Search

Background: Older adults make up 33% of all trauma admissions in Australia despite comprising 17% of the population with rates rising faster for older age groups compared to any other age group. A high proportion of older adults admitted to hospital following trauma are frail and have increased rates of hospital acquired complications, resulting in poorer outcomes as well as increased resource utilisation and cost to the healthcare system. Length of Stay (LOS) is an important outcome for hospitals, contributing to resource utilisation and patient flow. This study aimed to determine factors associated with the primary outcome of LOS in older persons admitted with trauma at a major trauma centre as targets for improvement. Methods: Ethics approval was obtained to collect data on all adult trauma admissions ≥ 1 day in patients aged 65 years and over. Patients were included in the Trauma in older persons (TOPS) database if they otherwise met criteria for the pre-existing trauma registry maintained by the hospital's trauma service. Admissions between January 2022 and January 2023 were included. Univariable negative binomial regression identified variables associated with LOS with p-values ≤ 0.1 which were then included in a multivariable regression model. Significance was taken as p-value ≤ 0.05. Results: 1250 admissions ≥ 1 day and alive at discharge were included in the primary analysis. The median LOS was 7 (4–13) days. In the multivariable model, delirium (Incidence Rate Ratio (IRR) = 1.41, 95%CI = 1.25–1.59), inpatient fall (IRR = 1.46, 95%CI = 1.15–1.86), pneumonia (IRR = 1.28, 95%CI = 1.08–1.53), thromboembolism (IRR = 1.43, 95%CI = 1.05–1.96), blood transfusion (IRR = 1.34, 95%CI = 1.17–1.53) and unplanned intensive care admission (IRR = 1.52, 95%CI = 1.08–2.14) were all associated with increased LOS. Low fall mechanism was high risk for longer LOS (IRR = 1.26, 95%CI = 1.11–1.43). Conclusions: After controlling for available factors, inpatient complications and patients admitted following low falls were identified as high risk for increased LOS and may represent areas for targeted quality improvement for older adults admitted following trauma. [ABSTRACT FROM AUTHOR]

Summary: The minute 'dust seeds' of some terrestrial orchids preferentially germinate and develop as mycoheterotrophic protocorms near conspecific adult plants. Here we test the hypothesis that mycorrhizal mycelial connections provide a direct pathway for transfer of recent photosynthate from conspecific green orchids to achlorophyllous protocorms.Mycelial networks of Ceratobasidium cornigerum connecting green Dactylorhiza fuchsii plants with developing achlorophyllous protocorms of the same species were established on oatmeal or water agar before the shoots of green plants were exposed to 14CO2. After incubation for 48 h, the pattern of distribution of fixed carbon was visualised in intact entire autotrophic/protocorm systems using digital autoradiography and quantified in protocorms by liquid scintillation counting.Both methods of analysis revealed accumulation of 14C above background levels in protocorms, confirming that autotrophic plants supply carbon to juveniles via common mycorrhizal networks. Despite some accumulation of plant‐fixed carbon in the fungal mycelium grown on oatmeal agar, a greater amount of carbon was transferred to protocorms growing on water agar, indicating that the polarity of transfer may be influenced by sink strength.We suggest this transfer pathway may contribute significantly to the pattern and processes determining localised orchid establishment in nature, and that 'parental nurture' via common mycelial networks may be involved in these processes. [ABSTRACT FROM AUTHOR]

Background: Acute surgical units (ASU) are increasingly being adopted and in our system are staffed by colorectal and non‐colorectal general surgeons. This study aims to evaluate whether surgeon specialization was associated with improved outcomes in perianal abscess. Methods: Patients with perianal abscess admitted to the ASU between 2016 and 2020 were identified from a prospective database and their medical records reviewed. Patients with IBD, treatment for fistula‐in‐ano within the preceding year, or perianal sepsis of non‐cryptoglandular origin were excluded. Patients admitted under an ASU colorectal (CR) consultant were compared with those under a non‐CR general surgeon in a retrospective cohort study. Primary outcome was perianal abscess recurrence. For those without initial fistula, hazard of recurrent abscess or fistula was analysed. Multivariable Cox PH regression analysis was performed. Results: Four‐hundred and eight patients were included (150 CR, 258 non‐CR). The CR group more frequently had a fistula identified at index operation (34.0% versus 10.9%, P < 0.0001). However, Cox multivariable analysis found no difference in hazard of recurrent abscess between groups (HR 1.12, 95% CI 0.65–1.95, P = 0.681)). Abscess recurred in 18.7% CR and 15.5% non‐CR. Subsequent fistula developed in 14.7% in both groups. For patients without initial fistula, there was no difference between groups in hazard of recurrent abscess or fistula (HR 1.18, 95% CI 0.69–2.01, P = 0.539). Conclusion: Surgeon specialization was not associated with improved outcomes for ASU patients with perianal abscess, albeit with potential selection bias. CR surgeons were more proactive identifying fistulas; this raises the possibility that drainage alone may be adequate treatment. [ABSTRACT FROM AUTHOR]

Introduction Due to an aging population, it is predicted that by 2040, neurodegenerative diseases, such as Alzheimer's disease (AD), will be the second most common cause of morbidity in the [...], The current frontline symptomatic treatment for Alzheimer's disease (AD) is whole-body upregulation of cholinergic transmission via inhibition of acetylcholinesterase. This approach leads to profound dose-related adverse effects. An alternative strategy is to selectively target muscarinic acetylcholine receptors, particularly the M1 muscarinic acetylcholine receptor (M1 mAChR), which was previously shown to have procognitive activity. However, developing M1 mAChR-selective orthosteric ligands has proven challenging. Here, we have shown that mouse prion disease shows many of the hallmarks of human AD, including progressive terminal neurodegeneration and memory deficits due to a disruption of hippocampal cholinergic innervation. The fact that we also show that muscarinic signaling is maintained in both AD and mouse prion disease points to the latter as an excellent model for testing the efficacy of muscarinic pharmacological entities. The memory deficits we observed in mouse prion disease were completely restored by treatment with benzyl quinolone carboxylic acid (BQCA) and benzoquinazoline-12 (BQZ-12), two highly selective positive allosteric modulators (PAMs) of M1 mAChRs. Furthermore, prolonged exposure to BQCA markedly extended the lifespan of diseased mice. Thus, enhancing hippocampal muscarinic signaling using M1 mAChR PAMs restored memory loss and slowed the progression of mouse prion disease, indicating that this ligand type may have clinical benefit in diseases showing defective cholinergic transmission, such as AD.