Journal articles: '813.54 20'

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Bhamani, Shireen Shehzad, Omrana Pasha, Rozina Karmaliani, Nargis Asad, and Iqbal Azam. "Validation of the Urdu Version of Wagnild and Young’s Long and Short Resilience Scales Among 20- to 40-Year-Old Married Women Living in Urban Squatter Settlements of Karachi, Pakistan." Journal of Nursing Measurement 23, no. 3 (2015): 425–35. http://dx.doi.org/10.1891/1061-3749.23.3.425.

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Background: There were no instrument exists in South Asia to assess resilience. Thus, this study assessed the validity and reliability of the Urdu version of Wagnild and Young’s long and short Resilience Scales. Methods: Study was carried out in two urban squatter settlements of Karachi, Pakistan. Resilience Scales were validated against the depression, anxiety, and life satisfaction scales among 20- to 40-year-old married women. Sample size for validity and reliability were 636 and 319. Results: Moderate negative correlation with the depression and anxiety and moderate positive significant correlation with life satisfaction were found with both scales. The test–retest correlation were .54 and .49, respectively. Internal consistency were found acceptable. Concurrent validity were .729 and .813. Conclusions: Study found a valid and reliable resilience scale in Urdu language.

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Shrestha, Sharmila, Nirmala Pradhan, Shyam Lamsal, and Rambha Sigdel. "Prevalence of Substance Use among Youths in Selected Ward of Gadhi Rural Municipality, Sunsari, Nepal: A Descriptive Cross-sectional Study." Journal of BP Koirala Institute of Health Sciences 3, no. 2 (December 31, 2020): 28–32. http://dx.doi.org/10.3126/jbpkihs.v3i2.36066.

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Background: Tobacco and alcohol are the most prevalent substances in Nepal and their use is becoming a serious health problem. We aimed to find out the prevalence of substance use among youths and assess the association with selected demographic variables. Methods: A descriptive cross-sectional study was conducted among 813 youths residing in Gadhi Rural Municipality, ward number 1. The youths were selected through total enumerative sampling and eligible candidates were interviewed using semi-structured questionnaires on substance use. Data were analyzed using descriptive and inferential statistics. Results: Nearly 54% of the youths belonged to the age group 16-25 years and 51.2% were females. Tarai Janajati ethnic group represented 64.2%, and 99.8% were Hindu by religion. The prevalence of substance use was 26.4%. The majority of the youths (62.2%) had started the consumption of substances between the age of 13-20 years. Many (36.2%) had been using the substances for 6-10 years. Almost two-thirds (62.2%) had a family history of substance use. Curiosity was the main reason (29.7%) for the youths to consume the substance. Nearly 37% of the youths were found to be alcohol dependent. Age, sex, ethnicity, and income were significantly associated with substance use (p < 0.05). Conclusion: About one in every four youths was involved in substance use. In addition, it was more prevalent in male youths and the majority had started using substances at the age of 13 to 20 years.

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Rubio Rincón, Gina Sorel, and Claudia Xiomara Amaya Perozzo. "Miopía, alteración visual en habitantes de Bogotá y Cundinamarca." Ciencia & Tecnología para la Salud Visual y Ocular, no. 9 (December 1, 2007): 43. http://dx.doi.org/10.19052/sv.1514.

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Objetivo: conocer la prevalencia de la miopía en dos instituciones médicas de Bogotá y tres de Cundinamarca durante marzo de 2006 y febrero de 2007, a través de una investigación descriptiva. Materiales y métodos: se examinaron 813 pacientes, de bajos estratos socioeconómicos y principalmente afiliados al régimen subsidiado en salud, que asistieron a la consulta de optometría de los Hospitales Rafael Uribe Uribe, Centro Médico San Camilo de Bogotá, Hospitales El Salvador de Ubaté, San Rafael de Girardot y Mario Gaitán Yanguas de Soacha, de Cundinamarca; mediante valoración optométrica y previa estandarización de la prueba, se recolectó la información en bases de datos SPSS 15.0, determinando aquellas refracciones para ambos ojos, que tuvieran esferas negativas y cilindros menores o iguales a su tercera parte. Resultados: se advirtió que la prevalencia de la miopía fue 17,5% (20/114) en el grupo de 54 - 71 años seguido por el grupo de 18 – 35 años en 16% (24/150). E igualmente la prevalencia por sexo fue en un 10,3% (53/515) en mujeres y en 9,1% (27/298) en hombres. Conclusiones: la miopía se presenta principalmente en personas adultas en edad económicamente productiva, lo que refleja la importancia del diagnóstico y el tratamiento oportuno de la misma por presentar una prevalencia media y significativas alteraciones visuales en la población.

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Ertenli, A. İ., U. Kalyoncu, O. Karadag, L. Kiliç, A. Akdoğan, I. Dogan, Ş. A. Bilgen, et al. "AB0200 TRENDS IN THE CHOICE OF FIRST BIOLOGIC AND TARGETED SYNTHETIC DMARD IN RHEUMATOID ARTHRITIS PATIENTS: 20-YEARS JOURNEY OF HUR-BIO REAL-LIFE REGISTRY." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1124.2–1124. http://dx.doi.org/10.1136/annrheumdis-2021-eular.693.

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Background:In the last 20 years, there have been extraordinary improvements and practice-changing developments in the management of rheumatoid arthritis (RA). Exploring the pathogenetic mechanisms first enabled clinicians to use anti-tumor necrosis factor (TNF) alpha agents, then drugs targeting different molecules. Parallel to these developments, treatment guidelines have been changed accordingly. Meanwhile, how these developments have been reflected into the real-word practice is a question of interest.Objectives:In this study, we aimed to explore the first biologic agent trends of our 20-years of single-center experience.Methods:HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2005. Patients who were started biologics before 2005 were registered retrospectively. In brief; demographic data, treatment-related data (including adverse events) and disease-related data of RA patients have been recorded in HUR-BIO. Until the end of the 2020, 21 different rheumatologists contributed to the development of HUR-BIO. In this study, distribution of the first-line biologic agents was calculated according to 5-year periods starting from the 2001. Also, demographic and serologic data of RA patients were reported.Results:A total of 2080 RA patients was registered in HUR-BIO by the end of 2020. Of these patients, 79.5% was female. Mean age at the starting of bDMARD was 53.3 ± 17.8 years. Rate of rheumatoid factor and anti-cyclic citrullinated peptide positivity was 67.6% and 61.0%, respectively. 65 (3.2%), 335 (16.1%), 858 (41.2%) and 822 (39.5%) patients were prescribed with their first bDMARD in 2001-2005, 2006-2010, 2011-2015 and 2016-2020, respectively. There was a trend towards the increasing prescription of non-Anti-TNF bDMARDs over time.Table 1.Distribution of first biologic DMARDs in RA patients according to 5-years periods2001-20052006-20102011-20152016-2020TotalAdalimumab15 (23.1)111 (33.0)187 (21.8)153 (18.6)466 (22.4)Etanercept30 (46.2)154 (45.8)229 (26.7)54 (6.6)467 (22.4)İnfliximab20 (30.8)58 (17.3)64 (7.5)7 (0.9)149 (7.1)Golimumab0037 (4.3)43 (5.2)80 (3.8)Certolizumab0037 (4.3)68 (8.3)105 (5.0)Anti-TNF65 (100)323 (96.4)554 (64.5)325 (39.5)1267 (60.9)Tofacitinib006 (0.7)212 (25.8)218 (10.5)Tocilizumab009 (1.0)102 (12.4)111 (5.3)Rituximab012 (3.6)136 (15.8)84 (10.2)232 (11.1)Abatacept00153 (17.8)99 (12.0)252 (12.1)Non-Anti-TNF012 (3.6)304 (35.5)497 (60.5)813 (39.1)Total65 (100)335 (100)858 (100)822 (100)2080 (100)Approval years of drugs in Turkey; Infliximab: 2003, etanercept:2004, adalimumab: 2005, golimumab: 2013, certolizumab: 2014, abatacept: 2010, tocilizumab: 2013, rituximab:2009, tofacitinib: 2015,Conclusion:Real-life practice in RA seems consistent with treatment guidelines. Use of non-Anti-TNF bDMARDs becoming more frequent year-by-year. Jak kinase inhibitor has rised through the last 5 years. Next decade may be the years of Jak kinases inhibitors.Disclosure of Interests:None declared

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Amein, T., C. H. B. Olsson, M. Wikström, R. Findus, D. AB, and S. A. I. Wright. "First Report in Sweden of Downy Mildew on Parsley Caused by Plasmopara petroselini." Plant Disease 90, no. 1 (January 2006): 111. http://dx.doi.org/10.1094/pd-90-0111a.

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During September 2004, downy mildew of parsley caused by a species of Plasmopara was observed in an experimental field of parsley (Petroselinum crispum subsp. crispum L. cv. Gigante d'Italia/Hilmar) in Borgeby in southern Sweden. The summer of 2004 was exceptionally wet and humid. Disease became widespread throughout the field in just a few days. Local growers reported that symptoms consistent with downy mildew had appeared in their parsley fields every year since 2001. Plasmopara, under P. nivea, has been reported on parsley in Europe since the middle of the 19th century (4). In recent years, this disease has caused severe damage to parsley grown in several European countries, e.g., France, Germany, Switzerland, and Belgium (1,3). The first symptoms appeared as faint chlorotic spots on the upper surfaces of the leaves. On the corresponding lower surfaces, mycelium and sporangiophores grew profusely and developed a white mat that in part turned dark gray. Eventually, the leaves and stalks became necrotic and died. The sporangiophores were monopodially branched, 248.4 ± 13.36 μm long (n = 17), each branch ending in 2 to 5 ultimate branchlets tapered toward the tip. The trunk diameter measured 7.0 ± 0.77 μm (n = 9) above the basal part and 6.1 ± 0.81 μm just below the first branch. The sporangia were broadly ellipsoidal to ellipsoidal, hyaline, 22.5 ± 0.73 μm long and 16.6 ± 0.48 μm wide (n μ 40). They were mostly nonpapillate when young, although exit pores 4.8 ± 0.32 μm (n = 10) were visible. Mature sporangia exhibited a dehiscence apparatus and a plug in the exit pore. On the basis of the characteristics above, the pathogen was identified as P. petroselini (= P. nivea pro parte [2]). Independent verification of the identity was done by O. Constantinescu at the Botanical Museum, Uppsala, Sweden. A voucher specimen was deposited at the Herbarium UPS, in Uppsala under the number UPS F-118873. To our knowledge, this is the first report of P. petroselini on parsley in Sweden. References: (1) E. Bèliard and J. Thibault. Phytoma 554:2, 2002. (2) O. Constantinescu. Taxon 54:813, 2005. (3) C. Crepel and S. Inghelbrecht. Plant Dis. 87:1266, 2003. (4) A. de Bary, Ann. Sci. Nat. Bot., Sér. 4, 20:5, 1863.

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Raisingani, Manish Gope. "Risk of Complications in Children With Type 1 Diabetes and Covid-19." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A62. http://dx.doi.org/10.1210/jendso/bvab048.126.

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Abstract Background: There is some data available in adults which suggests that Type 1 diabetes may be associated with higher risk with Covid-19 (1). Limited data has been available in pediatric Type 1 diabetes with Covid-19. Methods: We used TriNetX, with a large COVID-19 database, collecting real-time electronic medical records data. We compared children (0–18 years) who were diagnosed with Covid-19 with and without Type 1 diabetes. This database collected information from 54 health care organizations. Results: Mortality rate in children with Covid-19 and Type 1 diabetes was 0.618% (10/1618). Mortality rate in children with Covid-19 without Type 1 diabetes was 0.102% (257/251517). Relative risk of mortality for children with Covid-19 and Type 1 diabetes was 6.05 with a p value of < 0.0001. Endotracheal intubation rate in children with Covid-19 and Type 1 diabetes was 0.618% (10/1618). Endotracheal intubation rate in children with Covid-19 without Type 1 diabetes was 0.071% (178/251517). Relative risk of endotracheal intubation for children with Covid-19 and Type 1 diabetes was 8.73 with a p value of < 0.0001. Pneumonia rate in children with Covid-19 and Type 1 diabetes was 0.804% (13/1618). Pneumonia rate in children with Covid-19 without Type 1 diabetes was 0.562% (1414/251517). Relative risk of pneumonia for children with Covid-19 and Type 1 diabetes was 1.43 with a p value of < 0.1959. Septic shock rate in children with Covid-19 and Type 1 diabetes was 1.05% (17/1618). Septic shock rate in children with Covid-19 without Type 1 diabetes was 0.293% (737/251517). Relative risk of septic shock for children with Covid-19 and Type 1 diabetes was 3.59 with a p value of < 0.00001. Conclusion: Mortality rate, endotracheal and septic shock were increased in children with Type 1 diabetes and Covid-19 versus children with Covid-19 and no Type 1 diabetes. Further studies with larger sample size are needed to study complication rate of Covid-19 and Type 1 diabetes. References 1) Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study. Lancet Diabetes Endocrinol 2020 Oct;8(10):813–822. doi: 10.1016/S2213-8587(20)30272-2. Epub 2020 Aug 13.

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Watts, Michael J., Stuart J. Ings, Carmen Balsa, Caroline Penn, David Leverett, and David C. Linch. "Successful Customization of Peripheral Blood Stem Cell Harvest Volume and Cell Concentration during Apheresis." Blood 104, no. 11 (November 16, 2004): 4992. http://dx.doi.org/10.1182/blood.v104.11.4992.4992.

