Retrogenesis: clinical,physiologic, and pathologic mechanisms in brain aging,Alzheimer’s and other dementing processes

Data from clinical, electrophysiologic, neurophysiologic, neuroimaging and neuropathologic sources indicates that the progression of brain aging and Alzheimer’s disease (AD) deterioration proceeds inversely to human ontogenic acquisition patterns. A word for this process of degenerative developmental recapitulation, “retrogenesis”, has been proposed. These retrogenic processes provide new insights into the pathologic mechanism of AD deterioration. An understanding of retrogenic phenonmena can also result in insights into the applicability of retrogenic pathologic mechanisms for non-AD dementing disorders. Management strategies based upon retrogenesis have recently been proposed. Retrogenic pathophysiology also points to previously unexplored pharmacologic approaches to dementia prevention and treatment.     

Surgery for menorrhagia within English regions: variation in rates of endometrial ablation and hysterectomy

Objective  To examine variation between English regions in the use of surgery (endometrial ablation or hysterectomy) for the treatment of menorrhagia.
Design  Analysis of Hospital Episodes Statistics (HES) data to produce rates of surgery for English Strategic Health Authorities (SHAs) and Primary Care Trusts (PCTs).
Population  Women aged between 25 and 59 years who had endometrial ablation or hysterectomy for menorrhagia between April 2003 and March 2006 in English NHS hospitals.
Methods  Multilevel Poisson regression was used to determine the level of systematic variation in the regional rates of surgery and their association with regional characteristics (deprivation, service provision and mix of surgical procedures).
Main outcome measure  Age-standardised annual rates of surgery.
Results  The English rate of surgery for menorrhagia was 143 procedures per 100 000 women. Surgical rates within SHAs ranged from 52 to 230 procedures per 100 000 women, while rates within PCTs ranged from 20 to 420 procedures per 100 000 women. While, 60% of all procedures were endometrial ablations, the proportion across SHAs varied, ranging from 46% to 75%. Surgery rates were associated with the regional characteristics, but only weakly, and risk adjustment reduced the amount of unexplained variation by <15% at both SHA and PCT levels.
Conclusion  Regional differences in surgical rates for menorrhagia have persisted despite changes in practice and improved evidence, suggesting there is scope for improving the management of menorrhagia within England.     

Transfusion associated in-hospital mortality and morbidity in isolated Coronary Artery Bypass Graft surgery

Transfusion after cardiac surgery is very common. This rate varies between institutions and has remained high despite established transfusion guidelines. We analyzed our database of patients who underwent isolated CABG (Coronary Artery Bypass Graft) to determine the predictive factors of homologous transfusion and associated postoperative morbidity, mortality and resource utilization. All 14,152 patients who underwent first-time isolated CABG, with or without cardiopulmonary bypass (CPB) who had postoperative homologous transfusion between February 2002 and March 2008 in Tehran Heart Center, were evaluated retrospectively. Overall, 16.5% of patients received transfusion. Transfused patients demonstrated a significantly higher incidence of postoperative complications (cardiac, infectious, ischemic, reoperation) and mortality (p<0.001). Homologous blood transfusion effect on mortality, morbidity and resource utilization. By Multivariable logistic regression analysis adjusted for confounders: Homologous blood transfusion effect on Mortality (30-days) (OR=3.976, p<0.0001), Prolonged ventilation hours (OR=4.755, p<0.0001), Total ICU hours (β =14.599, p<0.0001), Hospital length of stay (β =1.141, p<0.0001), Post surgery length of stay (β =0.955, p<0.0001). We conclude that the isolated CABG patients receiving blood transfusion have significantly higher mortality, morbidity and resource utilization. Homologous blood transfusion is an independent factor of increased resource utilization, morbidity and mortality.     

Interspecies scaling of inhalational anesthetic potency minimum alveolar concentration (MAC): application of a correction factor for the prediction of MAC in humans.

The objective of this study was to predict minimum alveolar concentration (MAC) of inhalational anesthetics in humans from animal data. The MAC of 10 anesthetics was obtained from the literature. At least three animal species (excluding humans) were used in the scaling. Interspecies scaling of MAC was performed in two ways: (1) using the traditional allometric approach, the MAC of each drug was plotted against the body weight of the species on a log-log scale, and MAC in humans was predicted from the resultant equation; and (2) MAC in each species was multiplied by a correction factor obtained by adjusting the lung weight of the species based on per kg body weight. The product of the correction factor and the MAC was then plotted against body weight as described in the traditional approach. Predicted MAC values in humans from animal data using simple allometry produced comparatively more error than the prediction made by incorporating the correction factor into the scaling. The results of this study indicate that MAC may not be predicted in humans from animal data using simple allometry; however, applying a correction factor may significantly improve the prediction of MAC in humans from animal data.     

A comparison between the effect of bathing in a tub with and without swaddle on behavioral responses to stress in premature infants

The purpose of the present study was to compare the effect two bathing methods, bathing in a tub with and without swaddle, on the behavioral responses to stress in premature infants who were hospitalized in the NICU. In this study of clinical trial, the mean behavioral stress score for infants who were given a bath in the tub without swaddle (56.84 ± 21.79) was significantly more than the one for the infants who received a swaddle bath (17.12 ± 7.67) (P < 0.001). The infants’ crying time in the group without swaddle (15.57 s) was longer than the group with swaddle (5 s) (P < 0.001). The mean score for sudden twitches was 0.90 in infants bathed without swaddle and 0.18 in infants bathed with swaddle (P < 0.001). In this study, swaddle bathing caused fewer behavioral responses to stress in premature infants. Therefore, applying this method can improve the quality of care delivered to these infants in the NICU.