Quantitation of the förster energy transfer for two-dimensional systems: II. Protein distribution and aggregation state in biological membranes

Analytical solutions are presented of the average rate of the Förster energy transfer for several processes affecting intrinsic membrane proteins within a phospholipid bilayer. The physical phenomena considered here are lateral phase separation of the protein, i.e., formation of eutectic mixtures, changes in the aggregation state of the protein and non-random distribution of protein molecules. It is shown that the average rate of energy transfer among protein and phospholipid molecules labelled with donor and acceptor molecules, respectively, allows differentiation between them and also that the average rate of energy transfer can be used to quantitate these phenomena.     

Quantitation of the förster energy transfer for two-dimensional systems: I. Lateral phase separation in unilamellar vesicles formed by binary phospholipid mixtures

An analytical solution is presented for the rate of energy transfer in unilamellar vesicles formed by binary mixtures of phospholipids showing lateral phase separation. The analytical approach developed here is mainly based on geometrical considerations and therefore, is formally different for lateral phase separation phenomena taking place in the gel and in the liquid crystalline states of the lipid system. The rate of energy transfer among donor and acceptor molecules attached to chemically different phospholipids is mathematically correlated to the average cluster size of the less-rich component of the binary mixture, thus allowing its calculation from experimental measurements. Moreover, the equations derived here permit the calculation of the average cluster size as a function of the concentration of each lipid component within certain ranges, and this can be used to improve our knowledge of the thermodynamics of these processes.     

Análisis de las defunciones de pacientes con demencia ingresados en una unidad de psicogeriatría

Aim

To determine the characteristics of patients with dementia who died in a psychogeriatric unit, and to describe the conditions that led to their death.

Material and methods

Observational study of patients who died in the Psychogeriatric unit of Hospital de la Santa Creu de Vic during a three and a half year period.

Results

Of the 554 patients admitted during the study period, we recorded a mortality of 14.6% (81 patients). The analysis of those who died showed that 67.9% were women, with a mean age of 85.8 years, with the most frequent cause being Alzheimer type dementia (37%) and being in an advanced stage (CDR3, GDS 6-7) in 72.8% of cases. On admission the following characteristics were recorded: Mini Mental State Examination (MMSE) 9.5, Barthel Index (BI) prior to entry 50.1, BI on admission 17.4, and Neuropsychiatric Inventory (NPI) 31.4. A therapeutic limitation treatment was determined for 84% of patients on admission. From the analysis of the conditions that lead to death it was noted that: In 74.1% of the patients the death was a direct result of a triggering event (the most frequent being respiratory infection), in 17.3% the death occurred by a gradual decline, with no clear precipitating factor, and in 8.6% of patients palliative sedation was required due to poorly controlled symptoms.

Conclusions

Intercurrent problems were the most common factors related to the death of the patients. Most patients died in the stages prior to the established criteria for terminal dementia. In some cases patients may experience disorder behavior as a refractory symptom.     

First proposal of quality indicators and standards and recommendations to improve the healthcare in the Spanish National Registry of Hip Fracture

BackgroundThe Spanish National Hip Fracture Registry (or Registro Nacional de Fractura de Cadera, RNFC) is a database of hip fracture patients admitted to Spanish hospitals. Its goals include assessment and continuous improvement of the care process.ObjectivesTo (1) establish a series of indicators, (2) evaluate their initial fulfillment, (3) propose quality standards, (4) suggest recommendations to facilitate standards compliance, and (5) monitor the indicators.MethodThe indicators fulfilled the criteria of (1) evaluating the process or outcome, (2) being clinically relevant for patients, (3) being modifiable through changes in healthcare practice, and (4) being considered important by the RNFC participants. The first quartile obtained by the group of hospitals in each of the respective variables was proposed as the standard. The Indicators Advisory Committee (IAC) elaborated a list of recommendations for each indicator, based on the available evidence.ResultsSeven indicators were chosen. These indicators (its baseline compliance vs. the standard to be reached, respectively) were: the proportion of patients receiving surgery within 48 h (44% vs. 63%), mobilized the first postoperative day (56% vs. 86%), with antiosteoporotic medication at discharge (32% vs. 61%), with calcium supplements at discharge (46% vs. 77%), with vitamin D supplements at discharge (67% vs. 92%), who developed pressure ulcers during hospitalization (7.2% vs. 2.1%) and with independent mobility at 30 days (58% vs. 70%). The IAC has established 25 recommendations for improving care.ConclusionThe indicators and standards chosen are presented, as well as the list of recommendations. This process completes the first step to improve quality of care. The results will be evaluated 6 months after implementing the recommendations.     

