Geriatric giants--contemporary occurrence in 12,210 in-patients

OBJECTIVES

With advancing age, the degree of dependency and occurrence of great geriatric syndromes (GS), also referred to as geriatric giants, grow substantially.

DESIGN

The prospective cohort study was aimed at conducting an analysis and comparison of geriatric syndromes (geriatric giants) among different age groups at admission to the acute geriatric department.

SETTING, PARTICIPANTS

Between 1995 and 2012, we had altogether 12,210 elderly patients at an average age of 80.5 ± 7.0 y (range 65-103 y) hospitalised at the Department of Geriatrics. We divided the patient set into three different age subgroups (65-74 y; 75-84 y and ≥85 y; e.g. 21.4%; 47.9% and 30.7%) and compared the results among them.

RESULTS

3,787 persons (31.0%) were without any GS. The growing tendency of the occurrence of all geriatric syndromes in combinations with increased age (p<0.001) is obvious. Their occurrence in the above mentioned different age sets was examined in relation to individual geriatric syndromes and sex (female and male), namely falls 22.0%, 27.8%, 39.9% and 20.5%, 27.0%, 36.1%; immobility 26.4%, 29.3%, 42.5% and 30.3%, 30.1% and 39.2%; incontinence 38.4%, 50.6%, 69.5% and 38.2%, 47.4%, 61.8 %; dementia and cognitive impairment 13.4%, 23.4%, 38.1% and 15.8%, 24.3%, 33.2% respectively. Age cut-off for geriatric syndromes occurrence based on ROC analysis is 83.5-84.5 y for females and 78.5-82.5 y for males.

CONCLUSION

The occurrence of geriatric giants increasing with age and female gender is of crucial importance not only for individuals and families but also for demands on costs of health and social care in oncoming decades (Tab. 6, Fig. 3, Ref. 52).

Development and validation of a weight-bearing finite element model for total knee replacement

Total knee arthroplasty (TKA) is a successful procedure for osteoarthritis. However, some patients (19%) do have pain after surgery. A finite element model was developed based on boundary conditions of a knee rig. A 3D-model of an anatomical full leg was generated from magnetic resonance image data and a total knee prosthesis was implanted without patella resurfacing. In the finite element model, a restarting procedure was programmed in order to hold the ground reaction force constant with an adapted quadriceps muscle force during a squat from 20° to 105° of flexion. Knee rig experimental data were used to validate the numerical model in the patellofemoral and femorotibial joint. Furthermore, sensitivity analyses of Young's modulus of the patella cartilage, posterior cruciate ligament (PCL) stiffness, and patella tendon origin were performed. Pearson's correlations for retropatellar contact area, pressure, patella flexion, and femorotibial ap-movement were near to 1. Lowest root mean square error for retropatellar pressure, patella flexion, and femorotibial ap-movement were found for the baseline model setup with Young's modulus of 5 MPa for patella cartilage, a downscaled PCL stiffness of 25% compared to the literature given value and an anatomical origin of the patella tendon. The results of the conducted finite element model are comparable with the experimental results. Therefore, the finite element model developed in this study can be used for further clinical investigations and will help to better understand the clinical aspects after TKA with an unresurfaced patella.

Switchable Coupling of Vibrations to Two-Electron Carbon-Nanotube Quantum Dot States

We report transport measurements on a quantum dot in a partly suspended carbon nanotube. Electrostatic tuning allows us to modify and even switch "on" and "off" the coupling to the quantized stretching vibration across several charge states. The magnetic-field dependence indicates that only the two-electron spin-triplet excited state couples to the mechanical motion, indicating mechanical coupling to both the valley degree of freedom and the exchange interaction, in contrast to standard models.

In vitro activity of josamycin against Streptococcus pyogenes isolated from patients with upper respiratory tract infections in France

OBJECTIVES

The primary objective of our study was to obtain susceptibility data for josamycin against Streptococcus pyogenes isolated from patients presenting with upper respiratory tract infections in France. The secondary objective was to characterize the molecular mechanism of resistance in macrolide-resistant isolates.

