Because the electrodes are wrapped around the vagus nerve, there is the potential for nerve injury during their removal. METHODS: We attempted removal of the spiral stimulating electrodes from 10 patients who received long-term vagus nerve stimulation therapy for drug-resistant epilepsy. In some patients, replacement with electrodes was also performed for poorly functioning leads. RESULTS: The mean duration of electrode implantation was 3.7+/-2.2 years (range 1.1-7.3 years). In seven patients, the old electrodes were removed completely from the nerve. No adverse events occurred intraoperatively or postoperatively. CONCLUSIONS: Our results indicate that the spiral electrodes may be safely removed from the vagus nerve, even after the electrodes have been implanted for several years. The reversibility of lead implantation may enhance the attractiveness of vagus nerve stimulation therapy for patients with medically-intractable epilepsy.

On lifting the fog of war in the battle on heart disease: Star Wars technology in pursuit of a seamless integration strategy.

In our efforts to reduce cardiac morbidity and mortality we often use terms such as the "battle" or "war" on heart disease. If we believe efforts to reduce cardiac disease are the moral equivalent of war, then perhaps we should explore ways that military strategic and tactical metaphors can be applied through technology to the cardiac battle. In this article we explore three major areas for technological advancement: adaptation of the strategies of outcomes management and evidence-based medicine, computer simulation and animation efforts to create horizontal and vertical integration of strategic efforts, and use of interactive multimedia in "recruiting an army" through community empowerment. The overall goal is to find ways to lift "the fog of war" in the battle on heart disease, in order to further the integration of our various efforts.

Use of distortion-product otoacoustic emissions for auditory evaluation in Menière's disease.

Otoacoustic emissions are a relatively new tool for assessment of inner ear function. We studied 65 patients diagnosed as having Menière's disease. In order to obtain and characterize responses at different frequencies we used distortion-product otoacoustic emissions (DPOAE). In unilateral cases, the difference in response between ears on the diseased and healthy sides was evident at all frequencies. In the former the result was lower than expected for a group of normally hearing subjects, while in the latter it was better than expected according to pure tone averages. Reduction in amplitude and increment in threshold of the DPOAE in the diseased ear was a significant finding and could be correlated to the stage of the disease. In those subjects treated with Betahistine after 1 year's follow-up, DPOAE testing showed the recovery of response at low frequencies and a reduction of its threshold at all frequencies studied.

Knowledge-based modeling of a legume lectin and docking of the carbohydrate ligand: the Ulex europaeus lectin I and its interaction with fucose.

Ulex europaeus isolectin I is specific for fucose-containing oligosaccharide such as H type 2 trisaccharide alpha-L-Fuc (1-->2) beta-D-Gal (1-->4) beta-D-GlcNAc. Several legume lectins have been crystallized and modeled, but no structural data are available concerning such fucose-binding lectin. The three-dimensional structure of Ulex europaeus isolectin I has been constructed using seven legume lectins for which high-resolution crystal structures were available. Some conserved water molecules, as well as the structural cations, were taken into account for building the model. In the predicted binding site, the most probable locations of the secondary hydroxyl groups were determined using the GRID method. Several possible orientations could be determined for a fucose residue. All of the four possible conformations compatible with energy calculations display several hydrogen bonds with Asp-87 and Ser-132 and a stacking interaction with Tyr-220 and Phe-136. In two orientations, the O-3 and O-4 hydroxyl groups of fucose are the most buried ones, whereas two other, the O-2 and O-3 hydroxyl groups are at the bottom of the site. Possible docking modes are also studied by analysis of the hydrophobic and hydrophilic surfaces for both the ligand and the protein. The SCORE method allows for a quantitative evaluation of the complementarity of these surfaces, on the basis of molecular lipophilicity calculations. The predictions presented here are compared with known biochemical data.

[Studies of aggregation using pairs of agonists in platelet concentrates stored for 5 days. Influence of autologous fresh plasma]. / Estudios de agregación con pares de agonistas en concentrados plaquetarios almacenados durante 5 días. Influencia del plasma fresco autólogo.

Aggregation was studied with synergistic agents on platelets stored for 5 days. Fixed concentrations of agonist agents, capable of inducing maximum response upon platelet concentrate (PC) preparations were used, and the results were compared with those achieved from samples previously incubated in fresh autologous plasma. Platelet aggregation on day 0 ranged between 77 +/- 3% with the combination epinephrine/ADP and 72 +/- 7% with collagen/ADP, these figures decreasing by the fifth day to 14 +/- 5% and 10 +/- 4%, respectively. The other paired aggregation agents were epinephrine/collagen and arachidonic acid (AA)/ADP; with these agents, similar values were attained on day 0, along with an analogous derangement of the response by the fifth day. With the last combination, the aggregation value attained on days 3 was 14 +/- 10% in experiments with the PC plasma, as opposed to 49 +/- 15% in assays with fresh plasma (p less than 0.001). Such difference persisted on day 5 and was thought to be due to competence of the high concentration of fatty acids generated in the PC plasma by AA. No differences induced by fresh plasma on the other agonist combinations were detected. These results suggest that some derangement of platelet function, conditioned by nonreversible alterations, and measured by paired agonist aggregation, may derive from storage.

Staining of Merkel cells of pig snout epidermis using the uranaffin reaction. Morphometric analysis of neuroendocrine granules.

The uranaffin reaction (UR) specifically stains neurosecretory (NS) granules of the neuroendocrine system when performed at pH 3.9 and at a 4% concentration of uranyl acetate. Merkel-cell NS granules stained using the UR were found to have a different appearance than granules observed after routine processing. We therefore compared the average values obtained with both methods, examining the maximum diameter, area, form factor, and numerical density of such NS granules. The maximum diameter and area of NS granules were significantly greater (P less than 0.001) in samples stained using a conventional technique (CT) (93.30 nm, 6,411 nm2) that in those stained with the UR (63.95 nm, 2,148 nm2). The form factor of conventionally stained NS granules (0.9) was significantly greater (P less than 0.001) than that of granules stained with the UR (0.7). No significant difference in numerical density was found for the two techniques (CT: 8.11 +/- 2.51; UR: 6.14 +/- 2.38). It was found that the UR is a useful cytochemical marker for NS granules of Merkel cells, and that the ultrastructural morphology and intracellular arrangement of NS granules stained with the UR are different from those revealed using CT.

Hypothalamic-pituitary-gonadal function in patients with myotonic dystrophy.

Gonadal function was studied in three post-pubertal siblings (two male and one female) and one unrelated male patient with myotonic dystrophy. The diagnosis was confirmed in all cases by electromyography and muscle biopsy. Basal levels of plasma immunoreactive LH, FSH, testosterone, and estradiol were measured. Hypothalamic, pituitary, and gonadal reserve and responsiveness were evaluated by clomiphene, LHRH, and HCG tests. Histologic examination of gonadal biopsies was also performed. The results showed that gonadal failure present in the four patients had different characteristics. In the same family, hypothalamic amenorrhea was observed in the female patient, and hypothalamic eunuchoidism and hypergonadotropic hypogonadism with marked tubular and leydig cells failure in the male patients. The non-related male patient had hypergonadotropic hypogonadism with tubular failure but with a compensatory leydig-cell hyperplasia. These data are interpreted as demonstrating different expressivity of the hypogonadism associated with the same inherited muscle disease.