Predictors of Functional Recovery in Patients Admitted to Geriatric Postacute Rehabilitation

Objective

To examine characteristics associated with functional recovery in older patients undergoing postacute rehabilitation.

Design

Observational study.

Setting

Postacute rehabilitation facility.

Participants

Patients (N=2754) aged ≥65 years admitted over a 4-year period.

Interventions

Not applicable.

Main Outcome Measure

Functional status was assessed at admission and again at discharge. Functional recovery was defined as achieving at least 30% improvement on the Barthel Index score from admission compared with the maximum possible room for improvement.

Results

Patients who achieved functional recovery (70.3%) were younger and were more likely to be women, live alone, and be without any formal home care before admission, and they had fewer chronic diseases (all P<.01). They also had better cognitive status and a higher Barthel Index score both at admission (mean ± SD, 63.3±18.0 vs 59.6±24.7) and at discharge (mean ± SD, 86.8±10.4 vs 62.2±22.9) (all P<.001). In multivariate analysis, patients <75 years of age (adjusted odds ratio [OR]=1.51; 95% confidence interval [CI], 1.16–1.98; P=.003), women (adjusted OR=1.24; 95% CI, 1.01–1.52; P=.045), patients living alone (adjusted OR=1.61; 95% CI, 1.31–1.98; P<.001), and patients without in-home help prior to admission (adjusted OR=1.39; 95% CI, 1.15–1.69; P=.001) remained at increased odds of functional recovery. In addition, compared with those with moderate-to-severe cognitive impairment (Mini-Mental State Examination score <18), patients with mild-to-moderate impairment (Mini-Mental State Examination score 19–23) and those cognitively intact also had increased odds of functional recovery (adjusted OR=1.56; 95% CI, 1.13–2.15; P=.007; adjusted OR=2.21; 95% CI, 1.67–2.93; P<.001, respectively).

Conclusions

Apart from sociodemographic characteristics, cognition is the strongest factor that identifies older patients more likely to improve during postacute rehabilitation. Further study needs to determine how to best adapt rehabilitation processes to better meet the specific needs of this population and optimize their outcome.     

造血与白血病的分子研究

由于分子生物学、细胞遗传学、免疫学和生物化学等基础学科的迅速发展及其与血液病学的相互渗透,近10年来血液病研究取得了较快进展.分子血液学的迅速发展也极大地推动了白血病的分子机制研究以及临床白血病的分子诊断与治疗工作.目前,不少研究者致力于造血与白血病的分子研究,其中造血与分子调控、药物代谢酶基因多态性与急性白血病(acute leukaemia,AL)、免疫与分子靶向治疗、白血病的基因诊断与基因治疗是主要的几个研究领域.     

Age and gender related reference values for transthoracic Doppler-echocardiography in the anesthetized CD1 mouse

Objective: Doppler-echocardiography of the mouse has evolved to a commonly used technique in the past years as recent advances in imaging quality have substantially improved spatial and temporal resolution allowing the adaptation of this technique to murine models. Although mouse echocardiography is widely used, there is only little information on reference data for wild-type animals available, particularly in older mice. Methods: We therefore established a database with echocardiographic reference-values in a large set of young (8 weeks) and older adult (52 weeks) Swiss type CD1-mice of either sex. We performed a complete Doppler-echocardiographic examination under light Ketamine-Xylazine-anesthesia. LV-mass was calculated and compared with necropsy heart weights to validate the LV-mass calculation. Results: Doppler-echocardiographic measurements in mice were feasible to assess cardiac morphology and function. Sonomorphological and functional parameters hardly changed between the age of 12 and 52 weeks. Wall thickness, LV-mass and cardiac output were stable with aging. There was a good relative correlation between echocardiographically estimated LV-mass and necropsy heart weight although absolute values differed. There were no significant echocardiographic differences between male and female mice. Conclusions: The reference values established in this study can be useful in recording and quantifying pathological changes in murine models of cardiovascular diseases. There is hardly any change of cardiac function between the age of 12 and 52 weeks.*Jörg Stypmann, Markus A. Engelen contributed equally to this work. ** Parts of these data are part of C. Epping’s doctoral thesis. Address for correspondence: Dr. med. Jörg Stypmann, Medizinische Klinik und Poliklinik C, Kardiologie und Angiologie, Universitätsklinikum Münster, Albert-Schweitzer-Str. 33, D-48149 Münster, Germany Tel.: +49-251-83-47617; Fax: +49-251-83-47684; E-mail: stypmann@mednet.uni-muenster.de     

Novel immunomodulator FTY720 is phosphorylated in rats and humans to form a single stereoisomer. Identification, chemical proof, and biological characterization of the biologically active species and its enantiomer

In vivo phosphorylation of FTY720 (1) in rats and humans resulted exclusively in the biologically active (S)-configured enantiomer, which was proven by an ex vivo o-phthaldialdehyde derivatization protocol especially elaborated for phosphates of 1. Starting from the prochiral amino alcohol 1, racemic and enantiomerically pure phosphates of 1 were synthesized. Pure enantiomers were obtained after purification of a partially protected key intermediate on an enantioselective support. The absolute stereochemistry was determined by X-ray diffraction.     

Monitoring of heparin therapy and establishment of an optimal therapy scheme for thrombosis prophylaxis in a pig model for human catheter interventions

This study aims to investigate variables suitable for monitoring of unfractionated heparin (UFH) therapy and establishment of an optimal therapy scheme in pigs. This is a prospective study of 32 pigs undergoing catheterization for endovascular embolization of experimentally induced arteriovenous malformation. Pigs were assigned to four groups receiving different UFH treatment during catheter intervention. In groups?1 and 2, UFH was applied as a bolus of either 100?IU/kg (n?=?6) and 200?IU/kg (n?=?6). Groups?3 and 4 received a continuous infusion of 66?IU/kg/h?UFH (n?=?10) and 100?IU/kg/h (n?=?10), respectively, which was applied 20?min after an initial bolus of 100?IU/kg. Blood samples were taken 0, 10, 20, 40, 60, 100, and 140?min after starting catheterization (groups?1?+?2) and after 0, 10, 20, 30, 40, 50, 60, 80, 100, 120, and 140?min, respectively (groups 3?+?4). High/low range activated coagulation time (LR-ACT), activated partial thromboplastin time (aPTT), prothrombin time, fibrinogen, and anti-FactorXa activity (FXa) activity were assessed. Based on anti-FXa activity, bolus injection of 100 and 200?IU/kg UFH had a mean half-life of 28.43?±?8.85 and 57.05?±?12.42?min, however, an aPTT exceeding 999?s was present in four of seven pigs in group?2. In group?3, aPTT increased from baseline 15?±?2?s to a steady state ranging from 30 to 33?s. In group?4, there was an increase of aPTT to 58?±?23?s 140?min after initiation of treatment. Suitable variables for monitoring UFH therapy included anti-FXa activity, aPTT, and LR-ACT. An initial bolus of 100?IU/kg?followed by a continuous UFH infusion of 66?IU?UFH/kg/h can be recommended as antithrombotic therapy during catheterization.