Προγνωστικοί δείκτες λειτουργικότητας γηριατρικών ασθενών που επιστρέφουν στο σπίτι μετά από κάταγμα

Εισαγωγή: Τα κατάγματα ευθραυστότητας αποτελούν μία από τις κύριες αιτίες θανάτου καθώς και την 4η αιτία αναπηρίας πανευρωπαϊκά όσον αφορά το γηριατρικό πληθυσμό, ο οποίος αυξάνει διαρκώς σε μέγεθος κατά τις τελευταίες δεκαετίες. Πολλαπλοί παράγοντες συμβάλλουν στην αυξημένη επίπτωση τέτοιου είδους καταγμάτων συμπεριλαμβανομένης της αυξημένης επίπτωσης των πτώσεων και της οστεοπόρωσης σε άτομα της τρίτης ηλικίας Σκοπός: Η καταγραφή της λειτουργικής ικανότητας και της θνησιμότητας των ασθενών άνω των 70 ετών μετά το εξιτήριο τους από την ορθοπαιδική κλινική του Πανεπιστημιακού Γενικού Νοσοκομείου Αθηνών ‟ΛΑΙΚΟ’’ όπου εισήχθησαν για νοσηλεία ή και χειρουργική αποκατάσταση μετά από οστεοπορωτικό κάταγμα ισχίου χαμηλής βίας. Επιπλέον στόχο αποτέλεσε η διερεύνηση των προγνωστικών παραγόντων και ο βαθμός αποκατάστασης της λειτουργικής ικανότητας των ασθενών σε διάστημα έξι μηνών μετά το εξιτήριό τους. Υλικό και Μέθοδος:Το δείγμα της μελέτης αποτέλεσαν 120 ασθενείς που εισήχθησαν με τραυματικό κάταγμα ισχίου, ύποπτο οστεοπόρωσης στο τμήμα επειγόντων περιστατικών. Η καταγραφή των ασθενών που τυχαιοποιήθηκαν στη συνήθη φροντίδα περιλάμβανε το εργαλείο διαστρωμάτωσης καταγματικού κινδύνου FRAX, το ιατρείο ιστορικό που είναι συναφές με την οστεοπόρωση, τη φαρμακευτική αγωγή, και τους βασικούς κοινωνικούς και δημογραφικούς παράγοντες. Στους ασθενείς που τυχαιοποιήθηκαν στη γηριατρική εκτίμηση χορηγήθηκαν επιπλέον έγκυρα αξιολογητικά εργαλεία για τη διανόηση, τη διάθεση, τον πόνο, τη λειτουργική ικανότητα, την κατάσταση της θρέψης τους, και την ευπάθεια. Αποτελέσματα: Από τους 120 ασθενείς, οι 25 αποκλείστηκαν καθώς δεν πληρούσαν τα κριτήρια της μελέτης. Από το υπόλοιπο δείγμα, 56 αξιολογήθηκαν με ενδελεχή γηριατρική αξιολόγηση ενώ 39 έλαβαν τη συνήθη ορθοπαιδική φροντίδα. 4 ασθενείς δε μπόρεσαν να επανεκτιμηθούν επομένως τα δεδομένα του εξαμήνου προέκυψαν από δείγμα 52 ατόμων. Η αποκατάσταση της κινητικότητας μετά το κάταγμα δεν συσχετίστηκε με το προηγούμενο επίπεδο αυτής, με το 69% των ασθενών να επιτυγχάνουν αυτόνομη βάδιση με ή χωρίς βοήθημα. Παράγοντες όπως η προϋπάρχουσα κατάθλιψη και ενδονοσοκομειακή πορεία επιπλεγμένη από ντελίριο φαίνεται ότι έχουν προγνωστική αξία με οριακή στατιστική σημαντικότητα. Άλλοι παράγοντες όπως η ηλικία, το φύλο, το επίπεδο κινητικότητας προ του κατάγματος, οι διαταραχές μνήμης καθώς και νόσοι όπως ο σακχαρώδης διαβήτης, η χρόνια αποφρακτική πνευμονοπάθεια και η κολπική μαρμαρυγή δεν θα πρέπει να αντιμετωπίζονται ως παράγοντες κακής πρόγνωσης για την αποκατάσταση της κινητικότητας των ηλικιωμένων καταγματιών. Συμπεράσματα: Η παρουσία καταθλιπτικής διαταραχής και το οργανικό ψυχοσύνδρομο φαίνεται