bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Anticoagulant Use during Pregnancy in Mothers with Antiphospholipid Syndrome: An Observational Cross-Sectional Study
Authors: Pandjaitan Inolyn , Tambunan Karmel L , Atmakusuma Tubagus Djumhana
Published: October 2019

Introduction: Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by vascular thrombosis and/or pregnancy morbidity with persistent elevated concentration of antiphospholipid antibody. The use of anticoagulant in pregnant women with APS has reduced implantation failure, reduced rate of placental insufficiency, increased rate of delivery of live infant, and reduced rate of abortion. However, compared to its beneficial effects, anticoagulant therapy during pregnancy can be challenging because of the burden of the treatment (self-injecting anticoagulant for 9 months, cost of the treatment) and potential anticoagulant side effects. The purpose of this study was to evaluate the outcome of pregnant women with APS with anticoagulant.

Method: We searched through medical records of pregnant women who visited hematology oncology clinic of Cikini CCI Hospital from year 2000 to 2017. Pregnant women with positive antiphospholipid antibodies who were treated with anticoagulant and followed up until presence of outcome were included in the study. Main outcome was any delivery of live infant above 22 weeks gestational age. Activated partial thromboplastin time (aPTT), d dimer level, birth weight and length were also documented.

Results: We identified 92 pregnancies in 88 mothers diagnosed with antiphospholipid syndrome who were prescribed anticoagulant. From 92 pregnancies, 67 (73%) and 25 (27%) patients were prescribed low molecular weight heparin (LMWH) and unfractionated heparin (UFH), respectively, with combination of low dose antiplatelet agent. APTT and d dimer level of every patients were monitored monthly. 80% of the pregnancies successfully resulted in live births. The proportion of successful delivery of healthy infant in patients treated with UFH (21 out of 25; 84%) was greater than LMWH (53 out of 67; 79%) but not statistically different (p = 0,708) (Figure 1). Birth weight and length between groups were similar.

Conclusion: UFH may be used as safe and cost-effective alternative treatment to LMWH in pregnant women with APS. Despite the use of anticoagulant and antiplatelet agents, 20% of patients still had adverse pregnancy outcome.

Disclosures

No relevant conflicts of interest to declare.
Epigenetic therapies in acute myeloid leukemia: where to from here?
Authors: Fennell Katie A. , Bell Charles C. , Dawson Mark A.
Published: October 2019

In a Perspective, Fennell et al review the current state of epigenetic therapies for acute myeloid leukemia, highlighting their proposed mechanisms of action, the role of the immune system in mediating their response, and the outlook for new agents and combined therapies to maximize their potential efficacy.
A statistical approach for detecting genomic aberrations in heterogeneous tumor samples from single nucleotide polymorphism genotyping data
Authors: Yau Christopher , Mouradov Dmitri , Jorissen Robert N , Colella Stefano , Mirza Ghazala , Steers Graham , Harris Adrian , Ragoussis Jiannis , Sieber Oliver , Holmes Christopher C
Published: October 2019

We describe a statistical method for the characterization of genomic aberrations in single nucleotide polymorphism microarray data acquired from cancer genomes. Our approach allows us to model the joint effect of polyploidy, normal DNA contamination and intra-tumour heterogeneity within a single unified Bayesian framework. We demonstrate the efficacy of our method on numerous datasets including laboratory generated mixtures of normal-cancer cell lines and real primary tumours.
Preparation and Pharmacokinetic Study of Daidzein Long-Circulating Liposomes
Authors: Wang Qiao , Liu Wenjin , Wang Junjun , Liu Hong , Chen Yong
Published: October 2019

In this study, daidzein long-circulating liposomes (DLCL) were prepared using the ultrasonication and lipid film-hydration method. The optimized preparation conditions by the orthogonal design was as follows: 55 to 40 for the molar ratio of soybean phosphatidylcholine (SPC) to cholesterol, 1 to 10 for the mass ratio of daidzein to total lipid (SPC and cholesterol) (w:w), the indicated concentration of 5% DSPE-mPEG2000 (w:w), 50 °C for the hydration temperature, and 24 min for the ultrasonic time. Under these conditions, the encapsulation efficiency and drug loading of DLCL were 85.3 ± 3.6% and 8.2 ± 1.4%, respectively. The complete release times of DLCL in the medium of pH 1.2 and pH 6.9 increased by four- and twofold of that of free drugs, respectively. After rats were orally administered, a single dose of daidzein (30 mg/kg) and DLCL (containing equal dose of daidzein), respectively, and the MRT0−t (mean residence time, which is the time required for the elimination of 63.2% of drug in the body), t1/2 (the elimination half-life, which is the time required to halve the plasma drug concentration of the terminal phase), and AUC0−t (the area under the plasma drug concentration-time curve, which represents the total absorption after a single dose and reflects the drug absorption degree) of daidzein in DLCL group, increased by 1.6-, 1.8- and 2.5-fold as compared with those in the free group daidzein. Our results indicated that DLCL could not only reduce the first-pass effect of daidzein to promote its oral absorption, but also prolong its mean resident time to achieve the slow-release effect.
Unravelling the hybrid vigor in domestic equids: the effect of hybridization on bone shape variation and covariation
Authors: Hanot Pauline , Herrel Anthony , Guintard Claude , Cornette Raphaël
Published: October 2019

