Frailty Could Predict Death in Older Adults after Admissionat Emergency Department? A 6-month Prospective Study from a Middle-Income Country.

BACKGROUND: The number of older adults attending emergency department (ED) is increasing all over the world. Usually, those patients are potentially more complex due to their greater number of comorbidities, cognitive disorders, and functional or physical disabilities. Frailty is a vulnerable state that could predict adverse outcomes of those patients. There are very few studies that addressed this topic in the ED, and none of them used a simple instrument for frailty assessment. OBJECTIVES: The primary outcome was to evaluate the association between frailty identified through the FRAIL questionnaire at baseline and death after a 6-month follow-up period after hospital discharge from the ED. Secondary outcomes were readmission to the ED and disability after 6 months. METHODS: A 6-month follow-up prospective study (FASES study) was conducted at a university-based trauma-center ED in Jundiaí, southwestern of Brazil. A total of 316 older adults aged 60 or older were randomly included based on a lottery of their medical record admission number. Frailty was evaluated through the FRAIL questionnaire. The association between frailty and death was estimated through a binary logistic regression adjusted for age, sex, and cognitive performance. RESULTS: From the total sample, the mean age was 72.11±8.0 years, and 51.6% were women. Participants presented 2.28±1.4 comorbidities and 25.6% were frail. Mean hospital stay was 5.43±5.6 days. Death occurred in 52 participants, readmission to the emergency in 55, and new disability in 16 after 6 months. Frailty was associated with an odds ratio of 2.18 for death after 6 months (95% CI = 1.10-4.31; p = 0.024). This association lost significance after multivariate analysis taking into account cognitive performance. There was no association between frailty status at baseline and readmission to the ED or disability. CONCLUSION: The identification of frailty using the FRAIL at admission was not predictive of death after a 6-month period after discharge from the ED. Simple frailty assessment could identify patients at higher risk for death in the follow-up.

Role of Necl-5 in the pathophysiology of colorectal lesions induced by dimethylhydrazine and/or dextran sodium sulphate.

Necl-5 is an immunoglobulin-like molecule that was originally identified as a poliovirus receptor. Although Necl-5 expression is often up-regulated in cancer cells, its pathophysiological significance in the development of cancer remains unclear. We investigated the roles of Necl-5 in the development of colitis-associated neoplasia. Necl-5-deficient mice were generated and treated with dimethylhydrazine (DMH) and/or dextran sodium sulphate (DSS) to induce colitis and its associated neoplasias. Colon tissues were examined for histology, Ki-67 expression by immunohistochemistry and K-ras gene mutation. Colon tumours occurred significantly less frequently in heterozygous (Necl-5(+/-)) or homozygous Necl-5-deficient (Necl-5(-/-)) mice than in wild-type (WT) mice with DMH/DSS treatment. Total ulcer index and inflammatory cell infiltration were significantly lower in Necl-5(-/-) mice than in WT mice with DSS alone or DMH/DSS treatment. Colon tumours in both WT and Necl-5(-/-) mice showed high cell proliferation ability but lacked K-ras mutation. The total Ki-67 labelling index in non-neoplastic colon epithelium was significantly higher in WT (45.9 +/- 0.94) than in Necl-5(+/-) (34.3 +/- 1.40) or Necl-5(-/-) (27.7 +/- 1.15) mice with DMH/DSS treatment (p < 0.001). Necl-5 plays a role in the development of colitis-associated cancer by up-regulating colonic mucosal cell proliferation.

Expression of SDF-1 alpha and nuclear CXCR4 predicts lymph node metastasis in colorectal cancer.

Although stromal cell-derived factor (SDF)-1 alpha and its receptor CXCR4 are experimentally suggested to be involved in tumorigenicity, the clinicopathological significance of their expression in human disease is not fully understood. We examined SDF-1 alpha and CXCR4 expression in colorectal cancers (CRCs) and their related lymph nodes (LNs), and investigated its relationship to clinicopathological features. Specimens of 60 primary CRCs and 27 related LNs were examined immunohistochemically for not only positivity but also immunostaining patterns for SDF-1 alpha and CXCR4. The relationships between clinicopathological features and SDF-1 alpha or CXCR4 expression were then analysed. Stromal cell-derived factor-1 alpha and CXCR4 expression were significantly associated with LN metastasis, tumour stage, and survival of CRC patients. Twenty-nine of 47 CXCR4-positive CRCs (61.7%) showed clear CXCR4 immunoreactivity in the nucleus and a weak signal in the cytoplasm (nuclear type), whereas others showed no nuclear immunoreactivity but a diffuse signal in the cytoplasm and at the plasma membrane (cytomembrane type). Colorectal cancer patients with nuclear CXCR4 expression showed significantly more frequent LN metastasis than did those with cytomembrane expression. Colorectal cancer patients with nuclear CXCR4 expression in the primary lesion frequently had cytomembrane CXCR4-positive tumours in their LNs. In conclusion, expression of SDF-1 alpha and nuclear CXCR4 predicts LN metastasis in CRCs.