Energy migration in the poly(ra-rU)-ethidium complex. determination of the unwinding angle of the polyribonucleic helix

The polarized fluorescence of the ethidium bromide (EB)-poly(rA-rU) complex has been studied by pulse fluorometry. As expected for a polynucleotide snowing one single kind of intercalation site, the decay of the whole emission is a single exponential (time constant 27 ns). The anisotropy decay is analysed as follows: (1) A brownian contribution having two correlation times, one of which characterizes local motions and the other a macromolecular motion. (2) A contribution due to transfers between EB molecules fixed to the same polynucleotide molecule, is analysed by a method analogous to the method used in previous work on EB-DNA complexes. That method consists in choosing a molecular model of the complex depending on geometrical parameters, and in simulating the energy migration on that model with a Monte Carlo calculation. Poly(rA-rU) is assumed here to adopt the structure A of RNA. Intercalated EB molecules modify the anale between two consecutive base pairs by δ. The angular position of the EB transition moment is defined by an angle φ. One finds that the angle φ is situated between 0° and 30°, which corresponds to a whole intercalation of the chroniophore as opposed to the semi-intercalation which has been proposed for certain dyes. The angle δ is negative; therefore there is an unwinding of the polyribonucleotide helix. Its absolute value is about 38°, sensibly greater than The value previously found for EB-DNA complexes.     

La unidad de ortogeriatría de agudos. Evaluación de su efecto en el curso clínico de los pacientes con fractura de cadera y estimación de su impacto económico

Objective

To study the effects of the management of hip fracture patients in an acute orthogeriatric unit shared between the departments of Orthopedic Surgery and Geriatrics compared with the usual hospital care, and to analyse financial differences in both systems of care.

Method

Prospective quasy-experimental randomized intervention study in 506 patients admited to a terciary hospital with an osteoporotic hip fracture. The usual model of care was the admission to the orthopedic ward with a request to Geriatrics (RC) and the study model consisted of the admission to an orthogeriatric unit (OGU) for the shared co-management between orthopaedic surgeons and geriatricians. This model included the appointment of one spokesperson from each department, the specialist geriatric nurse management, early geriatric assessment, shared daily clinical care, weekly joint ward round and coordinated planning of the surgery schedule, the start of the ambulation and the time and setting of patient discharge.

Results

Two hundred fifty five consecutive patients admitted to the OGU and 251 patients managed simultaneusly by the RC model were included. Except for a mean age slightly lower in the OGU group, there were no differences neither in the baseline patients characteristics nor in the surgical rates between the two groups. Among the OGU patients group it was more frequent to receive rehabilitation in the acute setting, to be able to walk at discharge and to be referred to a geriatric rehabilitation unit (all with P<.05). The OGU patients received geriatric assessment and were operated on earlier than the RC patients (P<.001). The length of stay in the acute ward was 34% shorter in the OGU patients (mean 12.48±5 vs 18.9±8.6 days, P<.001) (median 12 [9-14] vs 17 [13-23] days, P<.001). The whole hospital length of stay, including the days spent in the geriatric rehabilitation units, was 11% shorter in the OGU patients (mean 21.16 ±14.7 vs 23.9 ±13.8 days, P<0.05) (median 14 [10-31] vs 20 [14-30] days, P<.001). The OGU saved 1,207 € to 1,633 € per patient when estimated by the costs for process model, and 3,741 € when estimated by the costs for stay model.

