Frailty is associated with increased mortality in older adults 12 months after discharge from post-acute care in Swiss nursing homes.

Frail older adults with ongoing care needs often require post-acute care (PAC) following acute hospitalization when not eligible for specific rehabilitation. Long-term outcomes of PAC in this patient group have not been reported for Switzerland so far. In the present report, we investigated 12-month mortality in regard to frailty status upon admission to PAC in a nursing home setting. In our sample of 140 patients (mean age 84 [±8.6] years) 4.3% were robust, 37.1% were pre-frail, 54.3% were frail and 4.3% were missing frailty status. Mortality at 12-months follow-up stratified by baseline frailty was 0% (robust), 11.5% (pre-frail) and 31.6% (frail). Kaplan-Meier analysis stratified by frailty status showed a decreased probability of 12-months survival for frail individuals compared to their pre-frail and robust counterparts (P = 0.0096). Being frail was associated with more than 4-fold increased odds of death at follow-up (OR 4.19; 95% CI 1.53-11.47).

[Modern varicose vein surgery]. / Moderne Varizenchirurgie.

Varicose vein operations belong to the most commonly performed surgical procedures in Germany. Besides the classic operation employing modern technology, which shows manageable recurrence rates with good cosmetic results and must be considered as the established standard therapeutic procedure, endoluminal treatment methods (endovenous radiofrequency therapy, endoluminal laser therapy) have been increasingly used in recent years. The endoluminal treatment methods offer patients reduced post-operative pain and a shorter recovery time compared to traditional surgery. Unfortunately due to limitations caused by vessel diameter and the ability to probe the vessel, they are only available to a limited range of patients. It remains to be seen how these procedures compare to the classical techniques, in particular in regards to improving the long-term quality of life and recurrence rates. A further therapeutic option is chemical endoluminal therapy, catheter-assisted foam sclerotherapy. It can be used as a safe treatment option with good postoperative results in some cases. However, the primary closure rates are inferior to surgery and endoluminal procedures.

[Vacuum-therapy of chronic wounds in long-term care institutions]. / Lokale Unterdrucktherapie im Wundmanagement in Institutionen der Langzeitpflege.

Negative pressure wound therapy is still mainly used in hospitals. By the introduction of the diagnosis related groups the average length of stay in hospitals is expected to be reduced even more. Therefore, the question arises whether the Negative pressure wound therapy in nursing homes should be applied, too, because they often provide the continuity of care in elderly patients after treatment in a hospital. Based on the literature, the authors formulate recommendations for the use of Negative pressure wound therapy in nursing homes.

Nitric oxide synthase in the spinal cord of the frog, Xenopus laevis.

The expression of nitric oxide synthase was investigated in the spinal cord of the South African clawed frog by NADPH diaphorase histochemistry and immunohistochemistry. The dorsal field contained many strongly positive neurons and a dense plexus of processes. Only few nitric oxide synthase-positive cells occurred in the lateral and central field. Motoneurons were negative. A dense accumulation of stained neurons was located dorsal and dorsomedial to the motoneurons. The white matter harbored many positive fibers. These were most abundant in the dorsal funiculus, and obviously consist of nonprimary projections to the brainstem. These results suggest that nitric oxide represents a widely used messenger molecule in the frog spinal cord, in particular with respect to the processing of sensory information.

Co-localization of glutamate, choline acetyltransferase and glycine in the mammalian vestibular ganglion and periphery.

Glutamate (Glu) is considered to be the main transmitter at the central synapses of primary vestibular afferents (PVA) and glycine (Gly) is assumed to play a modulatory role. In the vestibular periphery a transmitter role for acetylcholine (ACh) has been attributed chiefly to vestibular efferents (VE), however only a subset of VE neurons displays immunoreactivity (ir) for choline acetyltransferase (ChAT) and acetylcholine esterase (AChE). Controversial results exist on the presence of these two enzymes in PVA. In this study the presence of Glu, ChAT, Gly and their co-localization in the vestibular ganglia (VG) and end organs of mouse, rat, guinea pig and squirrel monkey were investigated. In the VG all bipolar neurons display strong Glu-ir and the majority of cells show a graded ChAT-ir and Gly-ir in all species examined. ChAT and Gly are present in highly overlapping neuronal populations and with a similar gradation. In the end organs ChAT and Gly are again co-localized in the same sets of fibers and endings. In conclusion, in the vestibular ganglion and end organs ChAT appears also to be present in primary afferents rather than being restricted to efferent processes. ChAT in primary afferents might indicate a modulatory or co-transmitter function of acetylcholine.

