The potential effects of polyunsaturated ω-3 fatty acids on spinal cord injury: A systematic review & meta-analysis of preclinical evidence.

Polyunsaturated fatty acids (PUFAs) have received attention for their anti-inflammatory and antioxidant properties. Preclinical studies have investigated the efficacy of PUFAs in animal models of spinal cord injury (SCI) to determine if these properties can translate to neuroprotection and locomotor recovery. Findings from such studies have been promising, suggesting PUFAs as potential treatments against the neurological dysfunction induced by SCI. This systematic review and meta-analysis sought to investigate the efficacy of PUFAs for promoting locomotor recovery in animal models of SCI. PubMed, Web of Science and Embase (Ovid) were searched for relevant papers and those that examined the restorative effects of PUFAs on locomotor recovery in preclinical SCI models were included in our analysis. A random effects meta-analysis (restricted maximum likelihood estimator) was employed. A total of 28 studies were included and the results showed the claim that PUFAs have a beneficial therapeutic effect for promoting locomotor recovery (SMD = 1.037, 95% CI = 0.809-1.2644, p = <0.001) and cell survival (SMD = 1.101, 95% CI = 0.889-1.313, p = <0.001) in animal models of SCI. No significant differences for the secondary outcomes of neuropathic pain and lesion volume. Moderate asymmetry was observed in the funnel plots for locomotor recovery, cell survival and neuropathic pain measures, suggesting publication bias. Trim-and-fill analysis estimated 13, 3, 0 and 4 missing studies for locomotor recovery, cell survival, neuropathic pain, and lesion volume, respectively. A modified CAMARADES checklist was also used to assess risk of bias, showing that the median score for all included papers was 4 out of a possible 7.

Recent declines in salmon body size impact ecosystems and fisheries.

Declines in animal body sizes are widely reported and likely impact ecological interactions and ecosystem services. For harvested species subject to multiple stressors, limited understanding of the causes and consequences of size declines impedes prediction, prevention, and mitigation. We highlight widespread declines in Pacific salmon size based on 60 years of measurements from 12.5 million fish across Alaska, the last largely pristine North American salmon-producing region. Declines in salmon size, primarily resulting from shifting age structure, are associated with climate and competition at sea. Compared to salmon maturing before 1990, the reduced size of adult salmon after 2010 has potentially resulted in substantial losses to ecosystems and people; for Chinook salmon we estimated average per-fish reductions in egg production (-16%), nutrient transport (-28%), fisheries value (-21%), and meals for rural people (-26%). Downsizing of organisms is a global concern, and current trends may pose substantial risks for nature and people.

Loneliness and vascular biomarkers: the Dublin Healthy Ageing Study.

BACKGROUND: Loneliness has been associated with poor physical health and a link has been suggested between the presence of loneliness, cardiovascular health and inflammatory markers. OBJECTIVE: To investigate the association between vascular disease biomarkers and loneliness in a community-dwelling non-demented elderly population. DESIGN: cross-sectional community based assessment. PARTICIPANTS: 466 subjects with mean age 75.45 (SD, 6.06) years. 208 (44.6%) were male. RESULTS: Higher levels of HbA1c, but not other vascular biomarkers were independently associated with being lonely. CONCLUSION: Loneliness was associated with raised levels of HbA1c in a community dwelling elderly population. The mechanism for this association has yet to be elucidated but may reflect an abnormal stress response in people who are lonely.

Associations between holotranscobalamin, vitamin B12, homocysteine and depressive symptoms in community-dwelling elders.

BACKGROUND: Vitamin B12 and homocysteine have been shown to be associated with depression or depressive symptoms, but the relationship has not been universal. Both vitamin B12 and homocysteine may exert an effect via vascular mechanisms; it is possible that other mechanisms apply. Holotranscobalamin is a novel, more accurate measure of tissue vitamin B12. OBJECTIVES: To examine associations between vitamin B12, serum folate, holotranscobalamin, homocysteine and depressive symptoms in a sample of healthy elderly. METHODS: Cross-sectional, observational community based study. RESULTS: Lower levels of holotranscobalamin and vitamin B12 were associated with higher levels of depressive symptoms when controlled for Mini-mental state examination scores and psychosocial and cardiovascular risk factors. Homocysteine was not associated with depressive symptoms when biological and psychosocial covariates were included. CONCLUSIONS: It is possible that low levels of vitamin B12 or holotranscobalamin are associated with depressive symptoms via mechanisms other than vascular pathology.

