Informal carers' perspectives on the delivery of acute hospital care for patients with dementia: a systematic review.
Providing high quality acute hospital care for patients with dementia is an increasing challenge as the prevalence of the disease rises. Informal carers of people with dementia are a critical resource for improving inpatient care, due to their insights into patients' needs and preferences. We summarise informal carers' perspectives of acute hospital care to inform best practice service delivery. We conducted a systematic search of bibliographic databases and sought relevant grey literature. We used thematic synthesis analysis to assimilate results of the studies and describe components of care that influence perceived quality. Twenty papers met the inclusion criteria. Findings identified four overarching components of care that influenced carer experience and their perceptions of care quality: 'Patient care', 'Staff interactions', 'Carer's situation' and 'Hospital environment'. Need for improvement was identified in staff training, provision of help with personal care needs, and dignified treatment of patients. Carers need to be informed, involved and supported during hospital admission in order to promote the most positive experience. This review identifies common perspectives of informal carers of people with dementia in the acute hospital setting and highlights important areas to address to improve the experience of an admission for both carer and patient.


Mending cracks in the pathway.
In the UK, more than 700,000 people live with late-onset dementia, two thirds of whom live in care. Many of them lack mental capacity to make decisions about their care, and 30% to 60% may exhibit distressed or disturbed behaviour such as shouting, wandering and restlessness.


Should urinary catheters be avoided in patients with total joint arthroplasty?
Patients undergoing total joint arthroplasty typically have indwelling urinary catheters placed preoperatively to decompress the bladder, assess urinary output, and prevent postoperative urinary retention. However, catheterization is associated with several complications and increased hospital length of stay, and research supports eliminating routine placement of urinary catheters in most patients undergoing elective joint arthroplasty and certain general surgeries lasting no more than 2 hours.


Binary photoacoustic tomography for improved vasculature imaging.
The proposed binary tomography approach was able to recover the vasculature structures accurately, which could potentially enable the utilization of binary tomography algorithm in scenarios such as therapy monitoring and hemorrhage detection in different organs. Photoacoustic tomography (PAT) involves reconstruction of vascular networks having direct implications in cancer research, cardiovascular studies, and neuroimaging. Various methods have been proposed for recovering vascular networks in photoacoustic imaging; however, most methods are two-step (image reconstruction and image segmentation) in nature. We propose a binary PAT approach wherein direct reconstruction of vascular network from the acquired photoacoustic sinogram data is plausible. Binary tomography approach relies on solving a dual-optimization problem to reconstruct images with every pixel resulting in a binary outcome (i.e., either background or the absorber). Further, the binary tomography approach was compared against backprojection, Tikhonov regularization, and sparse recovery-based schemes. Numerical simulations, physical phantom experiment, and in-vivo rat brain vasculature data were used to compare the performance of different algorithms. The results indicate that the binary tomography approach improved the vasculature recovery by 10% using in-silico data with respect to the Dice similarity coefficient against the other reconstruction methods. The proposed algorithm demonstrates superior vasculature recovery with limited data both visually and based on quantitative image metrics.


The integration of quality management into chronic disease health services.
Quality management strategies can be integrated into health services and processes to evaluate, measure, and improve the health services delivered to patients. Over a 6-month period, Living Well with a Chronic Condition program, a chronic disease management health service, had its support services evaluated and significantly improved, reducing the delays that participants experienced trying to access education and exercise classes. Through the use of quality management tools, including process mapping, performance data collection and evaluation, and participant feedback, the program intake process was improved significantly. Wait times of up to 90 days, with an average of 45 days, were reduced to less than 1 week. Postimprovement measures continued to demonstrate improved service, indicating that involving the staff and participants in quality management strategies can lead to significant optimization of services to participants.