Nitric oxide synthase expression in the opossum superior colliculus: a histochemical, immunohistochemical and biochemical study.

The expression of neuronal nitric oxide synthase (nNOS) in the superior colliculus (SC) of the opossum Didelphis marsupialis was studied by NADPH diaphorase (NADPH-d) histochemistry and nNOS immunohistochemistry. In addition, the activity of nNOS was quantified by measurement of [(3)H]-L-arginine conversion to [(3)H]-L-citrulline in tissue extracts from SC superficial layers in opossums and rats. Our results show that the number of NADPH-d stained cells was small and virtually identical in stratum opticum (SO) and stratum griseum superficiale (SGS) and their staining was very light, particularly in SGS. Neuropil staining was heavier in the stratum zonale (SZ) than in SGS or SO. The intermediate and deep layers contained heavily stained cells and moderate neuropil staining. Surprisingly, nNOS-immunoreactive cells were far more numerous than NADPH-d+ cells in every layer. The production of [(3)H]-L-citrulline from [(3)H]-L-arginine in tissue extracts enriched in superficial layers indicated that nNOS specific activity is as high in the opossum as in the rat. Our results suggest that the location of nNOS-expressing neurons in retino-receptive layers may be related to inter-specific differences in the processing of visual information.

Prenatal development of the serotonin transporter in mouse brain.

The prenatal development of the serotonin transporter was analyzed in mouse brain and spinal cord by autoradiographic localization of [3H]citalopram binding. Transporter expression started at embryonic day (E) 12 in two discontinuous bands in the anterior and posterior brainstem. Labeling extended cranially and caudally, reaching the basal diencephalon at E 13, the septal complex at E 15, and the cerebral cortex at E 16. The caudal extension of the labeling descended at the ventrolateral margin of the spinal cord and reached lumbar levels at E 14. At E 17-E 18, [3H]citalopram binding emerged in the striatum, amygdaloid area, ventrobasal thalamus, paraventricular and periventricular hypothalamic nuclei, and substantia nigra. The overall spatiotemporal expression pattern of the serotonin transporter in the mouse agrees with data on the immunohistochemical localization of serotonin in the rat embryo. These results suggest that serotonergic fibers have the equipment to engage in transmitter reuptake long before synapse formation, and that transporter expression might represent a prerequesite for the developmental functions exerted by serotonin.

Transient expression of the serotonin transporter in the developing mouse thalamocortical system.

The serotonin transporter was visualized in sections through the developing mouse thalamus by autoradiography of [3H]citalopram binding. In late gestation, a high density of transporter expression appeared in the ventrobasal thalamic complex and medial geniculate body. During the first postnatal week, binding in these areas decreased to low levels. A similar pattern of transient [3H]citalopram binding was observed in the somatosensory cortex, although the rise and decline of labeling occurred some days later. The density of the serotonergic innervation in the ventrobasal thalamic complex is known to be very low during the entire developmental period. Therefore, these data suggest that the serotonin transporter may be expressed transiently by thalamic neurons projecting to the cerebral cortex (as a "heterocarrier") which are capable of taking up serotonin in the somatosensory cortex. We propose that serotonin may act temporarily as a "false" transmitter in thalamocortical axons.

Localization of nitric oxide synthase in the brain of the frog, Xenopus laevis.