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Abstract The high white cell counts associated with peripheral blood stem cell (PBSC) harvests make these products particularly prone to cellular damage during storage in the liquid phase. We recently described unexpectedly high thaw clonogenic losses of PBSC stored overnight at 4 deg C prior to cryopreservation. This was associated with high harvest white cell counts and delayed engraftment in a cohort of patients receiving autologous transplantation procedures (Watts et al 2003 Blood 102:113 abstract 127). We showed in this study that pre-diluting the cells in autologous plasma to a WBC of 100x10^9/L preserved clonogenic yields during liquid storage and post freeze-thaw and suggested an upper WBC threshold of 200x10^9/L for liquid storage. In many patients however, to achieve this count or below would require further dilution of the cells. Conversely, where cells are to be frozen immediately, it is advantageous to collect a low PBSC harvest volume to fully utilize cryostorage space and to achieve this without centrifugation. The present study demonstrates that the collection of either a low white count or low volume PBSC harvest can be controlled successfully using the GAMBRO BCT Spectra AutoPBSC apheresis machine (version 6.1) and avoids the need for any further laboratory manipulations. This machine allows the adjustment of the amount of autologous plasma used to rinse each cycle of PBSC cells into the collection bag and is referred to as the “plasma chase volume”. The plasma chase volume was set to maximum (20ml/cycle) for healthy donor harvests for shipping, and to minimum (4ml/cycle) where the cells were for immediate cryopreservation. A total of 114 harvests from 99 mobilised healthy donors were collected using the maximum plasma chase volume whereas 527 autograft harvests from 365 mobilised patients were collected using the lowest plasma chase setting. The median (range) WBC and volume of the 114 healthy donor harvests was 100 (28–174)x10^9/L and 473 (54–871) ml respectively. The median (range) WBC and volume of the 527 “small volume” harvests for cryopreservation was 254 (51–495)x10^9/L and 66 (20–180) ml respectively. To determine whether the maximal plasma chase setting affected the progenitor dose collected, we compared the first day harvest of the 99 mobilised healthy donors obtained with the Spectra autoPBSC with that from 114 healthy donors collected on the standard manual Spectra (n=63) and CS3000 (n=51) apheresis machines. The median (range) CD34+ cell yield was 361 (34–1,380), 291 (21–1,356) and 259 (37–738)x10^6 respectively. The first day median (range) CD34+ cell yield x10^6 of the 365 mobilised patients where small volume autograft harvests were collected on the Spectra AutoPBSC was 202 (0–7,569) compared to 195 (0–5,054) using the manual Spectra (n=142) and 152 (0–4,830) x10^6 using the CS3000 machine (n=813). Our policy is to dilute any harvest for storage/shipping with a nucleated cell count greater than 200x10^9/L with autologous plasma, but none of the donor harvests exceeded this threshold and no laboratory manipulation was required. In the case of the autograft harvests for immediate cryopreservation, 502/527(95%) of the collections were 100ml or less. In conclusion, this study demonstrates for the first time that the cell count and volume of the PBSC harvest required can be customized at apheresis, that this is not detrimental to progenitor yields and results in a product that is optimal for storage/shipping without laboratory intervention.

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Magnus, Dan, Santosh Bhatta, and Julie Mytton. "432 Establishing injury surveillance in emergency departments in Nepal: epidemiology and burden of paediatric injuries." Emergency Medicine Journal 37, no. 12 (November 23, 2020): 825.2–827. http://dx.doi.org/10.1136/emj-2020-rcemabstracts.7.

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Aims/Objectives/BackgroundGlobally, injuries cause more than 5 million deaths annually. Children and young people are a particularly vulnerable group and injuries are the leading cause of death in people aged 5–24 years globally and a leading cause of disability.In most low and middle-income countries where the majority of global child injury burden occurs, systems for routinely collecting injury data are limited. There is a continuing need for better data on childhood injuries and for injury surveillance.The aim of our study was to introduce a hospital-based injury surveillance tool – the first of its kind in Nepal and explore its feasibility. We undertook prospective collection of data on all injuries/trauma presenting to 2 hospital emergency departments to describe the epidemiology of paediatric hospital injury presentations and associated risk factors.Methods/DesignA new injury surveillance system for use in emergency departments in Nepal was designed and used to collect data on patients presenting with injuries. Data were collected prospectively in two hospitals 24 h a day over 12 months (April 2019 - March 2020) by trained data collectors using tablet computers.Abstract 432 Table 1Socio-demographic profile and characteristics of injury among children attending emergency of hospitals in Makwanpur district, Nepal, April 2019 – March 2020 (N=2696)CharacteristicsFrequencyGender Male 1778 Female 918 Age groups 0–4 years 653 5–9 years 866 10–14 years 680 15–17 years 497 Median year (IRQ) 8 (5 – 13) Ethnicity/caste Janajati 1384 Brahmin/Chhetri 892 Dalit 148 Madhesi 146 Muslim 74 Others 50 Unknown 2 Place where injury occurred Home/Compound 1576 Highway/road/street 636 School 233 Recreational area 138 Workplace 76 Other 37 Activities at the time injury occurred Leisure/Play 1889 Travelling (other than to/from school/work) 296 Work 202 Travelling (to/from school/work) 184 Education 42 Organised sports 11 Other 52 Unknown 20 Intent of injury Unintentional 2560 Intentional (self-harm) 61 Intentional (assault) 75 Unintentional (n=2560) Fall 912 Animal or insect related 728 Road traffic injury 356 Injured by a blunt force 201 Stabbed, cut or pierced 176 Fire, burn or scald 65 Poisoning 52 Suffocation/choking 36 Electrocution 12 Drowning and submersion 7 Other 13 Unknown 2 Self-harm (n=61) Poisoning 38 Hanging, strangulation, suffocation 12 Stabbed, cut or pierced 6 Injured by blunt object 4 Other 1 Assault (n=75) Bodily force (physical violence) 43 Injured by blunt object 18 Stabbed, cut or pierced 8 Pushing from a high place 2 Poisoning 2 Sexual assault 1 Other 1 Nature of injury (one most severe) Cuts, bites or open wound 1378 Bruise or superficial injury 383 Fracture 299 Sprain, strain or dislocation 243 Internal injury 124 Head Injury/Concussion 83 Burns 67 Other 115 Unknown 2 Not recorded 2 Severity of injury No apparent injury 125 Minor 1645 Moderate 813 Severe 111 Not recorded 2 Disposition Discharged 2317 Admitted to hospital 164 Transferred to another hospital 179 Died 21 Leave Against Medical Advice (LAMA) 11 Unknown 2 Not recorded 2 Note:Not recorded = missing cases95% CI calculated using one proportion test and normal approximation method in Minitab.Abstract 432 Table 2Distribution of injuries by age-group, sex and mechanism of injury among children attending emergency of hospitals in Makwanpur district, Nepal, April 2019 – March 2020Age groups & Sex0 - 4 years5 - 9 years10–14 years15–17 yearsMaleFemaleTotalIntent & mechanismsn (%)n (%)n (%)n (%)n (%)n (%)n (%)Unintentional Fall 239 (26.2) 328 (36.0) 249 (27.3) 96 (10.5) 636 (69.7) 276 (30.3) 912 (100) Animal or insect related 175 (24.0) 260 (35.7) 190 (26.1) 103 (14.1) 470 (64.6) 258 (35.4) 728 (100) Road traffic injury 49 (13.8) 108 (30.3) 86 (24.2) 113 (31.7) 223 (62.6) 133 (37.4) 356 (100) Injured by a blunt force 54 (26.9) 74 (36.8) 49 (24.4) 24 (11.9) 150 (74.6) 51 (25.4) 201 (100) Stabbed, cut or pierced 20 (11.4) 56 (31.8) 49 (27.8) 51 (29.0) 127 (72.2) 49 (27.8) 176 (100) Fire, burn or scald 42 (64.6) 10 (15.4) 9 (13.8) 4 (6.2) 27 (41.5) 38 (58.5) 65 (100) Poisoning 33 (63.5) 6 (11.5) 5 (9.6) 8 (15.4) 26 (50.0) 26 (50.0) 52 (100) Suffocation/choking 24 (66.7) 5 (13.9) 2 (5.6) 5 (13.9) 20 (55.6) 16 (44.4) 36 (100) Electrocution 2 (15.7) 0 (0.0) 3 (25.0) 7 (58.3) 10 (83.3) 2 (16.7) 12 (100) Drowning and submersion 1 (14.3) 1 (14.3) 3 (42.9) 2 (28.6) 3 (42.9) 4 (57.1) 7 (100) Other 6 (46.2) 4 (30.8) 3 (23.1) 0 (0.0) 10 (76.9) 3 (23.1) 13 (100) Unknown 2 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (100) 2 (100) Total 647 (25.3) 852 (33.3) 648 (25.3) 413 (16.1) 1702 (66.5) 858 (33.5) 2560 (100) Self-harm Poisoning 0 (0.0) 0 (0.0) 6 (15.8) 32 (84.2) 7 (18.4) 31 (81.6) 38 (100) Hanging 0 (0.0) 0 (0.0) 3 (25.0) 9 (75.0) 4 (33.3) 8 (66.7) 12 (100) Stabbed, cut or pierced 0 (0.0) 0 (0.0) 2 (33.3) 4 (66.7) 1 (16.7) 5 (83.3) 6 (100) Injured by blunt object 0 (0.0) 2 (50.0) 2 (50.0) 0 (0.0) 4 (100) 0 (0.0) 4 (100) Other 0 (0.0) 0 (0.0) 0 (0.0) 1 (100) 1 (100) 0 (0.0) 1 (100) Total 0 (0.0) 2 (3.3) 13 (21.3) 46 (75.4) 17 (27.9) 44 (72.1) 61 (100) Assault Bodily force (physical violence) 3 (7.0) 1 (2.3) 11 (25.6) 28 (65.1) 37 (86.0) 6 (14.0) 43 (100) Injured by blunt object 2 (11.1) 8 (44.4) 4 (22.2) 4 (22.2) 13 (72.2) 5 (27.8) 18 (100) Stabbed, cut or pierced 1 (12.5) 0 (0.0) 2 (25.0) 5 (62.5) 7 (87.5) 1 (12.5) 8 (100) Pushing from a high place 0 (0.0) 1 (50.0) 1 (50.0) 0 (0.0) 1 (50.0) 1 (50.0) 2 (100) Poisoning 0 (0.0) 1 (50.0) 0 (0.0) 1 (50.0) 1 (50.0) 1 (50.0) 2 (100) Sexual assault 0 (0.0) 0 (0.0) 1 (100) 0 (0.0) 0 (0.0) 1 (100) 1 (100) Other 0 (0.0) 1 (100) 0 (0.0) 0 (0.0) 0 (0.0) 1 (100) 1 (100) Total 6 (8.0) 12 (16.0) 19 (25.3) 38 (50.7) 59 (78.7) 16 (21.3) 75 (100) Abstract 432 Table 3Association of injury location, nature and severity with age among children attending emergency of hospitals in Makwanpur district, Nepal, April 2019 – March 2020Age groups0 – 4 years5 – 9 years10–14 years15–17 yearsTotalChi-SquareInjury characteristicsn (%)n (%)n (%)n (%)n (%)P valueLocation of injury sustained Home/Compound 537 (34.1) 504 (32.0) 319 (20.2) 216 (13.7) 1576 (100) <0.001 Highway/road/street 85 (13.4) 196 (30.8) 190 (29.9) 165 (25.9) 636 (100) School 15 (6.4) 107 (45.9) 85 (36.5) 26 (11.2) 233 (100) Recreational area 9 (6.5) 44 (31.9) 55 (39.9) 30 (21.7) 138 (100) Workplace 1 (1.3) 4 (5.3) 19 (25.0) 52 (68.4) 76 (100) Other 6 (16.2) 11 (29.7) 12 (32.4) 8 (21.6) 37 (100) Total 653 (24.2) 866 (32.1) 680 (25.2) 497 (18.4) 2696 (100) Nature of injury Cuts, bites or open wound 328 (23.8) 506 (36.7) 314 (22.8) 230 (16.7) 1378 (100) <0.001 Bruise or superficial injury 81 (21.1) 99 (25.8) 118 (30.8) 85 (22.2) 383 (100) Fracture 48 (16.1) 101 (33.8) 112 (37.5) 38 (12.7) 299 (100) Sprain, strain or dislocation 48 (19.8) 78 (32.1) 72 (29.6) 45 (18.5) 243 (100) Internal injury 44 (35.5) 8 (6.5) 18 (14.5) 54 (43.5) 124 (100) Head Injury/Concussion 18 (21.7) 26 (31.3) 18 (21.7) 21 (25.3) 83 (100) Burns 42 (62.7) 9 (13.4) 10 (14.9) 6 (9.0) 67 (100) Other 41 (35.7) 38 (33.0) 18 (15.7) 18 (15.7) 115 (100) Unknown 2 (100) 0 (0.0) 0 (0.0) 0 (0.0) 2 (100) Total 652 (24.2) 865 (32.1) 680 (25.2) 497 (18.4) 2694 (100) Severity of injury No apparent injury 39 (31.2) 45 (36.0) 26 (20.8) 15 (12.0) 125 (100) <0.001 Minor 419 (25.5) 535 (32.5) 406 (24.7) 285 (17.3) 1645 (100) Moderate 171 (21.0) 262 (32.2) 225 (27.7) 155 (19.1) 813 (100) Severe 23 (20.7) 23 (20.7) 23 (20.7) 42 (37.8) 111 (100) Total 652 (24.2) 865 (32.1) 680 (25.2) 497 (18.4) 2694 (100) Abstract 432 Table 4Association of injury location, nature and severity with sex among children attending emergency of hospitals in Makwanpur district, Nepal, April 2019 – March 2020SexMaleFemaleTotalChi-SquareInjury characteristicsn (%)n (%)n (%)P valueLocation of injury sustained Home/Compound 979 (62.1) 597 (37.9) 1576 (100) <0.001 Highway/road/street 421 (66.2) 215 (33.8) 636 (100) School 176 (75.5) 57 (24.5) 233 (100) Recreational area 111 (80.4) 27 (19.6) 138 (100) Workplace 62 (81.6) 14 (18.4) 76 (100) Other 29 (78.4) 8 (21.6) 37 (100) Total 1778 (65.9) 918 (34.1) 2696 (100) Nature of injury Cuts, bites or open wound 959 (69.6) 419 (30.4) 1378 (100) <0.001 Bruise or superficial injury 246 (64.2) 137 (35.8) 383 (100) Fracture 200 (66.9) 99 (33.1) 299 (100) Sprain, strain or dislocation 154 (63.4) 89 (36.6) 243 (100) Internal injury 50 (40.3) 74 (59.7) 124 (100) Head Injury/Concussion 59 (71.1) 24 (28.9) 83 (100) Burns 27 (40.3) 40 (59.7) 67 (100) Other 79 (68.7) 36 (31.3) 115 (100) Unknown 2 (100) 0 (0.0) 2 (100) Total 1776 (65.9) 918 (34.1) 2694 (100) Severity of injury No apparent injury 81 (64.8) 44 (35.2) 125 (100) 0.048 Minor 1102 (67.0) 543 (33.0) 1645 (100) Moderate 533 (65.6) 280 (34.4) 813 (100) Severe 60 (54.1) 51 (45.9) 111 (100) Total 1776 (65.9) 918 (34.1) 2694 (100) Abstract 432 Table 5Distribution of injuries by outcome and mechanism of injury among children attending emergency of hospitals in Makwanpur district, Nepal, April 2019 – March 2020Outcome of injuryDischargedAdmittedTransferredDiedLAMAUnknownTotalIntent & mechanismsn (%)n (%)n (%)n (%)n (%)n (%)n (%)Unintentional Fall 787 (86.5) 65 (7.1) 53 (5.8) 0 (0.0) 4 (0.4) 1 (0.1) 910 (100) Animal/insect bite/sting 704 (96.7) 3 (0.4) 19 (2.6) 0 (0.0) 1 (0.1) 1 (0.1) 728 (100) Road traffic injury 260 (73.0) 47 (13.2) 44 (12.4) 5 (1.4) 0 (0.0) 0 (0.0) 356 (100) Injured by a blunt force 190 (94.5) 4 (2.0) 6 (3.0) 0 (0.0) 1 (0.5) 0 (0.0) 201 (100) Stabbed, cut or pierced 165 (93.8) 8 (4.5) 3 (1.7) 0 (0.0) 0 (0.0) 0 (0.0) 176 (100) Fire, burn or scald 52 (80.0) 12 (18.5) 1 (1.5) 0 (0.0) 0 (0.0) 0 (0.0) 65 (100) Poisoning 30 (57.7) 4 (7.7) 16 (30.8) 1 (1.9) 1 (1.9) 0 (0.0) 52 (100) Suffocation/choking/asphyxia 24 (66.7) 4 (11.1) 6 (16.7) 1 (2.8) 1 (2.8) 0 (0.0) 36 (100) Electrocution 7 (58.3) 2 (16.7) 2 (16.7) 1 (8.3) 0 (0.0) 0 (0.0) 12 (100) Drowning and submersion 4 (57.1) 0 (0.0) 0 (0.0) 3 (42.9) 0 (0.0) 0 (0.0) 7 (100) Other 12 (92.3) 1 (7.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 13 (100) Unknown 2 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (100) Total 2237 (87.5) 150 (5.9) 150 (5.9) 11 (0.4) 8 (0.3) 2 (0.1) 2558 (100) Self-harm Poisoning 5 (13.2) 8 (21.1) 23 (60.5) 0 (0.0) 2 (5.3) 0 (0.0) 38 (100) Hanging 1 (8.3) 0 (0.0) 1 (8.3) 10 (83.3) 0 (0.0) 0 (0.0) 12 (100) Stabbed, cut or pierced 6 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 6 (100) Injured by blunt object 4 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 4 (100) Other 1 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (100) Total 17 (27.9) 8 (13.1) 24 (39.3) 10 (16.4) 2 (3.3) 0 (0.0) 61 (100) Assault Bodily force (physical violence) 34 (79.1) 5 (11.6) 3 (7.0) 0 (0.0) 1 (2.3) 0 (0.0) 43 (100) Injured by blunt object 18 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 18 (100) Stabbed, cut or pierced 6 (75.0) 1 (12.5) 1 (12.5) 0 (0.0) 0 (0.0) 0 (0.0) 8 (100) Pushing from a high place 2 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (100) Poisoning 1 (50) 0 (0.0) 1 (50.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (100) Sexual assault 1 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (100) Other 1 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (100) Total 63 (84.0) 6 (8.0) 5 (6.7) 0 (0.0) 1 (1.3) 0 (0.0) 75 (100) Abstract 432 Figure 1Seasonal variation of injuries identified by the injury surveillance system over a year among children attending emergency of hospitals in Makwanpur district, Nepal, April 2019 – March 2020Results/ConclusionsThe total number of ED patients with injury in the study was 10,154.2,696 were patients aged <18 years. Most injuries in children were unintentional and over half of children presenting with injuries were <10 years of age. Falls, animal bites/stings and road traffic injuries accounted for nearly 75% of all injuries with some (drowning, poisonings and burns) under-represented. Over half of injuries were cuts, bites and open wounds. The next most common injury types were superficial injuries (14.2%); fractures (11.1%); sprains/dislocations (9.0%). Child mortality was 1%.This is the biggest prospective injury surveillance study in a low or middle country in recent years and supports the use of injury surveillance in Nepal for reducing child morbidity and mortality through improved data.CHILD PAPER: RESULTS SECTIONTotal number of ED patients: 33046Total number of ED patient with injury: 10154 (adult=7458 & children=2696)8.2% (n=2696) patients with injury were children aged <18 yearsHetauda hospital: 2274 (84.3%)Chure hill hospital: 422 (15.7%)