Background

Hybridization has been widely practiced in plant and animal breeding as a means to enhance the quality and fitness of the organisms. In domestic equids, this hybrid vigor takes the form of improved physical and physiological characteristics, notably for strength or endurance. Because the offspring of horse and donkey is generally sterile, this widely recognized vigor is expressed in the first generation (F1). However, in the absence of recombination between the two parental genomes, F1 hybrids can be expected to be phenotypically intermediate between their parents which could potentially restrict the possibilities of an increase in overall fitness. In this study, we examine the morphology of the main limb bones of domestic horses, donkeys and their hybrids to investigate the phenotypic impact of hybridization on the locomotor system. We explore bone shape variation and covariation to gain insights into the morphological and functional expressions of the hybrid vigor commonly described in domestic equids.

Results

Our data reveal the occurrence of transgressive effects on several bones in the F1 generation. The patterns of morphological integration further demonstrate that the developmental processes producing covariation are not disrupted by hybridization, contrary to functional ones.

Conclusions

These results suggest that an increase in overall fitness could be related to more flexibility in shape change in hybrids, except for the main forelimb long bones of which the morphology is strongly driven by muscle interactions. More broadly, this study illustrates the interest of investigating not only bone shape variation but also underlying processes, in order to contribute to better understanding how developmental and functional mechanisms are affected by hybridization.
RADseq population genomics confirms divergence across closely related species in blue coral (Heliopora coerulea)
Authors: Iguchi Akira , Yoshioka Yuki , Forsman Zac H. , Knapp Ingrid S.S. , Toonen Robert J. , Hongo Yuki , Nagai Satoshi , Yasuda Nina
Published: October 2019

Background

Heliopora coerulea, the blue coral, is the octocoral characterized by its blue skeleton. Recently, twoHelioporaspecies were delimited by DNA markers: HC-A and HC-B. To clarify the genomic divergence of theseHelioporaspecies (HC-A and HC-B) from sympatric and allopatric populations in Okinawa, Japan, we used a high throughput reduced representation genomic DNA sequencing approach (ezRAD).

Results

We found 6742 biallelic SNPs shared among all target populations, which successfully distinguished the HC-A and HC-B species in both the sympatric and allopatric populations, with no evidence of hybridization between the two. In addition, we detected 410 fixed SNPs linking functional gene differences, including heat resilience and reproductive timing, between HC-A and HC-B.

Conclusions

We confirmed clear genomic divergence betweenHelioporaspecies and found possible genes related to stress-responses and reproduction, which may shed light on the speciation process and ecological divergence of coral species.
DNA methylomes and transcriptomes analysis reveal implication of host DNA methylation machinery in BmNPV proliferation in Bombyx mori
Authors: Huang Haoling , Wu Ping , Zhang Shaolun , Shang Qi , Yin Haotong , Hou Qirui , Zhong Jinbo , Guo Xijie
Published: October 2019

Background

Bombyx mori nucleopolyhedrosis virus (BmNPV) is a major pathogen that threatens the sustainability of the sericultural industry. DNA methylation is a widespread gene regulation mode in epigenetics, which plays an important role in host immune response. Until now, little has been known about epigenetic regulation on virus diseases in insects. This study aims to explore the role of DNA methylation in BmNPV proliferation.

Results

Inhibiting DNA methyltransferase (DNMT) activity of silkworm can suppress BmNPV replication. The integrated analysis of transcriptomes and DNA methylomes in silkworm midguts infected with or without BmNPV showed that both the expression pattern of transcriptome and DNA methylation pattern are changed significantly upon BmNPV infection. A total of 241 differentially methylated regions (DMRs) were observed in BmNPV infected midguts, among which, 126 DMRs were hyper-methylated and 115 DMRs were hypo-methylated. Significant differences in both mRNA transcript level and DNA methylated levels were found in 26 genes. BS-PCR validated the hypermethylation of BGIBMGA014008, a structural maintenance of chromosomes protein gene in the BmNPV-infected midgut. In addition, DNMT inhibition reduced the expression of inhibitor of apoptosis family genes, iap1 from BmNPV, Bmiap2, BmSurvivin1 and BmSurvivin2.

Conclusion

Our results indicate that DNA methylation plays positive roles in BmNPV proliferation and loss of DNMT activity could induce the apoptosis of infected cells to suppress BmNPV proliferation. Our results may provide a new idea and research direction for the molecular mechanism on insect-virus interaction.
Comparative transcriptomic analysis and endocuticular protein gene expression of alate adults, workers and soldiers of the termite Reticulitermes aculabialis
Authors: Rasheed Humaira , Ye Chenxu , Meng Yufeng , Ran Yuehua , Li Jing , Su Xiaohong
Published: October 2019

Background

The insect cuticle is mainly composed of exocuticle and endocuticle layers that consist of a large number of structural proteins. The thickness and synthesis of the exocuticle depend on different castes that perform various functions in alates, workers and soldiers. However, it is not clear whether the soft endocuticle is involved in the division of labour in termite colonies. To reveal the structural characteristics of the endocuticle in different castes, we investigated the thickness of endocuticle layers in alates, workers and soldiers of the termite Reticulitermes aculabialis, and then we sequenced their transcriptome and detected the endocuticle protein genes. The differential expression levels of the endocuticular protein genes were confirmed in the three castes.