Vitamin B12 status, homocysteine and mortality amongst community-dwelling Irish elders.

BACKGROUND: Vitamin B12 deficiency is associated with hyperhomocysteinaemia, which is associated with atherosclerosis and increased mortality. High levels of vitamin B12 have also been associated with increased mortality in certain patient populations. AIMS: We examined vitamin B12 and homocysteine status and mortality rates in a population of Irish community-dwelling elders over a 3-year period. METHODS: Prospective, community-based observational cohort study. RESULTS: Subjects in the highest quartile of homocysteine had increased mortality rates (14.68 vs. 7.32%, relative risk 2.09). This relationship was attenuated when controlled for the presence or absence of a history of stroke or myocardial infarction. There was no relationship between vitamin B12 status and mortality during the observation period. CONCLUSION: Vitamin B12 levels are not associated with death rates in Irish community-dwelling elders. Homocysteine levels are associated with mortality and may act via the mechanism of atherosclerotic disease.

Resource utilisation for syncope presenting to an acute hospital Emergency Department.

BACKGROUND: Syncope is a common clinical problem accounting for up to 6% of hospital admissions. Little is known about resource utilisation for patients admitted for syncope management in Ireland. AIM: To determine the utilisation of resources for patients admitted for syncope management. METHODS: Single centre observational case series of consecutive adult patients presenting to an acute hospital Emergency Department with syncope over a 5-month period. RESULTS: Two-hundred and fourteen of 18,898 patients (1.1%) had a syncopal episode, 110 (51.4%) of whom were admitted. Mean length of stay was 6.9 days. Sixty-four of these admissions were deemed unnecessary by retrospective review when compared to ESC guidelines. Eighty-five (77.3%) admitted patients had cardiac investigations and 56 (51%) had brain imaging performed. CONCLUSIONS: Syncope places a large demand on overstretched hospital resources. Most cases can be managed safely as an outpatient and to facilitate this, hospitals should develop outpatient Syncope Management Units.

Physiological effects of sleeping with the head of the bed elevated 18 in. in young healthy volunteers.

BACKGROUND: Sleeping with the head of bed tilted upwards (SHU) is recommended as a treatment of orthostatic hypotension though the supporting evidence is weak. AIM: To investigate the physiological effects of SHU amongst a group of young healthy volunteers. METHODS: Twenty-nine volunteers, mean age 22 years, underwent 1-week of SHU at 18-in. elevation. Before and after hemodynamic and non-haemodynamic parameters were recorded. RESULTS: After SHU, there were reductions in the systolic blood pressure drop on standing, upright total peripheral resistance, haemoglobin, nocturnal urinary volume, orthostatic dizziness and increases in weight, standing cardiac output and ankle circumference. There were no differences in heart rate, stroke volume, renin, aldosterone, pro-atrial natriuretic peptide or 24-h blood pressure. CONCLUSIONS: In these healthy subjects, SHU for 1 week had a nocturnal antidiuretic effect with both intra- and extra-vascular accumulation of fluid and was associated with reduced postural drop in SBP and improved orthostatic tolerance.

Health-related quality of life of stroke survivors attending the volunteer stroke scheme.

BACKGROUND: The Volunteer Stroke Scheme (VSS) provides patients with the opportunity to participate in community-based therapeutic activities and physiotherapy sessions. AIMS: To provide the first profile of VSS attendees in terms of their functioning across the range of recommended WHO International Classification of Functioning, Disability and Health (ICF) outcomes. METHODS: A convenience sample of 41 VSS patients completed standardised measures of cognitive functioning (MMSE), activity levels [Frenchay Activity Index (FAI), and Barthel Index (BI)], depression [Hospital Anxiety and Depression Scale (HADS)] and Quality of Life (SF-36). RESULTS: A total of 37% met the criteria for mild cognitive impairment and 44% met the criteria for clinical depression. Scores on the BI (M = 79.5) and FAI (M = 18.4) incidated limitations in activity levels. Quality of life levels was low. CONCLUSIONS: High levels of psychological morbidity, severe disability across a range of domains and poor quality of life were reported.

