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The behaviour of two different organometallic complexes based on Pd were examined in depth with the aim to obtain the selective oxidation of glycerol to 1,3-dihydroxyacetone (DHA). An high glycerol conversion (93.5%) was obtained in a acetonitrile/water mixture in the presence of oxygen as a terminal oxidant.

Background: Frailty is a dynamic age-related condition of increased vulnerability characterized by declines across multiple physiologic systems and associated with an increased risk of death. We compared the predictive accuracy for one-month and one-year all-cause mortality of four frailty instruments in a large population of hospitalized older patients in a prospective multicentre cohort study. Methods and Findings: On 2033 hospitalized patients aged $65 years from twenty Italian geriatric units, we calculated the frailty indexes derived from the Study of Osteoporotic Fractures (FI-SOF), based on the cumulative deficits model (FI-CD), based on a comprehensive geriatric assessment (FI-CGA), and the Multidimensional Prognostic Index (MPI). The overall mortality rates were 8.6% after one-month and 24.9% after one-year follow-up. All frailty instruments were significantly associated with one-month and one-year all-cause mortality. The areas under the receiver operating characteristic (ROC) curves estimated from age- and sex-adjusted logistic regression models, accounting for clustering due to centre effect, showed that the MPI had a significant higher discriminatory accuracy than FI-SOF, FI-CD, and FI-CGA after one month (areas under the ROC curves: FI-SOF = 0.685 vs. FI-CD = 0.738 vs. FI-CGA = 0.724 vs. MPI = 0.765, p,0.0001) and one year of followup (areas under the ROC curves: FI-SOF = 0.694 vs. FI-CD = 0.729 vs. FI-CGA = 0.727 vs. MPI = 0.750, p,0.0001). The MPI showed a significant higher discriminatory power for predicting one-year mortality also in hospitalized older patients without functional limitations, without cognitive impairment, malnourished, with increased comorbidity, and with a high number of drugs. Conclusions: All frailty instruments were significantly associated with short- and long-term all-cause mortality, but MPI demonstrated a significant higher predictive power than other frailty instruments in hospitalized older patients.

The number of patients affected by cardiovascular disease admitted to internal medicine and geriatric wards is expanding due to the increasing prevalence of cardiovascular disease in the ageing population. This contributes to a growing demand for cardiology consult visits, with requests for perioperative risk stratification for non-cardiac surgery or endoscopy, and general clinical management. This document was jointly drafted by the Cardiology and Anesthesiology departments, medical and surgical departments, and endoscopy services of the Azienda Ospedaliero-Universitaria "Ospedali Riuniti" in Trieste (Italy). It addresses critical issues such as antiplatelet and anticoagulant therapy in non-cardiac surgery, electric device management, and prophylaxis of bacterial endocarditis. It provides general guidelines and appropriateness criteria, prompted by the Joint Commission International and approved by the Hospital Guidelines Committee. It provides a basis for periodic educational meetings, and will be periodically updated. Periodic audits will monitor its application, and critical and controversial points, in order to promote quality of health care, organizational efficiency, and appropriateness.

The prepn. of gadolinium complexes of peptide conjugates as contrast agents for use in NMR (MRI) is described. This novel class of contrast agents may be used to identify and locate primary human tumors and their metastases which over-express type CCK A and/or type B cholecystokinin receptors, and/or type SSTR 1-5 somatostatin receptors (no data). Thus, gadolinium DTPA-peptide deriv. conjugates with Gly-CCK8 or vapreotide were prepd. (DTPA = diethylenetriaminepentaacetic acid, Gly-CCK8 = H-Gly-Asp-Tyr-Met-Gly-Trp-Met-Asp-Phe-NH2).