Results

We found that there was a great difference in the thickness of the endocuticle among the alates, soldiers and workers. The thickest endocuticle layers were found in the heads of the workers 7.88 ± 1.67 μm. The endocuticle layer in the head of the workers was approximately three-fold and nine-fold thicker than that in the heads of soldiers and alates, respectively. The thinnest endocuticle layers occurred in the head, thorax and abdomen of alates, which were 0.86 ± 0.15, 0.76 ± 0.24 and 0.52 ± 0.17 μm thick, respectively, and had no significant differences. A total of 43,531,650 clean sequencing reads was obtained, and 89,475 unigenes were assembled. Of the 70 identified cuticular protein genes, 10 endocuticular genes that belong to the RR-1 family were selected. qRT-PCR analysis of the five endocuticular genes (SgAbd-2, SgAbd-9, Abd-5, SgAbd-2-like and Abd-4-like) revealed that the endocuticle genes were more highly expressed in workers than in soldiers and alates.

Conclusion

These results suggest that SgAbd and Abd are the key components of the endocuticle. We infer that the thicker endocuticle in workers is helpful for them to perform their functions against environmental stress.
Effect of root exudates of Eucalyptus urophylla and Acacia mearnsii on soil microbes under simulated warming climate conditions
Authors: Wu Jiahui , Yu Shixiao
Published: October 2019

Background

Recent studies demonstrated that warming and elevated carbon dioxide (CO2) indirectly affect the soil microbial community structure via plant root exudates. However, there is no direct evidence for how the root exudates affect soil microbes and how the compositions of root exudates respond to climate change.

Results

The results showed that warming directly decreased biomass of soil-borne bacteria and fungi forAcacia mearnsiiDe Willd but it did not impact soil microbial community forEucalyptus urophylla S.T. Blake. In contrast, elevated CO2had strong direct effect on increasing soil microbial biomass for both plant species. However, plant roots could significantly increase the secretion of antibacterial chemicals (most probable organic acids), which inhibited the growth of bacteria and fungi in elevated CO2environment. This inhibitory effect neutralized the facilitation from increasing CO2concentration on microbial growth.

Conclusions

We concluded that climate change can directly affect microorganisms, and indirectly affect the soil microbial community structure by changes in composition and content of plant root exudates.
Lack of association between intraoperative handoff of care and postoperative complications: a retrospective observational study
Authors: O’Reilly-Shah Vikas N. , Melanson Victoria G. , Sullivan Cinnamon L. , Jabaley Craig S. , Lynde Grant C.
Published: October 2019

Background

The significance of intraoperative anesthesia handoffs on patient outcomes are unclear. One aspect differentiating the disparate results is the treatment of confounding factors, such as patient comorbidities and surgery time of day. We performed this study to quantify the significance of confounding variables on composite adverse events during intraoperative anesthesia handoffs.

Methods

In this retrospective study, we analyzed data from the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP). We examined the effects of intraoperative handoffs between anesthesia personnel. A total of 12,111 cases performed examined at two hospitals operated by a single healthcare system that were that included in the ACS NSQIP database performed. The presence of attending and anesthetist or resident handoffs, patient age, sex, body mass index, American Society of Anesthesiologists Physical Status (ASA-PS) classification, case length, surgical case complexity, and evening/weekend start time were measured.

Results

A total of 2586 of all cases in the NSQIP dataset experienced a handoff during the case. When analyzed as a single variable, attending handoffs were associated with higher rates of adverse outcomes. However, once confounding variables were added into the analysis, attending handoffs and complete care transitions were no longer statistically significant.

Conclusions

Inclusion of significant covariates is essential to fully understanding the impact provider handoffs have on patient outcomes. Case timing and lengthy case duration are more likely to result in both a handoff and an adverse event. The impact of handoffs on patient outcomes seen in the literature are likely due, in part, to how covariates were addressed.
Impact of multi-disciplinary treatment strategy on systolic heart failure outcome
Authors: Chen Shyh-Ming , Fang Yen-Nan , Wang Lin-Yi , Wu Ming-Kung , Wu Po-Jui , Yang Tsung-Hsun , Chen Yung-Lung , Hang Chi-Ling
Published: October 2019

Background

Patients with reduced ejection fraction have high rates of mortality and readmission after hospitalization for heart failure. In Taiwan, heart failure disease management programs (HFDMPs) have proven effective for reducing readmissions for decompensated heart failure or other cardiovascular causes by up to 30%. However, the benefits of HFDMP in different populations of heart failure patients is unknown.

Method

This observational cohort study compared mortality and readmission in heart failure patients who participated in an HFDMP (HFDMP group) and heart failure patients who received standard care (non-HFDMP group) over a 1-year follow-up period after discharge (December 2014 retrospectively registered). The components of the intervention program included a patient education program delivered by the lead nurse of the HFDMP; a cardiac rehabilitation program provided by a physical therapist; consultation with a dietician, and consultation and assessment by a psychologist. The patients were followed up for at least 1 year after discharge or until death. Patient characteristics and clinical demographic data were compared between the two groups. Cox proportional hazards regression analysis was performed to calculate hazard ratios (HRs) for death or recurrent events of hospitalization in the HFDMP group in comparison with the non-HFDMP group while controlling for covariates.

