Factors related to withholding life-sustaining treatment in hospitalized elders

OBJECTIVES

To look for predictors in the clinical records of orders for "limitation of life sustaining treatment" (LLST) or "do not attempt resuscitation" (DNAR) in hospitalized elders and to assess the relationship between the presence of these orders and the quality of end-of-life (EOL) care.

DESIGN

Retrospective clinical record review.

SETTING

Inpatients of an inner city elderly acute care unit (EACU) in Spain.

PARTICIPANTS

Of 103 hospitalized patients who died in the EACU during one year, 90 dying an expected death either from acute or chronic disease were included.

MEASUREMENTS

Demographic, functional, cognitive, clinical, and end-of-life (EOL) parameters. The influence of identifying closeness to death and the number of LLST suborders on the quality of EOL-management were considered simultaneously using structural equation modelling with LISREL 8.30 software.

RESULTS

LLST and specific DNAR orders were registered in 91.1% and 83.3% of patients, respectively. Failure of acute treatment, discussions with the patient/family, recognizing the presence of common EOL symptoms, and prescribing specific symptomatic treatment were recorded in 88.9%, 93.3%, 94.4%, and 86.7% of patients, respectively. LLST-orders were more likely to be documented if there was severe functional impairment prior to admission (p < 0.001), advanced organ disease criteria were met (p=0.006), or closeness to death was acknowledged in writing (p < 0.001). The quality of the EOL-management was better in patients for whom there were LLST-orders (p =0.01) and written acknowledgement of closeness to death (p < 0.001).

CONCLUSIONS

LLST-orders were more likely to be written in an EACU for patients with previous severe impairment, co-morbidity, or advanced disease. Written acknowledgement of closeness to death and LLST-orders were predictors of better EOL-management.

Contrast responses to bright slits of visual cells in the superior colliculus of the albino rat

Contrast is the most effective stimulus in the visual system. The response of single cells to changes in stimulus contrast has been studied in a large variety of animals and the contrast response function determined. In the rat, studies on responses to contrast have been focused primarily in the geniculocortical pathway and there are relatively few in subcortical structures. We report here for the first time the contrast response function of single units located in the superior colliculus (SC) of the albino rat to several stimulus contrast. Cells in the SC require a relatively high contrast to elicit a reliable response and the dynamic response range is restricted to a short contrast interval.

Structure and stability of semiconductor tip apexes for atomic force microscopy

The short range force between the tip and the surface atoms, that is responsible for atomic-scale contrast in atomic force microscopy (AFM), is mainly controlled by the tip apex. Thus, the ability to image, manipulate and chemically identify single atoms in semiconductor surfaces is ultimately determined by the apex structure and its composition. Here we present a detailed and systematic study of the most common structures that can be expected at the apex of the Si tips used in experiments. We tackle the determination of the structure and stability of Si tips with three different approaches: (i) first principles simulations of small tip apexes; (ii) simulated annealing of a Si cluster; and (iii) a minima hopping study of large Si tips. We have probed the tip apexes by making atomic contacts between the tips and then compared force-distance curves with the experimental short range forces obtained with dynamic force spectroscopy. The main conclusion is that although there are multiple stable solutions for the atomically sharp tip apexes, they can be grouped into a few types with characteristic atomic structures and properties. We also show that the structure of the last atomic layers in a tip apex can be both crystalline and amorphous. We corroborate that the atomically sharp tips are thermodynamically stable and that the tip-surface interaction helps to produce the atomic protrusion needed to get atomic resolution.

Anti-ganglioside anti-idiotypic monoclonal antibody-based cancer vaccine induces apoptosis and antiangiogenic effect in a metastatic lung carcinoma

Anti-idiotype monoclonal antibody (mAb) 1E10 was generated by immunizing BALB/c mice with an Ab1 mAb which recognizes NeuGc-containing gangliosides, sulfatides and some tumor antigens. 1E10 mAb induces therapeutic effects in a primary breast carcinoma and a melanoma model. However, the tumor immunity mechanisms have not been elucidated. Here we show that aluminum hydroxide-precipitated 1E10 mAb immunization induced anti-metastatic effect in the 3LL-D122 Lewis Lung carcinoma, a poorly immunogenic and highly metastatic model in C57BL/6 mice. The therapeutic effect was associated to the increment of T cells infiltrating metastases, the reduction of new blood vessels formation and the increase of apoptotic tumor cells in lung nodules. Interestingly, active immunization does not induce measurable antibodies to the 1E10 mAb, the NeuGc-GM3 or tumor cells, which may suggest a different mechanism which has to be elucidated. These findings may support the relevance of this target for cancer biotherapy.

Combined therapeutic effect of a monoclonal anti-idiotype tumor vaccine against NeuGc-containing gangliosides with chemotherapy in a breast carcinoma model

Anti-idiotypic monoclonal antibodies (mAb) have been evaluated for actively induced immunotherapy with encouraging results. However, rational combination of cancer vaccines with chemotherapy may improve the therapeutic efficacy of these two approaches used separately. The main objective of this study was to evaluate the antitumor effect of the co-administration of 1E10 (Racotumomab), a monoclonal anti-idiotype tumor vaccine against an IgM mAb, named P3 that reacts specifically with NeuGc-containing gangliosides and low-dose Cyclophosphamide in a mammary carcinoma model. F3II tumor-bearing mice were immunized subcutaneously with 100 microg of 1E10 mAb in Alum or with 150 mg/m(2) of Cyclophosphamide intravenously 7 days after the tumor inoculation. While a limited antitumor effect was induced by a single 1E10 mAb immunization; its co-administration with low-dose Cyclophosphamide reduced significantly the F3II mammary carcinoma growth. That response was comparable with the co-administration of the standard high-dose chemotherapy for breast cancer based on 60 mg/m(2) of Doxorubicin and 600 mg/m(2) of Cyclophosphamide, without toxicity signs. Combinatorial chemo-immunotherapy promoted the CD8(+) lymphocytes tumor infiltration and enhanced tumor apoptosis. Furthermore, 1E10 mAb immunization potentiated the antiangiogenic effect of low-dose Cyclophosphamide. Additionally, splenic myeloid cells Gr1(+)/CD11b(+) associated with a suppressor phenotype were significantly reduced in F3II tumor-bearing mice immunized with 1E10 mAb alone or in combination with low-dose Cyclophosphamide. This data may provide a rational for chemo-immunotherapy combinations with potential medical implications in breast cancer.