να διαδραματίζουν σημαντικό, ανάμεσα στους παράγοντες που εξετάστηκαν, ρόλο στην αποκατάσταση των ηλικιωμένων με κατάγματα ευθραυστότητας. Υπογραμμίζεται συνεπώς η ανάγκη της ψυχοδιανοητικής αξιολόγησης και υποστήριξης τόσο κατά τη νοσηλεία όσο και κατά την περίοδο της αποκατάστασης.Introduction: Fragility fractures are one of the leading causes of death as well as the 4th leading cause of pan-European disability in the geriatric population, which has been steadily increasing in size in recent decades. Multiple factors contribute to the increased incidence of such fractures including the increased incidence of falls and osteoporosis in the elderly. Purpose: The recording of the functional capacity and mortality of patients over 70 years after their discharge from the orthopedic clinic of the University General Hospital of Athens "LAIKO" where they were admitted for hospitalization or surgical rehabilitation after low energy osteoporotic fractures. An additional goal was to investigate the prognostic factors and the degree of recovery of patients' functional capacity within six months after their discharge. Materials and methods: The study sample consisted of 120 patients admitted in the emergency department with a traumatic hip fracture. Recording of patients randomized to routine care included the FRAX risk assessment tool, medical history relevant to osteoporosis, medication list, and basic sociodemographic factors. Patients randomized to geriatric care were additionally administered validated scales for assessment of cognition, mental health, pain, functional ability, nutritional status, and frailty. Results: Out of 120 patients, 25 were excluded as they did not meet the study criteria. 56 were evaluated with a thorough geriatric assessment while 39 received standard orthopedic care. 4 patients could not be re-evaluated, so the 6-month data were obtained from a sample of 52 patients. Restoration of mobility after fracture was not correlated with its previous level and 69% of patients achieved autonomous gait with or without assistance. Factors such as pre-existing depression and in-hospital course complicated by delirium appear to have prognostic value with marginal statistical significance.Other factors such as age, gender, level of pre-fracture mobility, memory disorders as well as diseases such as diabetes, chronic obstructive pulmonary disease and atrial fibrillation should not be treated as poor prognostic factors to restore mobility. Conclusions: The presence of depressive disorder and delirium seem to play an important role in the rehabilitation of the elderly with fragility fractures. The need for psychosocial evaluation and support during both hospitalization and rehabilitation is therefore emphasized

