Day services for people with mental handicaps: A PURPOSE IN LIFE?

There is a continuing debate about the future of day services for people with mental handicaps. In this study people who attended adult training centres were interviewed to ascertain their views on their day placements. They were glad to have somewhere to go during the day and enjoyed elements of the daily programmes. However, most people felt that in the long-term the services did not make a positive contribution to their lives and wished for ordinary jobs.     

Factors affecting blood loss in total knee arthroplasty patients

The aim of the study was to identify the factors affecting major blood loss in patients undergoing total knee arthroplasty (TKA), in order to reduce blood loss and requirements for blood transfusion. This prospective randomized study included 80/184 patients treated by TKA at University Hospital of Traumatology, Zagreb, Croatia, from January 2005 till December 2007. The following parameters were analyzed: patient age, sex, body mass index (BMI), arterial blood pressure, preoperative hemoglobin level and hemoglobin level preceding blood transfusion, length of surgery, blood loss and volume of blood transfused. According to patient age, there were no differences in the length of surgery, blood loss volume, hemoglobin level before blood transfusion and use of blood transfusion. Older patients had lower hemoglobin level before blood transfusion and received greater volumes of blood transfusion, but the difference was not statistically significant. Male patients had a significantly higher preoperative hemoglobin level as compared to female patients (P = 0.012). The mean volume of blood loss and of transfused blood was larger in male than female patients, however, the difference did not reach statistical significance. According to BMI, there were no differences in the length of surgery, blood loss, volume of transfused blood and hemoglobin level before transfusion. Patients with a lower preoperative hemoglobin level did not lose more blood during and after surgery, but the requirement for blood transfusion was significantly higher (P = 0.014). Hypertensive patients had a statistically greater perioperative blood loss (P = 0.038), but did not receive more transfused blood (P = 0.494). Preoperative hemoglobin level was higher in patients with elevated arterial blood pressure than in those with normal blood pressure, but the difference was not statistically significant (P = 0.595). Hemoglobin level before blood transfusion was also higher in hypertensive patients than in those with normal blood pressure, but it was not statistically significant (P = 0.288). In patients with longer duration of surgery, blood loss and volume of blood transfused blood were statistically significantly greater (P = 0.003 and P = 0.015, respectively). Study results yielded a significant positive correlation between the length of surgery and the volume of blood loss (r = 0.282; P = 0.011) as well as between the length of surgery and the volume of blood transfused (r = 0.362; P = 0.001). A significant negative correlation was established between the preoperative hemoglobin level and application of blood transfusion (r = -0.250; P = 0.025). Patients with hypertension had a significantly larger blood loss volume as compared to patients with normal arterial pressure (P = 0.038) and received more blood transfusions than patients with normal blood pressure, but the difference was not statistically significant (P = 0.494). Age, sex and BMI had no statistically significant effect on blood loss volume and application of blood transfusion. Male patients had a significantly higher preoperative hemoglobin level (P=0.012), larger mean blood loss volume (P = 0.057) and received more blood transfusions than female patients, however, the difference did not reach statistical significance (P = 0.562). Based on study results, it is concluded that requirements for blood transfusion will be greater in patients with hypertension and lower preoperative hemoglobin level as well as in all cases with longer duration of surgery. To reduce the use of allogeneic blood transfusion, it is necessary to correct arterial blood pressure before surgery in hypertensive patients and also to magnify preoperative hemoglobin level if it is lower.     

Veno-Arterial Extracorporeal Membrane Oxygenation in the Adult: A Bridge to the State of the Art

Despite the technological advancements in the last 40 years, conditions such as refractory cardiogenic shock and cardiac arrest still present a very high mortality rate in real-world clinical practice.In this light, we have reviewed the techniques, indications, contraindications, and results of the so- called Veno-Arterial Extracorporeal Circulatory Membrane Oxygenation (VA-ECMO) in the adult population to evaluate the current results of this temporary cardio-pulmonary support as salvage and/or bridge therapy in the patient suffering from refractory cardiogenic shock or cardio-circulatory arrest.The results are encouraging, especially in the setting of refractory cardiogenic shock and in-hospital cardiac arrest. Among a selected population, the prompt institution of a VA-ECMO may radically change the prognosis by sustaining vital functions while looking for the leading cause or waiting for the reversal of the temporary cardio-respiratory negative condition.The future directions aim to standardized and shared protocols, miniaturization of the machines, and possibly the institution of specialized “ECMO teams” for in and the out-of-hospital institution of the tool.     

