Feasibility and predictive performance of the Hendrich Fall Risk Model II in a rehabilitation department: a prospective study

BACKGROUND:Falls are a common adverse event in both elderly inpatients and patients admitted to rehabilitation units. The Hendrich Fall Risk Model II (HIIFRM) has been already tested in all hospital wards with high fall rates, with the exception of the rehabilitation setting. This study's aim is to address the feasibility and predictive performances of HIIFRM in a hospital rehabilitation department. METHODS: A 6 months prospective study in a Italian rehabilitation department with patients from orthopaedic, pulmonary, and neurological rehabilitation wards. All admitted patients were enrolled and assessed within 24 h of admission by means of the HIIFRM. The occurrence of falls was checked and recorded daily. HIIFRM feasibility was assessed as the percentage of successful administrations at admission. HIIFRM predictive performance was determined in terms of area under the Receiver Operating Characteristic (ROC) curve (AUC), best cutoff, sensitivity, specificity, positive and negative predictive values, along with their asymptotic 95% confidence intervals (95% CI). RESULTS: One hundred ninety-one patents were admitted. HIIFRM was feasible in 147 cases (77%), 11 of which suffered a fall (7.5%). Failures in administration were mainly due to bedridden patients (e.g. minimally conscious state, vegetative state). AUC was 0.779(0.685-0.873). The original HIIFRM cutoff of 5 led to a sensitivity of 100% with a mere specificity of 49%(40-57%), thus suggesting using higher cutoffs. Moreover, the median score for non-fallers at rehabilitation units was higher than that reported in literature for geriatric non fallers. The best trade-off between sensitivity and specificity was obtained by using a cutoff of 8. This lead to sensitivity\u2009=\u200973%(46-99%), specificity\u2009=\u200972%(65-80%), positive predictive value\u2009=\u200917% and negative predictive value\u2009=\u200997%. These results support the use of the HIIFRM as a predictive tool. CONCLUSIONS: The HIIFRM showed satisfactory feasibility and predictive performances in rehabilitation wards. Based on both available literature and these results, the prediction of falls among all hospital wards, with high risk of falling, could be achieved by means of a unique tool and two different cutoffs: a standard cutoff of 5 in geriatric wards and an adjusted higher cutoff in rehabilitation units, with predictive performances similar to those of the best-preforming pathology specific tools for fall-risk assessmen

Impact of calreticulin mutations on clinical and hematological phenotype and outcome in essential thrombocythemia

Key Points CALR mutations occur in half of JAK2 and MPL wt patients with ET and associate with some distinctive phenotypic traits. Patients with ET harboring CALR mutations are at significantly lower risk of thrombosis compared with JAK2- and MPL-mutated patients

Correlation between visual field index and quality of life in glaucoma patients: a new tool to screen quality of life perception?

PurposeTo evaluate the correlation between the visual field index (VFI) and vision-related quality of life (QoL) considering several confounding variables that may have a positive or negative effect.MethodsWe conducted a cross-sectional, mono-centric study on glaucoma patients. Quality of life was examined with the NEI-VFQ 25 and the Glaucoma Symptom Scale (GSS). The visual field was examined with the Humphrey Field Analyzer. The variables considered were age, gender, comorbidities, years (at diagnosis and duration of the illness), treatment and related active principles, intraocular pressure, and visual acuity. The analysis was performed on both the better and the worse eye. The linear regression univariate analysis and the multivariate analyses were performed.ResultsIn total, 193 patients enrolled in the study. The mean age was 70.8 ± 10.4 years. The mean follow-up period since diagnosis 11.4 ± 9.2 years. Approximately 50% of the patients suffered from primary open angle glaucoma (POAG) and 45% were on monotherapy. The mean VFI was 81.3 ± 26. Regarding QoL, the NEI-VFQ total mean was 80.4 ± 17.8 and the GSS total score was 77.2 ± 21. Regarding NEI-VFQ 25, the single linear regression analysis found the following relations: age at time of visit (r = −0.30, p = 0.016), years of illness (r = −0.32, p = 0.020), the minimum and maximal visual acuity (r = 2.04 and r = 3.96, p < 0.001), the IOP min (r = 1.13, p = 0.002) and max (r = −0.52, p = 0.017), and the number of previous surgeries (r = −3.94, p < 0.001). The multivariate analysis found the following relations: gender (r = 5.13, p = 0.019), visual acuity max (r = 3.16, p < 0.001), and previous surgeries (r = −1.80, p = 0.032). Regarding GSS, the single linear regression analysis found relations with visual acuity (r = 2.37, p < 0.001), VFI (r = 0.41, p < 0.001), previous surgeries in the eye considered (r = −7.27, p < 0.001), and number of instillations (r = −3.67, p = 0.031). Data confirmed that a higher VFI has a positive impact on the score of both the NEI-VFQ 25 (r = 0.22, p = < 0.001) and the GSS questionnaire (r = 0.36, p < 0.001).ConclusionsThe study demonstrated a correlation between the VFI and QoL of patients and their visual and non-visual ocular symptoms and function both in the worst and in the better eye, even when accounting for several clinical and demographic confounding variables. Our data support that the visual field index is an important metric instrument in the follow up of patients with glaucoma

