Specialist alcohol inpatient treatment admissions and non-specialist hospital admissions for alcohol withdrawal in England: an inverse relationship

© The Author(s) 2020. Medical Council on Alcohol and Oxford University Press. AIMS: We assessed the relationship between specialist and non-specialist admissions for alcohol withdrawal since the introduction of the UK government Health and Social Care Act in 2012. METHODS: Using publicly available national data sets from 2009 to 2019, we compared the number of alcohol withdrawal admissions and estimated costs in specialist and non-specialist treatment settings. RESULTS: A significant negative correlation providing strong evidence of an association was observed between the fall in specialist and rise in non-specialist admissions. Significant cost reductions within specialist services were displaced to non-specialist settings. CONCLUSIONS: The shift in demand from specialist to non-specialist alcohol admissions due to policy changes in England should be reversed by specialist workforce investment to improve outcomes. In the meantime, non-specialist services and staff must be resourced and equipped to meet the complex needs of these service users

Medical gas plasma-stimulated wound healing: Evidence and mechanisms

Defective wound healing poses a significant burden on patients and healthcare systems. In recent years, a novel reactive oxygen and nitrogen species (ROS/RNS) based therapy has received considerable attention among dermatologists for targeting chronic wounds. The multifaceted ROS/RNS are generated using gas plasma technology, a partially ionized gas operated at body temperature. This review integrates preclinical and clinical evidence into a set of working hypotheses mainly based on redox processes aiding in elucidating the mechanisms of action and optimizing gas plasmas for therapeutic purposes. These hypotheses include increased wound tissue oxygenation and vascularization, amplified apoptosis of senescent cells, redox signaling, and augmented microbial inactivation. Instead of a dominant role of a single effector, it is proposed that all mechanisms act in concert in gas plasma-stimulated healing, rationalizing the use of this technology in therapy-resistant wounds. Finally, addressable current challenges and future concepts are outlined, which may further promote the clinical utilization, efficacy, and safety of gas plasma technology in wound care in the future

Zur wahlsoziologischen Bedeutung eines Modells sozialstrukturell verankerter Konfliktlinien im vereinten Deutschland

Der von Stein Rokkan 1967 zusammen mit Seymour Martin Lipset herausgegebene Sammelband 'Party systems and voter alignments' ist zweifellos eines der einflußreichsten und meistzitierten Werke der Wahlsoziologie. Der vorliegende Beitrag geht der Frage nach, ob das von Rokkan und Lipset konzipierte Konfliktlinienmodell (cleavage) noch einen Beitrag zur Erklärung des Wahlverhaltens im neuen, größeren Deutschland leisten kann. Bei der Prüfung der Theorie stützen sich die Autoren hauptsächlich auf die Daten der Forschungsgruppe Wahlen und das ZDF-Politbarometer. Die gesellschaftlichen Subsysteme bergen nach Lipset/Rokkan folgende Konfliktpotentiale in sich, die in dem Parteiensystem ihren Niederschlag finden: die Spaltung Besitz-Arbeit, die Spaltung Staat-Kirche, die Spaltung Stadt-Land und die Ethnische/Linguistische Spaltung. Die Sekundäranalyse zeigt, daß die Theorie sozialstrukturell verankerter Konfliktlinien als Determinanten des Wahlverhaltens nach wie vor einen eigenständigen Beitrag zur Erklärung der individuellen Parteipräferenzen in Deutschland zu leisten vermag. (pmb)'Electoral behavior in West Germany on state and federal levels was characterized by remarkable stability until the late 80's. This could be explained for a long time by the so called 'cleavage theory' of Stein Rokkan and Seymour Martin Lipset which says that the more or less frozen party systems of western democraties are based on sociostructural conflicts in these societies. Since the late 80's we report a clear drop in the stability of voting results. In addition, the unification of the two german states raises the question whether the cleavage model still can explain individual party preferences although voters in West and East were brought up in very different social and political structures. To answer this question we analyse party preferences in West and East separately as well as for the whole unified Germany. It will be clear that even under the changed conditions of the united Germany the model of Lipset and Rokkan can still contribute an independent part of the explanation of voting behavior.' (author's abstract