The visual pigment xenopsin is widespread in protostome eyes and impacts the view on eye evolution

Photoreceptor cells in the eyes of Bilateria are often classified into microvillar cells with rhabdomeric opsin and ciliary cells with ciliary opsin, each type having specialized molecular components and physiology. First data on the recently discovered xenopsin point towards a more complex situation in protostomes. In this study, we provide clear evidence that xenopsin enters cilia in the eye of the larval bryozoan Tricellaria inopinata and triggers phototaxis. As reported from a mollusc, we find xenopsin coexpressed with rhabdomeric-opsin in eye photoreceptor cells bearing both microvilli and cilia in larva of the annelid Malacoceros fuliginosus. This is the first organism known to have both xenopsin and ciliary opsin, showing that these opsins are not necessarily mutually exclusive. Compiling existing data, we propose that xenopsin may play an important role in many protostome eyes and provides new insights into the function, evolution, and possible plasticity of animal eye photoreceptor cells.publishedVersio

原著

摘出ラット上頸交感神経節を用いて,刺激頻度と薬物作用との関係を検討し,次の結果を得た。1.Hexamethonium,d-Tubocurarine,PhysostigmineおよびParaoxon作用下では,神経節伝達抑制作用が低頻度刺激よりも高頻度刺激により増強された。このような薬物効果をType Aとした。2.Adrenaline(Adr.),Nor-Adrenaline(Nor-Adr),MgCl_2,MnCl_2ならびにCa^-deficit Ringer(0.1〜0.4mM CaCl_2)では,低頻度刺激時にみられた抑制効果が高頻度刺激下で著しく回復され,この効果をType Bとした。3.ProcaineおよびPropranolol作用下の抑制効果は,刺激頻度の多少にほとんど影響されなかった。この効果をType Cとした。4.Adr.,Nor-Adr.のType B効果はPhentolamineにより拮抗されたが,ほとんどPropranololの影響をうけなかった。MgCl_2,MnCl_2およびCa^#-deficit効果は,α-,およびβ-効果遮断薬により影響されなかった。5.Type B作用群薬物の効果は,high Ca^-Ringer(9mM CaCl_2)で消失され,low Ca^-Ringer液中で増強された。6.Ringer液中のNa^+およびK^+イオンの増減ならびにOuabain(10μM)はType B効果に影響を与えなかった。7.Sucrose-gap法による実験で,Type B作用群薬物は単発刺激による神経節のspike potentialを消失し,比較的大きなsynaptic potentialを生じた。このsynaptic potentialは,300msec以下の刺激間隔で与えた2発刺激により容易にspike potentialに発展した。また高頻度刺激によっても漸次増大するspike potentialが容易に発生した。8.Type B作用群薬物の作用機構についてとくに神経終末からの伝達物質遊離抑制面から考察した。The relationship between the rate of stimulation and effects of drugs on the superior cervical ganglion was investigated. Under the effect of hexamethonium, d-tubocu-rarine, physostigmine or paraoxon, ganglionic transmission was blocked more effectively with higher rate of stimulation than lower rate of stimulation (Type A drugs). Under the effect of adrenaline, noradrenaline, MgCl_2, MnCl_2 or Ca^-deficit Ringer (0.1-0.4mM CaCl_2,) solution, ganglionic transmission was depressed with lower rate of stimulation, but it was restored with higher rate of stimulation (Type B drugs). The inhibitory effect of procaine and propranolol on the ganglionic transmission was not affected by frequency change in transmission (Type C drugs). The effect of adrenaline or noradrenaline, those belong to the type B group, was blocked by phentolamine but not by propranolol. Phentolamine and propranolol had no effect on the action of MgCl_2, MnCl_2 and Ca^-deficit Ringer solution. The effect of the type B group drugs was decreased in Ringer solution containing higher concentration of Ca^ and augmented in Ringer solution containing lower concentration of Ca^. The effect of the type B group drugs was not affected by increasing or decreasing of the concentration of Na^+ or K^+ in Ringer solution. Ouabain (10μM) had no effect on the action of the type B drugs. By means of the sucrose-gap method, the spike potentials evoked by applying single stimulation were transferred to the synaptic potentials under the influence of the type B drugs. When the synaptic potential was evoked by the doubleshock stimuli of an interval shorter than 300 msec, the synaptic potential easily devoloped to the spike potential. In this work, the mechanism of action of the type B drugs was discussed on the standpoint of the depressed transmitter release

Feasibility study and prototyping of a blockchain-based transport-service pricing and allocation platform

This report summarizes the activity and findings of the JRC Proof of Concept Project Ridechain. The project investigated the applicability and market potential of blockchain technology for asset sharing in the road transport sector. The project comprised two principal activities. The first activity was market research and analysis to support the development of a new service concept and business model for blockchain-powered shared mobility. Specifically, the research resulted in the definition of a novel technology platform that leverages blockchain, cloud services, and in-car technology to enhance trust, streamline coordination and improve information exchange in P2P car sharing ecosystems. The second activity was technology prototyping to demonstrate the technical feasibility of the novel service concept using state of the art blockchain and IoT frameworks. These two activities provided answers to two respective research questions. First, what would be a high-value transport sector market to which a blockchain-powered technology product could offer a high-value solution? Second, how could this technology product be realized?JRC.C.4-Sustainable Transpor