PATIENTS AND METHODS

MICs of erythromycin, clarithromycin, azithromycin, josamycin, and clindamycin were determined by the broth microdilution method. Resistance genes erm(B), erm(TR), and mef(A) were screened by PCR.

RESULTS

The MIC50 and MIC90 of josamycin against 193 isolates of S. pyogenes were 0.12 and 0.25mg/L, respectively, with a resistance rate estimated at 4.7%. Resistance was due to the erm(B) gene whereas strains harboring erm(TR) or mef(A) remained susceptible.

CONCLUSIONS

Josamycin was active against >95% of S. pyogenes isolated from patients with upper respiratory tract infections, and can be used as an alternative for the treatment of pharyngitis.

RNA expression profiling in depressed patients suggests retinoid-related orphan receptor alpha as a biomarker for antidepressant response

Response to antidepressant treatment is highly variable with some patients responding within a few weeks, whereas others have to wait for months until the onset of clinical effects. Gene expression profiling may be a tool to identify markers of antidepressant treatment response and new potential drug targets. In a first step, we selected 12 male, age- and severity-matched pairs of remitters and nonresponders, and analyzed expression profiles in peripheral blood at admission and after 2 and 5 weeks of treatment using Illumina expression arrays. We identified 127 transcripts significantly associated with treatment response with a minimal P-value of 9.41 × 10(-)(4) (false discovery rate-corrected). Analysis of selected transcripts in an independent replication sample of 142 depressed inpatients confirmed that lower expression of retinoid-related orphan receptor alpha (RORa, P=6.23 × 10(-4)), germinal center expressed transcript 2 (GCET2, P=2.08 × 10(-2)) and chitinase 3-like protein 2 (CHI3L2, P=4.45 × 10(-2)) on admission were associated with beneficial treatment response. In addition, leukocyte-specific protein 1 (LSP1) significantly decreased after 5 weeks of treatment in responders (P=2.91 × 10(-2)). Additional genetic, in vivo stress responsitivity data and murine gene expression findings corroborate our finding of RORa as a transcriptional marker of antidepressant response. In summary, using a genome-wide transcriptomics approach and subsequent validation studies, we identified several transcripts including the circadian gene transcript RORa that may serve as biomarkers indicating antidepressant treatment response.

Integrating silver compounds and nanoparticles into ceria nanocontainers for antimicrobial applications

Silver compounds and nanoparticles (NPs) are gaining increasing interest in medical applications, specifically in the treatment and prevention of biomaterial-related infections.

The mobility of nitrogen across tree-rings of Norway spruce (Picea abies L.) and the effect of extraction method on tree-ring δ¹⁵N and δ¹³C values

RATIONALE

The use of stable nitrogen (N) isotope ratios (δ(15)N values) in dendroecological studies is often preceded by an extraction procedure using organic solvents to remove mobile N compounds from tree-rings. Although these mobile N compounds may be capable of distorting potential environmental signals in the tree-ring δ(15)N values, recent investigations question the necessity of such an extraction.

METHODS

We used an on-going experiment with simulated elevated N deposition previously labelled with (15)N, in conjunction with control trees, to investigate the necessity of extracting mobile N compounds (using a rapid extraction procedure) for tree-ring δ(15)N and δ(13)C studies, as well as N and C concentration analyses. In addition, we examined the magnitude of radial redistribution of N across tree-rings of Norway spruce (Picea abies).

RESULTS

The (15)N label, applied in 1995/96, was found in tree-rings as far back as 1951, although the increased N availability did not cause any significant relative increase in tree growth. The rapid extraction procedure had no significant effect on tree-ring δ(15)N or δ(13)C values in either labelled or control trees, or on N concentration. The C concentrations, however, were significantly higher after extraction in control samples, with the opposite effect observed in labelled samples.

