The Prevalence of Frailty by the FRAIL-NH Scale in Taiwan Nursing Home Residents.

INTRODUCTION: The prevalence of frailty defined by FRAIL-NH varies among different studies in nursing homes, ranging from 19.0% to 75.6%. This study investigated the prevalence of frailty in a nursing home in Taiwan using different diagnostic criteria for frailty. METHODS: The 7-item FRAIL-NH scale was used for assessing frailty. There are 7 components: fatigue, resistance, mobility, incontinence or disease, weight loss, eating style and assistance with dressing. Each item is worth 0, 1, or 2 points for a total score of 14 points. We sorted and summarized the patients, according to the number of variables, into the not frail, frail, and most frail groups. Descriptive analysis was applied to understand the basic attributes of the elderly with different degrees of frailty, the influencing factors of frailty, and the occurrence of frailty. RESULTS: Our final sample included 34 residents. They were aged between 56 and 100 years (mean age 83.91 ± 10.84), and 18 (52.94%) were female. The frail group revealed a higher prevalence of males than of females. The marital status composition of participants was as follows: 2 (5.88%) unmarried, 24 (70.59%) married, and 8 (23.53%) widowed. The mean FRAIL-NH score was 5.79±3.72. CONCLUSIONS: A significant prevalence of frailty defined by FRAIL-NH was observed in a nursing home in Taiwan. Our findings indicate that frailty is an important issue in nursing homes. Further prospective cohort studies using FRAIL-NH evaluation are warranted.

Serum white blood cell count and pulmonary function test are negatively associated.

INTRODUCTION: A variety of inflammatory disorders influence the serum white blood cell (WBC) count. Elevated systemic inflammatory insult may contribute to impaired lung function, such as obstructive or restrictive lung disease. The aim of our study is to investigate the correlation between WBC count and pulmonary function. MATERIAL AND METHODS: Eligible participants aged ≥18 years (n=16 312) were enrolled from the United States National Health and Nutrition Examination Survey III, 1988-1994. Pertinent information including pulmonary function test, demographics, WBC count, glucose, C-reactive protein and a personal health questionnaire were obtained for subjects without known pulmonary diseases. White blood cell counts were classified into quartiles over the normal range. Multiple hierarchical regression models and trends testing were used to assess the correlation between WBC counts and pulmonary function tests. RESULTS: In the unadjusted mode of quartile-based analysis, the beta coefficients interpreted as the differences in FEV1% predicted upon comparing subjects in the upper three quartiles of WBC count to those in the lowest quartile were -0.007, -0.022 and -0.041 (P<0.001). After adjusting for multiple pertinent covariates, inverse association between quartiles of WBC count and FEV1% predicted remained essentially unchanged. The negative trends between FEV1% predicted and WBC count quartiles in the stratified comparison with extended-model approach were statistically significant (P for trends<0.001) in quartile-based multiple linear regression. CONCLUSIONS: Elevated WBC count is independently associated with declined pulmonary function. It may be a simple, accessible and inexpensive indicator of changes in pulmonary function.

Antibacterial silver-containing silica glass prepared by ion implantation.

Recently, there is much interest in nanocomposites consisting of metal nanoparticles dispersed in dielectric matrix. Silver is the first candidate used in antibacterial research. In the present study, sliver-containing silica glass is prepared by ion implantation. The bactericidal properties of Ag-implanted samples are investigated using E. coli. The implanted samples are characterized by optical absorption spectroscopy, atomic force microscopy and transmission electron microscopy. The size and position of the silver nanoparticles formed by ion implantation can be optimized by adjusting the implanted process parameters. All the implanted samples show antibacterial properties. But the samples with silver nanoparticle-enriched surfaces possess excellent antibacterial properties in comparison with other implanted samples. This indicates that ion implantation is a potential method for synthesizing antibacterial biomaterials.

Synthesis and Magnetic Properties of Maghemite (gamma-Fe(2)O(3)) Short-Nanotubes.