A CASE OF COMBINED CENTRAL AND PERIPHERAL DEMYELINATION IN A PATIENT WITH PEDIATRIC MULTIPLE SCLEROSIS AFTER SARS-COV-2 VACCINATION

We present a case of combined central and peripheral demyelination in a patient with pediatric multiple sclerosis after the first dose of ChAdOx1-S (Chimpanzee Adenovirus Oxford 1) vaccination. The patient presented with ascending flaccid quadriparesis with respiratory failure that required mechanical ventilation. The lumbar puncture revealed albuminocytological dissociation, was negative for presence of JCV (John Cunningham Virus) in the CSF (Cerebrospinal Fluid) and ruled out other infections. A few days later he developed anisocoria and multiple new enlarging acute demyelinating lesions in the brain MRI (Magnetic Resonance Imaging). He was treated with intravenous immunoglobulin, corticosteroids and plasma exchange with gradual improvement. All other diseases were excluded via MR Spectroscopy, MR Angiography and serum and CSF laboratory investigations. Seven months later, the patient is under intense physiotherapy and is improving every day

Ultrastructural correlates of enhanced norepinephrine and neuropeptide y cotransmission in the spontaneously hypertensive rat brain

The spontaneously hypertensive rat (SHR) replicates many clinically relevant features of human essential hypertension and also exhibits behavioral symptoms of attention-deficit/hyperactivity disorder and dementia. The SHR phenotype is highly complex and cannot be explained by a single genetic or physiological mechanism. Nevertheless, numerous studies including our own work have revealed striking differences in central catecholaminergic transmission in SHR such as increased vesicular catecholamine content in the ventral brainstem. Here, we used immunolabeling followed by confocal microscopy and electron microscopy to quantify vesicle sizes and populations across three catecholaminergic brain areas—nucleus tractus solitarius and rostral ventrolateral medulla, both key regions for cardiovascular control, and the locus coeruleus. We also studied colocalization of neuropeptide Y (NPY) in norepinephrine and epinephrine-containing neurons as NPY is a common cotransmitter with central and peripheral catecholamines. We found significantly increased expression and coexpression of NPY in norepinephrine and epinephrine-positive neurons of locus coeruleus in SHR compared with Wistar rats. Ultrastructural analysis revealed immunolabeled vesicles of 150 to 650 nm in diameter (means ranging from 250 to 300 nm), which is much larger than previously reported. In locus coeruleus and rostral ventrolateral medulla, but not in nucleus tractus solitarius, of SHR, noradrenergic and adrenergic vesicles were significantly larger and showed increased NPY colocalization when compared with Wistar rats. Our morphological evidence underpins the hypothesis of hyperactivity of the noradrenergic and adrenergic system and increased norepinephrine and epinephrine and NPY cotransmission in specific brain areas in SHR. It further strengthens the argument for a prohypertensive role of C1 neurons in the rostral ventrolateral medulla as a potential causative factor for essential hypertension

Additional file 3_7dpf_FMRF_aTub_DAPI_apical organ

Confocal z-stack showing FMRFamide-LIR (purple), aTub-LIR (cyan) and DAPI staining (dark blue) of the 7 dpf stage. Apical view of the apical organ

Data from: Owenia fusiformis - a basally branching annelid suitable for studying ancestral features of annelid neural development

