Development and validation of a delirium risk assessment tool in older patients admitted to the Emergency Department Observation Unit.

BACKGROUND: Delirium is frequent though undetected in older patients admitted to the Emergency Department (ED). AIMS: To develop and validate a delirium risk assessment tool for older persons admitted to the ED Observation Unit (OU). METHODS: We used data from two samples of 65 + year-old patients, one admitted to the ED of Brescia Hospital (n = 257) and one to the ED of Desio Hospital (n = 107), Italy. Data from Brescia were used as training sample, those collected in Desio as testing one. Delirium was assessed using the 4AT and patients' characteristic were retrieved from medical charts. Variables found to be associated with delirium in the training sample were tested for the creation of a delirium risk assessment tool. The resulting tool's performances were assessed in the testing subsample. RESULTS: Of all possible scores tested, the combination with the highest discriminative ability in the training sample included: age ≥ 75 years, dementia diagnosis, chronic use of neuroleptics, and hearing impairment. The delirium score exhibited an AUC of 0.874 and 0.893 in the training and testing samples, respectively. For a 1-point increase in the score, the odds of delirium increased more than twice in both samples. DISCUSSION: We propose a delirium risk assessing tool that includes variables that can be easily collected at ED admission and that can be calculated rapidly. CONCLUSION: A risk assessment tool could help improving delirium detection in older persons referring to ED.

4-mer hyaluronan oligosaccharides stimulate inflammation response in synovial fibroblasts in part via TAK-1 and in part via p38-MAPK.

4-mer hyaluronan (HA) oligosaccharides stimulate pro-inflammatory effects in different cell types by interacting with both the toll-like receptor-4 (TLR-4) and -2 (TLR-2). This interaction induces the activation of the transforming growth factor activated kinase-1 (TAK-1) that activates the nuclear factor kappaB (NF-kB) either directly and/or through the activation of p38-mitogen-activated protein kinase (p38-MAPK). This in turn induces the transcription of proinflammatory mediators that prime inflammation. Our aim was to investigate the involvement of TAK-1 and p38-MAPK in 4-mer HA oligosaccharide-induced inflammatory response in mouse synovial fibroblasts obtained from normal DBA/J1 mice (NSF) and from mice subjected to collagen-induced arthritis (CIA). Treatment of NSF and rheumatoid arthritis synovial fibroblasts (RASF) with 4-mer HA showed a marked up-regulation of TLR-4, TLR-2, TAK-1 and p38-MAPK mRNA expression and of the related proteins, as well as NF-kB activation. High levels were also detected of TNF-α, IL- 1ß, MMP-13 and iNOS. Treatment of NSF and RASF, previously stimulated with 4-mer HA oligosaccharides, with TAK- 1 and/or p38-MAPK specific inhibitors significantly reduced all the parameters, although the inhibitory effect of p38- MAPK was less effective than that of TAK-1. The addition of CD44 antibody to both NSF and RASF showed that CD44 was not involved in 4-mer HA-induced inflammation.

Palatal sliding strip flap: soft tissue management to restore maxillary anterior esthetics at stage 2 surgery: a clinical report.

A new soft tissue flap design technique, called "the palatal sliding strip flap" (PSSF), has been developed to improve the soft tissue surgical results at stage 2 implant surgery. The purpose of this flap design is to help form papillae between implants and between natural teeth in the anterior area of the maxilla. The flap is designed and managed so that the palatal attached mucosa slides in a labial direction to create papillae and at the same time augment the labial ridge. This surgical approach is valid, predictable, and has a low risk-to-benefit ratio. This new flap design is indicated for a variety of clinical situations, especially for the problematic maxillary soft tissue reconstruction around teeth and implants.

An alternative technique for an accurate implant-retained prosthesis impression.

A technique is described to help ensure the accurate reproduction of rigid implant components and the edentulous soft tissue. Splinted implant impression copings are luted together with resin to a specially designed custom tray.

Clinical and laboratory considerations in the use of a new all-ceramic restorative system.

Ceramic systems are continually under development in an effort to refine their clinical application. An all-ceramic full-coverage crown system (Procera, Nobel Biocare, Westmont, IL) that utilizes computer technology and industrial presses to fabricate precise copings has recently been introduced. Using this system, aluminous porcelain is baked over a high-strength, high-purity aluminum oxide coping to fabricate a functional, biocompatible, and aesthetic restoration. This article presents a discussion of the clinical and laboratory considerations that are involved in the utilization of this all-ceramic system.

Implant fixture position registration at the time of fixture placement surgery.

The implant registration procedures usually take place at the fixture uncovery surgery, months after the implant placement. In this article, the authors describe a technique for single implant fixture registration during the surgical placement of that fixture. The rationale and advantages of this procedure are also discussed.