Results

The two groups did not significantly differ in demographic characteristics. The risk of readmission was lower in the HFDMP group, but the difference was not statistically significant (HR = 0.36, p = 0.09). In patients with ischemic cardiomyopathy, the risk of readmission was significantly lower in the HFDMP group compared to the non-HFDMP group (HR = 0.13, p = 0.026). The total mortality rate did not have significant difference between this two groups.

Conclusion

The HFDMP may be beneficial for reducing recurrent events of heart failure hospitalization, especially in patients with ischemic cardiomyopathy.

Trial registration

Longitudinal case-control study ISRCTN98483065, 24/09/2019, retrospectively registered.
The reliability and accuracy of operational system data in a nationwide helicopter emergency medical services mission database
Authors: Heino A. , Iirola T. , Raatiniemi L. , Nurmi J. , Olkinuora A. , Laukkanen-Nevala P. , Virkkunen I. , Tommila M.
Published: October 2019

Aim

The aim of this study was to evaluate the reliability and accuracy of documentation in FinnHEMS database, which is a nationwide helicopter emergency service (HEMS) clinical quality registry.

Methods

This is a nationwide study based on written fictional clinical scenarios. Study subjects were HEMS physicians and paramedics, who filled in the clinical quality registry based on the clinical scenarios. The inter-rater -reliability of the collected data was analyzed with percent agreement and free-marginal multi-rater kappa.

Results

Dispatch coding had a percent agreement of 91% and free-marginal multi-rater kappa value of 0.83. Coding for transportation or mission cancellation resulted in an agreement of 84% and free-marginal kappa value of 0.68. An agreement of 82% and a kappa value of 0.73 for dispatcher coding was found. Mission end, arrival at hospital and HEMS unit dispatch -times had agreements from 80 to 85% and kappa values from 0.61 to 0.73. The emergency call to dispatch centre time had an agreement of 71% and kappa value of 0.56. The documentation of pain had an agreement of 73% on both the first and second measurements. All other vital parameters had less than 70% agreement and 0.40 kappa value in the first measurement. The documentation of secondary vital parameter measurements resulted in agreements from 72 to 91% and kappa values from 0.43 to 0.64.

Conclusion

Data from HEMS operations can be gathered reliably in a national clinical quality registry. This study revealed some inaccuracies in data registration and data quality, which are important to detect to improve the overall reliability and validity of the HEMS clinical quality register.
Acute poisoning related to the recreational use of prescription drugs: an observational study from Oslo, Norway
Authors: Grimsrud Marit Mæhle , Brekke Mette , Syse Victoria Lykke , Vallersnes Odd Martin
Published: October 2019

Background

Recreational use of prescription drugs is widespread. We describe acute poisonings related to the recreational use of prescription drugs.

Methods

Retrospective observational study. We retrospectively registered all patients presenting from October 2013 through March 2015 at a primary care emergency outpatient clinic in Oslo, Norway, with an acute poisoning related to recreational drug use. We registered demographic data, toxic agents taken, clinical course and treatment. From this data set we extracted the 819/2218 (36.9%) cases involving one or more prescription drugs.

Results

Among the 819 included cases, 190 (23.2%) were female. Median age was 37 years. The drugs most commonly involved were benzodiazepines in 696 (85.0%) cases, methadone in 60 (7.3%), buprenorphine in 53 (6.5%), other opioids in 56 (6.8%), zopiclone/zolpidem in 26 (3.2%), and methylphenidate in 11 (1.3%). Prescription drugs were combined with other toxic agents in 659 (80.5%) cases; heroin in 351 (42.9%), ethanol in 232 (28.3%), amphetamine in 141 (17.2%), cannabis in 70 (8.5%), gamma-hydroxybutyrate (GHB) in 34 (4.2%), cocaine in 29 (3.5%), and other illegal drugs in 46 (5.6%). The patient was given naloxone in 133 (16.2%) cases, sedation in 15 (1.8%), and flumazenil in 3 (0.4%). In 157 (19.2%) cases, the patient was sent on to hospital.

Conclusions

One in three acute poisonings related to recreational drug use involved prescription drugs. Benzodiazepines were by far the most common class of drugs. Prescription drugs had mostly been taken in combination with illegal drugs or ethanol.
Prevalence of mild hyponatremia and its association with falls in older adults admitted to an emergency geriatric medicine unit (the MUPA unit)
Authors: Boyer Sophie , Gayot Caroline , Bimou Charlotte , Mergans Thomas , Kajeu Patrick , Castelli Muriel , Dantoine Thierry , Tchalla Achille
Published: October 2019

Background

Hyponatremia is the most common electrolyte disorder in older adults and it can increase morbidity and mortality. Approximately one in three older adults fall each year; mild chronic hyponatremia can predispose this group to injurious falls and fractures and serum levels of sodium can also influence bone health. Little is known regarding the association between mild chronic hyponatremia and injurious fall prevalence in elderly patients admitted to the Emergency Department (ED). Therefore, the present study investigated the link between mild hyponatremia and the risk of injurious falls in elderly patients admitted to the Emergency Geriatric Medicine Unit (The MUPA Unit).