[Bronchiectasis].

Obstructive impairment of pulmonary function in bronchiectasis depends on the number of segments involved in the bronchiectatic process and severity of the morphologic abnormalities in the region of the dilated bronchi. There is no obstructive change in bronchiectasis with single segmental lesion without fatal cases with multiple dilatation of bronchi. Immotile cilia syndrome, Kartagener syndrome, diffuse panbronchiolitis and cystic fibrosis can result from a multitude of heredity were observed in the obstructive impairment. A case of panbronchiolitis obliterans with diffuse cystic dilatation of bronchi due to mycoplasma pneumoniae infection was presented in severe obstructive disturbance.

Identification and characterization of bovine herpesvirus-1 glycoproteins E and I.

To identify the products of the bovine herpesvirus-1 (BHV-1) gE and gI genes, we constructed baculovirus recombinants containing the putative gE or gI genes. These recombinant viruses synthesized BHV-1 gE and gI with apparent molecular masses of 84 and 41 kDa, respectively. Polyclonal antibodies against these recombinant gE or gI proteins were produced and by using these antibodies, we showed the presence of gE and gI with apparent molecular masses of 94 and 45 kDa, respectively, in purified BHV-1 virions. We also demonstrated that like their herpes simplex virus-1 and pseudorabies virus counterparts BHV-1 gE and gI form a complex. A gI- BHV-1 mutant failed to express gI but gE was found in the virions. On the other hand, neither gE nor gI was found in the virions of a gE- BHV-1 mutant. In the gE- BHV-1 mutant, gI was produced but released into the medium without being integrated in the virions.

Splitting of high right atrial potentials in atrial flutter with rapid pacing.

Rapid pacing from the high right atrium was performed in 7 patients with atrial flutter in whom potentials with multicomponent high-frequency deflections were recorded at the high right atrium to examine the origin of these potentials during transient entrainment in atrial flutter. In all of the patients with relatively slow rapid pacing, the potentials were captured orthodromically through the atrial flutter reentry circuit with a long conduction time. With more rapid pacing, the potentials were split into 2 associated components: P1 and P2. P1 was captured antidromically with a short conduction time whereas P2 was captured persistently in an orthodromic direction through the reentry circuit with a progressively long conduction time. In 3 of the 7 patients, atrial flutter was converted into another atrial flutter by rapid pacing. During this other atrial flutter, the potentials at the high right atrium were split from the beginning to form double potentials: D1 and D2. During rapid pacing, D1 and D2 were fused, and D1 was captured antidromically whereas D2 was captured orthodromically through the reentry circuit. In sinus rhythm, the potentials at the high right atrium formed fractionated potentials. These findings suggest that 1) fractionated potentials may represent 2 atrial regions with different conductivity properties, 2) fractionated potentials may be able to change into double potentials, and 3) double potentials may be attributable to their conductivity properties rather than refractoriness.

Patterns of interruption of atrial flutter induced by rapid atrial pacing.

We evaluated the patterns of interruption of atrial flutter (AFl) induced by rapid atrial pacing in 10 patients using standard electrophysiologic techniques. We observed 3 patterns of interruption of AFl: 1) interruption resulting from block of an orthodromic wavefront within the reentry loop in 5 patients; 2) interruption when pacing impulses no longer captured all of the recording sites in the atrium during rapid atrial pacing in 2 patients, and 3) interruption with 1 echo wave after the cessation of pacing in 3 patients. These findings suggest that there are patterns of interruption of AFl other than that resulting from a simple block of an orthodromic wavefront within the reentry loop.

[Treatment of seventy-eight patients with testicular tumors].

Seventy-eight patients with testicular tumors were treated in our clinic between April, 1972 and October, 1990. The average age of patients with seminoma (37.5 yrs) was higher than that (24.5 yrs) of those with non-seminomatous germ cell tumor (NSGCT). Histopathologically, 34 patients had seminoma and 36 patients had NSGCT. The remaining 8 patients had non-germinal cell tumors. The 5-year survival rate was 76.7%, 90.3% and 75.8% for all patients, seminoma group and NSGCT group, respectively. As for seminoma group, the 5-year survival rate was 100%, 50.0% and 33.3% for Stage I, Stage IIb and Stage III, respectively. The survival rate of Stage IIb and Stage III in seminoma group were lower than Stage I statistically. In NSGCT group, the 5-year survival rate was 100% for Stage I and 26.7% for Stage III, between the two groups there was significant difference. The higher serum LDH and HCG levels, the lower the survival rate in NSGCT. Serum AFP, beta-HCG levels and ESR were unrelated to the survival rate. The survival rate for the patients treated by the chemotherapy including CDDP was compared to those treated by the other therapy in germ cell tumor (greater than or equal to Stage IIb). The survival rate of CDDP group was higher than the others (p less than 0.01).