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Mesa, Ruben, Carole B. Miller, Maureen Thyne, James Mangan, Sara Goldberger, Salman Fazal, Xiaomei Ma, et al. "Gaps in Perception Between Patients and Physicians Regarding Symptomatology and Treatment Attitudes for Myeloproliferative Neoplasms: MPN LANDMARK SURVEY." Blood 124, no. 21 (December 6, 2014): 4827. http://dx.doi.org/10.1182/blood.v124.21.4827.4827.

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Abstract Background : Patients diagnosed with myeloproliferative neoplasms (MPNs), including myelofibrosis (MF), polycythemia vera (PV), and essential thrombocythemia (ET), experience disease burdens that can negatively affect their quality of life. Disconnects between patient and physician perceptions of disease burden or poor patient-physician communication may delay or prevent achievement of treatment goals. The MPN LANDMARK SURVEY is the first large US-based survey designed to evaluate disease burden and patient-physician communication in MPN disease settings. Methods : All eligible patients diagnosed with 1 of the 3 MPNs and physicians treating patients with MPNs that were recruited were surveyed in the US during May-July 2014.The surveys included ≤67 questions (depending on the type of MPN and respondent) and required approximately 20–25 minutes to complete. Descriptive analyses were conducted to identify gaps in perceptions of disease burden and patient-physician communication. Results : The MPN LANDMARK SURVEY was completed by 813 patients (MF=207; PV=380; ET=226) and 457 physicians. Approximately half of the patients were 60–74 years of age (MF, 55%; PV, 51%; ET, 46%), the majority were female (MF, 54%; PV, 62%; ET, 72%) and had a degree from a 4-year college or postgraduate institution (MF, 65%; PV, 65%; ET, 58%), and >98% had health insurance. The majority of physicians graduated from medical school 5–24 years before the survey (67%) and practiced in outpatient settings (single specialty groups, 42%; academic hospitals, 31%). Patient-physician communication gaps were identified in several important areas: (1) Prognostic assessment: most patients did not recall receiving a prognostic risk score, but most physicians reported classifying patients by prognostic risk (Table 1). (2) Symptom assessment: physicians were more likely than patients to report that physicians ask about patients' most important disease-related symptoms or about a full and comprehensive list of symptoms (Table 1). (3) Treatment goals: the most important treatment goals were different in MF (patients: delay disease progression; physicians: improve symptoms) and PV (patients: delay disease progression; physicians: prevent vascular/thrombotic events) settings (Table 2). Patients and physicians in the ET setting both reported that prevention of vascular/thrombotic events was the most important treatment goal. Patients and physicians in the MF and PV settings reported fatigue as the most pressing disease manifestation that patients would like to resolve (MF: patients, 47%; physicians, 65%; PV: patients, 33%; physicians, 31%), whereas patients and physicians differed in the ET setting (patients: fatigue, 33%; physicians: stroke, 29%). Most patients reported a desire to be ≥50% responsible for their treatment decisions (MF, 72%; PV, 71%; ET, 75%). Physicians reported that most patients sometimes or often did not wish to comply with their primary treatment recommendation (MF, 77%; PV, 84%; ET, 79%). (4) Treatment satisfaction: overall, more than one third of patients were somewhat satisfied or dissatisfied with their physician's communication about their condition and treatment (MF, 34%; PV, 43%; ET, 45%) and with their physician's overall management of their disease (MF, 36%; PV, 40%; ET, 42%). Among patients who changed their MPN doctor (MF, 47%; PV, 46%; ET, 56%), dissatisfaction with prior care received was the most frequently reported reason for the change (MF, 40%; PV, 37%; ET, 33%). Approximately one fifth to one fourth of patients included their doctor's office among the most helpful sources of information about their diagnosis (MF, 27%; PV, 22%; ET, 20%), and most patients included the internet among the most helpful sources (MF, 90%; PV, 87%; ET, 89%). Conclusion : Important disconnects exist between patients' and physicians' perceptions in MPN disease settings. In addition, the majority of physicians report classifying patients by prognostic risk, including PV and ET settings, which do not have widely accepted prognostic risk scores. Although physicians generally appreciate the burden that MPNs have on patients, patient management may be enhanced with improved elucidation of patient symptoms and clear communication regarding the goals and potential benefits of interventions. Disclosures Mesa: Incyte Corporation: Research Funding; CTI: Research Funding; Gilead: Research Funding; Genentech: Research Funding; Eli Lilly: Research Funding; Promedior: Research Funding; NS Pharma: Research Funding; Sanofi: Research Funding; Celgene: Research Funding. Miller:Incyte Corporation: Honoraria, Research Funding. Thyne:Incyte Corporation: Speakers Bureau. Mangan:Incyte Corporation: Membership on an entity's Board of Directors or advisory committees; Alexion Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees. Goldberger:Incyte Corporation: Membership on an entity's Board of Directors or advisory committees. Fazal:Incyte Corporation: Consultancy, Research Funding, Speakers Bureau; Gilead: Research Funding, Speakers Bureau. Ma:Incyte Corporation: Consultancy. Wilson:Incyte Corporation: Honoraria. Dubinski:Incyte Corporation: Employment, Equity Ownership. Boyle:ICF International: Employment, Equity Ownership. Mascarenhas:Novartis Pharmaceuticals: Research Funding; Incyte Corporation: Consultancy, Research Funding.

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Bangal, Dr Surekha V., Dr Bhushan Patil, and Dr Akshita Sharma. "Clinical Study of Risk Factors for Diabetic Maculopathy." VIMS Health Science Journal 8, no. 1 (March 18, 2021): 9–13. http://dx.doi.org/10.46858/vimshsj.8103.

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Aim: To determine the association between various systemic risk factors with diabetic maculopathy. Methodology: A prospective observational study was conducted on 50 patients having diabetic maculopathy. Patients with maculopathies secondary to Vitreous Haemorrhage, Ocular disorders like Glaucoma, Uveitis, Advanced Diabetic Eye Disease, Vitreo-macular traction, maculopathy along with proliferative diabetic retinopathy, ischemic maculopathy, and history of laser treatment in last six months were excluded from the study. Data was collected using a structured proforma that included name, age, sex, occupation, height, weight, history of other systemic diseases like hypertension, investigations and treatment taken in past, family history, duration of DM, smoking, hyperlipidemia, hyperglycemia and nephropathy. Results: Out of 50 patients, 38 (76%) were males and 12 (24%) were females suggestive of male predominance. Mean age of the patient was 57.36±11.65 years in males and 56.67±10.17 years in females. Among 50 patients, 19 patients had diabetes mellitus for 6-10 years duration, 14 patients had diabetes mellitus for 1-5 years, in 12 patients for 11-15 years, in 2 patients for 16-20 years, in 2 patients for 21-25 years and only 1 patient more than 25 years. Mean duration of DM was 12.2±6.1 years. Majority of patients having maculopathy had duration of DM up to 20 years. Among 50 patients, 27 patients (54%) had systemic hypertension, 37 patients (74%) had uncontrolled blood sugar level, 29 patients (58%) were found to have hyperlipidemia and 20 patients (40%) had nephropathy. Among 50 patients, pseudophakia was noted in 7 patients (14%), obesity was noted in 21patients (42%). Eleven patients (22%) were found to have anemia, 6 patients (12%) had family history of DM and 13 patients (26%) had history of smoking. Conclusion: Hyperglycemia, hypertension, duration of DM, hyperlipidemia are the major risk factors for the development and progression of diabetic maculopathy. While anemia, smoking, and obesity, family history of DM are the less significant risk factors.

