Role of behavioural disturbance in the loss of autonomy for activities of daily living in Alzheimer patients

BACKGROUND: Cognitive impairment is associated with functional impairment in patients with Alzheimer's disease (AD). Behavioural disturbance is very common in these patients. Nevertheless, there has been very little research into the relations between behavioural disturbance and functional status in AD. The purpose of this study is to investigate the relationship between behavioural disturbance and functional status after taking account of cognitive impairment. MATERIAL AND METHODS: 579 patients were prospectively evaluated at 16 French hospitals, all referents for AD, and were diagnosed with possible or probable AD. These patients were assessed with NeuroPsychiatric Inventory (NPI), cognitive subscales of the Alzheimer's Disease Assessment Scale (ADAS-cog), Clinical Dementia Rating scale (CDR) and Instrumental Activities of Daily Living scale (IADL). RESULTS: The number of men with available data for IADL total score was too small to make any analysis. 'Group A' gathered 256 women for whom the relation between autonomy for Activities of Daily Living (ADL) and the other variables were determined. 'Group B', pooled 85 women for whom relations found were verified. Linear regression was used for the analysis. With age, cognitive impairment allows us to explain best (38%) the loss of autonomy for ADL. CONCLUSION: The role of behavioural disturbances in the loss of autonomy for ADL was not determinant in our study, whereas cognitive impairment and age were better able to determine the loss of autonomy for ADL. Further study is needed to explain the decline of functional status in AD patients.     

Prostaglandin E2 preparations for preinduction cervical ripening

PGE2 is an effective agent for cervical ripening. It is most effective when administered intravaginally. Patients with unfavorable cervices who begin labor during cervical ripening have greater gestational ages, more baseline uterine activity, more initial uterine activity in response to PGE2, and lesser cesarean delivery rate than those patients who do not begin labor during cervical ripening. However, PGE2 should not be continued or administered when the patient is in active labor because it leads to unacceptable rates of hyperstimulation. Unfortunately, cervical ripening with PGE2 has little or no effect on the overall cesarean delivery rate.     

An antibody that facilitates hematopoietic engraftment recognizes CD44

Pretreatment of recipients with the monoclonal antibody (MoAb) S5 facilitates engraftment of bone marrow from mismatched, unrelated donors in the canine transplantation model. In the direct comparisons reported here, the S5 glycoprotein (gp) was found to have structural homology to CD44 that in humans has been implicated in adhesive interactions of one type of effector cell, the lymphocyte. The S5 antigen and gp90Hermes-1 exhibited codistribution on canine peripheral blood cells. Both S5 and Hermes-1 (anti-CD44) MoAbs recognized 90-Kd species in radioimmune precipitations of 125I surface-labeled canine peripheral blood lymphocytes and bone marrow cells. Competitive antibody binding experiments showed that the epitope detected by S5 was distinct from that bound by Hermes-1 but overlapped with those defined by two other known anti-CD44 reagents, IM7 and Hutch-1. Sequential immunoprecipitation with S5 and Hermes-1 indicated that the two antibodies recognize the same or overlapping subsets of membrane gps. Tryptic digestion of S5 and anti-CD44 immunoprecipitates generated two major iodinated peptides of 27 and 35 Kd in both cases, a further indication of structural homology. Similarly, after N-glycanase digestion, S5 and CD44 immunoprecipitates were resolved to a single 68- Kd species. These findings suggest that CD44-mediated adhesive events may affect the fate of transplanted hematopoietic cells. The previous implications of this gp in T-lymphocyte activation and lymphocyte adhesion to endothelium thus provide useful paradigms to analyze its function in the bone marrow transplant setting.     

Satisfaction with the dentition related to dental functional status and tooth replacement in an adult Bulgarian population: a cross-sectional study

Objectives

The purpose of this study is to assess satisfaction with the dentition in general, dental esthetics, and chewing function related to dental functional status and tooth replacement in subjects, dentate in both jaws.

Materials and methods

Dentitions of subjects (n?=?2,437) aged ≥20 years were categorized in a hierarchical functional classification system, with and without tooth replacements, according to four dental conditions: ‘≥10 teeth in each jaw’, ‘complete anterior regions’, ‘sufficient premolar regions’ (≥3 occluding pairs), and ‘sufficient molar regions’ (bilaterally ≥1 occluding pair). Likelihood ratios (LR) were used to express the ability of these conditions to discriminate between satisfied and not satisfied subjects. Odds ratios (OR) were calculated to evaluate associations between satisfaction, the four dental conditions separately, and tooth replacement.