Simulation multi-domaines et calcul parallèle pour l'aéroacoustique en écoulement confiné

Un outil numérique de simulations aéroacoustiques est présenté pour des applications à des géométries complexes. Le solveur est basé sur des schémas à différences finies d'ordre élevé, ce qui impose l'utilisation de maillages structurés. Pour traiter des géométries complexes, le domaine de calcul est subdivisé en maillages partiellement recouvrants. La communication entre les différents maillages est réalisée par interpolations. L'utilisation de polynômes de Lagrange d'ordre elevé permet de maintenir l'ordre global de la solution. Le code est entièrement parallélisé à l'aide de la librairie MPI. La diffraction d'un pulse acoustique par un cylindre ainsi que l'écoulement transsonique dans un tube circulaire en 3-D sont présentés. Les deux simulations se comparent très bien avec les solutions analytiques

Statistics of heart failure and mechanical circulatory support in 2020

Heart failure is increasing in prevalence, with approximately 26 million patients affected worldwide. This represents a significant cause of morbidity and mortality. Statistics regarding heart failure patient age, hospitalization likelihood, and mortality differ significantly by country. Heart failure patients are typically classified by ejection fraction, with distinct phenotypes associated with reduced ejection fraction (rEF) or preserved ejection fraction (pEF). Heart failure has a significant financial impact related to hospitalization, medication, and procedural expenses. The costs of heart failure also extend to the reduced quality of life conferred by heart failure symptoms. Management of heart failure includes a variety of interventions, including mechanical circulatory support (MCS). MCS, including left ventricular assist devices (LVADs), right ventricular assist devices (RVADs) and extracorporeal membrane oxygenation (ECMO), has been a means of managing end stage heart failure. Given the relative scarcity of transplant organs, the utilization of MCS, particularly as a bridge to transplantation (BTT) has grown significantly. In this review, we discuss statistics related to heart failure and MCS. We evaluate how patients are classified and examine global trends and regional differences. We then address MCS therapies, the costs associated with heart failure, the impact of heart failure on patient quality of life, and data regarding morbidity and mortality

Biologic effects of light: An enlighting prospective

During the past several decades our knowledge on the effects of light on human health and its underlying mechanisms has been expanded exponentially. These findings have led to an enormous scientific progress including new concepts for prevention and treatment of many diseases such as autoimmune diseases, cardiovascular disease, skin cancer and other malignancies. To summarize our present knowledge on this topic and to stimulate new research initiatives, an international symposium entitled Biologic Effects of Light, that was organized by J. Reichrath, Th. Vogt and M.F. Holick, and that was supported by Deutsche Forschungsgemeinschaft (DFG), was held June 11/12, 2015 in Homburg/Saar, Germany. This meeting was specially designed to offer scientists and clinicians a platform to discuss the latest developments in this intriguing research area. Plenary and Keynote lectures as well as Round Table Discussions gave an update on carefully selected hot topics, including Vitamin D, skin cancer prevention, UVA radiation and cellular homeostasis, photocarcinogenesis, and photochemical internalization (PCI). Some of the relevant findings and conclusions of this meeting are published in this issue of Anticancer Research (1-13) and can be summarized as follows

Fetal trans-apical stent delivery into the pulmonary artery: prospects for prenatal heart-valve implantation