We report a rational synthesis of maghemite (gamma-Fe(2)O(3)) short-nanotubes (SNTs) by a convenient hydrothermal method and subsequent annealing process. The structure, shape, and magnetic properties of the SNTs were investigated. Room-temperature and low-temperature magnetic measurements show that the as-fabricated gamma-Fe(2)O(3) SNTs are ferromagnetic, and its coercivity is nonzero when the temperature above blocking temperature (T(B)). The hysteresis loop was operated to show that the magnetic properties of gamma-Fe(2)O(3) SNTs are strongly influenced by the morphology of the crystal. The unique magnetic behaviors were interpreted by the competition of the demagnetization energy of quasi-one-dimensional nanostructures and the magnetocrystalline anisotropy energy of particles in SNTs.

Peripartum cardiomyopathy--a case report.

Peripartum cardiomyopathy in the form of congestive heart disease of unknown etiology appears relatively rarely during the last month of pregnancy or within 5 months after delivery, and it is potentially life-threatening. This case report describes a 34-year-old female, G4P1, at 36 weeks' gestation who was admitted for cesarean section under lumbar epidural anesthesia due to twin pregnancy. She had no past history of cardiovascular diseases. However, rapid onset of dyspnea at ward and acute cardiac failure developed 15 h after cesarean section. Peripartum cardiomyopathy was diagnosed. After a 7-day intensive treatment she was discharged. Since then she was symptom-free and her two babies were doing well during a period of one more years after discharge.

Does augmented growth impose an increased risk of fetal death?

OBJECTIVE: Our purpose was to examine the risk of fetal death associated with augmented fetal growth. STUDY DESIGN: All live births recorded in Virginia between January 1, 1991, and December 31, 1993, were examined. Mortality rates were examined for infants born at or beyond 24 weeks' gestational age with weights between the 75th and 90th percentiles, from the 90th to the 95th percentile, and >95th percentile. RESULTS: Mortality rates were found to rise only slightly with birth weights >90th percentile. A recorded diagnosis of maternal diabetes, however, was associated with a significant risk in the presence of augmented fetal growth. Augmented fetal growth without maternal glucose intolerance showed no increase in mortality. CONCLUSION: Augmented fetal growth in the absence of maternal glucose intolerance appeared not to be associated with a significant increase in the risk of death among these births. Increased risk was found when augmented fetal growth was associated with maternal diabetes.

Epidural anesthesia for emergency caesarean section in a patient with single ventricle and aortic stenosis.

A 24-year-old parturient with single ventricle and moderate aortic stenosis was admitted due to preeclampsia and fetal distress at 31 weeks' gestation. Emergency Caesarean section was performed under lumbar epidural anesthesia and epidural analgesia was given for post-operative pain control. Mother and baby both survived. The anesthetic techniques and managements in other parturients with similar congenital cardiac anomalies are also reviewed and described.

A selective aggressive approach to the neonate exposed to meconium-stained amniotic fluid.

OBJECTIVE: We attempted to determine the effect on meconium aspiration syndrome from a selective approach of neonatal endotracheal intubation in meconium-exposed fetuses. STUDY DESIGN: All pregnancies delivered at the Medical College of Virginia in 1990 were included. Meconium was noted at membrane rupture and qualified as thick, moderate, or thin. Neonates underwent suctioning with a DeLee device at delivery. They were observed without endotracheal intubation if they fulfilled the following criteria: vaginal delivery, gestational age > 37 weeks, birth weight > 2500 gm, and anticipated Apgar score > or = 8 at 1 minute. RESULTS: Of 4289 deliveries, 659 were exposed to meconium and 48% of infants were intubated. Birth weights, gestational ages at delivery, and umbilical arterial pH were similar between intubated and nonintubated neonates. Neonatal intensive care unit admissions were significantly higher in intubated neonates. All 9 neonates diagnosed with meconium aspiration syndrome were intubated at birth. CONCLUSIONS: Utilization of this protocol resulted in reduction of neonatal intubation. Meconium aspiration syndrome did not occur in the nonintubated group.