Structural and chemical characterization of Yb2O3-ZrO2 system by HAADF-STEM and HRTEM

ZrO2:Yb3+ nanocrystalline phosphors with high concentrations of ytterbium ions were prepared using the sol-gel method. X-ray diffraction, high-angle annular-dark-field scanning transmission electron microscopy (HAADF-STEM), energy dispersive X-ray spectroscopy, and high-resolution transmission electron microscopy (HRTEM) were used to characterize the nanocrystalline phosphors annealed at 1000 degrees C. Unit-cell distortion and changes in the crystalline structure of the monoclinic zirconia to tetragonal zirconia, and subsequently cubic zirconia, were observed with increased Yb concentration. Yb ions were randomly distributed into the lattice of the crystalline structure. No segregation of Yb2O3 phase was observed. The substitution of Zr atoms by Yb atoms on different crystalline phases was confirmed by the experimental results and theoretical simulations of HRTEM and HAADF-STEM.

Psychiatric Family History in Juvenile Psychiatric Patients

Introduction:

The presence of mental illness in any of the parents can be a stressful factor in the child and be in certain way generator of disease. AIMS describe and quantify the psychiatric family history in patients who were consecutively referred to the outpatient department of children and adolescent psychiatry,mental health community center of collado villalba, Madrid

Material and method:

Obtain data of a series of cases filing a card of the 18-year-old minor patients who in September, October, November and December, 2007 come for the first time to our mental health community center.

Results:

The total number of patients were 114. There were psychiatric family history in 36,8% (N=42), the mother was or had been in psychiatric treatment in 28% (N=31)) of the cases, the father in 15% (N=17) and the brothers in 7 % (N=8), the most frequent diagnoses in mothers it were neurosis in 21 % (N=24), toxic abuse in 3,5% (N=4) and personality disorder in 1,8% (N=2), toxic abuse was the most frequent with 8,8% (N=10) in parents, followed by neurosis diagnosed in 4,4% (N=5), the most frequent diagnoses in brothers was the emotional disorder in 4,4,% (N=5). The mean age of parents was 41,34 (SE =6,34), in mothers was 38,43 (SE=6,59).

Conclusions:

We have to consider the existence of some kind of psychiatric family history in the therapeutic plan of the patient.

Agricultural waste from the tequila industry as substrate for the production of commercially important enzymes

Approximately 1 million tons of Agave tequilana plants are processed annually by the Mexican Tequila industry generating vast amounts of agricultural waste. The aim of this study was to investigate the potential use of Agave tequilana waste as substrate for the production of commercially important enzymes. Two strains of Aspergillus niger (CH-A-2010 and CH-A-2016), isolated from agave fields, were found to grow and propagate in submerged cultures using Agave tequilana waste as substrate. Isolates showed simultaneous extracellular inulinase, xylanase, pectinase, and cellulase activities. Aspergillus CH-A-2010 showed the highest production of inulinase activity (1.48 U/ml), whereas Aspergillus niger CH-A-2016 produced the highest xylanase (1.52 U/ml) and endo-pectinase (2.7U/ml) activities. In both cases production of enzyme activities was significantly higher on Agave tequilana waste than that observed on lemon peel and specific polymeric carbohydrates. Enzymatic hydrolysis of raw A. tequilana stems and leaves, by enzymes secreted by the isolates yielded maximum concentrations of reducing sugars of 28.2 g/l, and 9.9 g/l respectively. In conclusion, Agave tequilana waste can be utilized as substrate for the production of important biotechnological enzymes.

The cochlear microphonic potential does not reflect the passive basilar membrane traveling wave

OBJECTIVE

Understanding the cochlear microphonic potential (CM) can contribute to its clinical usefulness, e.g. in auditory neuropathy where the CM is present, while auditory evoked neural potentials are absent. The space-time pattern of the basilar membrane traveling wave in the cochlea is thought to be responsible for generation of the CM and its pattern along the cochlea. This relationship was studied in two experiments. EXPERIMENT I:

METHODS

The threshold of the CM was measured in animals before and after drilling a hole in the wall of the inner ear vestibule. Such a hole likely reduces the magnitude of the basilar membrane traveling wave.

RESULTS

The hole did not cause a change in CM threshold.

CONCLUSION

This is evidence that the passive basilar membrane traveling wave described by von Bekesy in cadavers in response to high intensity stimulation may not be the trigger for cochlear activation and CM generation at low intensities. EXPERIMENT II:

METHODS

A saline filled tube provided fluid coupling between the cochlea of one animal and that of a second through the perforated round windows of their cochleae.

RESULTS

In response to sound stimulation of animal 1, CM (and ABR) could be recorded in animal 2, even when animal 1 was no longer living.

CONCLUSION

It is highly unlikely that a basilar membrane traveling wave could have been induced in cochlea 2 in these conditions.

SIGNIFICANCE

It is therefore suggested that at low sound intensities, the initial event activating the cochlea in general and the CM in particular is the fluid pressures (condensations/rarefactions) induced in the cochlear fluids by sound-induced stapes footplate vibrations.