A better understanding of trauma epidemiology may allow to enhance the organisation of trauma systems with a potentially relevant impact on the level of trauma care. A one year epidemiology study (1st March 1998-28th February 1999) was planned in Friuli Venezia Giulia with the aim to collect all prehospital, hospital and outcome data of patients who sustained a major trauma (ISS > 15) within the regional border. In 12 months 15,429 traumatized patients (14,108 residents) were admitted to any one of the Regional hospitals. Over 1% of the whole population sustained injuries severe enough to cause hospital admission. 630 people (77.3% male, 27.7% female average age 42 ys) had a major trauma. The incidence of major trauma is 525 per million people per year. RTA was by far the most important cause of major injuries (78.6%) followed by work accidents (6.8%), domestic (5.9%) and sport accidents (1.9%). Only 1.2% of all the major injuries was the consequence of interpersonal violence. One hundred-sixty-six trauma victims died on the spot (149) or before hospital arrival (17). 464 patients with major injuries reached the hospital alive. More than two third of the patients with ISS > 15, suffered from a multiple trauma. 70% had a severe injury to the head (AIS > or = 3). Head trauma occurred as an isolated injury in only 35.3%. Hospital mortality within 30 days from admission (trauma death) was 25.1%. The results of the follow-up at 6 months are still incomplete. However the preliminary data clearly show that a high percentage of the patients who were discharged alive from the ICU had a good neurologic recovery.

Hypothesis: A pattern of prehospital care combining advanced life support, physician staffing, and helicopter transport improves the outcome of patients with severe brain injuries, compared with combined expanded basic life support, nurse staffing, and ground transport. Design: Inception cohort from the data set of a population-based, prospective study on major trauma. Setting: Prehospital and hospital trauma systems of an Italian region. Patients: All patients with major trauma (Injury Severity Score, ≥ 16) and severe head injury (Abbreviated Injury Scale score for the head, ≥ 4) rescued alive from March 1, 1998, to February 28, 1999, who received either form of care. Patients with self-inflicted injuries were excluded. The 184 patients who met the entry criteria were divided equally between care groups. Interventions: None. Main Outcome Measures: Mortality at 30 days and Glasgow Outcome Scale score of survivors. Results: After verifying the comparability of the cohorts, no survival or disability benefit could be demonstrated (95% confidence interval [CI] of the odds ratio for mortality [helicopter/ambulance] [95% CI 1], 0.72 to 2.67; 95% CI of the difference in Glasgow Outcome Scale score medians between helicopter and ambulance groups [95% CI 2], 0.0 to 0.0). Similar results were derived from analyses restricted to the subgroups identified by low( ≤ 90 mm Hg) roadside systolic blood pressure (95% CI 1, 0.58 to 7.17; 95% CI 2, -1 to 2) and by need for urgent neurosurgical intervention (95% CI 1, 0.16 to 2.60; 95% CI 2, 0 to 2). Exclusion from the ambulance group of victims rescued in urban areas did not change the results (95% CI 1, 0.80 to 3.24; 95% CI 2, 0.0 to 0.0). Stratification by age, Injury Severity Score, and Glasgow Coma Scale score demonstrated a small survival benefit (95% CI 1, 1.12 to 2.12) in the ambulance subgroup with Glasgow Coma Scale score from 10 to 12. Multiple logistic regression analysis confirmed that the group did not affect mortality. Conclusion: This study was conceived to emphasize the supposed advantages of the combined helicopter, physician, and advanced life-support rescue. No increased benefit compared with the simpler rescue group could be demonstrated.

Report epidemiologico sui traumi gravi in Friuli-Venezia Giulia

A better understanding of trauma epidemiology may allow to enhance the organisation of trauma systems with a potentially relevant impact on the level of trauma care. A one year epidemiology study (1st March 1998-28th February 1999) was planned in Friuli Venezia Giulia with the aim to collect all prehospital, hospital and outcome data of patients who sustained a major trauma (ISS > 15) within the regional border. In 12 months 15,429 traumatized patients (14,108 residents) were admitted to any one of the Regional hospitals. Over 1% of the whole population sustained injuries severe enough to cause hospital admission. 630 people (77.3% male, 27.7% female average age 42 ys) had a major trauma. The incidence of major trauma is 525 per million people per year. RTA was by far the most important cause of major injuries (78.6%) followed by work accidents (6.8%), domestic (5.9%) and sport accidents (1.9%). Only 1.2% of all the major injuries was the consequence of interpersonal violence. One hundred-sixty-six trauma victims died on the spot (149) or before hospital arrival (17). 464 patients with major injuries reached the hospital alive. More than two third of the patients with ISS > 15, suffered from a multiple trauma. 70% had a severe injury to the head (AIS > or = 3). Head trauma occurred as an isolated injury in only 35.3%. Hospital mortality within 30 days from admission (trauma death) was 25.1%. The results of the follow-up at 6 months are still incomplete. However the preliminary data clearly show that a high percentage of the patients who were discharged alive from the ICU had a good neurologic recovery.