OBJECTIVE The purpose of this study was to assess the technical feasibility of a fetal trans-apical stent delivery into the pulmonary artery using a novel hybrid-intervention technique as a possible route for prenatal minimally invasive heart-valve-implantation approaches. METHODS Pregnant Pre-Alp sheep between 122 and 128 days' gestation (n=3) underwent a midline laparotomy. The fetus was left in utero or partially externalized and its chest was opened via a left-sided minithoracotomy. The fetal heart was cannulated and a guide wire was introduced through the ductus arteriosus into the aorta. A 14-French delivery system was then mounted onto the guide wire and advanced to the landing zone in the pulmonary artery, where the stent was deployed. The position of the stent was confirmed using echocardiography, angiography as well as computed tomography. RESULTS The trans-apical implantation was successful in all animals. However, at necropsy in one animal, the stent was found to partly occlude one of the pulmonary valvular leaflets. Bleeding at the antero-apical incision occurred in all animals but could be managed without fetal demise. No fetal cardiopulmonary bypass was performed. In all animals, contrast angiography displayed normal perfusion of the pulmonary vasculature as well as the ductus arteriosus. CONCLUSIONS Our study demonstrates the principal technical feasibility of a prenatal stent delivery into the pulmonary artery using a novel trans-apical hybrid-intervention technique. This approach demonstrates the first step towards possible future minimally invasive prenatal heart-valve-implantation procedure

Effects of lithium on electrical activity and potassium ion distribution in the vertebrate central nervous system

Three different regions of the vertebrate central nervous system maintained in vitro (frog spinal cord, guinea pig olfactory cortex and hippocampus) have been used to investigate how Li+ influences membrane potential, membrane resistance, action potentials, synaptic potentials and the transmembrane K+-distribution of neurons and glial cells. In view of the therapeutic action of Li+ in manicdepressive disease, a special effort was made to determine the threshold concentration for the actions of Li+ on the parameters described above. It was observed that Li+ induced a membrane depolarization of both neurons and glial cells, a decrease of action potential amplitudes, a facilitation of monosynaptic excitatory postsynaptic potentials and a depression of polysynaptic reflexes. The membrane resistance of neurons was not altered. Li+ also induced an elevation of the free extracellular potassium concentration and a decrease of the free intracellular potassium concentration. Furthermore, in the presence of Li+ a slowing of the recovery of the membrane potential of neurons and glial cells, and of the extracellular potassium concentration after repetitive synaptic stimulation was observed. The threshold concentrations for the effects of Li+ were below 5 mmol/l in the frog spinal cord and below 2 mmol/l in the guinea pig olfactory cortex and hippocampus. The basic mechanism underlying the action of Li+ may be an interaction with the transport-function of the Na+/K+ pump

Off-pump coronary bypass grafting is safe and efficient in patients with left main disease and higher EuroScore

Background: Summary Left main disease (LMD) and associated cardiac risk factors are often perceived as a limiting factor for the outcome of off-pump coronary artery bypass (OPCAB) grafting. In this study, we assess whether the outcome of OPCAB surgery is affected in such patients. Methods: We retrospectively compared perioperative parameters in 66 OPCAB patients (group A) with LMD and 216 OPCAB patients without (group B) LMD. The patients were operated in the time frame between 2002 and 2007. LMD was defined as a stenosis >50%. Results: Patients in group A had a higher EuroSCORE (logistic: 3.7 ± 0.1 vs 6.3 ± 0.3, p = 0.027), increased coronary artery disease (CAD) family history (p = 0.015) and cerebrovascular accidents (p = 0.027), increased history of congestive heart failure (p = 0.013), more urgent surgery (p = 0.008), previous percutaneous transluminal coronary angioplasties (PTCAs) (p = 0.05) and previous stent implantation (p = 0.023). An intra-aortic balloon pump (IABP) was inserted more frequently in the LMD group preoperatively (p = 0.004). There were two conversions to on-pump during OPCAB surgery. There were no differences in the postoperative outcomes in the LMD group A versus group B, such as cardiac-related events, neurological deficits, cardiac enzyme course, arrhythmias, blood loss, infections and renal failure. Conclusions: The presence of LMD and higher EuroSCORE does not yield adverse outcomes in OPCAB patient