[Crisis unit at the general hospital: Determinants of further hospitalization]. / Facteurs prédictifs d'hospitalisation à partir des lits de crise des urgences d'un hôpital général.

INTRODUCTION: The availability of short-stay beds for brief admission (less than 72hours) of crisis patients presenting to the emergency room is a model that has gained a growing interest because it allows time for developing alternatives to psychiatric hospitalization and favors a maintained functioning in the community. Still, the determinants influencing the disposition decision at discharge after crisis intervention remain largely unexplored. OBJECTIVE: The primary objective of this study was to determine the factors predicting aftercare dispositions at crisis unit discharge: transfer for further hospitalization or return to the community. Secondary objectives included the description of clinical and socio-demographic characteristics of patients admitted to the crisis unit upon presentation to the emergency room. METHOD: All patients (n=255) admitted to the short-stay unit of the emergency department of Rambouillet General Hospital during a one-year period were included in the study. Patient characteristics were collected in a retrospective manner from medical records: patterns of referral, acute stressors, presenting symptoms, initial patient demand, Diagnostic and Statistical Manual, 5th edition (DSM-5) disorders, psychiatric history, and socio-demographic characteristics were inferred. Logistic regression analysis was used to determine the factors associated with hospitalization decision upon crisis intervention at discharge. RESULTS: Following crisis intervention at the short-stay unit, 100 patients (39.2%) required further hospitalization and were transferred. Statistically significant factors associated with a higher probability of hospitalization (P<0.05) included the patient's initial wish to be hospitalized (OR=4.28), the presence of a comorbid disorder (OR=3.43), a referral by family or friends (OR=2.89), a history of psychiatric hospitalization (OR=2.71) and suicidal ideation on arrival in the emergency room (OR=2.26). Conversely, significant factors associated with a lower probability of hospitalization were the presence of a personality disorder (OR=0.31), a precipitating conflict situation (OR=0.41), age between 20 and 39 years (OR=0.42), being employed (OR=0.49). CONCLUSION: Our study confirms that clinical factors such as the presence of a personality disorder or the context of a precipitating conflict situation are predictive of a community return. Interestingly, it points out the importance of the patient's initial wish in the hospitalization decision.

KRAS Mutations in Canine and Feline Pancreatic Acinar Cell Carcinoma.

Companion animals may serve as valuable models for studying human cancers. Although KRAS is the most commonly mutated gene in human ductal pancreatic cancers (57%), with mutations frequently occurring at codons 12, 13 and 61, human pancreatic acinar cell carcinomas (ACCs) lack activating KRAS mutations. In the present study, 32 pancreatic ACC samples obtained from 14 dogs and 18 cats, including seven metastases, were analyzed for six common activating KRAS mutations located in codons 12 (n = 5) and 13 (n = 1) using Sequenom MassARRAY. No KRAS mutations were found, suggesting that, similar to human pancreatic ACC, KRAS mutations do not play a critical role in feline or canine pancreatic ACC. Due to the similarity of the clinical disease in dogs and cats to that of man, this study confirms that companion animals offer potential as a suitable model for investigating this rare subtype of pancreatic carcinoma.

Broiler breeder manure phosphorus forms are affected by diet, location, and period of accumulation.

Phosphorus (P) modifications of poultry diets have successfully decreased the total P (TP) in manures, but the effects on manure water-soluble P (WSP(M)) remain unclear. Our objectives were to characterize P forms in broiler breeder manures as affected by dietary P modification, location within the pen, and manure accumulation period. Two diets were formulated with and without phytase to attain 0.40% available P (AvP) during the breeder laying phase (22-64 wk of age). Manure was collected after accumulation periods of 48 h, 3 wk, and 39 wk in locations under the feeder and drinker and under the common area (between the feeder and drinker) of the pen. The TP, WSP(M), orthophosphate, and phytate in manure were measured. Broiler breeders that were fed phytase with a simultaneous reduction in nonphytate P (NPP) produced manures with 15% lower TP than those fed a traditional diet, but did not change WSP(M) when averaged over manure accumulation periods and locations within the pen. Regardless of diet, location within the pen, or accumulation period (r(2) = 0.76), the WSP(M) increased linearly as the manure moisture increased. As manure accumulation periods increased (48 h, 3 wk, and 39 wk), TP manure concentrations increased (11.9, 13.2, and 17.3 g/kg, respectively), orthophosphate proportions increased (73.2, 80.1, and 91.0%, respectively), and phytate proportions decreased (23.1, 17.0, and 6.7%, respectively). The mineralization of phytate and other organic complexes, which drive off carbon dioxide, presumably contributed to the increased orthophosphate and TP concentrations. Keeping breeder manures dry helps to avoid the mineralization of phytate to orthophosphate; this mineralization increased WSP(M) in our study, and thus increased the potential for elevated P loss in runoff when surface applied.

