Rutin, an antioxidant flavonoid, induces glutathione and glutathione peroxidase activities to protect against ethanol effects in cadmium-induced oxidative stress in the testis of adult rats.

Exposure to cadmium (Cd) reduces sperm quality and induces oxidative stress in the testis. Rutin is an effective antioxidant flavonoid. We studied the effect of ethanol (EtOH, 5 g/kg b.wt.) intake on Cd (50 mg/kg b.wt.)-induced testicular toxicity with or without RUT pre-treatment (25, 50, 100 mg/kg b.wt.) in rats. At the end of the 15-day oral treatment, co-treatment with EtOH decreased the activities of glutathione (GSH), GSH-peroxidase and superoxide dismutase resulting to slight increase in the testicular MDA level compared to Cd-treated rats. The Cd+EtOH animals had higher levels of abnormal spermatozoa, decreased epididymal sperm number and serum testosterone levels (p < .05) compared to the Cd-treated animals. Rutin co-administration protected against the EtOH effects in a dose-dependent manner, with the Cd+EtOH+50 mg/kg RUT- and Cd+EtOH+100 mg/kg RUT-treated animals having higher GSH and GSH-Px activities beyond the control values (p < .05). In a supplementary study, animals treated daily with RUT alone (25, 50, 100 mg/kg b.wt.) for 15 days dose-dependently increased testicular GSH-peroxidase and GSH activities by 9.38%, 31.25%, 56.25% and 7.14%, 32.14%, 60.71%, respectively, compared to control values. Therefore, RUT induces GSH and GSH-Px activities to protect against Cd+EtOH-induced testis oxidative stress in rats.

Interfacial dynamics in pressure-driven two-layer laminar channel flow with high viscosity ratios.

The large-scale dynamics of an interface separating two immiscible fluids in a channel is studied in the case of large viscosity contrasts. A long-wave analysis in conjunction with the Kármán-Polhausen method to approximate the velocity profile in the less viscous fluid is used to derive a single equation for the interface. This equation accounts for the presence of interfacial stress, capillarity, and viscous retardation as well as inertia in the less viscous fluid layer where the flow is considered to be quasistatic; the equation is shown to reduce to a Benney-type equation and the Kuramoto-Sivashinskiy equation in the relevant limits. The solutions of this equation are parametrized by an initial thickness ratio h0 and a dimensionless parameter S , which measures the relative significance of inertial to capillary forces. A parametric continuation technique is employed, which reveals that nonuniqueness of periodic solutions is possible in certain regions of (h0,S) space. Transient numerical simulations are also reported, whose results demonstrate good agreement with the bifurcation structure obtained from the parametric continuation results.

Empiema subdural de evolución fulminante. A propósito de un caso / Fulminat subdural empyema. A case report

Presentamos el caso de un paciente varón de 24 años que fue traído a urgencias por presentar empeoramiento de cuadro de malestar general y cefalea de varios días de evolución y aparición en las últimas horas de somnolencia, vómitos y debilidad de hemicuerpo derecho. Fue diagnosticado inicialmente de meningoencefalitis y posteriormente de empiema subdural, que fue tratado con cirugía y antibioterapia de amplio espectro, a pesar de lo cual el paciente falleció. El empiema subdural es una colección purulenta focal intracraneal entre la duramadre y la aracnoides, que causa sintomatología clínica por compresión extrínseca del cerebro e inflamación del cerebro y las meninges. Es importante su diagnóstico precoz de cara a instaurar un tratamiento eficaz lo antes posible. A pesar de los avances en antibioterapia y neurocirugía su morbimortalidad continúa siendo elevada (AU)

Case of a 24-year-old male who comes to the Emergency suffering from headache, menigism, vomits, and right hemiparesis. He was first diagnosed of meningoencephalitis and a few hours later operated from a left subdural empyema, but he did not responde to any therapeutic measure and died a few days later. Subdural empyema is an intracranial focal collection of purulent material located between the dura mater and the arachnoid mater, which causes clinical problems through extrinsic compression of the brain and inflammation of the brain and meninges. Rapid recognition and treatment are important; nevertheless prognosis continues being poor (AU)

Effects of particle size on near-wall depletion in mono-dispersed colloidal suspensions.