Results

In the hierarchical system, subjects having ‘<10 teeth’ were more likely of being not satisfied with their dentitions (LR 4.09), esthetics (LR 3.51), and chewing (LR 5.49). As a separate condition, ‘≥10 teeth’ was significantly associated only with satisfaction with chewing. The conditions ‘complete anterior regions’ and ‘sufficient’ premolar and molar regions’ were associated with all satisfaction variables (ORs 1.47–2.96, p values ≤0.012). When dental conditions were determined on the basis of natural teeth only, having teeth replaced was positively correlated with satisfaction; when determined on the basis of natural plus replaced teeth, subjects having teeth replaced tended to be less satisfied than their counterparts with natural teeth only.

Conclusions

Satisfaction was strongly associated with dental functional status.

Clinical relevance

Dental configurations comprising both natural and artificial teeth were less likely to provide the same level of satisfaction as equivalent dental configurations comprising natural teeth only.     

Innovative Approaches to Reducing Financial Barriers to Obstetric Care in Low-Income Countries

Lack of access to quality care is the main obstacle to reducing maternal mortality in low-income countries. In many settings, women must pay out-of-pocket fees, resulting in delays, some of them fatal, and catastrophic expenditure that push households into poverty.Various innovative approaches have targeted the poor or exempted specific services, such as cesarean deliveries. We analyzed 8 case studies to better understand current experiments in reducing financial barriers to maternal care.Although service utilization increased in most of the settings, concerns remain about quality of care, equity between rich and poor patients and between urban and rural residents, and financial sustainability to support these new strategies.LACK OF ACCESS TO QUALITY care is the main obstacle to reducing maternal mortality in low- and middle-income countries.¹ Two types of barriers are critical: physical and financial.^2–4 Poor countries often have few and widely spaced health facilities that are adequately equipped and staffed with competent, available, and committed personnel.⁵ Many women prefer to deliver at home rather than embark on a long, expensive, and painful journey to underequipped health centers and poorly functioning district hospitals.⁴When women or their families in these countries decide to seek health care, the next obstacle is out-of-pocket payment for the services. Access to a cesarean delivery is directly affected by household wealth. In a study of Demographic and Health Survey data for 42 developing countries, cesarean birth rates were extremely low among the very poor: less than 1% for the poorest quintile of the population in 20 countries and less than 1% for 80% of the population in 6 countries.² Childbirth can be costly for households in countries that do not provide universal health care. If mother or child suffers complications, costs can skyrocket.⁶ There is increasing recognition that maternal costs, especially when complications occur, can plunge a household into poverty or force it to rely on risky coping strategies.^7,8A recent review by the World Health Organization found that the direct costs of maternal health care ranged between 1% and 5% of total annual household expenditures, rising to between 5% and 34% if the woman suffered a complication.⁹ The Economic Commission for Africa has called for the elimination of user fees for basic health services as a “quick win” that can diminish health inequities related to poverty and gender discrimination.^10(p15) In recent years, Nepal and several countries in sub-Saharan Africa have introduced policies that eliminate fees for maternal health care.¹¹Social health insurance subsidized by taxation at the national level is considered to be the best way to fund health care, but most countries in sub-Saharan Africa and South Asia do not have the means to organize it. Social health insurance presents challenges in rural areas because of low incomes, limited formal sector employment, and minimal health care infrastructure.¹² Countries are therefore pursuing more specific approaches through different pooling and targeting mechanisms. However, published evaluations of these attempts to reduce financial barriers to obstetric care are still scarce.We aimed to contribute to a better understanding of current experiments in reducing financial barriers to maternal care by analyzing results from 8 case studies, which are published elsewhere.¹³ The initiatives described in these studies varied broadly in mechanism (from fee exemption to cash assistance), structure (some local and others national), location (ranging across Africa, Asia, and Latin America), and population target (from all pregnant women to only those from poor households). This breadth allowed us to extract some preliminary lessons for policymakers about likely challenges in different contexts.     

The relationship between hiccups and heart rate in the fetus.

OBJECTIVE: The purpose of this study was to determine the effect of fetal hiccups on fetal heart rate from 20 weeks of gestation onward. METHODS: One thousand four hundred and fifty-six collected fetal heart rate tracings from three cohorts that participated in longitudinal studies of fetal neurobehavioral development were reviewed retrospectively for fetal hiccups. Tracings were recorded at four-week intervals from 20 weeks. A hiccup-free period before or after the episode of hiccups was used as the control fetal heart rate; thus each fetus was used as its own control. The paired t-test was used for statistical analysis. RESULTS: From 28 weeks onward, the mean fetal heart rate increased with hiccups reaching statistical significance at 32 weeks. Fetal heart rate variability was unaffected by hiccups until 36 weeks, at which time it decreased during hiccup periods. CONCLUSION: This change in response to fetal hiccups may represent another neurodevelopment milestone for the fetus.     