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Eliašová, Adriana, Miroslav Repčák, and Andrea Pastírová. "Quantitative Changes of Secondary Metabolites of Matricaria chamomilla by Abiotic Stress." Zeitschrift für Naturforschung C 59, no. 7-8 (August 1, 2004): 543–48. http://dx.doi.org/10.1515/znc-2004-7-817.

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AbstractThe responses of young plants of diploid and tetraploid Matricaria chamomilla cultivars to abiotic stress were studied. The course of quantitative changes of main leaf secondary metabolites was evaluated within an interval from 6 h before to 54 h after spraying the leaf rosettes with aqueous CuCl2 solution. The content of herniarin in the treated plants rose approximately 3 times, simultaneously with a decline of its precursor (Z)- and (E)-2-β-ᴅ-glucopyranosyloxy- 4-methoxycinnamic acid. The highest amounts of umbelliferone in stressed plants exceeded 9 times and 20 times those observed in control plants of the tetraploid and diploid cultivar, respectively. Due to stress the concentration of ene-yne-dicycloether in leaves decreased by more than 40%. The pattern of quantity changes of the examined compounds in tetraploid and diploid plants was similar.

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Goodrick, I., and P. N. Nelson. "Mineralisation of soil organic carbon in two Andisols under oil palm: an incubation study into controlling factors." Soil Research 56, no. 1 (2018): 105. http://dx.doi.org/10.1071/sr16089.

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Understanding the factors controlling stability against mineralisation of soil organic matter is important for predicting changes in carbon stocks under changed environment or management. Soil carbon dynamics in oil palm plantations are little studied and have some characteristics that are unusual compared with other agricultural soils, such as high management-induced spatial variability and warm moist conditions. The aim of this work was to determine the factors controlling the mineralisability of the intermediate-stability carbon fraction of volcanic ash surface soils (0–5 and 15–20 cm depth) from oil palm plantations in Papua New Guinea. Soils with carbon contents of 2.2–35.2%, from areas with low and high organic matter inputs, were incubated for up to 812 days and soil respiration was measured periodically. Mean carbon turnover rates were 0.18–1.58, 0.07–0.23 and 0.03–0.07 a–1 on Days 54, 379 and 812 respectively. Turnover rate was initially (Day 54) correlated with pre-incubation total carbon content (r = 0.88), the ratio of permanganate-oxidisable carbon to total carbon (r = 0.62) and the ratio of oxalate-extractable Al and Fe to total carbon (r = –0.51 and –0.54 respectively), but the correlations decreased with time, being insignificant on Day 812. In the soils that had changed from C4 grassland 25 years previously, turnover rate was negatively correlated with δ13C, which increased with depth, but δ13C did not change significantly over the course of the incubation. Temperature sensitivity of mineralisation varied little, despite large differences in soil properties and changes in mineralisation rate. This suggested that turnover rates were affected to similar extents by biochemical recalcitrance and physical protection, as these two factors influence temperature sensitivity in opposing directions. Physico-chemical protection of organic matter appeared largely related to interaction with poorly crystalline Al and Fe oxides.

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Zufry, Hendra. "LAMA RAWATAN DAN DIRECT COST PASIEN KAKI DIABETIK TERAMPUTASIDI RS DR. ZAINOEL ABIDIN BANDA ACEH : PRE-ELIMINARY STUDY." AVERROUS: Jurnal Kedokteran dan Kesehatan Malikussaleh 4, no. 1 (September 27, 2018): 81. http://dx.doi.org/10.29103/averrous.v4i1.807.

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Kaki Diabetik adalah salah satu komplikasi Diabetes Mellitus (DM) yang sangat umum terjadi dan dapat menyebabkan infeksi, amputasi bahkan kematian. Amputasi sendiri menghabiskan banyak kerugian sehingga menjadi beban dalam pelayanan kesehatan. TujuanPenelitian ini bertujuan melihat gambaran lama rawatan dan direct cost pasien kaki diabetik teramputasi di RS Dr.Zainoel Abidin Banda Aceh.Metode Penelitian :Penelitian ini merupakan suatu pre-eliminary study yang bersifat deskriptif. Data pasien diambil dari rekam medis pasien. Setiap pasien akan dinilai tipe luka , masa rawatan dan biaya yang dihabiskan selama rawatan.Hasil : Dari 37 pasien yang menjalani amputasi , didapatkan rerata rawatan selama 15 hari dengan rerata biaya yang dihabiskan sebesar 45,5 juta rupiah. Dari keseluruhan, 5 orang (14%) memiliki tipe luka neuropati, 20 orang (54 %) tipe vaskulopati dan 12 orang (32%) tipe infeksi. Dari 5 orang pasien dengan luka neuropati, lama rawatan adalah 11 ± 7,19 hari dan rerata biaya yang dihabiskan sebesar 42,3 juta rupiah . Pada 20 pasien dluka vaskulopati, lama rawatan adalah 14 ± 6,95hari serta rerata biaya yang dikeluarkan adalah 41,1 juta rupiah. Sedangkan 12 pasien luka infeksi, didapatkan rerata lama rawatan adalah 17 ± 8,13 hari dengan rerata biaya sebesar 54 juta rupiah Kesimpulan : Hasil penelitian ini memperlihatkan bahwa rerata masa rawatan dan rerata biaya rawatan pasien ulkus diabetikum yang menjalani amputasi di RS dr.Zainoel Abidin pada tahun 2017 cukup tinggi. Akan tetapi untuk masing – masing tipe luka, lama masa rawatan dan biaya yang dikeluarkan tidak terlalu jauh berbeda.

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Afsharian, Parvaneh, Ylva Terelius, Stefan Lundgren, and Moustapha Hassan. "The Effect of Repeated Administration of Cyclophosphamide on CYP2B1 and 2B2 in Rat." Blood 106, no. 11 (November 16, 2005): 4460. http://dx.doi.org/10.1182/blood.v106.11.4460.4460.

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Abstract Cyclophosphamide is used in high doses as a part of the conditioning regimen prior to stem cell transplantation. It is usually given for two or four consecutive days, primarily to facilitate engraftment of donor cells. Cyclophosphamide is a prodrug that is activated in liver by a 4-hydroxylation reaction catalyzed by cytochrome P450 (CYP) enzymes. Several studies have shown that cyclophosphamide induces its own metabolism, which affects its pharmacokinetic parameters after repeated dose (Chang TK, Yu L et al. Cancer Res1997; 57:1946–54 and Schuler U, Ehninger G et al. Cancer Chemother Pharmacol1987; 20:248–52). In the present study, we aimed to investigate the effect of repeated doses of cyclophosphamide on the CYPs in rat. mRNA, protein, and enzyme activity levels were investigated. Animals received (200 mg/kg, i.v.) at time 0, 20, 48 h. Additionally another group of animals was treated at 0, 6, 20, 26, 48 and 54 h. At each time point three animals were killed 30 min after the administration (Xie H, Afsharian P et al. Xenobiotica2005; 35:239–51). mRNAs of CYP2B1 and 2B2 were significantly induced up to 458- and 8.3-fold at 6h, 983- and 102-fold at 26 h, and 342- and 33-fold at 54 h. CYP2B protein levels were increased and their peaks was observed at 20 and 48 h. Microsomal activity of CYP2B was determined at three different concentration of cyclophosphamide (1, 0.5, 0.1 mM) by measuring the formation rate of 4-hydroxy-cyclophosphamide (4-OH-CPA). The microsomal activity increased as reflected in an increase in cyclophosphamide 4-hydroxylation at all concentrations used using microsomes from rats treated at 6, 20 and 48 h. A significant increase of 4-hydroxylation of cyclophosphamide (0.1 mM) by 2.9-, 4.4- and 4.2- fold, respectively compared to the control rats. However, a decrease in the hydroxylation rate was observed using microsomes from rats treated at 26 and 54 h and in all concentrations used that might due to hepatotoxicity effect of cyclophosphamide when administered in short time period of repeated dose. A significant (p<0.05) decrease in CPA concentration and a significant (p<0.05) increase in its metabolite (4-OH-CPA) level in plasma were observed with repeated administration of CPA. In conclusion, an induction effect on CYP2B and a substantial up regulation of its mRNA expression were observed after repeated administration of CPA. This information can have a high clinical importance when a dosing schedule for cyclophosphamide considering the polymorphism of CYPs in cancer patient.

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Fudge, Tyler J., David A. Lilien, Michelle Koutnik, Howard Conway, C. Max Stevens, Edwin D. Waddington, Eric J. Steig, Andrew J. Schauer, and Nicholas Holschuh. "Advection and non-climate impacts on the South Pole Ice Core." Climate of the Past 16, no. 3 (May 7, 2020): 819–32. http://dx.doi.org/10.5194/cp-16-819-2020.

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Abstract. The South Pole Ice Core (SPICEcore), which spans the past 54 300 years, was drilled far from an ice divide such that ice recovered at depth originated upstream of the core site. If the climate is different upstream, the climate history recovered from the core will be a combination of the upstream conditions advected to the core site and temporal changes. Here, we evaluate the impact of ice advection on two fundamental records from SPICEcore: accumulation rate and water isotopes. We determined past locations of ice deposition based on GPS measurements of the modern velocity field spanning 100 km upstream, where ice of ∼20 ka age would likely have originated. Beyond 100 km, there are no velocity measurements, but ice likely originates from Titan Dome, an additional 90 km distant. Shallow radar measurements extending 100 km upstream from the core site reveal large (∼20 %) variations in accumulation but no significant trend. Water isotope ratios, measured at 12.5 km intervals for the first 100 km of the flowline, show a decrease with elevation of −0.008 ‰ m−1 for δ18O. Advection adds approximately 1 ‰ for δ18O to the Last Glacial Maximum (LGM)-to-modern change. We also use an existing ensemble of continental ice-sheet model runs to assess the ice-sheet elevation change through time. The magnitude of elevation change is likely small and the sign uncertain. Assuming a lapse rate of 10 ∘C km−1 of elevation, the inference of LGM-to-modern temperature change is ∼1.4 ∘C smaller than if the flow from upstream is not considered.

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An, Gaili, Li He, Xifang Wang, Yu Lei, Dejian Gu, Rongrong Chen, Xuefeng Xia, and Jun Bai. "Molecular characteristics of EGFR exon 20 uncommon R776H mutation and response to osimertinib in NSCLC patients." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e21001-e21001. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e21001.

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e21001 Background: EGFR R776H is an uncommon exon 20 mutation in non-small cell lung cancer (NSCLC) patients. This mutation was first reported in samples after first generation EGFR TKI treatment as an acquired resistant mutation to first generation of EGFR-TKI. We further analyzed the molecular characteristics of patients with EGFR R776H mutation and its correlation with EGFR TKI therapy. Methods: In this study, a total of 16131 NSCLC patients from multiple centers with NGS data were retrospectively analyzed to study the molecular characteristics and clinical outcomes of patients with EGFR R776H mutation. Results: 44 of the 16131 patients (0.27%) had EGFR R776H mutation, and 28 of them (63.6%) were treatment-naïve while performing the mutation test. TP53 was the most common concomitant mutation in both treatment-naïve (57.1%) and treated (81.3%) patients. EGFR R776H mutation was found to coexist with multiple types EGFR mutation. The common mutations were EGFR L858R (54%) and EGFR G719A/S (25%), but It almost never coexists with 19del (2%). The coexist of EGFR R776H mutation was similar in both treatment-naïve and treated patients. In 16 of treated patients, all had received first - or second-generation EGFR TKI treatment, and the median progression-free survival (PFS) was 9 months. Interestingly, four of them found the presence of not only EGFR R776H but also EGFR T790M. It may be that EGFR R776H and T790M appear together in drug resistance, or it may be that EGFR R776H and EGFR sensitive mutation are not in the same cell clone. Two patients with EGFR R776H received treatment of Osimertinib and achieved partial response. The PFS of two patients in Osimertinib were 11 and 10 months, respectively. Moreover, EGFR C797S mutation was detected in two patients after resistant to Osimertinib. Conclusions: Presence of EGFR R776H mutation was rare in NSCLC patients and our retrospective study provides clinical evidence that Osimertinib could be of benefit and may potentially be an effective treatment strategy to improve survival outcomes in patients with EGFR R776H.

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Imaña-Encinas, José, Milton Serpa de Meira-Junior, Roberto Cervantes-Proaño, and Otacílio Antunes-Santana. "Abundancia, peso específico y diversidad funcional de un fragmento del bosque estacional semi deciduo de la Región Central del Brasil." Revista Forestal Mesoamericana Kurú 14, no. 34 (December 14, 2016): 37. http://dx.doi.org/10.18845/rfmk.v14i34.3000.