In this work we investigate the change in particle concentration near a solid boundary for colloidal dispersions in pressure driven flow, commonly referred to as wall depletion. In particular we determine the effect of Peclet number on the strength and spatial extent of the depleted layer. The change in concentration near the solid boundary is measured with attenuated total reflection infrared (ATR-IR) spectroscopy described previously (P.J.A. Hartman Kok et al., J. Rheol. 46 (2002) 481). The method is capable of measuring the concentration of particles at distances ranging from 0.2 to 1.0 mum from the boundary. The suspensions investigated consisted of mono-dispersed polystyrene particles in water. Particles of four different sizes were used, with radius, a, of 30, 54, 105, and 197 nm. (The ratio H/a was in the range 2500-17,000 with H being the height of the flow cell.) This enabled us to measure the wall depletion effect over a wide range of Peclet numbers, ranging from 0.01 to 45. We found that wall depletion was not significant for Peclet numbers smaller than unity. Estimates of the wall slip layer thickness obtained from rheological experiments were consistent with the results obtained by ATR-IR spectroscopy.

A review of the rheology of the lamellar phase in surfactant systems.

The rheology of the liquid crystal lamellar phase has been studied in a wide range of systems including non-ionic, anionic and cationic surfactants and block co-polymers. This review summarises the main advances in this area over the past twenty years and includes examples of the rheo-optical techniques, which help to elucidate the changes in microstructural conformation taking place in the lamellar phase during shear. Particular emphasis is given to the microstructural change of the lamellar phase from sheet-like bilayers to dispersed multilamellar vesicles (droplets). Examples of this transition are provided for both surfactant and block co-polymer systems. The review highlights similarities in the rheological signatures of the transition for different systems and also summarises the variation in behaviour of the lamellar phase at different surfactant concentrations and on the addition of salt.

Dyneins have run their course in plant lineage.

Flowering plant genomes lack flagellar and cytoplasmic dyneins as well as the proteins that make up the dynactin complex. The mechanisms for organizing the Golgi apparatus, establishing spindle poles, and moving nuclei, vesicles, and chromosomes in flowering plants must be fundamentally different from those in other systems where these processes are dependent upon dynein and dynactin.

Couette flow of two immiscible liquids between two concentric cylinders: the formation of toroidal drops and liquid sheaths.

We describe the direct observation of deforming water drops in oil undergoing shear flow in a horizontal annular Couette cell. The drops assume a wide variety of highly reproducible structures depending on drop size, rotation speed, and flow history. These structures include toroidal rings of water around the rotating shaft and water sheaths, which, depending on experimental conditions, can either expand to press against the inner walls of the outer stationary cylinder or contract to hug the outside of the rotating shaft.

Palliative terminal cancer care in community hospitals and a hospice: a comparative study.

BACKGROUND: Despite palliative care being an accepted role of community hospitals, there is little quantitative evidence of the type of care provided. AIM: To obtain quantitative data comparing palliative cancer care provided in 12 community hospitals in 10 towns (approximately 350 medical beds) and in a consultant-led purpose-built hospice (12 beds). METHOD: Retrospective medical and nursing case note analysis over one year of cancer deaths in the former Exeter Health District. RESULTS: A total of 171 community hospital and 116 hospice casenotes were analysed. Hospice patients had significantly different reasons for admission compared with community hospital patients (P < 0.001), with pain and symptom control being more frequent and terminal nursing care less frequent reasons for admission to the hospice. Community hospital length of stay was significantly longer than hospice length of stay (P = 0.002; mean community hospital stay 16 days, mean hospice stay eight days). Symptoms on admission differed significantly. Drug prescribing on admission and at death and indications of active treatment of symptoms were broadly similar. Community hospital patients received more investigations than hospice patients, linked to the observation that around one in ten community hospital patients were admitted for investigation and active treatment. Community hospital medical notes were significantly less likely to meet minimum quality standards than were hospice notes (81/171 vs. 18/116; P < 0.001), with major deficiencies in the areas of examination, progress reporting, and absence of confirmation of death. CONCLUSIONS: This study confirms the role of community hospitals in palliative terminal cancer care. Differences in care between community hospitals and a hospice have been demonstrated that may reflect either different admission populations to each setting or differences in the way care was delivered.