Evaluation of healing and antimicrobiological effects of herbal therapy on venous leg ulcer: pilot study

Venous leg ulcers represent a significant public health problem that will increase as the population ages. Numerous herbs and their extracts are potentially conducive to wound healing, including the ability to serve as an antimicrobial, antifungal, astringent, etc. A total of 32 patients with venous leg ulcers were randomized into two groups: a group with herbal therapy treatment (PT) (17 patients) and a control group (C) (15 patients). The investigation focused on five controls of parameter changes important for ulcer healing and the control of microbiological flora. Within‐treatment analysis of the PT group showed that, following herbal therapy treatment, there was a significant decrease in the scores of surface leg ulcer and venous leg ulcer after week 7 of treatment (p < 0.05). In group C following topical antibiotic treatment there was no significant decrease in the surface leg ulcer. Comparing the results of decreased venous leg ulcer surface of the) PT group with the C group showed a significant difference at p < 0.05 after week 7 of treatment. The number of different types of isolated bacterial species decreased significantly (p < 0.05) after the use of herbal preparations. The results of this pilot study demonstrate the healing and antimicrobiological effects of herbal therapy on non‐infected venous leg ulcer. Copyright © 2009 John Wiley & Sons, Ltd.     

Stress-Induced Increase in Blood–Brain Barrier Permeability in Control and Monosodium Glutamate-Treated Rats

Glutamate administration in neonatal rats causes reversible changes in blood–brain barrier (BBB) permeability and known neurotoxic lesions. This study was aimed to evaluate whether glutamate administered to neonatal rats influences properties of the developing BBB with consequences on adult BBB function. The vulnerability of the BBB was examined after short-lasting stress exposure by measurement of plasma albumin extravasation using immunoelectrophoresis. In control rats, 30 min of immobilization stress resulted in increased endogenous albumin extravasation in the hypothalamus, hippocampus, brain stem and cerebellum, but not in the cortex and striatum. Basal levels of albumin in adult glutamate-treated rats (4 mg monosodium glutamate/g BW, IP, five times during neonatal period) were significantly lower in the hypothalamus compared to that in controls. Stress-induced increase in albumin levels was lower in the brain stem, higher in the hypothalamus, and similar in other brain regions studied in glutamate-treated rats in comparison with controls. It is concluded that short-lasting immobilization stress increased BBB permeability in some but not all brain regions studied. Glutamate treatment of neonatal rats resulted in low basal albumin levels in the hypothalamus but did not exert a pronounced influence on adult BBB function. BBB vulnerability in glutamate-treated rats during stress exposure was increased in the hypothalamus and decreased in the brain stem.     

A further characterization of alanine dehydrogenase from Streptomyces aureofaciens

Homogeneous alanine dehydrogenase isolated from Streptomyces aureofaciens, a producer of tetracycline, was characterized from the point of its molecular and catalytic properties. Using analytical ultracentrifugation the molecular weight of alanine dehydrogenase was found to be 198,000. The enzyme could use as cofactors apart from NAD+ also 1,N6-etheno-NAD+, 3-acetylpyridine-NAD+, deamino-NAD+ and nicotinamide guanine dinucleotide. The enzyme activity in the direction of oxidative deamination was not affected by the addition of nonsubstrate amino acids, however, it was sensitive to inhibitors of SH-groups. Reductive amination of pyruvate was inhibited by L-alanine, L-serine and D-alanine. The inhibition by L-alanine and L-serine was uncompetitive with respect to NADH and noncompetitive with regard to pyruvate and ammonium ions.