Change in Red Blood Cell Distribution width During the Last Years of Life in Geriatric Patients.

OBJECTIVES: Most of the studies that evaluate the association between red blood cell distribution width (RDW) and mortality assess it on a single occasion instead of doing so through serial measurements. Very few studies have investigated repeated measurements of RDW and its prognostic value, and most of them are focused on patients with cardiovascular diseases. RDW is a dynamic value so we aimed at determining the prognostic value of sequential RDW assessment in the last years of life in patients enrolled in a Department of Geriatrics. DESIGN: This work is part of a prospective study derived from a cohort of 122 patients over 75 years hospitalized in 2005 for the purpose of assessing the prognostic significance of several comorbidity and prognostic indices. SETTING: Patients were consecutively recruited for the study at admission in a tertiary hospital and then followed up for at least 5 years. PARTICIPANTS: A total of 55 patients with repeated RDW assessments during all the five years before their death were selected from the total cohort of 122 patients. RESULTS: We found a strong correlation between progressive rise in RDW and mortality risk, especially during the last year of life. There was a gradual significant increase in the RDW values along the last five years of life, with means growing up from 14,8 (95% CI: 13,98-15.62) to 16,37 (15,80-16,94). CONCLUSION: In our cohort of geriatric patients, RDW is a dynamic variable that is modified during the last five years of life, irrespective of their age, and especially during the last year.

Evolution of composition of dairy manure supernatant in a controlled dung pit.

Anaerobic conversion of dairy manure into biogas is an attractive way of managing this waste. It is well known that the hydrolysis of large molecules into small, directly biodegradable ones is the rate limiting step of the overall anaerobic process. The present work studies the development of the hydrolytic and acidogenic stages of dairy manure with different solid concentrations (40, 60 and 80 g VS/L) at ambient temperature (20 degrees C). The purpose was to determine the operational conditions that provide a liquid fraction with a high soluble chemical oxygen demand (COD) and a high volatile fatty acids (VFA) content in manure before the methanogenic stage starts up. At 20 degrees C, the evolution of the studied parameters showed that, in a controlled plug-flow dung pit, the hydrolytic and acidogenic stages progressed moderately in a continuous way during the 25 days that the experimentation lasted, whereas no methanization was observed. Supernatant COD and VFA concentrations increased 30% and 107%, respectively, for the 60 g VS/L samples. Manure was also operated at 35 degrees C with a similar increase in supernatant COD but a higher increase in VFA, 154%. For both operational temperatures, the predominant VFAs were, in this order, acetic, propionic and butyric acids. During the operation at 35 degrees C, the methanogenic stage started between days 20 and 25 for the samples with lower solids content, i.e. 40 and 60 g VS/L.

[Experimental models on hemorragic shock]. / Modelos experimentales sobre shock hemorrágico.

This review addresses the pathophysiology and treatment of hemorrhagic shock, a condition produced by rapid and significant loss of intravascular volume. Hemorrhagic shock may lead sequentially to hemodynamic instability, decreases in oxygen delivery, decreased tissue perfusion and cellular hypoxia. Multiple organ failure, a systemic inflammatory process that leads to dysfunction of different vital organs, is a frequent complication after hemorrhagic shock and accounts for a high incidence of mortality. The pathogenesis of organ injury secondary to hypovolemic insults is still not completely understood, but both experimental studies and clinical observations indicate that macrophages are activated by translocated endotoxin-bacteria and ischemia/reperfusion. Activated Kupffer cells release pathologically active substances such as inflammatory cytokines, reactive oxygen species, and nitric oxide, all of which may participate in the mechanisms of hemorrhagic shock. Moreover, increased free radical production during hemorrhagic shock and resuscitation gives place to an increase in oxidative stress that would contribute to the organ damage. In the last few years, a number of experiments have been performed in an attempt to understand the pathophysiology and treatment of hemorrhagic shock. Different studies have shown positive effects on hemorrhagic shock treatment by antioxidant, amino acid, and lipid administration.

The Spanish Protocol for radiological surveillance of metal recycling: a collaboration of government and industry.

The presence of radioactive materials in scrap metal has been detected relatively often in recent years. As a result of an accidental melting of a 137Cs source in a Spanish steel mill (Acerinox) in 1998, the national authorities, the involved private companies, and the main trade unions drafted a protocol for prevention of and responding to such events ("Spanish Protocol"). The Protocol was signed in 1999. The number of subscribing companies is 90. The Protocol is a voluntary agreement defining the radiological surveillance of scrap metal and its products and the duties and rights of the signatories. From the effective date of the Protocol to December 2004, 461 pieces of ferric scrap were detected including sources of radiation and contaminated metal. Four melting incidents have happened in different companies.