Dying from cancer in community hospitals or a hospice: closest lay carers' perceptions.

BACKGROUND: Despite there being around 400 community hospitals in the United Kingdom, there is little published research on the quality of service provided by these hospitals. AIM: To compare the quality of terminal cancer care in community hospitals with a hospice as assessed by patients' closest lay carer (relative or friend). METHOD: Structured interview (or questionnaire based on the interview proforma) with closest lay carers of all patients dying over one year in 12 community hospitals in east Devon and a purpose-built hospice in the city of Exeter. RESULTS: A total of 292 cases (176 in community hospitals and 116 in a hospice) were identified, resulting in 238 carers being eligible for interview or questionnaire survey. Overall, 106 successful interviews and 55 questionnaires were completed, giving a response rate of 67.6%. Carers gave a near unanimous vote of excellence for the total care given by the hospice, while around 40% of carers of patients in community hospitals considered that improvements were possible. Community hospitals attracted more negative comments than hospices, with criticism being directed at problems of communication, lack of nursing staff, and lack of support in bereavement. Carers of hospice patients were significantly more likely to be present at the time of death than those of community hospital patients [45/70 (64%) vs. 31/89 (35%); chi 2 = 13.6, P < 0.001], an observation possibly because nursing staff in community hospitals are less experienced at dealing with terminally ill patients and such hospitals have fewer adequate facilities. CONCLUSIONS: Lay carers indicated great satisfaction with care given in the hospice and less satisfaction with care given in the community hospitals. However, the community hospitals are non-specialist units with far lower levels of trained staff. Improvements in terms of the communication skills of doctors and nurses, specific training for nurses in palliative care, and structured bereavement care could be made without necessarily increasing staffing numbers.

Effects of a single pre-operative dexmedetomidine dose on isoflurane requirements and peri-operative haemodynamic stability.

In a double-blind, placebo-controlled study we investigated the effect of a single pre-induction intravenous dose of dexmedetomidine 2 micrograms.kg-1 on anaesthetic requirements and peri-operative haemodynamic stability in 50 patients undergoing minor orthopaedic and general surgery. Patients were anaesthetised with nitrous oxide/oxygen/fentanyl, supplemented if necessary with isoflurane. The mean (SD) intra-operative isoflurane concentration was lower in the dexmedetomidine-treated patients than controls (0.01 (0.03)% compared to 0.1 (0.1)%; p = 0.001) although six of the 25 treated patients required isoflurane at some stage. The haemodynamic response to tracheal intubation and extubation was reduced in the dexmedetomidine group as was intra-operative heart rate variability; postoperative analgesic and anti-emetic requirements and peri-operative serum catecholamine concentrations were lower in the dexmedetomidine group. Hypotension and bradycardia occurred more frequently after dexmedetomidine.

Hemodynamic and coronary vascular effects of dexmedetomidine in the anesthetized goat.

