Allopurinol use is associated with greater functional gains in older rehabilitation patients.

INTRODUCTION: the xanthine oxidase system produces reactive oxidative species and its inhibition by allopurinol has been shown to have beneficial effects on cardiovascular function. Oxidative stress has also been implicated in the development of sarcopenia. Allopurinol, a xanthine oxidase inhibitor, both reduces oxidative stress and acts as a potential oxygen-sparing agent. We examined the association between allopurinol use and functional outcomes after rehabilitation in a cohort of older people. METHODS: analysis of routinely collected clinical data from a single rehabilitation unit. Data were prospectively collected on all admissions to the Dundee Medicine for the Elderly rehabilitation unit between 1 January 1999 and 31 December 2008. Multivariate analyses were performed to examine the difference between the 20-point Barthel score on admission and discharge, adjusting for age, sex, admission Barthel score, anti-platelet use and comorbid disease. RESULTS: a total of 3,593 patients were included in the analysis and 3% of patients were taking allopurinol on discharge (n = 102). Improvement in Barthel scores was greater in the allopurinol group than the non-allopurinol group (4.7 versus 3.6 points, mean difference 1.1, 95% CI: 0.4-1.8, P = 0.002). When adjusted for age, sex, admission Barthel, presenting disease and number of drugs on discharge, improvement in the Barthel score was still greater in the allopurinol group (4.8 versus 3.8 points, mean difference 0.94, 95% CI: 0.3 to 1.6, P = 0.006). CONCLUSIONS: this retrospective observational study suggests that allopurinol use is associated with a greater degree of improvement in function as measured by the Barthel score during rehabilitation in an older inpatient population. Prospective randomised controlled trials are required to further investigate this finding.

Association between statin medication use and improved outcomes during inpatient rehabilitation in older people.

BACKGROUND: statin drugs may induce skeletal myopathy, but might also have the potential to improve rehabilitation outcomes by improving sarcopenia or by preventing intercurrent illness. We examined the association between statin use and functional outcomes in the rehabilitation of older people. METHODS: retrospective cohort study using routinely collected clinical data. Admissions to Royal Victoria Hospital, Dundee for inpatient rehabilitation over a 10-year period were identified. Data were available regarding demographics, statin therapy, antiplatelet therapy, admission and discharge Barthel scores, length of stay and comorbid disease. Multivariate analyses were performed to examine the difference between admission and discharge Barthel score in patients taking statins compared with those not taking statins. RESULTS: a total of 3,422 patients were included. Mean age was 81.4 years; 40% were male. Baseline Barthel scores were similar in the statin/non-statin groups, respectively (10.4/20 versus 10.3/20, P = 0.57). Improvement in the Barthel score between admission and discharge was greater in the statin than non-statin group (3.59 versus 4.30 points, P < 0.001) after adjustment for age, sex, baseline Barthel score and comorbid disease. CONCLUSION: statin use was associated with improved Barthel scores on discharge from rehabilitation. This gain could contribute to improved outcomes as part of the rehabilitation package and requires further prospective investigation.

Trends in function and postdischarge mortality in a medicine for the elderly rehabilitation center over a 10-year period.

OBJECTIVES: To ascertain trends in function and mortality after admission to a medicine for the elderly rehabilitation unit, and to analyze factors associated with these outcomes. DESIGN: Retrospective cohort analysis of routinely collected clinical data during the period from January 1, 1999, to December 31, 2008. SETTING: Hospital-based medicine for the elderly rehabilitation unit. PARTICIPANTS: Patients (N=4449) admitted for rehabilitation after medical and surgical illness, stroke, and fractured neck of the femur. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Analysis of routinely collected clinical data: admission and discharge Barthel scores; indices of cognitive impairment, mental illness, swallowing and feeding difficulties. Discharge diagnoses, place of discharge, date of death, and discharge medications were analyzed, along with length of stay. Regression analysis of factors associated with improvement in Barthel score, place of discharge, and postdischarge mortality. RESULTS: Length of stay and admission Barthel scores were unchanged over the study period, but discharge Barthel scores improved from 13.5 (maximum score, 20) in 2002 to 14.8 in 2008 (P=.002 for trend). Discharge to home increased from 290 (61%) of 472 patients in 2001 to 290 (76%) of 382 patients in 2007 (P<.001 for trend). Age, admission Barthel score, cognitive impairment, problems with understanding, and problems with expression were independent predictors of the change in Barthel score between admission and discharge. The adjusted hazard ratio for postdischarge mortality in 2007 to 2008 compared with 1999 to 2000 was .76 (95% confidence interval, .63-.93). CONCLUSIONS: Functional and mortality outcomes improved over a 10-year period in this rehabilitation unit, despite similar Barthel scores on admission and equivalent lengths of stay.

Integral membrane proteins in the mitochondrial outer membrane of Saccharomyces cerevisiae.

Mitochondria evolved from a bacterial endosymbiont ancestor in which the integral outer membrane proteins would have been beta-barrel structured within the plane of the membrane. Initial proteomics on the outer membrane from yeast mitochondria suggest that while most of the protein components are integral in the membrane, most of these mitochondrial proteins behave as if they have alpha-helical transmembrane domains, rather than beta-barrels. These proteins are usually predicted to have a single alpha-helical transmembrane segment at either the N- or C-terminus, however, more complex topologies are also seen. We purified the novel outer membrane protein Om14 and show it is encoded in the gene YBR230c. Protein sequencing revealed an intron is spliced from the transcript, and both transcription from the YBR230c gene and steady-state level of the Om14 protein is dramatically less in cells grown on glucose than in cells grown on nonfermentable carbon sources. Hydropathy predictions together with data from limited protease digestion show three alpha-helical transmembrane segments in Om14. The alpha-helical outer membrane proteins provide functions derived after the endosymbiotic event, and require the translocase in the outer mitochondrial membrane complex for insertion into the outer membrane.