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Se estudió un fragmento de un bosque estacional semi deciduo de aproximadamente 10 ha, localizado en la hacienda Raio de Sol (15º 45’ 54’’ S y 49º 04’ 03’’ W) próxima a la ciudad de Pirenópolis (Goiás), en la bio región del Eco-Museo del Cerrado. Se distribuyeron sistemáticamente diez parcelas de 20 x 20 m. Se midieron todos los árboles vivos con DAP igual o superior a 5 cm. Se encontraron 742 individuos arbóreos, pertenecientes a 38 familias y 83 especies. Las familias de mayor riqueza florística fueron en el orden respectivo Leguminosae, Rubiaceae, Myrtaceae, Apocynaceae y Chrysobalanaceae. Las especies de mayor abundancia poblacional fueron Protium heptaphyllum (Aubl.) March (11,8 %), y Tapirira guianensis Aubl. (8,3 % de la población). 46 % de las especies mostraron poseer madera de dureza entre 0,61 y 0,75 g/cm3. Se identificaron seis grupos de diversidad funcional, grupo 1: formado por especies pioneras de dispersión autocoria, grupo 2: especies secundarias iniciales con dispersión zoocoria, grupo 3: especies secundarias tardias con dispersión zoocoria, grupo 4: especies pioneras y dispersión zoocoria, grupo 5: especies pioneras y dispersión anemocoria, y grupo 6: especies secundarias iniciales y tardias con dispersión anecoria.

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Beroeva, M. R., and A. M. Mkrtumyan. "The Prevalence of Diabetes Mellitus Type 2 in the Adult Population of Tskhinval." Effective Pharmacotherapy 16, no. 25 (September 30, 2020): 20–23. http://dx.doi.org/10.33978/2307-3586-2020-16-25-20-23.

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Summary: аssessment of the prevalence of type 2 diabetes mellitus (DM2) in the adult population of Tskhinval, Republic of South Ossetia. Material and methods. The outpatient records of 811 patients registered with the endocrinologist of the municipal polyclinic with a diagnosis of DM2 were analyzed. The study took into account outpatient records of 478 women and 333 men. To obtain a representative sample, patients (aged 38 to 93 years) were stratified by age, gender, and body mass index. The level of glycemia and the year of occurrence in the initial setting of DM2 were also taken into account. Results. The average age at the diagnosis of DM2 in women was higher than in men (62 and 57 years, respectively). The prevalence of DM2 in relation to gender was higher in women than in men (59 and 41%). At the age of 51–58 years, the largest number of newly detected cases of DM2 was observed. Conclusions. The prevalence of DM2 among the population of Tskhinval is 4.4%. Given the data from the NATION study that only 54% of cases of DM2 are diagnosed, the number of patients with DM2 in Tskhinval may be about 2.5 thousand people (about 8.1% of the urban population). The obtained data should form the basis of the service for medical examination of the population, prevention and treatment of DM2 in the Republic of South Ossetia

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Marzocchi, M., R. T. Brouillette, L. M. Klemka-Walden, S. L. Heller, D. E. Weese-Mayer, B. S. Brozanski, J. Caliendo, M. Daood, M. N. Ilbawi, and C. E. Hunt. "Effects of continuous low-frequency pacing on immature canine diaphragm." Journal of Applied Physiology 69, no. 3 (September 1, 1990): 892–98. http://dx.doi.org/10.1152/jappl.1990.69.3.892.

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Although diaphragm pacing has been shown to be a practical method of supporting ventilation in children, its usefulness has been limited because of concern that continuous (24 h/day) diaphragm pacing would fatigue and damage the diaphragm. We examined the functional and structural effects of continuous low-frequency diaphragm pacing on the left hemidiaphragm of five immature dogs aged 65 +/- 2 (SD) days at onset of pacing. Stimulus parameters approximated those required to pace infants: frequency 11.1 Hz, inspiratory time 810 ms, and respiratory rate 20 breaths/min. Animals were paced 24 h/day for 24-28 days. Paced tidal volumes and airway occlusion pressures were unchanged at low (less than 15 Hz) stimulus frequencies but were reduced at high (greater than 20 Hz) stimulus frequencies. Although histologically the paced hemidiaphragms appeared normal, histochemical studies showed a conversion from a mixture of type I (54%) and type II (46%) fibers to a uniform population of type I fibers with high oxidative enzyme activity. Transformation of muscle type was also demonstrated by pyrophosphate gel electrophoresis; fast and slow isomyosin bands were noted in control specimens, whereas only slow isomyosin was identified in paced specimens. Thus, in immature dogs, continuous low-frequency pacing affects both function and structure of the diaphragm.

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Hobbs, S. F., U. T. Oh, M. J. Chandler, and R. D. Foreman. "Cardiac and abdominal vagal afferent inhibition of primate T9-S1 spinothalamic cells." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 257, no. 4 (October 1, 1989): R889—R895. http://dx.doi.org/10.1152/ajpregu.1989.257.4.r889.

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Effects of electrically stimulating vagal afferents were determined on lumbosacral spinothalamic tract (STT) neurons in the T9-S1 segments. Stimulating left or right vagal afferents inhibited 20 (50%) and excited 4 (10%) of 40 STT neurons. Vagal stimulation reduced activity of the 20 inhibited cells by 71 +/- 6% and reduced the average activity of all 40 STT neurons by 28% from 11.5 +/- 1.3 to 8.3 +/- 1.4 impulses/s (P less than 0.01). Effects of activating thoracic and abdominal or just abdominal vagal afferents were also determined. Stimulating right abdominal vagal afferents inhibited 4 (11%), excited 1 (3%), and did not affect 30 (86%) of the STT neurons and overall did not significantly affect STT cell activity. In contrast, in 33 of these cells stimulation of afferents in the right cervical vagus inhibited 16 (48%), excited 2 (6%), and did not affect 15 (45%) neurons and overall significantly reduced cell activity by 29% (P less than 0.01). These data and those of Ammons et al. (J. Neurophysiol. 50: 926-940, 1983; Circ Res. 53: 603-612, 1983; J. Neurophysiol. 54: 73-89, 1985) suggest that cardiopulmonary but not abdominal vagal afferent input reduces STT cell activity in many spinal segments. This inhibitory vagal reflex may play a role in protecting the heart.

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Blinnik, А. S., A. G. Demidova, L. А. Naumkina, О. Yu Kurenskaya, and М. I. Lukashevich. "The testing results of the new white lupine varieties and samples in the forest-steppe conditions of the Central Blackearth region." Grain Economy of Russia, no. 3 (July 8, 2021): 51–56. http://dx.doi.org/10.31367/2079-8725-2021-75-3-51-56.

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The variety study of white lupine plants in the Belgorod region was carried out in field trials at the collection nursery of department of plant production, breeding and olericulture of the Belgorod State Agrarian University named after V.Ya. Gorin in 2018–2019. In the trial there were studied 4 varieties and 26 samples of white lupine of grain-fodder selection developed by the All-Russian Research Institute of Lupine, the variety ‘Michurinsky’ was taken as a standard one. Most of the samples in the trial significantly exceeded the standard variety in the value of seed productivity. In 2018 the highest yield of 4.86 t/ha was obtained from the sample ‘CH 40-15’, which was on 1.15 t/ha higher than that of the standard variety. A high yield from 4.19 to 4.82 t/ha was produced by the samples ‘СН 78-16’, ‘СН 20-13’, ‘СН 15-13’ and ‘СН 816-09’, which significantly exceeded the standard variety on 0.48–0.61 t/ha. Under the conditions of the year of 2019, a significant productivity increase (from 0.24 to 2.1 t/ha) in comparison with the standard variety was produced by 19 samples and two varieties ‘Pilgrim’ and ‘Timiryazevsky’. The largest productivity in the trial (5.26 and 5.24 t / ha) was produced by the samples ‘CH 54-08’ and ‘CH 12-13’. The yield increase of the samples ‘СН 77-17’, ‘СН 816-09’, ‘СН 1735-10’, ‘СН 17-14’ was 1.35–1.57 t/ha in comparison with the standard variety. The highest mean yield in the trial for 2 years (4.40–4.47 t/ha) was formed by the samples ‘СН 17-14’ and ‘СН 816-09’, their increase was 0.96–1.03 t/ha or 27.9–29.9% in comparison with the standard variety. The samples ‘СН 12-13’ and ‘СН 54-08’ showed the highest coefficient of adaptability in the trial at the level of 1.36–1.38. The most of the studied samples and the variety ‘Alyi Parus’ possessed the coefficient of adaptability >1, which characterizes them as highly adaptable to the arid conditions of the region. The most varieties and samples exceeded the standard value of the trait ‘seed weight per plant’ which is 4 g. The value of the trait ‘1000-seed weight’ in the trial varied from 234.8 g (the sample ‘CH 35-13’) to 302.6 g (the sample ‘CH 25-11’) in comparison with 264 g (the standard variety).

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Hill-Kayser, Christine E., Carolyn Vachani, Isabella Amaniera, Christina Bach, Karen Arnold-Korzeniowski, Margaret K. Hampshire, and James M. Metz. "Survivorship care engagement with American Indian and Alaska Native survivors of gastrointestinal (GI) cancers." Journal of Clinical Oncology 38, no. 4_suppl (February 1, 2020): 814. http://dx.doi.org/10.1200/jco.2020.38.4_suppl.814.

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814 Background: American Indian and Alaska Native (AI/AN) survivors are at significant risk for GI cancers, and also represent an underserved medical population. Gastrointestinal cancers represent the third most commonly diagnosed cancers in the AI/AN population and are a leading cause of death. Survivorship resources tailored for the AI/AN population are sparse and patterns of survivorship care poorly understood. Methods: The OncoLife survivorship care plan has been through the OncoLink website since 2007. The tool is free and publically available. It asks survivors to enter data regarding diagnosis, demographics, and treatments, and provides customized guidelines for future care. All research is IRB approved. Results: Over the past 12 years, the OncoLife tool has been utilized by >85,000 persons, with survivors of GI cancer representing 10-12% of users each year. Most users are women (75%) and Caucasian (80%). American Indian and Alaska Native survivors represent <1% of users since the launch of the tool. Of 519 AI/AN users, median age was 54 years, and 76% identified as female. Of plans created for AI/AN survivors, 13% were for survivors of GI cancers, with the most common GI diagnosis being colorectal cancer (74%), followed by pancreas (11%) and anal (6%). Most plans (73%) were created by HCP, with the remainder by survivors themselves; 20% of AI/ AN users completing plans requested information on smoking cessation as part of their care plan. Conclusions: American Indian and Alaska Native survivors represent a very small minority of survivors utilizing this free Internet-based tool, with most plans for this population being created by healthcare providers and not by survivors themselves. Future efforts should be directed at supporting this underserved population with survivorship information, particularly given high risk of morbidity and mortality related to GI cancers.

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Heist, Rebecca Suk, Xiaofei F. Wang, Lydia Hodgson, Gregory Alan Otterson, Tom Stinchcombe, Everett E. Vokes, and Mark A. Socinski. "CALGB 30704: A randomized phase II study to assess the efficacy of pemetrexed or sunitinib or pemetrexed plus sunitinib in the second-line treatment of advanced non-small cell lung cancer (NSCLC)." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 7513. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.7513.

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7513 Background: Second line chemotherapy improves survival modestly and new strategies are needed. This trial was designed to evaluate the paradigm of an anti-VEGF strategy with or without standard chemotherapy in previously treated NSCLC. Methods: Patients with Stage IIIB/IV NSCLC, PS 0-1 progressive after first-line chemotherapy were eligible for randomization to P (pemetrexed 500 mg/m2 d1), S (sunitinib 37.5 mg d1-21), or P+S (pemetrexed 500 mg/m2 d1 + sunitinib 37.5 mg d1-21). Pts were stratified by PS (0/1), stage (IIIB/IV), and gender (M/F). Primary objective was 18-week PFS rate; secondary objectives were response, OS, and toxicity. Target accrual was 225. The study was terminated early due to decreasing accrual rates. Results: Between 4/08 and 9/11, 130 pts registered; 128 pts treated (P=41, S=46, P+S=41). Median follow-up 99 weeks. Baseline characteristics in the three arms (P/S/P+S) were well balanced: Male (54%/54%/54%); PS 0 (32%/35%/34%); Stage IV (88%/83%/93%). Histology was predominantly adenocarcinoma (66%/57%/66%); squamous was allowed (10%/15%/15%). Toxicity was higher in the S-containing arms: Grade 3/4/5 hematologic toxicity: P 5/0/0 (12%), S 8/1/0 (21%), P+S 5/9/0 (36%); Grade 3/4/5 non-hematologic toxicity (excluding disease related deaths): P 6/2/0 (20%), S 21/3/1 (58%), P+S 21/3/1 (63%). The 18-week PFS rate in the three arms was: P 51% (38-69), S 36% (24-54), P+S 47% (34-65). There is an overall statistically significant difference in OS between the three arms (2-sided p=0.0179) with HR 0.65 (95%CI: 0.38-1.13) for P/S; HR 0.47 (95%CI: 0.27- 0.82) for P/P+S. Median OS was 10.5 mo (8.3-22.5) for P, 7.0 mo (6.0-13.0) for S, 6.7 (4.1-10.4) mo for P+S. Median PFS was 4.4 mo (1.7-8.8) for P, 3.3 mo (2.7-4.3) for S, 3.7 mo (2.5-4.3) for P+S (p=0.3). Fewer patients in the P+S arm received any subsequent therapy (29%) than either P (54%) or S (57%). Conclusions: Pemetrexed had a superior toxicity profile to either sunitinib or the combination of pemetrexed and sunitinib. OS was significantly better with P alone compared to the two S-containing arms, with P+S performing worst for OS.

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Renshaw, Andrew A., and Edwin W. Gould. "Reducing False-Negative and False-Positive Diagnoses in Anatomic Pathology Consultation Material." Archives of Pathology & Laboratory Medicine 137, no. 12 (December 1, 2013): 1770–73. http://dx.doi.org/10.5858/arpa.2013-0012-oa.