Survival of patients discharged to long term care.

Data on the life expectancy of elderly people in long term care facilities will be important for effective service planning and monitoring quality of care. To date there are no such data from an Irish perspective. A random sample of patients discharged to long term care between Jan 1st 1997 and December 31st 2003 from a single Dublin hospital was studied. Death by January 1st 2005 was ascertained through the register of births deaths and marriage. Median survival was calculated and factors associated with mortality were determined in a logistic regression. Mean (sd) age was 82 (11) years and 61 (29%) were female. Median survival was 30.3 (95%CI 22.4-45.0) months (mean Irish life expectancy at this age is about 78 months). Three factors were independently associated with death by 2 years: age (Odds ratio 1.11 [95%CI 1.05-1.17, F ratio 15.1, p=0.0001] per year), male gender (Odds ratio 1.52 [95%CI 1.05-3.68, F ratio 5.2, p=0.024]) and discharge to continuing care (Odds ratio 1.96 [1.05-3.68, F ratio 4.4, p=0.037]). These results (which are the first such Irish data) show that patients discharged to long term care are a frail group with a reduced life expectancy. Encouragingly survival for this cohort (25% at 1 year) was similar to that seen in other countries. Data on nursing home survival will allow more accurate planning of long term residential services and help monitor quality of care.

The Stroke Activity Scale: results of a validity study.

PURPOSE: To establish the concurrent validity and time to complete of the Stroke Activity Scale (SAS) a recently developed stroke motor disability scale designed for use in a busy clinical setting. METHOD: Forty-one stroke patients with residual hemiplegia were recruited and assessed on a single occasion using both the SAS (five items) and modified Motor Assessment Scale (MMAS) (eight items) by a research physiotherapist. Performance was videotaped and assessed subsequently by a second physiotherapist. RESULTS: Pearson's correlation coefficient between the two measures was 0.91. The SAS was significantly quicker to complete than the MMAS (2.8 vs. 10.4 min, p < 0.0001). CONCLUSION: The SAS had high concurrent validity with the MMAS but was much quicker to complete and therefore more suitable for use in clinical environments where time is at a premium.

Validating the Orpington Prognostic Score in an Irish in-patient stroke population.

An accurate assessment of stroke severity and the ability to predict prognosis is important for determining rehabilitation needs and long term management of patients after stroke. The Orpington Prognostic Score (OPS) is a clinically derived stroke severity scale that can be used to stratify patients into different severity groups. The aim of this study was to validate the Orpington Prognostic Score (OPS) in an Irish in-patient stroke population. Fifty 'first stroke' patients (21 male, median age 72.5 [range 31-93] years) were assessed within two weeks following stroke onset. Subjects were stratified into mild, moderate and severe groups using previously established cut-offs for the OPS. Outcomes were determined prospectively and compared to initial severity groups. Patients in the severe group had a significantly increased chance of dying (Odds ratio [95%CI] 2.16 [1.72-2.72] and this persisted after adjustment for age and gender. Length of stay increased significantly with increasing stroke severity group (F ratio 7.0 p=0.0025) and this association remained after adjusting for age and gender. The odds of being discharged home or of being able to walk independently by time of discharge decreased significantly (all p<0.001) as stroke severity increased and adjusting for age and gender did not alter these associations. A higher OPS score within 2 weeks of stroke onset was significantly associated with longer length of stay, increased mortality, reduced mobility at discharge and a reduced likelihood of discharge home. The OPS is a valid measure of stroke severity in Irish stroke in-patients.

Field trial of a new aeration system for enhancing biodegradation in a biopile.

