Catalytic Properties of Zirconocene-Based Systems in 1-Hexene Oligomerization and Structure of Metal Hydride Reaction Centers.

Despite large-scale investigations of homogeneous single-site metallocene catalysts and systems based on them, there are still unsolved problems related to the control of their activity and chemo- and stereoselectivity. A solution to these problems is required to develop efficient methods for the synthesis of practically useful products of alkene transformations, such as dimers, oligomers, and polymers. Here we studied the catalytic activity of structurally diverse zirconocenes (L2ZrCl2, L = Cp, C5Me5, Ind, L2 = Me2CCp2, Me2SiCp2, Me2C2Cp2, rac-Me2CInd2, rac-H4C2Ind2, BIPh(Ind)2, H4C2[THInd]2), and co-catalysts activating the system, namely HAlBui2, MMAO-12, and (Ph3C)[B(C6F5)4], at low activator/Zr ratios in a 1-hexene oligomerization reaction. The influence of catalyst structure and system composition on the alkene conversion, the type of products, and the reaction stereoselectivity were investigated. The composition of hydride intermediates formed in the L2ZrCl2-HAlBui2-activator system (L2 = ansa-Me2CCp2, Ind) was studied by NMR spectroscopy. Participation of the bis-zirconium hydride complex as the precursor of catalytically active sites of the alkene dimerization reaction was shown.

Efficacy of the Endolysin-Based Antibacterial Gel for Treatment of Anaerobic Infection Caused by Fusobacterium necrophorum.

Abscess formation is a common complication of severe life-threatening infections caused by obligate anaerobes. Fusobacterium necrophorum is among the frequently detected anaerobic pathogens from clinical specimens associated with liver abscesses, skin and soft tissue infections, or oral abscesses. The antimicrobial therapy for this kind of infection needs to be optimized. Here, we examined the possibility of treating F. necrophorum-induced abscess wound infections with candidate therapeutics based on three endolysins with activity against a broad spectrum of aerobe Gram-negative pathogens. Antibacterial gel containing three Gram-negative bacteria-targeting endolysins, LysAm24, LysAp22, and LysECD7, was formulated for topical use. Abscess formation was induced in rabbits with F. necrophorum and caused systemic infection. The survival and lifespan of the animals, general parameters, and biochemical and hematological blood tests were analyzed to assess the effectiveness of the gel treatment for the wound infection. The administration of the investigated gel twice per day for 5 days resulted in less acute inflammation, with decreased leukocytes and segmented neutrophils in the blood, retardation of infection progression, and an almost two-fold increase in the lifespan of the animals compared to the placebo group. The results indicate that endolysin-based therapy is an effective approach to treat anaerobic bacterial infections. The use of endolysins as independent pharmaceuticals, or their combination with antibiotics, could significantly reduce the development of complications in infectious diseases caused by sensitive bacterial species.

Bactericidal Activity of Superhydrophobic and Superhydrophilic Copper in Bacterial Dispersions.

A method based on nanosecond laser processing was used to design superhydrophilic and superhydrophobic copper substrates. Three different protocols were used to analyze the evolution of the bactericidal activity of the copper substrates with different wettability. Scanning electron microscopy was used to study the variation of cell morphology after the attachment to superhydrophilic and superhydrophobic surfaces. The dispersions of Escherichia coli K12 C600 and Klebsiella pneumoniae 811 in Luria Bertani broth in contact with the superhydrophilic copper surface showed enhanced bacterial inactivation, associated with toxic action of both hierarchically textured copper surface and high content of Cu2+ ions in the dispersion medium. In contrast, the bacterial dispersions in contact with the superhydrophobic copper substrates demonstrated an increase in cell concentration with time until the development of corrosion processes. The resistance of bacterial cells to contact the copper substrates is discussed on the basis of surface forces, determining the primary adhesion and of the protective action of a superhydrophobic state of the surface against electrochemical and biological corrosion.

Instrumental Mechanoreceptoric Palpation in Gastrointestinal Surgery.

BACKGROUND AND AIMS: Small gastric or colorectal tumours can be visually undetectable during laparoscopic surgeries, and available methods still do not provide a 100% localisation rate. Thus, new methods for further improvements in tumour localisation are highly desirable. In this study, we evaluated the usage of the Medical Tactile Endosurgical Complex (MTEC) in gastrointestinal surgery for localisation of tumours. The MTEC provides the possibility of instrumental mechanoreceptoric palpation, which serves as an analogue of conventional manual palpation. METHODS: Ninety-six elective surgeries were performed, including 48 open surgeries, 43 laparoscopies, and 5 robot-assisted surgeries. The 20 mm version of the MTEC tactile mechanoreceptor was used in open surgeries, and the 10 mm version in laparoscopic and robot-assisted surgeries. RESULTS: The mean time of instrumental mechanoreceptoric palpation was 3 minutes 12 seconds for open surgeries, which constituted the early stage of the learning curve, and 3 minutes 34 seconds for laparoscopic surgeries. No side effects or postoperative complications related to instrumental mechanoreceptoric palpation were observed, and this procedure provided data sufficient for tumour localisation in more than 95% of cases. CONCLUSION: Instrumental mechanoreceptoric palpation performed using MTEC is a simple, safe, and reliable method for tumour localisation in gastrointestinal laparoscopic surgery.