The quality of cold-pressed rapeseed oil obtained from seeds of Brassica napus L. with increased moisture content.
The basic parameter influencing the quality of cold-pressed oil is the quality of seeds used  for pressing. Adverse moisture content and storage temperature of rape seeds may affect the quality of oil obtained from them. This paper presents the effects of increased rapeseed moisture content on the quality of the oil pressed. The material used for the tests was rapeseed (canola) cv. PR 46 W14. The moisture content of the seeds was adjusted to 10%, 12% and 20%, and the seeds were stored at room temperature for 14 days. The samples were then dried to a seed moisture equal to 7% and oil was pressed from them. Acid and peroxide values, as well as the content of water, tocopherols and phenolic acids, were determined. In addition, a sensory analysis of the oil samples was carried out, and structural changes in the association colloids in the oil were determined using a fluorescent probe. With the increase in seed moisture, the increase in peroxide and acid values of the analyzed oils was recorded. A slight decrease in tocopherol content and a significant increase in phenolic acid concentration, depending on the seed moisture content, was observed. Sensory analysis showed odor sensory profile changes that probably indicate microflora development. The rapeseed moisture content has a crucial influence on the quality of oil obtained from them. Along with an increase in seed moisture, the possibility of developing undesirable microflora grows, which results in a deterioration in the quality of the obtained oil.


Treatment of central nervous system inflammation with inhibitors of basement membrane degradation.
Currently available anti-inflammatory drugs for the treatment of multiple sclerosis (MS) and other inflammatory diseases are generally inadequate, with disease progression not being arrested by the treatments and undesirable side effects posing problems. In response to these deficiencies our laboratories have, over the past 10 years, been developing novel drugs that interfere with the entry of leucocytes into inflammatory sites by inhibiting their passage through the subendothelial basement membrane (BM). This review initially summarizes evidence supporting the hypothesis that the subendothelial BM is a major barrier to the accumulation of leucocytes in inflammatory sites. An important point that has emerged is that breaching of the BM is probably a cooperative process, involving activation- and cytokine-induced degradative enzymes contributed by leucocytes, endothelial cells and platelets. The review then discusses the properties of three separate classes of anti-inflammatory compounds we have developed, namely sulfated polysaccharides/oligosaccharides, phosphosugars, and castanospermine (CS), which inhibit the passage of leukocytes through BM. Each drug type appears to prevent BM degradation by a different mechanism. Sulfated polysaccharides/oligosaccharides mediate their anti-inflammatory effect by inhibiting the endoglycosidase, heparanase, which plays a key role in the solubilization of BM by invading leucocytes. In fact, our studies have highlighted the heparanase enzyme as a major target for future drug development. Phosphosugars probably inhibit inflammation by displacing lysosomal enzymes, which are involved in BM degradation, from cell surface mannose 6-phosphate receptors. This mechanism of expressing degradative enzymes on the cell surface is particularly evident with activated T lymphocytes. On the other hand, CS interferes with appropriate targeting of lysosomal enzymes involved in BM degradation. For reasons which are still unclear, CS specifically inhibits BM degradation by endothelial cells, which results in a characteristic perivascular arrest of leucocytes in inflammatory sites. Overall, our studies have established that inhibitors of subendothelial BM degradation represent viable anti-inflammatory agents. It is hoped that future work will result in the development of a totally new class of highly effective, subtle and non-toxic anti-inflammatory drugs for the treatment of MS and other inflammatory diseases.


Changing concepts in the management of otitic intracranial infection: use of computerized axial tomography in early detection and monitoring of cerebritis.
The pathogenesis and course of intracranial inflammatory disorders of otitic origin have been studied extensively in the past by clinical, surgical, and morbid means. The recent contribution by CT scanning cannot be overestimated as a modality for identification of the pathologic process. Its use for early detection and monitoring of a clinically suspected intracranial complication of otitic suppurative disease is documented for the first time in this report. Cerebritis or encephalitis as the early manifestation of impending brain dissolution can be identified and followed during specific antibiotic therapy. The proper timing for surgery to remove the otitic focus is enhanced. A review of the literature and a case report illustrate this contribution.