BACKGROUND: In phase III trials, the hemodynamic stabilising effect of the alpha 2-adrenergic agonist dexmedetomidine (DEX) is being investigated in patients with coronary artery disease, Coronary vascular effects of alpha 2-agonists have been studied in dogs and pigs, but both species have a different hemodynamic response to DEX than man. The aim of this study was to investigate the hemodynamic and coronary vascular effects in goats. METHODS: In 6 open-chest goats anesthetized with halothane, central and coronary hemodynamics and oxygen supply and demand were measured before and following IV bolus infusion of DEX in doses ranging from 0.1 to 10 micrograms/kg. RESULTS: With DEX doses of 1 microgram/kg or higher, mean arterial pressure (MAP), systemic vascular resistance, coronary vascular resistance and arterio-mixed venous oxygen content increased within 2 min, but returned to baseline within 15 min. In contrast, there was a progressive and cumulative decrease in cardiac output (CO), heart rate, and dP/dtmax, Regional coronary venous oxygen extraction (C(a-cv)O2) transiently increased after 3 micrograms/kg DEX and decreased 15 min after 10 micrograms/kg DEX. LVEDP transiently increased after 3 and 10 micrograms/kg DEX. The changes after DEX 10 micrograms/kg differed from those after lower doses: MAP (35%), CO (50%), stroke volume (33%), C(a-cv)O2 (15%) and myocardial oxygen extraction (33%) were all decreased. Myocardial oxygen supply and demand decreased in parallel. CONCLUSIONS: 1) The cardiovascular response to IV DEX in goats is similar to man. 2) In goats after DEX, systemic and coronary vasoconstriction are short-lived, and 3) the balance between myocardial oxygen supply and demand is maintained.

Alleviation of the peripheral hemodynamic effects of dexmedetomidine by the calcium channel blocker isradipine.

BACKGROUND: Alpha 2-adrenergic agonists have peripheral vasoconstrictive effects and central sympatholytic and sedative effects. Whereas the latter are the basis of their use in anesthesia, the former could limit their clinical application. METHODS: To study whether a vasodilator could alleviate the systemic and coronary vasoconstrictor effects of dexmedetomidine without influencing the central sympatholytic effects, the calcium channel blocker isradipine was infused after a high dose of dexmedetomidine in anesthetized dogs. RESULTS: Dexmedetomidine 10 micrograms.kg-1 decreased plasma concentrations of norepinephrine and epinephrine by more than 90%, heart rate by 39%, cardiac output by 64%, dp/dtmax by 29% and increased mean arterial pressure by 55% and the left ventricular end-diastolic pressure (LVEDP) 4-fold as compared to baseline. In addition, coronary blood flow decreased by 52% and coronary venous oxygen saturation by 51%. Isradipine could completely antagonize all the coronary and systemic hemodynamic changes induced by dexmedetomidine, but only partially he increase in LVEDP. Isradipine caused no changes in plasma catecholamine levels. CONCLUSION: Isradipine could alleviate the peripheral hemodynamic actions of dexmedetomidine while having no effect on its central sympatholytic properties.

Differences in drug prescribing patterns in elderly parkinsonian patients identified at hospital admission.

In the period July 1984 to June 1993 a total of 4541 admissions to a Department of Medicine for the Elderly were investigated. Approximately 9% of the total were diagnosed to have parkinsonism. Full drug histories together with the available demographic and clinical data were investigated in order to identify differences in the prescribing patterns in this group compared to those of non-parkinsonian patients admitted during this time frame. There was a statistically significant lower incidence among the parkinsonian group for the prescribing of all cardiovascular drug groups, anticoagulants, hypoglycaemics, bronchodilators, and corticosteroids compared with non-parkinsonian patients. In contrast, the incidence of hypnotics, laxatives, antidepressants and antipsychotics were significantly higher.

The effect of dexmedetomidine on nutrient organ blood flow.

The alpha 2-adrenergic agonist dexmedetomidine decreases not only heart rate, myocardial contractility, and oxygen demand, but also cardiac output (Q). To investigate whether this reduction in Q could critically impair perfusion of individual organs, we studied the effect of dexmedetomidine on nutrient blood flow to the heart, brain, kidney, spleen, skin, intestine, liver, and arteriovenous anastomoses using the radioactive microsphere technique. Studies were conducted in 14 dogs with an open chest and anesthetized with either chloralose/urethane (CU) or fentanyl/halothane (FH), to create different baseline conditions. Hemodynamic variables, organ blood flow, arterial and mixed venous oxygen, and lactate content were measured before and after administration of 0.1, 1, and 10 micrograms/kg dexmedetomidine intravenously (IV). After 10 micrograms/kg dexmedetomidine Q decreased in both groups by 50%. The decrease in blood flow varied greatly between the organs. While flow through arteriovenous anastomoses and skin decreased by 70% to 90%, renal blood flow decreased by 30%, cerebral blood flow only when baseline blood flow was high (FH dogs), and left ventricular blood flow only in the CU group, where the largest decrease in hemodynamic variables occurred. Oxygen consumption decreased only in CU dogs, but so did arterial lactate levels. These data indicate that dexmedetomidine causes considerable redistribution of Q, predominantly reducing blood flow to less vital organs and shunt flow.