Nitric oxide synthase was localized in the brain of the South african clawed frog by NADPH diaphorase histochemistry and immunohistochemistry. All structures stained by the antiserum also displayed NADPH diaphorase activity. The fiber bundles of the terminal nerve, however, were positive for NADPH diaphorase but were not immunoreactive. In the forebrain, neurons expressing nitric oxide synthase were concentrated to the pallium, striatum, nucleus accumbens and anterior entopeduncular nucleus. Strongly stained neurons in the diencephalon were detected in the lateral thalamus, the tuberculum posterior and in the ventral hypothalamus. In the mesencephalon, the tectum and the magnocellular nucleus of the torus semicircularis contained many positive cells. Farther caudally, intensely stained neurons were abundant in an area corresponding to the anuran locus coeruleus, in the descending nucleus of the trigeminus and the inferior reticular nucleus. In the cerebellum, Purkinje cells were weakly stained. In summary, the expression pattern of nitric oxide synthase in the anuran brain reveals similarities to that of other vertebrates. The strongly positive cell group in the locus coeruleus may correspond to cholinergic cell groups in the mesopontine area in mammals.

Absence of coexistence between NADPH-diaphorase and antidiuretic hormone in the hypothalamus of two galliforms: Japanese quail (Coturnix japonica) and chicken (Gallus domesticus).

Based on previous studies demonstrating coexistence of NADPH-diaphorase (ND) and vasopressin (VP) in the rat hypothalamus. ND histochemistry and vasotocin (VT) immunocytochemistry have been combined in order to study the distribution of both markers in the hypothalamus of the Japanese quail (Coturnix japonica) and chicken (Gallus domesticus). No coexistence was found, however, close anatomical relationships between ND-positive and VT-immunoreactive elements were observed in specific preoptic and hypothalamic locations. These findings indicate interspecies differences in the expression of ND and the antidiuretic hormone with functional implications in osmoregulation.

Nitric oxide synthase in the peripheral nervous system of the goldfish, Carassius auratus.

Neuronal nitric oxide synthase was located in various organs of the goldfish by NADPH-diaphorase histochemistry and immunohistochemistry. Positive cells were detected throughout the digestive tract. A particularly dense plexus of nitric-oxide-synthase-containing fibers was present at the opening of the pneumatic duct into the esophagus and at the intestinal sphincter separating the esophagus and the intestinal bulb. The nitroxergic innervation was mainly confined to the muscularis. The muscular layer of the swim bladder and of the pneumatic duct was densely equipped with stained neurons and fibers. In the heart, the majority of small neurons located at the sinu-atrial junction was found to be positive for nitric oxide synthase. The muscularis of the urinary duct was supplied by fibers originating from many intramural ganglia harboring intensely stained neurons. These results suggest that nitric oxide represents a widespread transmitter in the peripheral nervous system of teleost species.

Prenatal development of nitric oxide synthase in the mouse spinal cord.

Nitric oxide synthase was localized in the spinal cord of the mouse embryo by immunocytochemistry. The first cell population which expressed the enzyme were preganglionic sympathetic neurons in the dorsolateral ventral horn at embryonic day 12. One day later, nitric oxide synthase was detected in neurons corresponding to the developing intermediolateral nucleus of the sacral spinal cord and in a group of cells surrounding the ventral part of the neuroepithelium. Positive cells appeared at day 14 in dorsal portions of the intermediate zone. The ventral horn of cervical and lumbar parts of the spinal cord contained several clusters of stained cells, presumably including motoneurons, which apparently disappear in the postnatal period. These results suggest that nitric oxide might possess different functions for subpopulations of developing spinal neurons.

Histochemical and immunocytochemical localization of nitric oxide synthase in the central nervous system of the goldfish, carassius auratus.