Abducens Nerve Palsy and Ipsilateral Horner Syndrome in a Patient With Carotid-Cavernous Fistula.
The combination of abducens nerve palsy and ipsilateral Horner syndrome was first described by Parkinson and considered as a localizing sign of posterior cavernous sinus lesions. The authors present a case with right abducens nerve palsy with ipsilateral Horner syndrome in a patient with carotid-cavernous fistula because of head trauma. The patient was referred to the ophthalmology clinic with diplopia complaint after suffering a head trauma during a motorcycle accident. Cerebral angiography showed low-flow carotid-cavernous fistula.


Acute multifocal placoid pigment epitheliopathy associated with erythema nodosum and a flu-like illness.
Acute multifocal placoid pigment epitheliopathy (AMPPE) is a rare inflammatory vasculitis of the choroid. Despite primarily being a disorder of the eye, a number of extra-ophthalmological features have been described in AMPPE and may accompany the visual disturbances. Such patients may be admitted under the care of physicians for evaluation of a systemic illness. We report AMPPE occurring in a 37-year-old man in his thirties admitted with a flu-like illness, erythema nodosum, visual disturbances and raised inflammatory markers. Conditions such as bacterial endocarditis and vasculitis, were considered before a diagnosis of AMPPE was made. The case illustrates how AMPPE can be a diagnostic dilemma, particularly when associated with extra-ophthalmological features. The epidemiology, clinical features, diagnosis and therapy of AMPPE are also discussed.


Hip fracture: effectiveness of early surgery to prevent 30-day mortality.
To estimate the effect of delay to surgery for hip fracture on 30-day mortality using a risk adjustment strategy to control for the effect of demographic and clinical confounders. This observational study was carried out on all patients admitted with a hip fracture and discharged between January 2004 and December 2007 from a teaching hospital. Gender, age, time to surgery, mortality and medical comorbidities were derived from hospital discharge records (SDO), while International Normalised Ratio (INR) and American Society of Anaesthesiologists (ASA) score were retrieved from clinical records. Backward stepwise logistic regression was used to identify potential confounders in the relationship between time to surgery and mortality. A final multivariate logistic regression analysis was carried out controlling for the effect of confounders. In the 1320 patients who underwent surgery (mean age = 83 years, % female = 76.8%), time to surgery was two days or less in 746 (56.5%) patients and 30-day mortality was 3.5%. The interventions included partial or total hip replacement (N=820, 62.1%) and reduction and internal fixation (N=500, 37.9%). Multivariate logistic regression analysis showed that patients with a time to surgery greater than two days had a 2-fold increase in 30-day mortality after adjusting for age, gender, and comorbidity (OR=1.992, 95% CI 1.065-3.725). In a second model also including ASA score the odd ratio decreased to 1.839 (95% CI 0.971-3.486). Patients with a hip fracture should have surgery within two days from admission in order to reduce 30-day mortality.


[Targeting chemotherapy of hepatocellular carcinoma by arterial administration of anticancer agents dissolved in lipiodol].
The lipid lymphographic agent, Lipiodol ultrafluid has been found to remain selectively in hepatocellular carcinoma. Using this characteristic nature of Lipiodol, a new targeting anticancer chemotherapy was devised. In order to achieve targeting anticancer chemotherapy and useful anticancer effects, anticancer drugs must be dissolved or suspended in Lipiodol and diffuse out from the Lipiodol gradually. Oily anticancer agents such as SMANCS dissolved in Lipiodol (SMANCS/Lipiodol), Mitomycin C in Lipiodol (MMC/Lipiodol), Aclarubicin in Lipiodol (ACR/Lipiodol) and a mixture of these were administered by catheterizing the celiac or hepatic artery under X-ray monitoring in 216 patients with hepatocellular carcinoma. Remarkable anticancer effects of this targeting chemotherapy were achieved, the serum AFP level and tumor size both showing a decrease in 91% of cases. The survival period of patients with unresectable hepatoma treated with the present protocol was definitely longer than the comparison group.