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Context.—Previous studies have shown that there are disagreements in interlaboratory consultation, including false-negative and false-positive diagnoses. To date, methods to reduce false-negative and false-positive diagnoses have been poorly documented. Objective.—To identify features associated with false-negative and false-positive diagnoses in anatomic pathology. Design.—We reviewed the results of interlaboratory consultation in our institution during a 9-year period. For false-negative and false-positive diagnoses, methods that might have prevented the error were identified. Results.—Disagreements were identified in 810 of 8082 consults (10%). Fifty-four false-negative cases (0.7% of all consults) and 27 false-positive cases (0.3%) were identified. False-negative cases were more common in breast (20 of 1131; 1.8%), genitourinary (16 of 970; 1.7%), hematologic (3 of 242; 1.3%), and cytology (3 of 404; 0.8%) than in all other sites combined (P < .001); no significant difference in sites were identified for false-positive cases. Overall, there was no difference in the percentage of cases that were reviewed by more than one pathologist in either false-negative cases (109 of 810; 13.5%) or false-positive cases (135 of 810; 16.7%), compared with all other consults (858 of 7272; 11.8%) (P = .74 and .59, respectively). However, on review, 12 of all 27 false-positive cases (44%) might have been prevented by the use of immunohistochemistry alone, and 36 of all 54 false-negative cases (67%) might have been prevented by the use of a second review; special stains, including immunohistochemistry; additional levels; changes in processing; and hedges. Conclusion.—Approximately one-half of false-negative and false-positive cases (48 of 81; 59%) might be preventable by the use of a combination of pathologic methods.

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Derion, T., H. J. Guy, K. Tsukimoto, W. Schaffartzik, R. Prediletto, D. C. Poole, D. R. Knight, and P. D. Wagner. "Ventilation-perfusion relationships in the lung during head-out water immersion." Journal of Applied Physiology 72, no. 1 (January 1, 1992): 64–72. http://dx.doi.org/10.1152/jappl.1992.72.1.64.

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Water immersion can cause airways closure during tidal breathing, and his may result in areas of low ventilation-perfusion (VA/Q) ratios (VA/Q less than or equal to 0.1) and/or shunt and, ultimately, hypoxemia. We studied this in 12 normal males: 6 young (Y; aged 20–29 yr) with closing volume (CV) less than expiratory reserve volume (ERV), and six older (O; aged 40–54 yr) with CV greater than ERV during seated head-out immersion. Arterial and expired inert gas concentrations and dye-dilution cardiac output (Q) were measured before and at 2, 5, 10, 15, and 20 min in 35 degrees C water. During immersion, Y showed increases in expired minute ventilation (VE; 8.3–10.3 l/min), Q (6.1–8.2 l/min), and arterial PO2 (PaO2; 91–98 Torr; P less than or equal to 0.05). However, O2 uptake (VO2), shunt, amount of low-VA/Q areas (% of Q), and the log standard deviation of the perfusion distribution (log SDQ) were unchanged. During immersion, O showed increases in shunt (0.6–1.8% of Q), VE (8.5–11.4 l/min), and VO2 (0.31–0.40 l/min) but showed no change in low-VA/Q areas, log SDQ, Q, or PaO2. Throughout, O showed more VA/Q inequality (greater log SDQ) than Y (O, 0.69 vs. Y, 0.47).(ABSTRACT TRUNCATED AT 250 WORDS)

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U., Bisrat. "Investigation of Major Factors That Cause Skin and Hide Rejection in Ethiopia: The Case of Tanneries in Addis Ababa and Modjo Towns." Journal of Africa Leather and Leather Producuts Advances 1, no. 1 (July 8, 2014): 35–44. http://dx.doi.org/10.15677/jallpa.2014.v1i1.7.

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A study was conducted from May 2013 to September 2013 with the objective of identifying the major causes of skin and hide rejection on wet blue skins and hides in AA and Modjo tanneries. A total of 769 rejected skins and hides out of which 272 wet blue sheep skins, 275 goat wet blue skins and 222 cattle hides were examined for the major defects that cause rejection. For sheep skins ekek 110(40.3%), scratch 54(19.9%), wound 54(19.4%), scar 23(8.3%), flay cut, machine defect, and pox each 11(4.2% and putrefaction4(1.4%)) were major causes of sheep skin rejection.. In goats skin, scratch 95(34.7%) was the dominant cause of rejection followed by scar 62(22.7%), ekek 49(18.1%),, flying defect 22(8%) and pox14(5.3%). In cattle hide, putrefaction 98(44.2%), flying cuts 58(26.2%), ekek 33(14.8%),Scratch 20(9%), branding 6(2.5%)were major causes of hide rejection. In sheep skin diseases such as Ekek and scratch caused high rejection of skin and entailed serious economic loss in terms of foreign exchange earning to Ethiopia. Therefore, this main cause of sheep skin rejection and factors that cause rejections should be controlled. where as in goat skins serious issue is scratch responsible for rejection. This study revealed that ekek, scratch, wound and scar, putrefaction and flay cuts were major causes of skin and hide rejection and this suggests out of six major defects four (67%) are pre-slaughter defects and there need to be integrated efforts towards improved livestock extension and husbandry and better health care which are vital issues for production of better quality hide and skin.

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Airoldi, Mario, Fulvia Pedani, Sara Marchionatti, Anna Maria Gabriele, Giovanni Succo, Pietro Gabriele, and Cesare Bumma. "Carboplatin plus Taxol is an Effective Third-line Regimen in Recurrent Undifferentiated Nasopharyngeal Carcinoma." Tumori Journal 88, no. 4 (July 2002): 273–76. http://dx.doi.org/10.1177/030089160208800405.

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Background Recurrent undifferentiated nasopharyngeal carcinoma is a chemosensitive disease. Few third-line treatments have been reported. Methods Twelve patients (9 males, 3 females; median age 50 years, range, 20-62) with recurrent undifferentiated nasopharyngeal carcinoma were treated with carboplatin AUC 5.5 + paclitaxel (175 mg/m2, 3-hr infusion) on day 1 every 3 weeks. All patients had been previously treated for recurrent disease with a first-line cisplatin-based chemotherapy and a second-line therapy with low-dose continous infusion 5-fluorouracil. Results Overall, 54 courses were given (median, 5; range, 2-6). Three patients (25%) obtained a partial response lasting 6, 10 and 26+ months, 1 (8.3%) a minimal response lasting 6 months, and 3 (25%) no change with a median duration of 5 months. The median survival time was 14 months for patients who had a partial or minimal response or no change, and 5 months for nonresponders. Median overall survival was 9.5 months (3-30+). The treatment was well tolerated, and toxicity was manageable. Conclusions The combination has a good pallitive role as third-line chemotherapy in recurrent undifferentiated nasopharyngeal cancer.

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Zhakiyev, Bazylbek, Murat Jakanov, Bernat Zhanabaev, Anuar Koyshibaev, Samat Mukanov, and Aliya Aitbayeva. "Mini-invasive revascularization operations in the complex treatment of neuroischemic and ischemic forms of diabetic foot syndrome." Bangladesh Journal of Medical Science 20, no. 4 (June 18, 2021): 817–25. http://dx.doi.org/10.3329/bjms.v20i4.54140.

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Objective: Diabetic foot syndrome is the most dramatic complication of diabetes mellitus. The treatment success is impossible without improving blood circulation and the elimination of hemodynamic disorders in the affected limb.The study aim was to evaluate mini-invasive revascularization operations effectiveness on the lower limbs peripheral arteries in neuro-ischemic and ischemic diabetic foot syndrome forms. Materials and methods: The study enrolled 104 patients with purulent-necrotic complications of diabetic foot syndrome. 54 (51.9%) patients underwent stenting and balloon angioplasty (the main group). The comparison group included 50 (48.1%) patients, undergoing indirect revascularization surgeries in complex treatment. Results and discussion:After endovascular interventions, the API index increased by 47.6% (p<0.01) after 20 days compared to the admission index, the average blood flow rate increased by 1.8 times (p<0.01), and the tPo2 value improved by 67.8% (p<0.01). In the control group, the tPo2 value increased by 40.3% after 20 days, and API – by 34.4%. In the main group, the swelling disappearance in the foot wounds area was by 3.7±0.5 days faster (p<0.001), wounds purification by 4.1 days (p<0.001), granulation appearance by 3.5±0.4 days (p<0.001), wound margins infiltration disappearance happened 3.3±0.9 days earlier (p<0.001), and the wound epithelization was 2.9 days earlier (p<0.01) than in the control group patients. Conclusion: Foot support function at discharge from hospital was preserved in 94.4% of the main group and in 84% of the control group. Bangladesh Journal of Medical Science Vol.20(4) 2021 p.817-825

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Brooke, J. D., J. Cheng, J. E. Misiaszek, and K. Lafferty. "Amplitude modulation of the soleus H reflex in the human during active and passive stepping movements." Journal of Neurophysiology 73, no. 1 (January 1, 1995): 102–11. http://dx.doi.org/10.1152/jn.1995.73.1.102.

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1. It was hypothesized that passive movement of either the whole leg or its separate segments, in a manner mimicking human gait, leads to attenuation of the soleus H reflex. It was further hypothesized that this attenuation arises from presynaptic effects. Reflex amplitudes were observed in humans during natural bipedal and unipedal stepping on the spot, during passive stepping, during passive movement of the lower limb segments about the hip, knee, and ankle individually in a stepping fashion, and during passive movement with tonic contraction of the soleus muscle. 2. In natural stepping at a cadence of 54 steps/min, the reflex means were substantially depressed in the swing phase (P < 0.01). (Means, standing control 90.1%, unipedal 8.3%, bipedal 6.9%, of maximum M wave.) During the stance phase, reflex magnitudes were mildly and significantly elevated in four of six subjects, compared with standing controls (P < 0.05). 3. For passive stepping, subjects were dorsally tilted 20 and 90 degrees (lying supine) from the vertical position, to obtain quiet electromyograms (EMGs) in the postural muscles. Recorded during natural stepping, the right leg was manipulated to match the electrogoniometer traces of the three major joints. 4. At 20 degrees of tilt of the body, mean H reflexes were significantly lower, by 26.4%, compared with the supine position (P < 0.05). During passive stepping movement of the leg at 54 steps/min, the reflex was profoundly attenuated over the entire cycle (P < 0.01). The significantly attenuated reflexes during active stepping and during passive stepping movement of the whole leg were not significantly different at the point where the limb approached full flexion in the swing phase (P > 0.48). This was the case for measurements made at either body position, 20 degrees dorsal tilt or supine. 5. Passive flexion-extension, around either the hip or the knee, significantly inhibited the mean reflex magnitude close to full flexion, at either body position (P < 0.01). Such movement around the ankle resulted in significant inhibition of the reflex in two of the four subjects (P < 0.05). The numeric sum of the reflex depression arising from the flexion-extension of the individual joints was greater than that arising from movement of the whole limb. 6. With the ankle braced, the significant reflex attenuation remained when a tonic isometric contraction of the soleus muscle was introduced. This suggests premotoneuronal mechanisms for the inhibition.(ABSTRACT TRUNCATED AT 400 WORDS)

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Bland, B. H., J. Konopacki, I. J. Kirk, S. D. Oddie, and C. T. Dickson. "Discharge patterns of hippocampal theta-related cells in the caudal diencephalon of the urethan-anesthetized rat." Journal of Neurophysiology 74, no. 1 (July 1, 1995): 322–33. http://dx.doi.org/10.1152/jn.1995.74.1.322.

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1. Single-unit discharge patterns of cells in specific nuclei of the caudal diencephalon were characterized in relation to simultaneously recorded field activity from the stratum moleculare of the dentate gyrus according to the criteria that have been used previously to classify cells in the hippocampal formation (including entorhinal cortex), medial septum, and cingulate cortex. Theta (theta)-related cells were classified as 1) tonic theta-ON, if they discharged nonrhythmically and increased their discharge rates during hippocampal theta relative to large, irregular hippocampal field activity (LIA); 2) tonic theta-OFF, if they discharged nonrhythmically and decreased their discharge rates during theta relative to LIA; or 3) phasic theta-ON, if they discharged rhythmically and in phase with ongoing theta, but nonrhythmically during LIA. Cells not meeting any of the above criteria were classified as nonrelated. 2. Recordings were obtained in a total of 127 cells from the caudal diencephalon. Recordings were made in 54 cells from the posterior hypothalamic nucleus (PH), 16 from the supramammillary nucleus (SuM), 20 from the PH/SuM border, and 23 from the medial mammillary nucleus (MM). Recordings were also made from nine cells from the central medial nucleus of the thalamus (CM) and five from the dorsomedial hypothalamic nucleus (DMH). 3. Of the 54 PH cells, 43 (80%) were classified as tonic theta-ON and 11 (20%) as nonrelated. Tonic theta-ON cells in the PH discharged at significantly higher rates during theta, either occurring spontaneously (9.6 +/- 1.7 Hz, mean +/- SE) or elicited with a tail pinch (TP theta; 10.6 +/- 1.9 Hz), than during LIA (3.6 +/- 1.4 Hz). Of the nine CM cells, seven (78%) were tonic theta-ON and two (22%) were nonrelated. Tonic theta-ON cells discharged at significantly higher rates during theta (17.5 +/- 7.8 Hz) or TP theta (18.0 +/- 7.1 Hz) than during LIA (7.3 +/- 4.8 Hz). All DMH cells were nonrelated. 4. Of the 20 PH/SuM border cells, 15 (75%) were classified as tonic theta-OFF and discharged at significantly higher rates during LIA (5.3 +/- 1.5 Hz) than during theta (0.8 +/- 0.4 Hz) or TP theta (0.4 +/- 0.3 Hz). Five (25%) cells in the PH/SuM border were nonrelated. 5. All of the 16 cells (100%) recorded from the body of the SuM were phasic theta-ON. The discharge rates of these cells did not change significantly across hippocampal field states (LIA = 8.3 +/- 1.6; theta = 7.3 +/- 1.6; TP theta = 8.6 +/- 1.7 Hz).(ABSTRACT TRUNCATED AT 400 WORDS)

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Pérez-Ferrer, Carolina, Anne McMunn, Paola Zaninotto, and Eric J. Brunner. "The nutrition transition in Mexico 1988–2016: the role of wealth in the social patterning of obesity by education." Public Health Nutrition 21, no. 13 (May 10, 2018): 2394–401. http://dx.doi.org/10.1017/s1368980018001167.