Background-Comparative investigations on bilaterian neurogenesis shed light on conserved developmental mechanisms across taxa. With respect to annelids, most studies focus on taxa deeply nested within the annelid tree, while investigations on early branching groups are almost lacking. According to recent phylogenomic data on annelid evolution Oweniidae represent one of the basally branching annelid clades. Oweniids are thought to exhibit several plesiomorphic characters, but are scarcely studied - a fact that might be caused by the unique morphology and unusual metamorphosis of the mitraria larva, which seems to be hardly comparable to other annelid larva. In our study, we compare the development of oweniid neuroarchitecture with that of other annelids aimed to figure out whether oweniids may represent suitable study subjects to unravel ancestral patterns of annelid neural development. Our study provides the first data on nervous system development in basally branching annelids. Results-Based on histology, electron microscopy and immunohistochemical investigations we show that development and metamorphosis of the mitraria larva has many parallels to other annelids irrespective of the drastic changes in body shape during metamorphosis. Such significant changes ensuing metamorphosis are mainly from diminution of a huge larval blastocoel and not from major restructuring of body organization. The larval nervous system features a prominent apical organ formed by flask-shaped perikarya and circumesophageal connectives that interconnect the apical and trunk nervous systems, in addition to serially arranged clusters of perikarya showing 5-HT-LIR in the ventral nerve cord, and lateral nerves. Both 5-HT-LIR and FMRFamide-LIR are present in a distinct nerve ring underlying the equatorial ciliary band. The connections arising from these cells innervate the circumesophageal connectives as well as the larval brain via dorsal and ventral neurites. Notably, no distinct somata with 5-HT -LIR in the apical organ are detectable in the larval stages of Owenia. Most of the larval neural elements including parts of the apical organ are preserved during metamorphosis and contribute to the juvenile nervous system. Conclusions-Our studies in Owenia fusiformis strongly support that early branching annelids are comparable to other annelids with regard to larval neuroanatomy and formation of the juvenile nervous system. Therefore, Owenia fusiformis turns out to be a valuable study subject for comparative investigations and unravelling ancestral processes in neural development in Annelida and Bilateria in general

Data from: Owenia fusiformis - a basally branching annelid suitable for studying ancestral features of annelid neural development

Background-Comparative investigations on bilaterian neurogenesis shed light on conserved developmental mechanisms across taxa. With respect to annelids, most studies focus on taxa deeply nested within the annelid tree, while investigations on early branching groups are almost lacking. According to recent phylogenomic data on annelid evolution Oweniidae represent one of the basally branching annelid clades. Oweniids are thought to exhibit several plesiomorphic characters, but are scarcely studied - a fact that might be caused by the unique morphology and unusual metamorphosis of the mitraria larva, which seems to be hardly comparable to other annelid larva. In our study, we compare the development of oweniid neuroarchitecture with that of other annelids aimed to figure out whether oweniids may represent suitable study subjects to unravel ancestral patterns of annelid neural development. Our study provides the first data on nervous system development in basally branching annelids. Results-Based on histology, electron microscopy and immunohistochemical investigations we show that development and metamorphosis of the mitraria larva has many parallels to other annelids irrespective of the drastic changes in body shape during metamorphosis. Such significant changes ensuing metamorphosis are mainly from diminution of a huge larval blastocoel and not from major restructuring of body organization. The larval nervous system features a prominent apical organ formed by flask-shaped perikarya and circumesophageal connectives that interconnect the apical and trunk nervous systems, in addition to serially arranged clusters of perikarya showing 5-HT-LIR in the ventral nerve cord, and lateral nerves. Both 5-HT-LIR and FMRFamide-LIR are present in a distinct nerve ring underlying the equatorial ciliary band. The connections arising from these cells innervate the circumesophageal connectives as well as the larval brain via dorsal and ventral neurites. Notably, no distinct somata with 5-HT -LIR in the apical organ are detectable in the larval stages of Owenia. Most of the larval neural elements including parts of the apical organ are preserved during metamorphosis and contribute to the juvenile nervous system. Conclusions-Our studies in Owenia fusiformis strongly support that early branching annelids are comparable to other annelids with regard to larval neuroanatomy and formation of the juvenile nervous system. Therefore, Owenia fusiformis turns out to be a valuable study subject for comparative investigations and unravelling ancestral processes in neural development in Annelida and Bilateria in general

I mongoli tra Oriente ed Occidente: la rappresentazione dell'alterità

Dai contributi contenuti nel fascicolo appare evidente come l'argomento dell'alterità e dei rapporti culturali sia declinabile in diversi termini; ma soprattutto emerge la complessità e la ricchezza degli studi mongoli che spesso richiedono allo studioso – in considerazione proprio delle molteplici culture, da Oriente a Occidente, con cui vennero in contatto – competenze linguistiche specifiche tali da permettergli di accedere alle fonti scritte, presupposto indispensabile per lo studio della storia e della cultura mongola nelle sue molteplici sfaccettature