[Clinical analysis of patients with occupational urothelial tumors].

The incidence of occupational urothelial tumor and the accompanied problems were studied on the workers who had manufactured or handled aromatic amines at a certain chemical factory. Twenty-five out of 398 dyestuff workers, who were examined at regular intervals, were found to have urothelial tumors and the incidence rate was 63%. The mean age at onset, the mean period of aromatic exposure and the mean latent period from the initial exposure until tumor development were 61 year-old, 7.2 years and 30 years, respectively. A high incidence rate was found in the long exposed workers and the smoking group. The negative correlation was observed between the age of first exposure to carcinogens and the latent period. The workers who had been exposed to two or three kinds of aromatic amines had the highest incidence followed by those exposed to benzidine and those to alpha-naphthylamine. No urothelial tumor occurred in the workers exposed to beta-naphthylamine. Ninety-four percent of the initial tumors were superficial and transurethral resection of tumors was performed as the initial surgery for the patients with bladder tumors. The recurrence rate in the bladder cavity after the surgery was 39%, which was almost the same rate as that of non-occupational bladder tumors, however, the recurrence rate in the upper urinary tract was high (26%). The positive rate in the examination of urine cytology was 60% for initial tumors, 74% for recurrent tumors. The urine cytology was a significant method for the detection and monitoring of the patients with occupational urothelial tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of renal cell carcinoma with intra-arterial administration of SMANCS dissolved in Lipiodol.

Patients 1 with an unresectable clear-cell carcinoma of the kidney was treated by intra-arterial administration of SMANCS dissolved in an oily medium, Lioidol, (SMANCS/Lipiodol). It was previously shown that targeting chemotherapy could be achieved for hepatoma by the arterially administered SMANCS/Lipiodol. In this study, SMANCS/Lipiodol was administered for renal cancer and the selective remaining of SMANCS/Lipiodol in renal cancer was observed in this patient. Patient 1, after three years and five months of repeated arterial injection of the drug, the patient's physical condition recovered sufficiently, reduction in tumor size was observed and the tumor became resectable. Patient 2 with renal carcinoma (4 cm in diameter) was treated by intra-arterial injection of SMANCS/Lipiodol and resected for prevention of postoperative recurrence. More than 90% of the tumor showed necrosis. Definite anticancer effects of the preoperative arterial administration of SMANCS/Lipiodol can be observed both clinically and histologically.

The genetic system controlling recombination in the silkworm.

The nature of recombination modifiers was investigated in Bombyx mori lines selected for high (H) and low (L) recombination rates between the p(S) and Y loci in chromosome 2. Since the mean recombination rates for the H x L and L x H F(1) crosses were approximately intermediate between those of high and low lines, the cytoplasmic maternal effect and difference in the activity of recombination modifiers between marked and unmarked second chromosomes were not detected. The H x (L x H), H x (H x L), L x (L x H) and L x (H x L) backcrosses indicated the presence of additive and dominance effects of marked and unmarked second chromosomes and the remaining chromosomes.--Recombination rates between the p(S) and Y loci in chromosome 2 and half-nonrecombination rates between the pe and re loci in chromosome 5 of high and low lines indicated that these recombination modifiers caused changes in the recombination frequency between p(S) and Y in chromosome 2, but not between pe and re in chromosome 5.--There were no differences in viability between individuals having the second chromosomes of the recombinant types [p(S) +, p(Y) (H); p(S) +, + Y (L)] and those of the nonrecombinant types [p(S) Y, p + (H); p(S) Y, + + (L)] in both high and low lines. Mean recombination rates measured in cis [p(S) Y/p + (H); p(S) Y/+ + (L)] and trans [p(S) +/p Y (H); p(S) +/+ Y (L)] males were the same in the high but not in the low line. No segregation of a single recombination modifier was indicated by the distribution of recombination rates measured in trans males [p(S) +/p Y (H); p(S) +/+ Y (L)] of high and low lines. Accordingly, the recombination modifiers distributed on chromosome 2 in the heterozygous condition were not gross chromosomal aberrations, but polygenic factors in the low line.