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AbstractObjectiveThe present study investigates whether the reversal of the social gradient in obesity, defined as a cross-over to higher obesity prevalence among groups with lower education level, has occurred among men and women in urban and rural areas of Mexico.DesignCross-sectional series of nationally representative surveys (1988, 1999, 2006, 2012 and 2016). The association between education and obesity was investigated over the period 1988–2016. Effect modification of the education–obesity association by household wealth was tested.SettingMexico.SubjectsWomen (n 54 816) and men (n 20 589) aged 20–49 years.ResultsIn both urban and rural areas, the association between education and obesity in women varied by level of household wealth in the earlier surveys (1988, 1999 and 2006; interaction P<0·001). In urban areas in 1988, one level lower education was associated (prevalence ratio; 95 % CI) with 45 % higher obesity prevalence among the richest women (1·45; 1·24, 1·69), whereas among the poorest the same education difference was protective (0·84; 0·72, 0·99). In the latest surveys (2012, 2016), higher education was protective across all wealth groups. Among men, education level was not associated with obesity in urban areas; there was a direct association in rural areas. Wealth did not modify the association between education and obesity.ConclusionThe reversal of the educational gradient in obesity among women occurred once a threshold level of household wealth was reached. Among men, there was no evidence of a reversal of the gradient. Policies must not lose sight of the populations most vulnerable to the obesogenic environment.

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Jerin, Sahajadi, Md Ataul Gani, Md Almujaddade Al Fasane, and Moniruzzaman Khondker. "Dynamics Of Environmental Factors In Relation To Phytoplankton Species In A Pond Of Old Dhaka, Bangladesh." Journal of the Asiatic Society of Bangladesh, Science 42, no. 2 (December 25, 2016): 169–75. http://dx.doi.org/10.3329/jasbs.v42i2.46220.

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The relationship between different environmental factors and abundance of phytoplankton species was studied for one year in a pond of old Dhaka named Sikkatuli pond. The range of annual mean of different variables in the pond was air and water temperatures 20 - 31.75˚C, secchi depth 21 - 54 cm, pH 7.39 - 8.3, alkalinity 3.9 - 9.2 meq/l, conductivity 484.5 - 2273.34 μS/cm, DO 3.35 - 8.33 mg/l, TDS 224.67 - 380.5 mg/l, SRS 12.03 - 79.93 mg/l, NO3-N 0.18 - 0.435 mg/l, SRP 0.33 – 4.28 μg/l, chlorophyll a 196.08 - 362.76 μg/l and phaeopigment 30.51 - 212.2 μg/l. During the investigation Cryptomonas erosa var. reflexa, Rhodomonas lens, Cyclotella comensis, Merismopedia gluaca, Euglena acus, Lyngbya limnetica, Chlorella vulgaris, Arthrospira platensis, Trachelomonas volvocina, Oscillatoria agardhii, Synechocystis aquatilis, Pelonema aphane and Peridinium sp. were found to be dominant phytoplankton. Pearson correlation showed that only alkalinity correlated with phytoplankton at 5% significant level. RDA orientation showed that air temperature, water temperature, secchi depth, chl a and pheopigment concentration are the important environmental factors. RDA ordination plot also showed that phytoplankton species of Pelonema aphane and Peridinium sp. were negatively correlated with secchi depth. Negative correlation was also observed between Trachelomonas volvocina and water temperature. Asiat. Soc. Bangladesh, Sci. 42(2): 169-175, December 2016

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Banerji, M. A., J. Lebowitz, R. L. Chaiken, D. Gordon, J. G. Kral, and H. E. Lebovitz. "Relationship of visceral adipose tissue and glucose disposal is independent of sex in black NIDDM subjects." American Journal of Physiology-Endocrinology and Metabolism 273, no. 2 (August 1, 1997): E425—E432. http://dx.doi.org/10.1152/ajpendo.1997.273.2.e425.

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To determine the interrelationship among insulin action, total or regional adiposity, and sex, we measured insulin-mediated glucose disposal by the euglycemic insulin clamp and adipose distribution using computed axial tomography (22 scans) in 32 black men and 20 black women with non-insulin-dependent diabetes mellitus (age 48 +/- 9 and 54 +/- 9 yr, body mass index 26.3 +/- 2.3 and 27.2 +/- 2.6 kg/m2, respectively). Women had approximately 80% more total and subcutaneous fat volume than men (31.8 +/- 8.3 vs. 18.6 +/- 6.1 and 28.5 +/- 7.3 vs. 14.7 +/- 4.6 liters) and less muscle volume (22.9 +/- 3.7 vs. 35.1 +/- 3.8 liters). Visceral fat volume did not differ between men and women (3.49 +/- 1.65 vs. 2.96 +/- 1.22 liters). Despite these body composition differences, an inverse nonlinear relationship existed between glucose disposal and visceral fat independent of sex (r = -0.58, P < 0.0001; men r = -0.60 and women r = -0.59; the slope and intercept were not different in men and women). Visceral fat explained a significant portion (34%) of variance in insulin-mediated glucose disposal, whereas total or subcutaneous fat and sex did not. Visceral fat appears to affect glucose disposal over a restricted range (up to approximately 2.5 l/m2 body surface area.

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Federici, Augusto B., Paolo Bucciarelli, Giancarlo Castaman, Maria G. Mazzucconi, Massimo Morfini, Angiola Rocino, Mario Schiavoni, Francesco Rodeghiero, and Pier M. Mannucci. "Incidence and Determinants of Bleeding in Different Types of von Willebrand Disease: Results of the First Prospective Multicenter Study on 814 Italian Patients." Blood 110, no. 11 (November 16, 2007): 713. http://dx.doi.org/10.1182/blood.v110.11.713.713.

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Abstract Background. von Willebrand disease (VWD) is the most common inherited bleeding disorder and is due to quantitative and/or qualitative defects of von Willebrand factor (VWF). Despite the improved knowledge of the disorder, no data on the incidence and determinants of bleedings requiring specific treatments have been available thus far. Aims and design of the study: to determine the incidence and determinants of bleedings requiring therapy with DDAVP and/or VWF concentrates in VWD, a national registry was organized by using a database devised to collect detailed retrospective information. Patients included in the registry were followed up for one year and prospective data on number, type and management of bleeding episodes were analyzed. Methods: all patients were diagnosed following recommendations of the ISTH-SSC-SC on VWF with bleeding severity score (BSS) calculated at enrollment. Diagnoses of VWD were confirmed by the coordinating center using also multimeric analysis in plasma and mutations of VWF gene in all types 2 and 3. For different risk categories the incidence of bleeding (mucosal and non-mucosal bleeding) was calculated. Bleeding-free survival was computed with the Kaplan-Meier method and a Cox’s proportional hazard model was used to calculate the risk of bleeding (hazard ratio = HR) Results: In the retrospective study, 1,234/1,529 (81%) cases satisfied the inclusion criteria and were enrolled in the registry as types 1 (54%), 2 (40%) and 3 (6%).VWD diagnosis occurs in young adults (83%), mainly in women (57%). Mucosal bleeding (64%) are more frequent than hematomas or hemarthrosis (15%) but 73% of patients did not require transfusions. In the prospective study based on 814/1,234 (66%) cases of the registry (type 1=47%, 2=47%, 3=6%) 147/815 (18%) were treated in a year for 318 bleeding episodes and 87 minor or major surgeries. BSS >10 (6.8, 3.8–12.3), bleeding time >20 min (BT = 5.5, 3.1–9.8), VWF:RCo <10 U/dL (3.2, 1.7–5.9) and FVIII:C <20 U/dL (4.1, 2.4–7) were significantly associated with high risk of bleeding. By multivariate model including all the variables, BSS (5.5, 2.8–10.8) was the most significant determinant of bleeding. The bleeding-free survival at one year was significantly different in type 3 (52%) versus types 1 (96%) and 2 (91%) VWD. On the other hands, patients with VWF.RCo >30 U/dL and FVIII:C > 40 U/dL showed always BSS <5 with the lowest incidence of bleeding. A total of 292 DDAVP injections were used to manage bleeding and surgeries in types 1 (65%) and 2 (35%) VWD and 452 injections of VWF concentrates were used to treat bleeding and surgeries in type 3 (75%), type 2 (34%) and type 1 (15%) VWD. Conclusions: This prospective study confirms that BSS is an important predictive factor for clinical bleeding and the need for treatment. In cases with VWF.RCo >30 U/dL and FVIII:C >40 U/dL bleeding episodes are very rare, in agreement with their relatively low BSS.

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Kurtasova, L. M., N. A. Shakina, and T. V. Lubnina. "Metabolic changes in peripheral blood lymphocytes from children with recurrent respiratory infections." Russian Journal of Infection and Immunity 10, no. 3 (August 7, 2020): 515–23. http://dx.doi.org/10.15789/2220-7619-mci-803.

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Objective: to examine activity and correlative relations for peripheral blood lymphocyte NAD (P)-dependent dehydrogenases in young children with recurrent respiratory infections with hypertrophy of the pharyngeal tonsils and bronchial obstructive syndrome. Methods. 89 children, aged 1–3 years, with recurrent respiratory infections were examined, including 35 children with hypertrophy of pharyngeal tonsils (HPT) and 54 children — with bronchial obstructive syndrome (BOS). Control group contained 20 age-matched healthy children. Activity and relations for peripheral blood lymphocyte for NAD(P)-dependent dehydrogenases were assessed by using bioluminescent method proposed by А.А. Savchenko and L.N. Suntsova (1989). Results. It was found that children with recurrent respiratory infections displayed altered enzyme status in peripheral blood lymphocytes. In particular, activity ribose-5-phosphate- and NAD(P)-dependent metabolic events as well as substrate flux via the tricarboxylic acid cycle were elevated that was paralleled with decreased lactate dehydrogenase anaerobic reaction, thereby implicating a role for malate-aspartate shunt in the energy turnover, substrate efflux from the tricarboxylic acid cycle into amino acid metabolic pathways as well as activity of glutathione reductase. Moreover, features of altered enzymatic profile in peripheral blood lymphocytes were uncovered, which depended on type of complication related to respiratory infection. In addition, children with hypertrophy of pharyngeal tonsils were featured with increased influx of lipid catabolism products into glycolysis, elevated level of malic enzyme activity and decreased pyruvate production. However, children with bronchial obstructive syndrome were found to have decreased glycerol-3-phosphate dehydrogenase activity resulting in lowered shunting activity of slow reactions in Krebs cycle and increased influx of amino acid metabolism intermediates into the tricarboxylic acid cycle. Reshaping of enzymatic profile in peripheral blood lymphocytes depended on type of complications coupled to respiratory infections (ENT-pathology or BOS syndrome). A correlation analysis revealed features of relationship between parameters of NAD(P)-dependent dehydrogenase activity in peripheral blood lymphocytes found in children with hypertrophy of pharyngeal tonsils and bronchial obstructive syndrome marked by quantity, modality and power of correlative links. Conclusion. Children with the recurrent respiratory infections require metabolic therapy aimed at restoring intracellular pathology-driven metabolic processes in immune cells.

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Grishlov, Dmitriy, Natalia Bratilova, Rimma Matveeva, and Olga Butorova. "Формирование кроны кедра сибирского за 12-летний период после декапитации (пригородная зона г. Красноярска)." Наукові праці Лісівничої академії наук України, no. 22 (June 19, 2021): 89–97. http://dx.doi.org/10.15421/412107.

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Показаны особенности формирования кроны кедра сибирского (Pinus sibirica Du Tour) после декапитации, произрастающего на плантации «Метеостанция» в Учебно-опытном лесхозе Караульного лесничества в условиях юга Средней Сибири. Объектом исследований являлась 54-летняя плантация кедра сибирского, выращенная из семян, заготовленных в 1964 г. в Лениногорском лесхозе (Республика Казахстан). Декапитация проведена у деревьев 42-летнего возраста в 2005 г. с оставлением ствола высотой 1,4-1,7 м. Верхняя часть кроны удалена на 50,0-66,7%. В 2017 г. деревья достигли высоты 5,6-9,1 м. Количество лидирующих побегов, заменивших центральный, составило 3-7 шт., длина которых за 12-летний период достигла 4,0-7,6 м. Деревья с диаметром ствола 12-18 см имели по 3-4, с диаметром 20-26 см – по 6-7 шт. лидирующих побега. Установлено, что уровень изменчивости высоты деревьев низкий; прироста побегов, диаметра ствола – средний, количества лидирующих побегов – высокий. Наибольшей высотой (9,1 м) отличалось дерево № 4-98, превосходя другие особи на 8,3-62,5%. Сопоставлено количество боковых ветвей, образовавшихся на лидирующих побегах за 5 лет (2013-2017 гг.). Отмечено, что их средний прирост за исследуемый период находился в пределах 23,6-45,5 см. Между диаметром ствола и числом лидирующих побегов коэффициент корреляции (r) равен 0,619; числом лидирующих побегов и количеством сформированных боковых ветвей спустя 7-12 лет после декапитации – 0,770, диаметром ствола при обрезке и высотой деревьев после 12 лет декапитации – 0,738.