Comparison of culture and rapid enzyme immunoassay for the detection of group B streptococcus in high-risk pregnancies.

OBJECTIVE: The purpose of this study was to evaluate the Equate Strep B(R) test for clinical use in patients at high risk for complications from group B streptococcus (GBS) disease. METHODS: Vaginoperineal swabs were obtained from patients with preterm premature rupture of the membranes and/or preterm labor and semiquantitative GBS cultures and Equate(R) assay were performed. RESULTS: From May 14, 1990, to April 30, 1992, 650 patients were enrolled; 626 had both culture and Equate(R) results available, of whom 24% were colonized with GBS. The sensitivity, specificity, positive predictive value, and negative predictive value of the rapid assay were 28%, 84%, 35%, and 79%, respectively. Although the prevalence of GBS was higher in patients with ruptured membranes compared with those with intact membranes, rupture of membranes did not affect test sensitivity or specificity. CONCLUSIONS: We conclude that the Equate(R) rapid assay is not a sensitive method of GBS detection in high-risk patients.

Maternal disease and injury in pregnancy.

Progress in the management of medical disorders of pregnancy has occurred in many areas. Only salient features are reviewed. The pathophysiology of maternal hyperglycemia in diabetes and its effects on the fetus are explored. Antiphospholipid antibodies, implicated in adverse pregnancy sequelae, come under closer scrutiny in terms of management and correlation with outcome. Studies defining a need for a strict diet for optimal neonatal outcome are presented regarding maternal phenylketonuria. Coagulopathies including protein C deficiency and deep venous thrombosis are reviewed for their impact on pregnancy. Uncommon disorders including cerebrovascular accidents, ureteric obstruction, and myocardial infarction are discussed in relation to management and outcome in pregnancy.

Obstetric complications in a patient with Bernard-Soulier syndrome.

We describe the obstetric complications and management of a patient with Bernard-Soulier syndrome. Severe bleeding at the time of delivery and delayed postpartum hemorrhage were prominent features of her pregnancies. Further complicating this woman's pregnancies was the development of antibodies to platelet glycoprotein IB/IX, leading to neonatal alloimmune thrombocytopenia.

Precision of umbilical artery Doppler studies. Intraobserver, interobserver, and biologic variability of fetal Doppler velocimetry.

The use of Doppler ultrasound to study fetal blood flow has become commonplace, despite the lack of detailed evaluation of the testing tool for precision. In evaluation of 25 patients, no significant intraobserver differences were found between readings on an individual waveform, nor were there significant differences between different observers on individual waveforms. Temporally separated waveforms within a 30-minute window gave the greatest variation. A multi-way analysis of variance noted significant differences in this category only. This study confirmed the precision of measurements by a single observer and between observers. Only biological alterations over time displayed significant variability.

Lower serum osteocalcin in ethanol-fed rats.

Serum osteocalcin was remarkably and significantly (-34 and -41% in two separate experiments; p less than 0.001) lower in rats fed an 8% (w/v) ethanol liquid diet (ELD) for 1 week than in rats fed an isocaloric control liquid diet (CLD). In a longer experiment that spanned 4 weeks, the ELD rats were given 6% ethanol on day 4, increased stepwise to 8% by day 9, and then maintained at 8% until day 28, when the experiment was terminated. Again, serum osteocalcin was much lower (-32%, p less than 0.001) in the ELD-fed rats than in CLD-fed rats. Even in rats fed only a 6% ELD for 12 days, serum osteocalcin was lower (-33%, p less than 0.001) than in controls. Also, the femora were weaker, more compliant, and more ductile in ELD-than in CLD-fed rats, findings that confirmed our earlier, related work. The fall in serum osteocalcin in ELD-fed rats is associated with a fall in femur ash weight and bone strength. There were significant correlations between serum osteocalcin and bone strength (r = 0.80; p less than 0.001) and between serum osteocalcin and bone stiffness (r = 0.83; p less than 0.001). Serum ionized calcium, like osteocalcin, was consistently lower in rats given ethanol for 1 or 4 weeks than in controls. From these experiments we conclude that excessive ethanol consumption inhibits osteoblastic activity as indicated by the reduced serum osteocalcin. The inhibition is also associated with other deleterious effects of ethanol on bone, including ash weight, bone strength, and bone stiffness.(ABSTRACT TRUNCATED AT 250 WORDS)