Intestinal neuromuscular function adaptation to ischemia/reperfusion injury: relevance of the microbiota-gut interplay

Intestinal ischemia/reperfusion (IR) injury represents an important clinical problem, inducing severe damage to the enteric nervous system and to the neuromuscular intestinal function. Recently, we have focused on hyaluronan (HA), an extracellular matrix component, as a new modulator of the neuroadaptive changes of enteric neuronal circuitries in the inflamed gut. In this study, we evaluated HA involvement in myenteric neuron derangements after IR injury. After IR, a gradual deposition of HA was observed along the intestinal layers, with the highest deposition occurring in the external longitudinal muscle with the myenteric plexus, which was associated to HA synthase2 upregulation. IR-induced HA deposition was reduced by treatment with 4MU, a HA synthesis inhibitor. After IR, the expression levels of HA targets, TLR2, TLR4 and CD44 increased in the muscularis externa with the myenteric plexus more than in submucosal and mucosal layers and were sensitive to 4MU. The efficiency of the intestinal transit was significantly reduced in IR and further reduced in the 4MU-treated IR group. Carbachol (CCh), electrical field stimulated (EFS) contractions and EFSinduced non-adrenergic-non-cholinergic (NANC) relaxations were reduced after I/R. In this condition, 4MU increased EFS contractions towards control values, but did not affect CCh-induced contractions neither NANC on-relaxations. Main alterations in the neurochemical coding of excitatory (tachykinergic) and inhibitory pathways (iNOS, VIPergic) were also observed after IR and were influenced by 4MU administration. Overall, our data suggest that, after an intestinal IR damage, changes of HA homeostasis in specific myenteric neuron populations may participate in neuromuscular function derangement

Natural Products with Toll-Like Receptor 4 Antagonist Activity

Toll-Like Receptors (TLRs) are the innate immunity receptors that play an activating role when interacting with molecules released by bacteria and viruses (PAMPs, pathogen-associated molecular patterns) or with molecules released by injured cells and tissues (DAMPs, danger-associated molecular patterns). TLR triggering leads to the induction of proinflammatory cytokines and chemokines, driving the activation of both innate and adaptive immunity. In particular, Toll-Like Receptor 4 (TLR4) has been described to be involved in the inflammatory processes observed in several pathologies (such as ischemia/reperfusion injury, neuropathic pain, neurodegenerative diseases, and cancer). Molecules obtained by natural sources have been discovered to exert an anti-inflammatory action by targeting TLR4 activation pathways. This review focuses on TLR4 antagonists obtained from bacteria, cyanobacteria, and plants

The Effect of Cyanobacterial LPS Antagonist (CyP) on Cytokines and Micro-RNA Expression Induced by Porphyromonas gingivalis LPS