Probiotic mixture VSL#3: An overview of basic and clinical studies in chronic diseases.
Probiotics are known as "live microorganisms" and have been proven to have a health effect on hosts at the proper dose. Recently, a kind of probiotic mixture including eight live bacterial strains, VSL#3, has attracted considerable attention for its combined effect. VSL#3 is the only probiotic considered as a kind of medical food; it mainly participates in the regulation of the intestinal barrier function, including improving tight junction protein function, balancing intestinal microbial composition, regulating immune-related cytokine expression and so on. The objective of this review is to discuss the treatment action and mechanism for the administration of VSL#3 in chronic diseases of animals and humans (including children). We found that VSL#3 has a therapeutic or preventive effect in various systemic diseases per a large number of studies, including digestive systemic diseases (gastrointestinal diseases and hepatic diseases), obesity and diabetes, allergic diseases, nervous systemic diseases, atherosclerosis, bone diseases, and female reproductive systemic diseases.


[Toxic liver injuries--a current view on pathogenesis. Part I].
Toxic liver injury poses an important heath problem in occupational medicine. Toxic response of this organ may arise from acute or chronic exposure to different substances. The final toxicological response to different toxicants may be defined as the regeneration of cells, loss of their function or necrosis. The morphology of toxic drug- or chemical-induced liver injury usuall differentiates into one of the following phenotypes: cholestatic injury, hepato- cellular injury, often associated with elevated l enzymes, mitochondrial injuries and delayed immunological injury. In this article, the authors present current knowledge of the pathogenesis of morphological changes in hepatocytes as the result of exposure to xenobiotics.


Autologous Bone Marrow-Derived Stem Cells in Spinal Cord Injury.
Spinal cord injury is a traumatic neurological condition which makes the patient disable. Its management still remains challenging but advancements in the regenerative medicine have changed the approach of treating this serious debilitating condition of the central nervous system. Cell based therapies can restore function in spinal cord injury by replacing the lost neural tissue. These therapies also rejuvenate the existing intact neurons by facilitating remyelination and by repairing and reducing progressive tissue damage and scarring. Autologous bone marrow stem cells were collected from the patients. 5 ml of the processed sample was injected back into the patients via lumbar puncture at L1/L2 level. The bone marrow harvesting and administration was repeated every 4 weeks 3 times (12 weeks). Significant improvements were noticed following the injections into the patients with the duration of injury less than 6 months. ASIA grade improvements were observed in 6 out of 10 patients. VTC and walking, at least with the support, was restored in eight patients. Bladder control and sexual functions improved in three and five patients respectively. Eight patients exhibited decreased spasticity. We believe that autologous bone marrow stem cells contributed towards the neuroplaticity and/or paracrine effect due to which we observed the considerable improvements in the conditions of the patients. This preliminary proof of patient improvement reinforces the potential of autologous bone marrow stem cell treatment in the patients suffering from Spinal Cord Injury. Although the results are encouraging further studies are needed to substantiate the claims.


Effect of water washing of shark (Scoliodon laticaudus) meat on the properties of proteins with special reference to gelation.
The effect of water washing of shark meat on the properties of proteins has been investigated. The contents of low-molecular-weight proteins and urea were reduced significantly with three washing cycles. The gel forming ability showed marked improvement with the number of washing cycles. The dynamic viscoelastic behavior of washed and unwashed meat revealed a structure build-up reaction that was more pronounced in the washed meat. The concentration of myosin heavy chain of washed meat increased as revealed by Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Addition of urea at biological concentration (approximately 250 mM) to the washed meat reduced the gel forming ability significantly as compared to unwashed meat. The emulsion capacity showed an increase with the number of washing cycles.