The influence of a new aeration system on the biopile performance was investigated. The purpose was to increase biodegradation efficiency by optimising airflow through the pile. During a 1-month field trial, the performance of a new system using two perforated vertical pipes with wind-driven turbines was compared with that of a standard pile configuration with two horizontal perforated pipes. Both piles were composed of a similar mix of diesel-contaminated soils, woodchips, compost and NPK fertiliser. Hydrocarbons were recovered using solvent extraction, and determined both gravimetrically and by gas chromatography. Total heterotrophs, pH and moisture content were also assessed. Air pressure measurements were made to compare the efficiency of suction in the pipes. Results at the end of the experiment showed that there was no significant difference between the two piles in the total amount of hydrocarbon biodegradation. The normalised degradation rate was, however, considerably higher in the new system than in the standard one, suggesting that the vertical venting method may have improved the efficiency of the biological reactions in the pile. The pressure measurements showed a significant improvement in the suction produced by the new aeration system. However, many factors other than the airflow (oxygen supply) may influence and limit the biodegradation rates, including moisture content, age of contaminants and the climatic conditions. Additional experiments and modelling need to be carried out to explore further the new aeration method and to develop criteria and guidelines for engineering design of optimal aeration schemes in order to achieve maximum biodegradation in biopiles.

A new stroke activity scale-results of a reliability study.

PURPOSE: To investigate the internal consistency, inter-rater and intra-rater reliability of a disability stroke activity scale (SAS) for stroke patients. Its intended use is as a measure of motor function at the level of disability in stroke patients. METHOD: Twelve stroke in-patients were video-recorded performing the five activities from the SAS. Seven senior physiotherapists, experienced in stroke care, independently rated the recordings on two occasions, three weeks apart, using the SAS. Twelve hospital inpatients participated in the study. The subjects were aged between 48 and 86 and were between 6 and 87 days post stroke. RESULTS: Reliability for total scores was found to be excellent (generalizability correlation co-efficient (GCC) values> or =0.95) and reliability for individual item scores was good (kappa> or =0.7). Internal consistency reliability using Cronbach's alpha was also good (0.68 at time 1 and 0.68 at time 2). CONCLUSION: The stroke activity scale is a reliable instrument for hospital stroke patients. It can be administered in less than 10 minutes and requires minimal equipment and training. Further work on the validity and responsiveness of the SAS is in progress.

A longitudinal evaluation of behavioural and psychological symptoms of probable Alzheimer's disease.

BACKGROUND: Non-cognitive symptoms are a frequent feature of Alzheimer's disease (AD). Much of the literature that has accumulated pertains to cross-sectional prevalence of these symptoms. There has been relatively little attention paid to the longitudinal course of Behavioural and Psychological Symptoms of Dementia (BPSD). AIMS: The purpose of this study is to examine the longitudinal course of BPSD in a group of patients with mild AD. METHODS: A retrospective review of a database was performed to identify patients with NINCDS/ADRDA criteria for probable AD and who had been evaluated three times at yearly interval over a two-year period. Fifty-two subjects were identified with probable AD that had completed follow-up for 24 months. The BEHAVE-AD was used to evaluate BPSD and data was analysed using a Markov analysis. RESULTS: Activity disturbance is a common and relatively persistent symptom in the mild stages of AD. Anxiety, paranoid ideation, and aggression were moderately persistent. Affective symptoms were not persistent with less than half the patients having the symptoms a year later. CONCLUSIONS: Activity disturbance is common and persistent in early AD. Paranoid and delusional ideation shows moderate persistence and depressive symptoms infrequently last longer than a year. These findings may have clinical relevance for the pharmacological and non-pharmacological management of BPSD.

Recurrent falls are associated with increased length of stay in elderly psychiatric inpatients.

OBJECTIVES: To identify factors which may contribute to prolonged length of stay in an elderly psychiatric inpatient setting. DESIGN: Retrospective case note study. METHODS: A list of all patients over the age of 65 discharged from a private psychiatric hospital over a three-year period excluding those with a length of stay of over 365 days was obtained (n = 1147). A random sample of 150 patients was selected from the study population. A case note study was then performed looking at a number of variables which have been postulated to affect length of stay. The resulting data was analysed using multivariate statistics. RESULTS: There was no statistically significant association found between baseline factors (including age, gender, cognitive impairment, marital status, order of admission and preadmission living arrangement) and length of stay. Having recurrent falls whilst an inpatient was associated with prolonged hospital stay (p = 0.0006). CONCLUSION: Experiencing recurrent falls whilst an inpatient is associated with prolonged length of stay. Recurrent falls in the elderly may be associated with both physical illness and the use of psychotropic medications. A prospective study examining factors contributing to falls would be important in decreasing fall risk and reducing length of stay.