Lipopolysaccharide (LPS) from Porphyromonas gingivalis (Pg-LPS) is a key bacterial structure involved in the maintenance of a chronic pro-inflammatory environment during periodontitis. Similar to other gram-negative LPS, Pg-LPS induces the release of pro-inflammatory cytokines through interaction with Toll-Like Receptor 4 (TLR4) and is able to stimulate negative TLR4 regulatory pathways, such as those involving microRNA (miRNA). In this work, we employed CyP, an LPS with TLR4-MD2 antagonist activity obtained from the cyanobacterium Oscillatoria planktothrix FP1, to study the effects on pro-inflammatory cytokine production and miRNA expression in human monocytic THP-1 cells stimulated with Pg-LPS or E. coli LPS (Ec-LPS). Results showed that CyP inhibited TNF-\u3b1, IL-1\u3b2 and IL-8 expression more efficiently when co-incubated with Pg-LPS rather than with Ec-LPS. The inhibition of pro-inflammatory cytokine production was maintained even when CyP was added 2 h after LPS. The analysis of the effects of CyP on miRNA expression showed that, although being an antagonist, CyP did not inhibit miR-146a induced by Pg-LPS or Ec-LPS, whereas it significantly inhibited miR-155 only in the cultures stimulated with Ec-LPS. These results suggest that CyP may modulate the pro-inflammatory response induced by Pg-LPS, not only by blocking TLR4-MD2 complex, but also by preserving miR-146a expression

Adsorbimento di acido perfluoroottanoico su materiali mesoporosi

L’acido perfluoroottanoico (PFOA) è un prodotto industriale utilizzato principalmente come intermedio, inoltre si può formare come sottoprodotto indesiderato di reazione in fase di produzione o di degradazione di sostanze perfluorurate. Il PFOA è una sostanza molto stabile chimicamente e può permanere inalterata se rilasciata nell’ambiente. La sua stabilità e la bassa tensione di vapore sono le proprietà chimico fisiche principali che la rendono classificabile come contaminante organico persistente. Questa tipologia di inquinante è inoltre caratterizzata da un’alta mobilità ambientale, infatti la particolare struttura molecolare con un gruppo idrofilo e uno lipofilo e la presenza del gruppo carbossilico rendono il destino ambientale del PFOA differente da quello dei composti organici persistenti. Gli studi sulla tossicità del PFOA su animali da laboratorio ne hanno evidenziato tossicità e effetti negativi sullo sviluppo (1). Il PFOA nell’ambiente si distribuisce preferenzialmente nel comparto acquatico, e date le sue caratteristiche di peristenza e tossicità costituisce un rischio per l’ecosistema e per la salute. Pertanto si sono studiate diverse metodologie per la sua rimozione dalle acque naturali, tra cui l’adsorbimento, che ha il vantaggio rispetto a processi ossidativi, di non formare sottoprodotti di degradazione. In questo lavoro, si sono studiate le proprietà adsorbenti di silici mesoporose ed in particolare di MCM-41 ed HMS nei confronti di PFOA in soluzioni acquose diluite. I risultati ottenuti hanno mostrato come questi materiali possono essere usati per rimuovere efficacemente il PFOA dalle acque. In particolare, l’applicazione di HMS sembra molto promettente. Questo materiale è caratterizzato dalla presenza di canali cilindrici interconnessi che gli conferiscono particolari proprietà desiderabili per l’adsorbimento in flusso quali una elevata capacità di adsorbimento e un buon trasferimento di massa. Inoltre la sintesi di HMS ha basso impatto ambientale in quanto avviene in fase idroalcolica a temperatura ambiente e al contrario della MCM-41 non richiede condizioni di elevata temperatura e pressione e neppure l’impiego di soluzioni alcaline corrosive. Infine, la rimozione del templante dall’HMS può essere condotta a basse temperatura impiegando alcoli o soluzioni acquose anzichè ricorrere a processi di calcinazione ad alte temperature. Le caratteristiche sopra descritte rendono quindi questo materiale, ‘green’ e compatibile con l’ambiente, particolarmente adatto a metodologie di bonifica ambientale