Instrumental tactile diagnostics in robot-assisted surgery.

BACKGROUND: Robotic surgery has gained wide acceptance due to minimizing trauma in patients. However, the lack of tactile feedback is an essential limiting factor for the further expansion. In robotic surgery, feedback related to touch is currently kinesthetic, and it is mainly aimed at the minimization of force applied to tissues and organs. Design and implementation of diagnostic tactile feedback is still an open problem. We hypothesized that a sufficient tactile feedback in robot-assisted surgery can be provided by utilization of Medical Tactile Endosurgical Complex (MTEC), which is a novel specialized tool that is already commercially available in the Russian Federation. MTEC allows registration of tactile images by a mechanoreceptor, real-time visualization of these images, and reproduction of images via a tactile display. MATERIALS AND METHODS: Nine elective surgeries were performed with da Vinci™ robotic system. An assistant performed tactile examination through an additional port under the guidance of a surgeon during revision of tissues. The operating surgeon sensed registered tactile data using a tactile display, and the assistant inspected the visualization of tactile data. First, surgeries where lesion boundaries were visually detectable were performed. The goal was to promote cooperation between the surgeon and the assistant and to train them in perception of the tactile feedback. Then, instrumental tactile diagnostics was utilized in case of visually undetectable boundaries. RESULTS: In robot-assisted surgeries where lesion boundaries were not visually detectable, instrumental tactile diagnostics performed using MTEC provided valid identification and localization of lesions. The results of instrumental tactile diagnostics were concordant with the results of intraoperative ultrasound examination. However, in certain cases, for example, thoracoscopy, ultrasound examination is inapplicable, while MTEC-based tactile diagnostics can be efficiently utilized. CONCLUSION: The study proved that MTEC can be efficiently used in robot-assisted surgery allowing correct localization of visually undetectable lesions and visually undetectable boundaries of pathological changes of tissues.

Identification of two rare ß-globin gene mutations in a patient with ß-thalassemia intermedia from Azerbaijan.

ß-Thalassemias are an inherited group of disorders of hemoglobin (Hb) and comprise the most common monogenic disorders in Azerbaijan. They are extremely heterogeneous at the molecular level. Here we report the first identification of a patient who is a compound heterozygote for two rare ß-thalassemia (ß-thal) mutations, IVS-I-130 (G>C) and codon 37 (TGG>TGA).

Medical rehabilitation in Croatia impact of the 1991-1995 war: past problems, present state, future concerns.

AIM: To assess whether the 1991-1995 war has stimulated development of the medical rehabilitation system in Croatia. METHODS: Review of documents pertaining to the system, study of clinical reports describing rehabilitation activities as published in the Croatian medical literature, study of data obtained and their consideration in terms of effectiveness and quality of rehabilitation care, and comparison of data from 1991 with those from 1995. RESULTS: There has been no significant change in the number of rehabilitation facilities, beds, and rehabilitation professionals. However, elements of structure and process of rehabilitation care have improved in respect of 1) education and composition of rehabilitation professionals, 2) availability of specialized facilities for rehabilitation of patients with complex impairments (traumatic brain and spinal cord injuries), 3) interdisciplinary team approach, 4) use of functional status measurements, and 5) laying the foundations for community-based rehabilitation in the country. CONCLUSION: The 1991-1995 war has stimulated the development of medical rehabilitation system in Croatia. Other factors may have played a complementary role, too. This proves that medical rehabilitation is a field that develops in association with war.

[Recommendations for earthquake preparedness in Israel].

Earthquakes have occurred in the past in our region, along the Afro-Syrian fault line and along the eastern border of Israel. Several earthquakes had a magnitude between 6.25 and 6.5 on the Richter scale and caused severe damage to the populated areas in the Galilee, the Judean Hills and along the coastline. The last major earthquake occurred in 1927 in the Jordan Valley and caused more than 300 fatalities and extensive property damage. If we consider the present densely populated regions in the areas at risk, the occurrence of an earthquake with a magnitude of > 6.25 will constitute a major disaster, causing thousands of casualties and extensive property and economic damage. Israel is presently planning a comprehensive response to mitigate the damages by enforcing existing anti-seismic building codes, retrofitting of public buildings, including hospitals and utilizing all available manpower and material resources in case of such an event. The health sector is a vital part of the overall preparedness and response. Hospitals have to plan alternative sites for continued activity and increase the number of beds. Army medical teams will have to operate in the disaster area in conjunction and coordination with the Home Front Command rescue teams and the EMS. Public and primary health services will have to be reinforced to deal with acute and chronic health problems in the wake of the disaster. The burial of the dead and their identification will become a major logistic and emotional problem and must be planned in advance. Preparedness includes establishing contact with NGOs and agencies in countries, which may render medical assistance in such an event.