An integrated, hospital information system based obstetrical medical record and database.

Described in this paper is the implementation and integration of an obstetrical medical record and database into an existing hospital information system. A unique feature of this system was the integration of existing data captured by the established hospital information systems with the newly implemented obstetrical database to form a complete patient data profile. This complete database integrated data from hospital functions such as demographic data obtained at patient registration, outpatient visits and tests, inpatient admission historical data, tests and procedures, newborn data and miscellaneous data required for birth registration. An important second feature was the utilization of physicians and nurses to enter the obstetrical data. This permitted immediate access to patient data from any hospital information system terminal, immediate retrieval for generating reports, and subsequently, ad hoc queries, statistical analysis and the electronic transfer of birth registration data to the State Vital Statistics Registry.

Prevalence of human papillomavirus infections in term pregnancy.

The prevalence of human papillomavirus (HPV) infections in the lower genital tracts of pregnant and nonpregnant women was studied. Cervical and vaginal exfoliated cells were obtained during a routine pelvic examination in 45 pregnant women in early labor, and in 44 nonpregnant women. A detailed questionnaire with emphasis on sexual history and sexually transmitted diseases was administered. The two groups of women were comparable with respect to mean age, prior pregnancy experiences, and number of lifetime sexual partners. Compared with pregnant women, the nonpregnant women had a more frequent history of sexually transmitted diseases (61% versus 39%; p = 0.06), and of genital warts (16% versus 0%; p = 0.01). Utilizing Southern transfer and hybridization with 32P-labeled viral DNA probes for HPV types 6, 11, 16, 18, and 31, DNAs extracted from cervicovaginal exfoliated cells were assessed for HPV genomic sequences. HPV genomic sequences were identified in 25% of nonpregnant women compared with 13.5% of term pregnant women. This difference was not statistically significant (p = 0.26). Six HPV isolates identified in pregnant women were distributed as follows: type 6/11, 1; type 16, 1, type 31, 1; and unknown type, 3. Eleven isolates were identified in nonpregnant women and were distributed as follows: type 6/11, 2; type 16, 6; type 18, 2; and type 31, 1. HPV type 6/11, the type responsible for laryngeal papillomatosis of juvenile onset, was identified in 2% of the pregnant population and accounted for only one of six isolates. HPV DNA-positive pregnant and nonpregnant women were predominantly asymptomatic and had normal Papanicolaou smears and normal clinical examinations.

Vulvar leiomyosarcoma in pregnancy.

To our knowledge, this is the first case of vulvar leiomyosarcoma occurring during pregnancy to be reported. The neoplasm was resected immediately after a term vaginal delivery. A wide local excision of the vulva with bilateral superficial inguinal node sampling was performed 6 weeks post partum. Four previous cases of vulvar sarcoma occurring in pregnancy are reviewed. The need to perform biopsy of vulvar lesions during pregnancy is emphasized.

Evaluation of inhospital cardiopulmonary resuscitation.