Conclusions

The OGU is a hospital setting that provides an improvement in the patients functional outcome and a reduction in the hospital length of stay. Therefore it saves health care resources. These findings show the OGU as an advisable setting for the acute care of hip fracture patients.     

Nucleotide sequence analysis of NIPBL gene in Indian Cornelia de Lange syndrome cases

BACKGROUND:

Cornelia de Lange syndrome (CdLS) is a multisystem developmental disorder in children. The disorder is caused mainly due to mutations in Nipped-B-like protein. The molecular data for CdLS is available from developed countries, but not available in developing countries like India. In the present study, the hotspot region of NIPBL gene was screened by Polymerase Chain Reaction which includes exon 2, 22, 42, and a biggest exon 10, in six CdLS patients and ten controls.

MATERIALS AND METHODS:

The method adopted in present study was amplification of the target exon by using polymerase chain reaction, qualitative confirmation of amplicons by Agarose Gel Electrophoresis and use of amplicons for Conformation Sensitive Gel Electrophoresis to find heteroduplex formation followed by sequencing.

RESULTS:

We report two polymorphisms in the studied region of gene NIPBL. The polymorphisms are in the region of intron 1 and in exon 10. The polymorphism C/A is present in intron 1 region and polymorphism T/G in exon 10.

CONCLUSION:

The intronic region polymorphism may have a role in intron splicing whereas the polymorphism in exon 10 results in amino acid change (Val to Gly). These polymorphisms are disease associated as these are found in CdLS patients only and not in controls.     

Lipid peroxidation and the generation of free radicals, superoxide anion, and hydrogen peroxide in beta-lapachone-treated Trypanosoma cruzi epimastigotes.

β-Lapachone, an antimicrobial agent, was reduced by Trypanosoma cruzi epimastigotes to a semiquinone radical. It markedly increased the generation of superoxide anion and hydrogen peroxide in intact cells. Using NADH as electron donor, β-lapachone also increased significantly the rate of H₂O₂ generation in epimastigote homogenates. Incubation of epimastigotes with β-lapachone stimulated lipid peroxidation.     

El fenómeno de las caídas en residencias e instituciones: revisión del Grupo de Trabajo de Osteoporosis,Caídas y Fracturas de la Sociedad Española de Geriatría y Gerontología (GCOF-SEGG)

The Workshop on Osteoporosis, Falls and Fractures (GCOF) of The Spanish Geriatrics and Gerontology Society (SEGG) formed a committee in order to review the state of the art on the detection, risk factors and assessment tools for falls, and intervention protocols when falls occurs in nursing homes, long-term hospitals or medium-stay units. The different patient profiles are described in order to make a comprehensive approach to this heterogeneous topic and population, offering a risk classification and specific advice according to these categories.     

Scintigraphie des parathyroïdes double isotope Tc-MIBI/I dans l’hyperparathyroïdisme primaire : comparaison entre un protocole d’acquisition planaire et une TEMP de soustraction couplée à la TDM

In patient with primary hyperparathyroidism, preoperative imaging first objective is to determine accurately and reliably position and anatomic localization of enlarged parathyroid gland in order to guide surgeon for gland removal and to permit minimally invasive surgery. Although subtraction planar scintigraphy is an efficient imaging to diagnose hyperfunctioning parathyroid, the lack of anatomical reference for this single imaging technique could be obviated by hybrid imaging. We compared, in 23 patients with primary hyperparathyroidism, a planar scan of neck and mediastinum associated with a cervical anterior pinhole scan to a subtraction (¹²³I/^99mTc-MIBI) SPECT scan of neck and mediastinum fused with CT. Surgical and histopathologic findings were used as the standard of truth. Subtraction SPECT/CT appeared to be more sensitive and specific than planar protocol to diagnose and to accurately localize pathologic parathyroid. Sensitivity was 76 and 56 %, specificity was 100 and 80 % for hybrid SPECT/CT and planar protocol respectively. SPECT protocol was typically more efficient to diagnose pathologic parathyroid derived from upper gland and for patient with concomitant nodular goiter.     