Quality of care for urinary incontinence in a rehabilitation setting for patients with stroke. Simultaneous monitoring of process and outcome.

OBJECTIVE: To study the quality of care provided for patients with urinary incontinence following a stroke, by monitoring both process and outcome elements of care simultaneously. DESIGN: Prospective follow-up of patients (of all ages and of both sexes) with urinary incontinence that appeared following a stroke who were admitted for rehabilitation during a six 6-month period. SETTING: A ward for stroke rehabilitation in The Loewenstein Hospital-Rehabilitation Centre in Raanana, Israel. RESULTS: Thirty-seven patients with stroke and urinary incontinence (mean age 61 years, 68% men) were included in the study; 84% of the 37 patients were discharged, although only 25% of them were continent. No lasting complications of urinary incontinence developed and there was no interference with rehabilitation activities. There was a correlation between incontinence and low score of Functional Independence Measure (FIM) on admission, being higher on discharge in those who became continent than in those who did not. CONCLUSIONS: Ward staff are aware of the potential problem of incontinence in patients with stroke. The problem is identified on admission and accorded adequate attention and care with satisfactory outcomes. The approach of monitoring process and outcome elements of care simultaneously in conditions that, during inpatient rehabilitation of patients with stroke, may endanger life, interfere with rehabilitation and delay functional recovery, could be a useful way to assess and improve the quality of care.

Community-based rehabilitation: better quality of life for older rural people with disabilities.

This article describes various categories of disability occurring in old age and goals that rehabilitation aims to achieve. It suggests that in rural areas these goals could be attained through application of rehabilitation care on a community level, provision of appropriate assistive technology and adaptation of the immediate environment.

Physical activity for elderly persons with neurological impairment: a review.

The paper reviews studies conducted on physical activities and exercise in elderly persons with neurological impairment due to stroke, Guillain-Barre syndrome, Parkinson's disease, multiple sclerosis or post-polio syndrome. The paper concludes: (i) it is not possible at present to draw conclusions regarding persons with Guillain-Barre syndrome and Parkinson's disease; (ii) individuals with multiple sclerosis and post-polio syndrome benefit from physical activity, but all studies have so far been conducted on those under 65 years of age, and its effect on elderly persons with these diseases is not known; (iii) exercise and customary activities (walking and swimming) should be encouraged and promoted in elderly persons after stroke.

Integrated institution--community rehabilitation in developed countries: a proposal.

PURPOSE: To propose a system for the provision of comprehensive, coordinated rehabilitation services that would meet all the needs of persons with disability in a timely and cost-effective manner. METHODS: Study of the literature pertaining to features of settings available for the delivery of medical rehabilitation in developed countries; presentation of the evolution of a tertiary rehabilitation centre into an institution practicing community-oriented rehabilitation. Review of various issues and implications of integrating institutional-based and community-based rehabilitation. RESULTS: Rehabilitation settings differ in skills and resources and consequently, in the treatment, care and concern they are able to offer. It is essential to find the balance between medical, nursing and social needs of persons with disability and their requirements for skills and resources at a given time, and to provide rehabilitation, support and guidance in the setting most appropriate to these requirements and needs at the lowest cost possible. CONCLUSION: The integration of the rehabilitation institution of a region with secondary and primary care of the region, into one functional entity for the purposes of providing the needed services, would enable finding the most appropriate setting, and facilitate addressing all needs, as well as increase the availability and accessibility of comprehensive rehabilitation at an affordable cost. This could be a viable way of providing rehabilitation in developed countries of Europe, where the need for it is expected to rise in excess of the population increase.

A conceptual proposal for the study of the quality of rehabilitation care.

PURPOSE: To propose a framework for the assessment and ongoing, continuous improvement of the quality of rehabilitation care. METHOD: The generally clarified and accepted approaches to the study of the quality of care are examined in view of the inherent characteristics of medical rehabilitation and the differences between it and other fields of medical practice. RESULTS: The process and outcome of care are distinct but complementary and their elements should, in rehabilitation, be used jointly and simultaneously as indicators of quality. CONCLUSIONS: Rehabilitation is of long duration and consists of various phases, each of them focusing on a different issue. It is proposed to monitor activities of rehabilitation professionals (process elements) that constitute the focus of care of a given phase and simultaneously to monitor relevant outcome elements attributable to the activities of the given phase. Comparison of monitored elements (the observed care) to their standards (the expected care) would enable assessment of the quality and its continuous improvement.

Quality of care in rehabilitation medicine.

This paper discusses the generally accepted approaches to the study of the quality of care in medical rehabilitation. It reviews clements of structure, process and outcome of rehabilitation care that are relevant during various phases of rehabilitation and suggests drawing criteria and standards for assessment of quality from these elements of care.