Methods

This cross-sectional study was conducted over 4 months and included patients ≥75 years of age who were admitted to the MUPA Unit of University Hospital Center of Limoges (France). Sociodemographic factors, fall events, comorbidities, medications, and sodium levels were assessed (hyponatremia was considered as sodium level < 136 mEq/L). Additionally, the short Comprehensive Geriatric Assessment (short-CGA), the Frailty score on the Short Emergency Geriatric Assessment (SEGA), and the Katz Activity of Daily Living (ADL) scale were administered.

Results

Of the 696 cases included in the final analysis, the mean age was 86.1 ± 5.6 years and 63.1% were female. The prevalence of falls was 27.9% (95% confidence interval [CI]: 24.6–31.2%) and that of mild hyponatremia was 15.9% (95% CI: 13.2–18.6%). The prevalence rate of mild hyponatremia was 13.2% (95% CI: 10.1–16.3%) in patients without falls and 26.1% (95% CI: 19.8–32.4%) in patients admitted for falls. Mild hyponatremia was significantly associated with falls (P < 0.001) and the adjusted odds ratio (OR) was 3.02 (95% CI: 1.84–4.96).

Conclusions

Because mild hyponatremia might be a risk factor for injurious falls and ED admission, determination of sodium levels during basic biomarker assessment on ED admission could be an important component of fall prevention strategies for the elderly.
The impact of an orthogeriatric intervention in patients with fragility fractures: a cohort study
Authors: Abrahamsen Charlotte , Nørgaard Birgitte , Draborg Eva , Nielsen Morten Frost
Published: October 2019

Background

While orthogeriatric care to patients with hip fractures is established, the impact of similar intervention in patients with fragility fractures in general is lacking. Therefore, we aimed to assess the impact of an orthogeriatric intervention on postoperative complications and readmissions among patients admitted due to and surgically treated for fragility fractures.

Methods

A prospective observational cohort study with a retrospective control was designed. A new orthogeriatric unit for acute patients of sixty-five years or older with fragility fractures in terms of hip, vertebral or appendicular fractures was opened on March 1, 2014. Patients were excluded if the fracture was cancer-related or caused by high-energy trauma, if the patient was operated on at another hospital, treated conservatively with no operation, or had been readmitted within the last month due to fracture-related complications.

Results

We included 591 patients; 170 in the historical cohort and 421 in the orthogeriatric cohort. No significant differences were found between the two cohorts with regard to the proportion of participants experiencing complications (24.5% versus 28.3%,p = 0.36) or readmission within 30 days after discharge (14.1% vs 12.1%,p = 0.5). With both cohorts collapsed and adjusting for age, gender and CCI, the odds of having postoperative complications as a hip fracture patient was 4.45, compared to patients with an appendicular fracture (p <  0.001). Furthermore, patients with complications during admission were at a higher risk of readmission within 30 days than were patients without complications (22.3% vs 9.5%,p <  0.001).

Conclusions

In older patients admitted with fragility fractures, our model of orthogeriatric care showed no significant differences regarding postoperative complications or readmissions compared to the traditional care. However, we found significantly higher odds of having postoperative complications among patients admitted with a hip fracture compared to other fragility fractures. Additionally, our study reveals an increased risk of being readmitted within 30 days for patients with postoperative complications.
Care trajectories of chronically ill older adult patients discharged from hospital: a quantitative cross-sectional study using health insurance claims data
Authors: de Man Yvonne , Atsma Femke , Jonkers Wilma , de Rooij Sophia E. J. A. , Westert Gert P. , Jeurissen Patrick P. T. , Groenewoud A. Stef
Published: October 2019

Background

For older adults, a good transition from hospital to the primary or long-term care setting can decrease readmissions. This paper presents the 6-month post-discharge healthcare utilization of older adults and describes the numbers of readmissions and deaths for the most frequently occurring aftercare arrangements as a starting point in optimizing the post-discharge healthcare organization.

Methods

This cross-sectional study included older adults insured with the largest Dutch insurance company. We described the utilization of healthcare within 180 days after discharge from their first hospital admission of 2015 and the most frequently occurring combinations of aftercare in the form of geriatric rehabilitation, community nursing, long-term care, and short stay during the first 90 days after discharge. We calculated the proportion of older adults that was readmitted or had died in the 90–180 days after discharge for the six most frequent combinations. We performed all analyses in the total group of older adults and in a sub-group of older adults who had been hospitalized due to a hip fracture.

Results

A total of 31.7% of all older adults and 11.4% of the older adults with a hip fracture did not receive aftercare. Almost half of all older adults received care of a community nurse, whereas less than 5% received long-term home care. Up to 18% received care in a nursing home during the 6 months after discharge. Readmissions were lowest for older adults with a short stay and highest in the group geriatric rehabilitation + community nursing. Mortality was lowest in the total group of older aldults and subgroup with hip fracture without aftercare.