Nathaniel Wallich, MD, PhD, FRS, FLS, FRGS, (1786–1854) and the Herbarium of the Honourable East India Company, and their relation to the de Candolles of Geneva and the Great Prodromus

The botanical career of Nathaniel Wallich is followed; his collecting activities in Asia enumerated, and the final disposition of his huge herbarium, largely the property of the Honourable East India Company, is given. His relationship with numerous eminent contemporary botanists, and particularly with the de Candolles of Geneva, is described, together with the role that each played in assisting Wallich to work up his material.
A full list of the works used in the composition of this paper is given in an Appendix rather than following the usual citation convention. Copies of the correspondence between Wallich and the de Candolles of Geneva are available on microfiche.     

Nonagenarios en los servicios de Medicina Interna españoles

Objetive

To describe the demographic and clinical profile of nonagenarian patients admitted to Internal Medicine departments in Spanish hospitals, and to compare it with younger patients.

Methods

We identified, through the MBDS (Basic Minimum Data Set), every patient older than 90 years admitted to Internal Medicine Departments of the Spanish National Health Service public hospitals between 2005- 2008. Hospital discharge data were obtained from the MBDS. A diagnosis-related group (DRG) was identified for every patient. The DRG 21.0 version was used. We compared this nonagenarian group with data of younger adult people. All centres submit this information to the Spanish Health Ministry. The Charlson Index (CCI) was used to determine comorbidity. All statistical analyses were performed using SPSS 14.0.

Results

The sample included 131,434 patients over 90 years (6% of total patients admitted), with 2,222 patients being over 100 years. There were 45.3% female patients under 90 years, compared to 67.3% over 90 years (P<.001). The top ten DRGs listed in the older group included three new conditions not present in the younger one: pulmonary oedema (DRG: 87), severe urinary tract infection (DRG: 320), and severe respiratory tract infection (DRG: 540). The first 5 DRG were: pneumonia/bronchitis (541): 11.9%, heart failure (127): 8.9%, rhythm disorders (544): 7.5%, pulmonary oedema (87): 3.8%, and other respiratory diseases (89): 3.24%. In any case the incidence of these conditions was higher than those found in younger patients. Among this top ten, only COPD and angina had a higher rate in the younger group. The incidence of hospital deaths were 9.1% among the younger group, and 21.8% among the nonagenarians (P<.001). If only the first 48 hours after admission are taken into account, the rates were 2.2% vs 6% (P<.001). The majority (78.2%) of nonagenarian patients return home after discharge

Conclusions

1) There are a high number of nonagenarians patients admitted in hospital Internal Medicine Departments; 2) The number of women increases with age; 3) List of diagnosis varies according with age; 4) Hospital death rates increase with age, both in first two days and total stay, and 5) The majority of these patients are able to return home after discharge.     

The use of fluorescence anisotropy decay of poly d(A-T) ethidium bromide complex to estimate the unwinding angle of the double helix.

We measured the fluorescence decay under polarized light, of ethidium bromide bound to the poly d(A-T) isolated from Cancer Pagurus. The decay of the whole fluorescence is a single exponential function revealing a good homogeneity of the binding sites. The anisotropy decay due to energy transfers between the ethidium bromide molecules bound to a same poly d(A-T) molecule has been analysed, with a Monte Carlo calculation. We found the dye unwinds the poly d(A-T) duplex by an angle of 17 degrees plus or minus 2 degrees. This result is in agreement with the value previously found in the case of calf thymus DNA-ethidium bromide complex, although the base compositions of the two nucleic acids are different.     

Resultado funcional de la artroplastia de hombro en mayores de 65 años

The aim of this study is to describe functional results one year after intervention in a group of patients over 65 years with partial shoulder replacement (PSR).