Mineral metabolism during short-term starvation in man.

Plasma and urine electrolytes were measured in five healthy non-obese young adults before, during and after a four-day period of total starvation (distilled water only). Plasma sodium, chloride and bicarbonate concentrations decreased in all subjects by a mean value of 4 mmol/l, whereas the sum of acetoacetate and hydroxybutyrate concentrations increased by 4-6 mmol/l. These changes occurred without alterations in the state of hydration or vascular volume. Hydroxybutyrate and ammonium ions became the main urinary ions during starvation, whereas sodium and chloride, which were quantitatively the most important urinary electrolytes before starvation, decreased four-fold, and potassium two-fold. Plasma zinc concentrations rapidly increased in all subjects by a mean of 4 mumol/1 (25%) and returned to normal on refeeding. The excretion of zinc in urine trebled and continued to rise on refeeding. There were no major changes in the excretion of calcium, magnesium, phosphate or sulphate during the starvation period. From knowledge of the intracellular concentrations of various minerals and extent of breakdown of lean tissues (N excretion), it is suggested that most of the urinary calcium, magnesium and phosphate probably originates from bone, and that the amount of zinc in urine is only a small fraction of that which is likely to be released from the breakdown of lean tissues. It is also suggested that the continued excretion of zinc on refeeding is due to release of zinc from tissues which 'buffered' it during the starvation period. This study provides useful data in non-obese individuals with which to compare changes which occur in post-traumatic and post-infective starvation.

Flow and aspiration of artificial feeds through nasogastric tubes.

The physical characteristics of 12 nasogastric tubes (Clinifeed, Portex prima, Vygon 6 and 9, Dobbhoff, Nutriflex and 6 Ryles tubes) and 13 feeds (4 Clinifeed Preparations, Nutranel, Nutrauxil, Express, Triosorbon, Fortison, Enteral 400, Elemental 028, Complan and Complan + Caloreen have been assessed under laboratory conditions. The accuracy of the stated internal diameter of the tubes tested varied from 88-119%. The rate of flow was inversely related to the length of the feeding tube and was greatly affected by diameter (an increase from 1 to 2 mm increased flow 10-fold); and was virtually unaffected by the side holes at the end of the tube. Giving sets provide only a small resistance to flow. The viscosities of liquid feeds did not correlate with their osmolarities. The values ranged from 1.9-28 centipois (cps) at 24 degrees C and universally decreased to 1.4-19 cps at 37 degrees C. All enteral feeds except Clinifeed 500, flow satisfactorily through fine bore tubes under a low head of pressure. Undiluted Clinifeed 500 (a high protein feed) requires pumping. Feeds containing casein (e.g. Complan, Nutrauxil, Fortison, Triosorbon) curdle in the presence of acid which hinders aspiration through even widebore tubes. Foods containing whey protein (Express, Enteral 400) or no protein (Elemental 028) do not coagulate with change of pH. Batch to batch variations in liquid feeds are usually small but with one preparation were sufficiently large to cause problems in delivery. The results of these studies provide further data on which to base the choice of liquid feed and giving tubes in clinical practice.

The effects of capsaicin pre-treatment on the responses of single neurones to sensory stimuli in the trigeminal nucleus caudalis of the rat: evidence against a role for substance P as the neurotransmitter serving thermal nociception.

Rats were systemically pre-treated with capsaicin either on the first day of life or at an age of 1 month. Both treatments were found to deplete substance P levels in the trigeminal nucleus caudalis (55.6% and 57.9% depletions, respectively). Extracellular single neurone recordings in the trigeminal nucleus caudalis revealed that neither type of capsaicin treatment greatly altered the proportions of neurones responding to non-noxious or noxious mechanical stimulation of the face. However, the proportion of mechanically-nociceptive neurones also responding to noxious thermal stimulation was greatly reduced in neonatally-treated, but not adult-treated rats. As both methods of capsaicin treatment caused similar depletions of substance P, it is concluded that this peptide may not be the neurotransmitter of afferent fibres to the trigeminal nucleus caudalis signalling thermal nociception.