The distribution of the neuronal type of nitric oxide synthase in the goldfish brain and spinal cord was investigated via NADPH-diaphorase histochemistry and immunocytochemistry using an antiserum raised against the purified mammalian enzyme. Many structures, including magnocellular neurosecretory cells, motoneurons, mesencephalic trigeminal neurons, and radial glial fibers, were stained by the NADPH-diaphorase reaction but were not immunoreactive. This nonspecific NADPH-diaphorase activity was strongly reduced after preincubation of the sections. Therefore, when sections were first reacted for immunofluorescence and, thereafter, stained for NADPH-diaphorase, a corresponding staining pattern was obtained that allowed the reliable localization of neuronal nitric oxide synthase based on both complementary staining methods. In the telencephalon, positive neurons were concentrated in the ventral and posterior parts of the area ventralis. Many intensely stained neurons were present in various diencephalic nuclei, including the nucleus centralis posterior and the ventromedial nucleus of the thalamus, the nucleus tori lateralis, the nucleus recessus lateralis, the nucleus tuberis posterior, and the central nucleus of the inferior lobe. In the midbrain, neurons containing nitric oxide synthase were located in the periventricular zone of the optic tectum, the nucleus vermiformis, and the nucleus reticularis mesencephali. Specific staining in the cerebellum was concentrated in Golgi cells. In the hindbrain, nitroxergic neurons were numerous in all four sensory nuclei of the trigeminus, in the facial lobe, the superior olive, the inferior reticular formation, and the medial general visceral nucleus of the vagus. The dorsal horn of the spinal cord was enriched with positive neurons. A few strongly stained cells were also present in the ventral horn. In conclusion, neurons capable of synthesizing nitric oxide occur throughout the teleost central nervous system. The presence of nitric oxide synthase in projection areas of most afferent nerves suggests a widespread involvement of nitric oxide in sensory information processing. The distribution of nitric oxide synthase-containing neurons in certain areas, e.g., the tectum opticum and the spinal cord, indicates an evolutionarily conserved pattern. Similar to the case in other vertebrates, there appears to be no comprehensive overlap between the distribution of nitric oxide synthase and that of any other chemically characterized neuronal population described thus far. However, strongly positive cell groups in the mesencephalic reticular formation suggest the idea of an evolutionarily conserved mesopontine cholinergic system coexpressing nitric oxide synthase.

NADPH diaphorase is not inhibited by ethylenediaminetetraacetic acid and is not specific for nitric oxide synthase in the choroid plexus of rat and mouse.

NADPH diaphorase is a histochemical activity which, in formaldehyde-fixed tissue, is rather specific for nitric oxide synthase. Recently, it was shown that NADPH diaphorase activity is inhibited by ethylenediaminetetraacetic acid (EDTA) in neurons but not in the choroid plexus epithelium. The present study, while confirming these results, demonstrates that the apparent sensitivity of NADPH diaphorase for EDTA reflects only the dependence of malic enzyme, which is used as the source of reduced cofactor, on Mg2+ or Mn2+ ions. Furthermore, evidence is provided that the apparent EDTA-insensitive NADPH diaphorase activity in the choroid plexus reflects the activity of alkaline phosphatase in conjunction with NADH diaphorase. Apart from these pitfalls, the use of the indirect, malic enzyme based method for NADPH diaphorase was found to cause much higher background staining compared to the direct method using NADPH, and is therefore proposed to be abandoned.

Immunocytochemical localization of nitric oxide synthase in the brain of the chicken.

The distribution of neuronal nitric oxide synthase (NOS) in the chicken brain was investigated by immunocytochemistry. Strongly stained neurones were concentrated in the paleostriatum augmentatum, lobus parolfactorius, ventral pallidum, olfactory tubercle, parts of the neostriatum, mesencephalic reticular formation and locus coeruleus. Cells in these areas have previously been shown to stain for NADPH-diaphorase, a histochemical activity associated with NOS. However, various structures which NADPH-diaphorase staining has suggested to contain NOS were not immunoreactive: these included the glomeruli of the olfactory bulb, magnocellular preoptic neurones, the median eminence, subcommissural organ and mesencephalic trigeminal neurones. NOS was sparsely present in the hyperstriatum ventrale, providing evidence against the involvement of nitric oxide in certain forms of learning and memory processes known to occur in this region.

Nitric oxide synthase in the brain of the turtle Pseudemys scripta elegans.