The organization of the reciprocal connections between the subiculum and the entorhinal cortex in the cat: I. A neuroanatomical tracing study

The connections between the subiculum (SUB) and the entorhinal cortex (EC) were studied in the cat with retrograde and anterograde tracing techniques. Injections of the retrogradely transported tracer WGA-HRP at different levels along the septotemporal axis of the subiculum result in labeled neurons predominantly in the medial entorhinal cortex (MEA) in the superficial layers II and III. In the deep layers labeled cells are found more widespread over the EC. The superficially located labeled EC neurons are topographically distributed in a lateromedial gradient, which corresponds to a septotemporal gradient along the longitudinal axis of the subiculum. This organization of the EC-SUB projection system could be substantiated by the use of injections anterogradely transported radioactively labeled amino acids in EC. The SUB to EC projections were investigated with the anterograde transport of WGA-HRP and with radioactively labeled amino acids that were injected at different levels along the septotemporal axis of the subiculum. This results in a patch of anterogradely labeled fibers and terminals in MEA, predominantly in layers II and III, with a wider band of label in the deep layers. Again, a topographical distribution along the lateromedial axis of the EC corresponding to the septotemporal axis of the SUB was observed. Contralateral reciprocal connections between EC and SUB are also present, and exhibit a similar topographical organization.     

Nonbursal lymphomas induced by nondefective reticuloendotheliosis virus

In previous studies we described bursal lymphomas similar to those of lymphoid leukosis in line 15x7 chickens inoculated with nondefective reticuloendotheliosis (RE) virus. A different type of neoplastic disease syndrome induced by nondefective RE virus is described in the present study. The tumours were characterised as lymphomas and most commonly involved the thymus, heart, liver, and spleen; the bursa invariably appeared normal or atrophied. Mortality from nonbursal lymphomas occurred as early as 6 weeks post-inoculation and was as high as 66%. The frequency of nonbursal lymphomas was markedly influenced both by the strain of RE virus and the line of chicken. Maximum tumour induction occurred in line 6(3) or line 0 chickens inoculated with RE viral strains SN or DIA. Histologically, the tumours were composed of a homogenous population of immature lymphoreticular cells. The tumours were often accompanied by enlarged peripheral nerves which were infiltrated with large, irregular cells with abundant cytoplasm. In an indirect membrane immunofluores-cent test, the tumour cells reacted weakly with anti-T cell serum but not with anti-B cell serum; the cells were refractory to treatment with . either serum in a complement-dependent antibody cytotoxicity assay. A proportion of the tumour cells contained membrane RE viral antigens. Although this syndrome superficially resembled Marek's disease (MD), nonbursal RE lymphomas lacked the MD tumour-associated surface antigen and the pleomorphic lymphocyte populations characteristic of MD. The nonbursal lymphomas appeared different from the previously-described RE virus-induced bursal lymphomas on the basis of latent period, cell surface antigens, and line susceptibility, and are probably induced by a different molecular mechanism.     

Ultraviolet irradiation of blood prevents transfusion-induced sensitization and marrow graft rejection in dogs

In a canine model using DLA-identical littermate pairs, we have shown that a regimen of three transfusions of donor blood given 24, 17, and 10 days before transplant uniformly leads to marrow graft rejection, presumably due to sensitization to minor (non-DLA) histocompatibility antigens. Untransfused dogs uniformly achieve sustained engraftment. In the present study, we investigated whether the exposure of blood to ultraviolet (UV) light (220-300 nm) prior to transfusion prevented sensitization of the recipient and allowed for successful marrow engraftment. Ten dogs were each given three pretransplant transfusions from the marrow donor. Each transfusion consisted of 50 mL of whole blood exposed in vitro to UV light for a total of 1.35 J/cm2. All ten dogs achieved engraftment. In contrast, all four dogs that had received sham-exposed transfusions rejected their grafts. In vitro studies revealed that although cell viability was not affected, leukocytes contained in UV-exposed blood were unable to function as stimulator cells in mixed leukocyte cultures or as accessory cells in mitogen- stimulated cultures. These data are consistent with the hypothesis that accessory cells are involved in transfusion-induced sensitization. We conclude that in vitro exposure of blood to UV light before transfusion prevents sensitization and allows for subsequent marrow engraftment.     

Hämoperfusion bei Flecainidintoxikation

Summary A 79-year-old patient, who had received a pacemaker after suffering two posterior myocardial infarctions, was treated with 2 × 100 mg flecainide daily for 9 days for ventricular extrasystoles (Lown IV b). On admission to the hospital the parameters of renal function were within the normal range. Ten days after flecainide treatment was begun a temporary electromechanic decoupling of the pacemaker occurred with reversible asystoly and progressive kidney failure. The flecainide plasma level at that time was 1460 ng/ml. Hemoperfusion for 3 h with activated charcoal removed only 35 mg flecainide in spite of an excellent flecainide clearance (164–180 ml/min). The patient's flecainide plasma level did not decrease sufficiently during the procedure, showing clearly that flecainide levels cannot be lowered fast enough by hemoperfusion to treat a flecainide intoxication.