Of 77 patients who received cardiopulmonary resuscitation (CPR) for an inhospital cardiac arrest from Jan. 1987 to Mar. 1988. 48(68%) survived the initial resuscitation, but only 11(16%) survived to leave hospital. A follow-up survey to Oct. 1988, of these 11 patients showed that one died within 11 months of discharge, but that others were all alive and living independently. The major cause of cardiopulmonary arrest was airway obstruction. Survival rates were lower if resuscitation efforts lasted more than 30 minutes or if the event occurred between midnight and 8:00 AM. Thirty of the 48 patients who were successfully resuscitated initially were transferred to the intensive care unit for prolonged cardiac life support. Of the patients who had underlying disease or severe neurologic impairment due to hypoxic encephalopathy, 19(63%) were dead within a few days or even hours after CPR. Therefore, we recommend (1) programs for routine CPR assessment (2) extension of CPR training for key personnel, especially ward staff working night shifts (3) assessment by CPR providers as to whether or not to continue or to give DNR (do-not-resuscitate) orders.

Influence of ethanol on stiffness, toughness, and ductility of femurs of rats.

Recently, we reported that the ingestion of alcohol in rats reduced the mechanical strength of femurs. Our results showed that, as the dose exceeded 0.012 g of ethanol per gram of body weight, a significant (p less than 0.001) loss of "strength" occurred that was independent of sex according to the relationship, Strength (N) = 140.4 - 6003 dose (g/g). In the present effort, the same flexure tests were reevaluated to include the parameters of stiffness, toughness, and ductility. These latest results confirm that the femurs of rats fed an ethanol liquid diet for 4 weeks are not only weaker but also more compliant and less energy absorbing. Although the femurs of rats fed ethanol are more ductile, the bones are more prone to fracture in fatigue and impact circumstances as well as under simple loading situations. The rat may be an appropriate model to study the mechanisms that lead to the higher incidence of fractures in the alcoholic human.

Ethanol-induced changes in morphology and strength of femurs of rats.

Chronic ingestion of ethanol resulted in ultrastructural and mechanical changes in rat femurs. Scanning electron microscopy of the distal end of the femur revealed that the trabeculae of bones from ethanol-fed rats were thinner, more columnar, and more extensive than those from control rats. Three-point bending tests of the rat femurs showed that the maximum force or so-called "strength" required to break the bone was less in ethanol- than in control-fed animals. A significant inverse correlation was observed between the strength required to break the femur and the dose of ethanol calculated on a body weight basis. For the first time our study presents quantitative proof that a relationship exists between bone strength and the consumption of ethanol in rats. The study revealed that ethanol consumption resulted in a weaker femur compared to controls. We suggest that a common mechanism may be responsible for the decreased bone strength of ethanol-fed rats and the increased incidence of fractures in human alcoholics.

Modulation of serum parathyroid hormone and ionized calcium concentrations during reproduction in rats fed a low calcium diet.

Moderate dietary restriction of calcium (0.1% Ca) was used to accentuate the changes in serum immunoreactive parathyroid hormone (iPTH) that had been reported earlier in lactating rats fed 0.4% Ca diet. In addition, the effects of this low-Ca diet on serum total and ionized Ca and iPTH during pregnancy, extended lactation, and weaning were examined. The positive correlation between serum total and ionized Ca was highly significant (r = 0.88, p less than 0.001, n = 120). Serum iPTH was significantly higher (36%) in pregnant rats on the day of parturition compared to nonmated controls, and there was a concomitant decrease in both total and ionized serum Ca. Within 1 day after parturition, however, serum Ca had risen to the control level. Serum iPTH remained significantly elevated during the first 2 weeks of lactation, and increased further during the third week of lactation to a level more than twice that of nonlactating controls. Serum Ca fell gradually during the second week of lactation. The high serum iPTH levels were maintained for another 2 weeks when lactation was extended with foster litters. Within 6 hr of removal of the suckling pups on day 16 of lactation, maternal serum ionized and total Ca had risen and serum iPTH had fallen; all three parameters were at levels similar to those of nonmated controls by 24-48 hr after weaning. The data suggest that serum ionized Ca is a major factor contributing to the hyperparathyroid state during lactation in rats fed a low-Ca diet.