The distribution pattern of nitric oxide synthase (NOS) was investigated in the brain of the turtle by NADPH-diaphorase histochemistry. The specificity of the histochemical staining was tested by immunocytochemical colocalization with an antiserum specific for NOS. In the forebrain, neurons staining intensely for nitric oxide synthase were localized in the olfactory tubercle, the basal ganglia complex, the basal amygdaloid nucleus, suprapeduncular nucleus, and the posterior hypothalamic area. Many positive fibers course in a tract connecting the basal amygdaloid nucleus with the hypothalamus, corresponding to the stria terminalis. Bundles of nitroxergic fibers were seen to course at the ventromedial edge of the optic tract and to cross in the supraoptic decussation, apparently consisting of tectothalamic and thalamotectal fibers. In the midbrain, strongly NOS-positive neurons were present in the substantia nigra, the nucleus profundus mesencephali, the periventricular grey of the optic tectum, the laminar nucleus of the torus semicircularis, and the nucleus of the lateral lemniscus. The area of the locus coeruleus harbored an accumulation of intensely stained neurons, which, as in mammals, might represent a cholinergic cell group of the reptilian brainstem. In the cerebellum, strong staining was confined to bundles of afferent fibers running in the lower molecular and in the Purkinje cell layer. These axons appeared to include ascending projections from the dorsal funicular nucleus or the spinal cord. NOS-positive cells in the caudal brainstem were found in the cerebellar nuclei, in the superior vestibular nucleus, in the reticular nuclei, ventrolateral to the nucleus of the solitary tract, in the perihypoglossal, and in the dorsal funicular nucleus. Taken together, these results suggest that nitric oxide acts as a messenger molecule in different areas of the reptilian brain and spinal cord. In certain areas, the pattern of expression of NOS appears to have evolved before radiation of present mammalian, avian, and reptilian species.

The expression pattern of a novel gene encoding brain-fatty acid binding protein correlates with neuronal and glial cell development.

Fatty acid binding proteins (FABPs) are a multigene family of small intracellular proteins that bind hydrophobic ligands. In this report we describe the cloning and expression pattern of a novel member of this gene family that is specifically expressed in the developing and adult nervous system and thus was designated brain (B)-FABP. B-FABP is closely related to heart (H)-FABP with 67% amino acid identity. B-FABP expression was first detected at mouse embryonic day 10 in neuroepithelial cells and its pattern correlates with early neuronal differentiation. Upon further development, B-FABP was confined to radial glial cells and immature astrocytes. B-FABP mRNA and protein were found in glial cells of the peripheral nervous system such as satellite cells of spinal and cranial ganglia and ensheathing cells of the olfactory nerve layer from as early as embryonic day 11 until adulthood. In the adult mouse brain, B-FABP was found in the glia limitans, in radial glial cells of the hippocampal dentate gyrus and Bergman glial cells. These findings suggest a function of B-FABP during neurogenesis or neuronal migration in the developing nervous system. The partially overlapping expression pattern with that of cellular retinoid binding proteins suggests that B-FABP is involved in the metabolism of a so far unknown hydrophobic ligand with potential morphogenic activity during CNS development.

NADPH diaphorase histochemistry in the adrenal gland of the mouse.

NADPH diaphorase, an enzymatic activity which, in neuronal tissue, is considered to be identical to nitric oxide synthase was localized in ganglion cells and nerve fibers of the mouse adrenal medulla. Staining was inhibited by treatment with N-ethylmaleimide, but was not influenced by removal of Ca++ or the presence of specific inhibitors of nitric oxide synthase. Reaction with NADH as the electron donor resulted in uniform staining of the adrenal medulla. These results suggest that nitric oxide is synthesized in intrinsic neurons and extrinsic axons of the mouse adrenal medulla and support the idea that adrenal function is influenced by nitric oxide.

Nitric oxide synthase-containing nerve fibres and neurones in the gall bladder and biliary pathways of the guinea-pig.

We investigated the distribution pattern of nitric oxide (NO) synthesizing nerve cell bodies and axons in the biliary system of the guinea-pig using immunohistochemistry for nitric oxide synthase (NOS). Nerve fibres staining for NOS were found to contact non-vascular smooth myocytes and to course beneath the epithelium. No perivascular NOS fibres were observed. The innervation density varied in different parts of the biliary tree. The lower portion of the common bile duct was more richly innervated than the remaining parts of the duct system. NOS-containing neurones encompassed a subpopulation of intramural ganglion cells. Sympathetic neurones in the coeliac ganglion were not stained. It is suggested that intrinsic NOergic neurones are involved in inhibitory motor control of the biliary musculature, including the sphincter of Oddi.