Conclusions

The organization of post-discharge healthcare for older adults may not be organized sufficiently to guarantee appropriate care to restore functional activity. Although receiving aftercare is not a clear predictor of readmissions in our study, the results do seem to indicate that older adults receiving community nursing in the first 90 days less often die compared to older adults with other types of aftercare or no aftercare. Future research is necessary to examine predictors of readmissions and mortality in both older adult patients discharged from hospital.
Simultaneous 18F-FDG PET/MRI in tuberculous spondylitis: an independent method for assessing therapeutic response - case series
Authors: Jeon Ikchan , Kong Eunjung , Kim Sang Woo
Published: October 2019

Background

18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) shows great potential for diagnosis and assessing therapeutic response of tuberculous spondylitis. Tuberculous spondylitis required long-term anti-tuberculosis (TB) medication therapy, and the optimal duration of therapy is controversial. There is still no clear way to tell when the anti-TB therapy can safely be discontinued.

Case presentation

Three patients with tuberculous spondylitis were evaluated for therapeutic response using 18F-FDG PET/magnetic resonance imaging (MRI). Clinical and hematological improvements were achieved after about 12 months of anti-TB medication therapy, and we considered whether to discontinue the therapy. There was no relapse during one year of follow-up after discontinuation of 12 months anti-TB medication based on the low maximum standardized uptake value (SUVmax) of 1.83 in one patient. However, the other two patients continued further anti-TB medication therapy based on the high SUVmax of 4.14 and 7.02, which were suspected to indicate active residual lesions in the abscess or granulation tissues. Continuous TB was confirmed by the bacterial and histological examinations.

Conclusions

18F-FDG PET/MRI has metabolic and anatomical advantages for assessing therapeutic response in TB spondylitis, and can be considered as a helpful independent and alternative method for determining the appropriate time to discontinue anti-TB medication.
Assessment of a new low-cost, PCR-based strategy for high-risk human papillomavirus DNA detection for cervical cancer prevention
Authors: Surriabre Pedro , Torrico Andrea , Vargas Tania , Ugarte Fuantina , Rodriguez Patricia , Fontaine Véronique
Published: October 2019

Background

HPV test implementation as a primary screening tool has the potential to decrease cervical cancer incidence as shown by several studies around the world. However, in many low-resource settings, the HPV test introduction has been backed down mainly due to its price. In this study, we present a novel low-cost strategy involving simple devices and techniques for high-risk human papillomavirus (HR-HPV) detection. The analytical performance to detect HR-HPV infections of this novel strategy was assessed by comparing it with the Hybrid Capture 2 system (HC2), which is used as gold standard.

Methods

Paired-cervical samples were collected from 541 women assisting to gynecological services in an outpatient clinic. One sample was transported in the Hybrid Capture Standard Transport Medium for HR-HPV detection by the HC2. The second sample was transported on glass slide for detection by PCR-based techniques (GP-EIA, BSGP-EIA and pU 1 M-L/2R).

Results

The level of agreement between the PCR-based techniques and HC2 system was determined with the Cohen’s kappa value. The kappa values between HC2 and GP-EIA, BSGP-EIA and pU 1 M-L/2R were 0.71 (CI 95% 0.63–0.78), 0.78 (CI 95% 0.71–0.84) and 0.63 (CI 95% 0.55–0.72), respectively. However, when the results from both BSGP-EIA and pU 1 M-L/2R were combined, the level of agreement with HC2 was increased to 0.82 (CI 95% 0.76–0.88), reflecting a very good agreement between the two HR-HPV detection strategies. Furthermore, the sensitivity of both techniques combined was also increased compared to the BSGP-EIA (88.7% vs 77.4%) and the pU (88.7 vs 60.9%) without penalizing the specificity obtained with the BSGP-EIA (95.1% vs 96.9%) and the pU (95.1% vs 96.5%).

Conclusions

This novel strategy, combining two PCR-based techniques for HR-HPV detection, could be useful for cervical cancer screening in self-collected samples in low-income countries.
Early detection of acute kidney injury in the perioperative period of liver transplant with neutrophil gelatinase-associated lipocalin
Authors: Lima Camila , de Paiva Haddad Luciana Bertocco , de Melo Patrícia Donado Vaz , Malbouisson Luiz Marcelo , do Carmo Lilian Pires Freitas , D’Albuquerque Luiz Augusto Carneiro , Macedo Etienne
Published: October 2019

Background

Acute kidney injury (AKI) is a common complication in patients undergoing liver transplant (LT) and is associated with high morbidity and mortality. We aim to evaluate the pattern of urine and plasma neutrophil gelatinase-associated lipocalin (NGAL) elevation during the perioperative period of LT and to assess it as a prognostic marker for AKI progression, need for dialysis and mortality.

Methods

We assessed NGAL levels before induction of anesthesia, after portal reperfusion and at 6, 18, 24, and 48 h after surgery. Patients were monitored daily during the first week after LT.

Results

Of 100 enrolled patients undergoing liver transplant, 59 developed severe AKI based on the KDIGO serum creatinine (sCr) criterion; 34 were dialysed, and 21 died within 60 days after LT. Applying a cut-off value of 136 ng/ml, UNGAL values 6 h after surgery was a good predictor of AKI development within 7 days after surgery, having a positive predictive value (PPV) of 80% with an AUC of 0.76 (95% CI 0.67–0.86). PNGAL at 18 h after LT was also a good predictor of AKI in the first week, having a PPV of 81% and AUC of 0.74 (95% CI 0.60–0.88). Based on PNGAL and UNGAL cut-off criteria levels, time to AKI diagnosis was 28 and 23 h earlier than by sCr, respectively. The best times to assess the need for dialysis were 18 h after LT by PNGAL and 06 h after LT by UNGAL.