Endogenous sex hormone levels in postmenopausal women with Alzheimer's disease.

A cross-sectional study examined whether there was a difference in endogenous serum sex hormone levels between community-dwelling postmenopausal women with Alzheimer's disease (AD) and healthy controls. Total morning levels of serum estrone, estradiol, androstenedione, testosterone, and cortisol were measured in 52 nondepressed women with AD and 60 postmenopausal women who were neither depressed nor cognitively impaired. Estradiol was undetectable in 35.7% of cases, but detectable hormone was found in 96-100% of cases otherwise. After adjustment for potential confounds, serum levels were significantly higher for estrone (P = 0.0057) and androstenedione (P = 0.02), but not testosterone (P = 0.086) or estradiol (P = 0.59), in subjects with AD. Sex hormone levels did not correlate with cognitive scores in either group. Although the failure to detect estradiol in a third of cases limits the conclusions that can be drawn for this hormone, the possibility that AD is associated with abnormalities in certain serum sex hormone levels should be considered and warrants further research.

Torsional properties of stainless-steel and nickel-titanium files after multiple autoclave sterilizations.

This study tested the hypothesis that multiple sterilizations of endodontic stainless-steel and nickel-titanium files will lead to a continuous decrease in the resistance of files to separation by torsion. One hundred stainless-steel and 100 nickel-titanium #30 K-type files were divided into 20 groups of 10 and sterilized in increments of 10 cycles, using a full cycle and a fast cycle autoclave. These files were tested by twisting each of them in a clockwise direction until fracture (torque g-cm). Samples of the fractured files were embedded in an epoxy resin and polished for Knoop hardness tests. In addition, the samples were chemically etched to reveal changes in microstructure. The findings of this study indicate that neither the number of sterilization cycles nor the type of autoclave sterilization used affects the torsional properties, hardness, and microstructure of stainless-steel and nickel-titanium files.

Mandibular molar with 5 canals: report of a case.

A unique case of a mandibular molar with 5 canals is described. Literature pertaining to the analysis of the morphology of mandibular first molars is reviewed. Clinicians should thoroughly examine the pulpal floor and radiographs for the possibility of additional canals.

A comparison of canal preparation with nickel-titanium and stainless steel instruments.

Maintaining the original canal path during instrumentation is a challenge in narrow curved canals. This study compared the maintenance of the original canal path of curved root canals during instrumentation with nickel-titanium (Mac) hand files, nickel-titanium engine-driven files, and stainless steel (K-Flex) files. Canal path maintenance was determined by superimposing instrumentation radiographs over an initial file radiograph and examining for discrepancies. Nickel-titanium hand and engine-driven instruments maintained the original canal path in all cases. The incidence of deviation from the original canal path during instrumentation with stainless steel files increased with file size. The difference between nickel-titanium groups and stainless steel became statistically significant with instruments larger than size 30. In this study, nickel-titanium files were more effective in maintaining the original canal path of curved root canals when the apical preparation was enlarged beyond size 30.

A comparison of tissue reactions to Ketac-Fil and amalgam.

The objective of this study was to compare the bone tissue reactions of Ketac-Fil to the most commonly used retrograde filling material, amalgam, in a rat model. Forty-eight Harlan rats were divided into three groups: amalgam, Ketac-Fil, and controls. Following anesthesia, the right lower incisor was extracted from each animal. A 3-mm long x 1-mm diameter polyethylene tube filled with amalgam or Ketac-Fil was implanted in the extraction site. The animals were killed at 14, 42, and 90 days; and the mandibles were dissected en block and processed histologically. The inflammatory reaction was assessed by the number of plasma cells, lymphocytes, polymorphonuclear neutrophils, giant cells, and osteoclasts within 100 microns of the implant. Bone formation was determined as either present or absent in the same area. There was no statistically significant bone apposition within 100 microns of the Ketac material, and there was a statistically significant increase in inflammation in the amalgam group. This study indicates that both Ketac-Fil and amalgam are relatively biocompatible, and provides support for clinical usage tests of Ketac-Fil as a retrograde filling material.