Changes in prescribing patterns of oral hypoglycaemics in elderly patients, over a period of 10 years: matching with general practitioners' perceptions of their own prescribing.

A 10-year hospital admissions database had demonstrated a steep decline in the prescribing of chlorpropamide, and to a lesser degree, of glibenclamide, with tolbutamide, metformin and the most recently introduced oral hypoglycaemic, gliclazide, maintaining relatively uniform levels. Glipizide was the most popular emerging agent. Interviews with 20 general practitioners (GPs) revealed that 55% had a definite first choice agent with a priority order of gliclazide, tolbutamide and glibenclamide. For the remaining GPs without a sole preference, gliclazide (30%), glipizide (30%) and glibenclamide (20%) featured as their most commonly prescribed agents.

The effect of dexmedetomidine on the balance of myocardial energy requirement and oxygen supply and demand.

The effect of the alpha(2)-adrenergic agonist dexmedetomidine on the balance between myocardial energy requirement and oxygen supply and demand was investigated in 16 open-chest dogs anesthetized with either chloralose/urethane (CU) or fentanyl/halothane (FH). Myocardial energy requirement (estimated from the pressure work index), blood flow and its transmural distribution (radioactive microspheres), as well as myocardial oxygen and lactate extraction, were measured before and after administration of dexmedetomidine in doses ranging from 0.1 to 10 micrograms/kg intravenously. Under CU anesthesia, dexmedetomidine decreased heart rate, arterial blood pressure, and cardiac output. During FH anesthesia, dexmedetomidine reduced heart rate and cardiac output whereas arterial blood pressure increased. Dexmedetomidine decreased myocardial energy requirement only during CU anesthesia; myocardial oxygen supply and demand decreased in parallel. At the (large) dose of 10 micrograms/kg, myocardial oxygen extraction increased during both types of anesthesia. Dexmedetomidine >/= 1 microgram/kg increased endocardial/epicardial blood flow ratio during FH anesthesia. These data indicate that dexmedetomidine >/= 1 microgram/kg reduces myocardial energy requirements, especially when baseline heart rate and blood pressure are increased. Dexmedetomidine preserves endocardial perfusion and reduces oxygen demand in parallel with oxygen supply and energy requirements.

Sodium in hand and pump expressed human breast milk.

Sodium content was analysed in the expressed breast milk from 30 mothers. Measurements were taken up to 24 days postpartum, during which time the mothers expressed manually or by means of a pump. Statistical analysis has confirmed not only the known decline in sodium levels postpartum but has also shown a significantly higher sodium content in manually expressed milk compared to that from pump expressed milk. This finding suggests that the method of expression may alter the sodium concentration in human breast milk, thus potentially reducing the amount of sodium supplementation required by some preterm infants.

Development and use of a gastropathy index for ranking the safety of non-steroidal anti-inflammatory drugs in the elderly.

This study, conducted at the Royal Devon & Exeter Hospital, Department of Geriatric Medicine, was carried out using 2987 sets of admission data. The number of patients taking non-steroidal anti-inflammatory drugs was identified together with a suite of clinical factors used to indicate the presence of gastrointestinal pathology. From this a gastropathy index was developed to establish a rank order for the individual drugs. Ketoprofen, piroxicam and fenbufen were all significantly associated with factors suggestive of gastropathy, whereas indomethacin, diclofenac and ibuprofen appeared relatively free of such association. Naproxen, azapropazone and mefenamic acid ranked in an intermediate category. This noninvasive analysis of routinely acquired data provides a potentially useful discriminator between individual non-steroidal anti-inflammatory drugs for this age group.