Conclusion

In conclusion, the plasma and urine NGAL elevation pattern in the perioperative period of the liver transplant can predict AKI diagnosis earlier. UNGAL was an early independent predictor of AKI development and need for dialysis. Further studies are needed to assess whether the clinical use of biomarkers can improve patient outcomes.

Trial registration

Registered at Clinical Trials (clinicaltrials.gov) in March 24th, 2014 by title “Acute Kidney Injury Biomarkers: Diagnosis and Application in Pre-operative Period of Liver Transplantation (AKIB)” and identifier NCT02095431, retrospectively registered.
Association between mineral and bone disorder in patients with acute kidney injury following cardiac surgery and adverse outcomes
Authors: Yang Tianye , Wang Wenji , Tang Xiao , Shi Peng , Zhang Lulu , Yu Wenyan , Xie Yingxin , Guo Daqiao , Ding Feng
Published: October 2019

Background

Numerous studies have evaluated the prevalence and importance of mineral and bone disorders among patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). However, little is known about dysregulated mineral and bone metabolism in acute kidney injury (AKI).

Methods

We evaluated the association between mineral and bone metabolites and clinical outcomes in 158 patients who underwent cardiac surgery and developed AKI between June 2014 and January 2016. The baseline characteristics of the patients were recorded, and the levels of mineral and bone metabolites, including calcium, phosphate, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25D), bone-specific alkaline phosphatase (BAP), tartrate-resistant acid phosphatase 5b (TRACP-5b) and C-terminal fibroblast growth factor 23 (cFGF23) were measured within 12 h after establishing the clinical diagnosis.

Results

The serum phosphate, iPTH and cFGF23 levels were significantly associated with the 28-day mortality (phosphate: Hazard Ratio [HR] =2.620, 95% CI: 1.083 to 6.338,p = 0.035; iPTH: HR = 1.044, 95% CI: 1.001 to 1.090,p = 0.046; cFGF23: HR = 1.367, 95% CI: 1.168 to 1.599,p < 0.001). Moreover, higher serum cFGF23 and BAP levels were independently associated with an increased risk of adverse outcomes. Additionally, we found that the serum cFGF23 levels rose most significantly and were associated with the severity of AKI (P < 0.001).

Conclusions

Mineral and bone metabolites are dysregulated and are associated with adverse clinical outcomes among patients with AKI.

Trial registration

www.clinicaltrials.govNCT 00953992. Registered 6 August 2009.
Augmentation of peripheral lymphocyte-derived cholinergic activity in patients with acute ischemic stroke
Authors: Yuan Meng , Han Bin , Xia Yiping , Liu Ye , Wang Chunyang , Zhang Chao
Published: October 2019

Background

Brain ischemia activates the parasympathetic cholinergic pathway in animal models of human disease. However, it remains unknown whether activation of the cholinergic pathway impacts immune defenses and disease outcomes in patients with ischemic stroke. This study investigated a possible association between peripheral cholinergic activity, post-stroke infection, and mortality.

Methods

In this study, we enrolled 458 patients with acute ischemic stroke (< 24 h after onset), 320 patients with ischemic stroke on day 10, and 216 healthy subjects. Peripheral cholinergic activity, reflected by intracellular acetylcholine (ACh) content in human peripheral blood mononuclear cells (PBMCs), was determined by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Expression of acetylcholinesterase (AChE) and choline acetyltransferase (ChAT) was measured by quantitative real-time PCR and western blot. Regression analyses were used to assess associations between peripheral cholinergic function and clinical outcomes.

Results

Within 24 h after the onset of acute ischemic stroke, there was a rapid increase in peripheral cholinergic activity that correlated with brain infarction volume (r = 0.67,P < 0.01). Specifically, lymphocyte-derived ACh levels were significantly higher in stroke patients with pneumonia (0.21 ± 0.02 ng/106PBMC versus 0.15 ± 0.01 ng/106PBMC,P = 0.03). Of note, lymphocytic AChE catalytic activity was significantly lower in these patients. One-year mortality was significantly greater in patients with higher intracellular ACh levels within the first 24 h after acute stroke.

Conclusions

Lymphocytes produced increased amounts of ACh in patients with acute stroke, and pneumonia was a likely result. The association between this enhanced cholinergic activity and increased risk of pneumonia/mortality suggests that increased cholinergic activity may contribute to fatal post-stroke infection.
Antenatal care use and its determinants among migrant women during the first delivery: a nation-wide cross-sectional study in China
Authors: Tang Xue , Ding Lulu , Feng Yuejing , Wang Yi , Zhou Chengchao
Published: October 2019

Background

Reasonable use of antenatal care (ANC) services by pregnant women played a crucial role in ensuring maternal and child safety and reducing the risk of complications, disability, and death in mothers and their infants. This study aimed to investigate the ANC use, and to explore the factors associated with ANC use among migrant women during the first delivery in China.

Methods

This study used the data of National Health and Family Planning Commission of People Republic of China in 2014. A total of 1505 migrant primiparous women were included in our current analysis. Frequencies and proportions were used to describe the data. Chi-square tests and multivariate binary logistic regression models were performed to explore the determinants that affect the number of times migrant women used ANC during their first delivery.