CONCLUSIONS

Our results indicate that the extraction of mobile N compounds through the rapid extraction procedure is not necessary prior to the determination of Norway spruce δ(15)N or δ(13)C values in dendrochemical studies. δ(15)N values, however, must be interpreted with great care, particularly when used as a proxy for the N status of trees, due to the very high mobility of N within the tree stem sapwood of Norway spruce over several decades.

Coupling graphene mechanical resonators to superconducting microwave cavities

Graphene is an attractive material for nanomechanical devices because it allows for exceptional properties, such as high frequencies, quality factors, and low mass. An outstanding challenge, however, has been to obtain large coupling between the motion and external systems for efficient readout and manipulation. Here, we report on a novel approach, in which we capacitively couple a high-Q graphene mechanical resonator (Q ≈ 10(5)) to a superconducting microwave cavity. The initial devices exhibit a large single-photon coupling of ∼10 Hz. Remarkably, we can electrostatically change the graphene equilibrium position and thereby tune the single photon coupling, the mechanical resonance frequency, and the sign and magnitude of the observed Duffing nonlinearity. The strong tunability opens up new possibilities, such as the tuning of the optomechanical coupling strength on a time scale faster than the inverse of the cavity line width. With realistic improvements, it should be possible to enter the regime of quantum optomechanics.

Low-frequency noise in individual carbon nanotube field-effect transistors with top, side and back gate configurations: effect of gamma irradiation

We report on the influence of low gamma irradiation (10(4) Gy) on the noise properties of individual carbon nanotube (CNT) field-effect transistors (FETs) with different gate configurations and two different dielectric layers, SiO2 and Al2O3. Before treatment, strong generation-recombination (GR) noise components are observed. These data are used to identify several charge traps related to dielectric layers of the FETs by determining their activation energy. Investigation of samples with a single SiO2 dielectric layer as well as with two dielectric layers allows us to separate traps for each of the two dielectric layers. We reveal that each charge trap level observed in the side gate operation splits into two levels in top gate operation due to a different potential profile along the CNT channel. After gamma irradiation, only reduced flicker noise is registered in the noise spectra, which indicates a decrease of the number of charge traps. The mobility, which is estimated to be larger than 2 × 10(4) cm(2) V(-1) s(-1) at room temperature, decreases only slightly after radiation treatment, demonstrating high radiation hardness of the CNTs. Finally, we study the influence of Schottky barriers at the metal-nanotube interface on the transport properties of FETs, analyzing the behavior of the flicker noise component.

Use of neutral protamine lispro insulin (NPL) in patients with hyperglycemia receiving parenteral nutrition

AIMS

Nutritional support with parenteral nutrition (PN), a key component in the care of critically ill patients, usually requires insulin therapy in patients with diabetes or may require insulin treatment in patients not known to be diabetic. We wanted verify whether it is possible to use neutral protamine lispro (NPL) in double administration monotherapy in patients receiving artificial nutrition (AN) and if the same NPL is capable of obtaining and maintaining acceptable glycemic control without inducing hypoglycemia.

PATIENTS AND METHODS

We studied 18 consecutive patients, who were not taking insulin, they needed to start artificial nutrition, and presenting at least two consecutive blood glucose > 120 mg/dL. Each patient was given at least 1 U of insulin for every 10 grams of glucose infused.

RESULTS

Eighteen consecutive patients, not stratified in any way, were judged eligible in the last 24 months, with a mean age of 71 years (range 54-85 yrs). All patients were evaluated after 2, 3 and 5 days of treatment; only 1 patient has not been evaluated to 5 days. Mean glycemic values on days 2, 3, 5 were in range between 145 and 180 mg/dL. Any adjustments in NPL dose were carried out by the team of nutrition and there was no hypoglycemia that required medical intervention in emergency.

CONCLUSIONS

Our impression is that also lispro protamine insulin (NPL) in double subcutaneous administration may contribute to improving the glycemic values in patients receiving parenteral nutrition with hyperglycemia.