Results

Of the 1505 participants, 279 (18.54%) women received the ANC less than 5 times, and 1226 (81.46%) women used the ANC at least 5 times during the first delivery. The multivariate logistic regression model showed that migrant primiparous women with college and above education(P < 0.05;OR = 2.57;95%CI = 1.19–5.55), from the households with higher monthly income (P < 0.01;OR = 2.01;95%CI = 1.30–3.13), covered by maternity insurance(P < 0.01;OR = 2.01;95%CI = 1.28–3.18), with maternal health records (P < 0.001;OR = 2.44;95%CI = 1.61–3.69), migrating across county (P < 0.05;OR = 2.57;95%CI = 1.14–5.81), having migration experience before pregnancy(P < 0.05;OR = 1.37;95%CI = 1.03–1.81) were more likely to use ANC for at least five times.

Conclusions

This study demonstrated that there were still some migrant maternal women (18.54%) who attended the ANC less than 5 times. Targeted policies should be developed to improve the utilization of ANC among migrant pregnant women.
Quality of life among symptomatic compared to PSA-detected prostate cancer survivors - results from a UK wide patient-reported outcomes study
Authors: Donnelly David W. , Vis Linda C. , Kearney Therese , Sharp Linda , Bennett Damien , Wilding Sarah , Downing Amy , Wright Penny , Watson Eila , Wagland Richard , Cross William R. , Mason Malcolm D. , Siesling Sabine , van Manen Jeannette G. , Glaser Adam W. , Gavin Anna
Published: October 2019

Background

Quality of life among prostate cancer survivors varies by socio-demographic factors and treatment type received; however, less in known about differences in functional outcomes by method of presentation. We investigate differences in reported urinary, bowel, sexual and hormone-related problems between symptomatic and PSA-detected prostate cancer survivors.

Methods

A UK wide cross-sectional postal survey of prostate cancer survivors conducted 18-42 months post-diagnosis. Questions were included on presentation method and treatment. Functional outcome was determined using the EPIC-26 questionnaire. Reported outcomes were compared for symptomatic and PSA-detected survivors using ANOVA and multivariable log-linear regression.

Results

Thirty-five thousand eight hundred twenty-three men responded (response rate: 60.8%). Of these, 31.3% reported presenting via PSA test and 59.7% symptomatically. In multivariable analysis, symptomatic men reported more difficulty with urinary incontinence (Adjusted mean ratio (AMR): 0.96, 95% CI: 0.96-0.97), urinary irritation (AMR: 0.95, 95% CI: 0.95-0.96), bowel function (AMR: 0.97, 95% CI: 0.97-0.98), sexual function (AMR: 0.90, 95% CI: 0.88-0.92), and vitality/hormonal function (AMR: 0.96, 95% CI: 0.96-0.96) than PSA-detected men. Differences were consistent across respondents of differing age, stage, Gleason score and treatment type.

Conclusion

Prostate cancer survivors presenting symptomatically report poorer functional outcomes than PSA-detected survivors. Differences were not explained by socio-demographic or clinical factors. Clinicians should be aware that men presenting with symptoms are more likely to report functional difficulties after prostate cancer treatment and may need additional aftercare if these difficulties persist. Method of presentation should be considered as a covariate in patient-reported outcome studies of prostate cancer.
Lymph node ratio as valuable predictor in pancreatic cancer treated with R0 resection and adjuvant treatment
Authors: You Min Su , Lee Sang Hyub , Choi Young Hoon , Shin Bang-sup , Paik Woo Hyun , Ryu Ji Kon , Kim Yong-Tae , Jang Dong Kee , Lee Jun Kyu , Kwon Wooil , Jang Jin-Young , Kim Sun-Whe
Published: October 2019

Background

Lymph-node (LN) metastasis is an important prognostic factor in resected pancreatic cancer. In this study, the prognostic value of American Joint Committee on Cancer (AJCC) 8th edition N stage, lymph-node ratio (LNR), and log odds of positive lymph nodes (LODDS) in resected pancreatic cancer was investigated.

Methods

Between January 2005 and December 2017, there were 351 patients with pancreatic cancer treated with R0 resection and adjuvant therapy at Seoul National University Hospital. Relationships between the three LN parameters and overall survival (OS) and recurrence-free survival (RFS) were evaluated using a log-rank test and Cox proportional hazard regression model. Each multivariate-adjusted LN parameter was internally validated by bootstrap-corrected Harrell’s C-index.

Results

The mean duration from surgery to adjuvant therapy was 47.6 ± 17.4 days. In total, the median OS and RFS was 31.7 (95% CI, 27.2-37.2) and 15.4 (95% CI, 13.5-17.7) months. The three LN classification systems were significantly correlated with OS and RFS in log-rank tests and multivariate-adjusted models (all p < 0.05). When internally validated, LNR showed the highest discrimination ability in predicting OS and RFS (each C–index = 0.65). LNR also showed the highest C-index in subgroup analysis, classified by adjuvant therapy modality. LNR and the AJCC 8th edition LN classification system were significantly associated with loco-regional recurrence (p = 0.026 and p = 0.027, respectively).

Conclusions

LNR, which showed the best prognostic performance and significant relationship with loco-regional recurrence, can help further stratify the patients and establish an active treatment plan.