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Holyoak, Joshua D., Zachary Panfili, Ravi P. Kiran, and Naveen Pokala. "Micropapillary bladder cancer: Stage at presentation and treatment outcome—Analysis of 121 patients from a cancer database." Journal of Clinical Oncology 31, no. 6_suppl (February 20, 2013): 289. http://dx.doi.org/10.1200/jco.2013.31.6_suppl.289.

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289 Background: The micropapillary variant of transitional cell cancer(MPTCC) is an aggressive pathological subtype of bladder cancer and radical cystectomy is recommended for patients with non−muscle invasive disease. This study compares the treatment patterns and survival outcome in 121 patients. Methods: Patients with MPTCC (code 8131) were identified from the Surveillance Epidemiology and End Results (SEER 17) database. Data was analyzed for demographics, stage, treatment, overall (OS) and cancer specific survival (CSS). Appropriate statistical tests were used. Results: 121 patients were identified (2001−08). Mean age was 73.3 years, 76.9% were male (76.9%, n=93), 82.7% were Caucasian. 40.5% (n=49) had non−muscle invasive (NMI) disease and 59.5% had muscle−invasive disease (MI) at diagnosis. The T stage was Ta or Tis (n=17), T1 (n=32), T2 (n=38) T3 (n=20) and T4 (n=14). 23 patients had node positive disease, the nodal status was not known in 4 patients. 10 patients had distant metastasis. Surgical procedures performed include, TURBT (n=83), Radical cystectomy (n=34), pelvic exenteration (n=1) and partial cystectomy (n=3). 8 patients received post−operative radiotherapy. The mean OS was 64.9, 42.9, 16.1 and 50.2 months and the mean CSS was 81.2, 56.3, 15.7 and 64.4 months for NMI, MI, distant and the whole group respectively. The 5−year OS was 40%, 54% and 34% and the 5 year CSS was 62%, 53% and 82% for the whole group, MI and NMI respectively. All patients with distant disease were dead by 28 months. On analysis of CSS by treatment type the 5−yr CSS for NMI was 81% (n=36) after TURBT and 100% (n=3) after Radical surgery. For MI disease the 3−yr CSS was 66% after TURBT (n=18) and the 5−yr CSS was 54% after radical surgery (n=29). On multivariate analysis, higher stage and age were associated with worse survival. TURBT was associated with better survival. Conclusions: MPTCC is a rare variant of TCC. 81% survival can be achieved with TURBT for non-muscle invasive MPTCC.

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Jain, Akshay, Smruti Milan Tripathi, and Poonji Gupta. "Paediatric acquired cholesteatoma, our experience in a tertiary care: two year prospective study." International Journal of Otorhinolaryngology and Head and Neck Surgery 6, no. 11 (October 23, 2020): 1960. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20204458.

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Background: Aim of the study was to estimate the benefits of having high-resolution computed tomography (HRCT) of temporal bone on clinically evaluated paediatric patients of acquired cholesteatoma.Methods: A total of 60 patients of paediatric age group (2-18 years) who were diagnosed with active squamosal type of chronic otitis media were selected for the study. HRCT of temporal bone was done in all the patients and findings were recorded.Results: Most patients were in the age group of 11-15 years (46.6%). Findings of pars tensa were subtotal perforation in 2 patients (3.3%), small central perforation in 8 patients (13.3%) and postero-superior marginal perforation in 12 patients (20%). Pars flaccida retraction pocket with cholesteatoma was seen in 31 patients (51.6%) and perforation with cholesteatoma in 13 patients (21.6%). Scutum erosion was seen in 31 patients (51.6%), ossicular erosion in 12 patients (20%) and facial nerve paralysis in 2 patients (3.3%). On HRCT temporal bone we found soft tissue density in middle ear in 60 patients (100%), soft tissue density in mastoid in 53patients (88.3%), osscicular erosion in 54 patients (90%), scutum erosion in 46 patients (76.6%), facial nerve canal dehiscence in 5 patients (8.3%), semicircular canal dehiscence in 2 patients (3.3%) and dural plate dehiscence in 11 patients (18.3%).Conclusions: HRCT of temporal bone is helpful in depicting a clearer picture of middle ear cavity structures involved by cholesteatoma and thus helpful in formulating a strategy for further management.

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Barrera Lozano, Luis Manuel, Jorge Ivan Gutierrez Montoya, and Jorge Enrique Henao Sierra. "Ureterostomía cutánea como derivación urinaria definitiva en trasplante renal." Revista Colombiana de Cirugía 35, no. 4 (October 16, 2020): 630–38. http://dx.doi.org/10.30944/20117582.485.

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Introducción. Cerca del 15 % de los pacientes con insuficiencia renal crónica terminal tienen alteraciones de las vías urinarias inferiores. Estas anomalías eran consideradas una contraindicación para el trasplante renal. Por lo anterior, el objetivo del presente trabajo es describir el comportamiento sociodemográfico y clínico de los pacientes trasplantados renales con ureterostomía cutánea como técnica de derivación definitiva de las vías urinarias. Métodos. Se realizó un estudio descriptivo, longitudinal y retrospectivo de los pacientes trasplantados renales con vejiga anormal y ureterostomía cutánea, entre enero de 1973 y octubre de 2012. Resultados. En 4.294 trasplantes renales, se practicaron 24 (0,55 %) ureterostomías, 19 (79,1 %) como técnica inicial y 5 por falla de la ureteroneocistostomía. Diez (41,7 %) ureterostomías fallaron, la mayoría (8 casos) por estenosis. Se presentó infección urinaria en 20 pacientes y la mortalidad fue del 8,3 % (2/24). El 50 % (12/24) de los pacientes con trasplante de riñón estuvieron libres de infección urinaria durante el primer año. La supervivencia del riñón trasplantado fue de 93,8 % (23/24) a los 18 meses, de 85,9 % (20/24) a los 36 meses y de 66,7 % (16/24) a los 50 meses de seguimiento. La supervivencia de los injertos con ureterostomía sin infección fue del 100 % durante el periodo de seguimiento, mientras que la supervivencia de los riñones con infección urinaria fue de 93 % (23/24) a los 18 meses, de 76 % (18/24) a los 36 meses y de 54 % (13/24) a los 50 meses (p=0,235). Conclusiones. La ureterostomía cutánea es una alternativa segura para la derivación urinaria en pacientes trasplantados renales con alteraciones de la vejiga que no permite su uso o preparación antes del trasplante.

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Gligorijevic, V., N. Spasic, D. Bojic, M. Protic, P. Svorcan, B. Maksimovic, V. Markovic, Z. Krivokapic, and Nj Jojic. "The role of pelvic MRI in assessment of combined surgical and Infliximab treatment for perianal Crohn's disease." Acta chirurgica Iugoslavica 57, no. 3 (2010): 89–95. http://dx.doi.org/10.2298/aci1003089g.

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AIM: To evaluate the role of pelvic MRI in diagnosis and assesment of combined surgical and infliximab treatment of perianal Crohn's disease (PACD). METHOD: 24 patients with signs of PACD were prospectively evaluated. They were previously treated with azathyoprin for a period of 6 months to 7 years and antibiotics and than started on Infliximab 5 mg/kg (IFX) at 0,2 and 6 weeks induction protocol. Luminal CD activity was assesed by colonoscopy. Perianal Disease Activity Index (PDAI) was calculated to evaluate perianal fistulae activity. Surgical examination under anesthesia (EUA) was performed and noncutting seton placed where appropriate. Pelvic MRI was performed in each patient before Infliximab treatment, and in half of the patients after IFX. MRI criteria were used to asses activity and remission of PACD. RESULTS: 14/24(58.5%) patients had ileocolitis, 10/24 (41.5%) colitis, and in 22/24(91.7%) rectum was affected. Median disease duration was 5.5+2.5 years. MRI revealed simple fistula in 4/24 (16.7%) and complex fistula in 20/24 (83.3%) patients. Abscess was present in 19/24(79%) patients. Enterocutaneous and recto-vaginal fistula was found in 2(8.3%) and 3(12.5%) patients, respectively. Median PDAI before and 8 weeks after IFX treatment was 8.3+2.08 and 3.5+1.03, respectively (p=0.00064). Incomplete response (reduction fistulae drainage by 50%) was found in 10/24(42%) patients, complete response (no drainage) in 11/24 (46%) patients, while in 3/24(12.5%) new fistula opened. Control pelvic MRI was performed in 13/24 (54%) patients. Of those, 9/13(69%) had complete remission according to MRI criteria. Seton was removed after second IFX dose in 15/24 (62.5%) patients and placed again in 2/24 (8%) patients 4 months after completion of IFX treatment. CONCLUSION: In patients with PACD, pelvic MRI before and after IFX treatment is an important diagnostic tool to asses fistula tract localization, reveal abscess, planning adequate treatment approach and assess the effect of treatment. Surgical decision to remove seton was in accordance with MRI criteria for remission in PACD.

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Gini, Guido, Patrizia Caraffa, Massimo Offidani, Silvia Trappolini, Caterina Bocci, Andrea Stronati, Laura Corvatta, et al. "LATE EFFECTS IN Hodgkin's POPULATION Treated BETWEEN 1980-2005 IN A SINGLE INSTITUTION." Blood 114, no. 22 (November 20, 2009): 4769. http://dx.doi.org/10.1182/blood.v114.22.4769.4769.

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Abstract Abstract 4769 From 1980 to 2005 in our institution we've diagnosed and treated 361 patients (pts) affected by Hodgkin's disease. At the moment of diagnosis the median age of the patients was 29 years (range 13-69).About 72% of patients were in the stage I-II and 28% were in the stage III-IV. More than 54% of all patients received ABVD, 17% received MOOP, 10% MOOP/ABVD, 3% VBM and 1% received Stanford V scheme. Over 70% of all patients received radiotherapy (RT) with median dose of 4500 cGy (range 1000-16210). Over 94% of all patients obtained a Complete remission, however 11% relapsed. 130 patients among 361 are at this moment evaluable for late effects of chemo-radiotherapy.26 pts were treated in the period 1980-84 (25%) ; 6 pts treated 1985-89 (4,6%);21 pts treated in 1990-94 (16,1%); 24 pts treated in 1995-99 (19%) and 35 pts in the period 2000-2005 (27%). 50 pts among 130 (38,5%) present late effects related to the therapy. 24 pts (48%) present heart disease: 13 pts (40%) Valvulopathy,8 pts (25%) Ischemic heart disease, 7 pts (21%) Congestive heart failure, 4 pts (14%) Pericardic disease. Therapies of these patients were performed : In 1980-89 (11 pts), 6 pts (25%) received MOOP + RT,2 pts (8,3%) received M/A and 3 pts only RT. In 1990-99 (7 pts), 3 pts(12,5%) received ABVD +RT, 2 pts(8,3%) received MA+RT, 1 pt(4,1%) received ABVD and 1 pt(4,1%) received M/A. In 2000-05 (6 pts), 2 pts (8,3%) received ABVD+RT and 4pts(16,6%) received only ABVD. 18 pts present Endocrinological-disease, in all cases, represented by hypothyroidism; 16 pts among 18 had done Chemoteraphy and Radiotheraphy, while 2 pts received only Chemotheraphy. Besides 8 pts show both endocrinological and cardiological disease; in these cases 3 pts (37,5) had done ABVD+RT, 4 pts (50%) MOOP+RT and 1 patient (12,5%) only RT. Furthermore 26/130 (20%) developed a second neoplasm. Conclusions In our population 38% of patients had developed secondary late effects and we assess that about 15% of our Hodgkin's population die for a secondary late effect of therapies Although there are many variables for the development of a late effect we think that this analysis could lead to try to reduce the late toxicities of treatments. Disclosures: Offidani: Celgene: Honoraria; Janssen Cilag: Honoraria.

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Boland, Elena, Allen Hsu, Marc I. Brand, and Theodore J. Saclarides. "Hartmann's Colostomy Reversal: Outcome of Patients Undergoing Surgery with the Intention of Eliminating Fecal Diversion." American Surgeon 73, no. 7 (July 2007): 664–67. http://dx.doi.org/10.1177/000313480707300705.

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Reversal of a Hartmann's operation can be a morbid undertaking; successful restoration of intestinal continuity cannot be guaranteed. Between June 2001 and July 2006, 35 Hartmann's reversals were undertaken. There were 19 males (54%). Mean age was 54.7 years (range, 14–82 years). Twenty-one (60%) patients had their Hartmann's for diverticular disease, 7 (20%) for anorectal cancer, 4 (11%) for volvulus, and 3 for miscellaneous reasons. Mean length of stay was 7.7 days (range, 3–16 days); 23 per cent required intensive care for a mean 2.3 days (range, 1–4 days). Blood loss was 470 mL, and mean operative time was 4.28 hours (range, 1–8.3 hours). The mean time interval between the original operation and its reversal was 8.9 months (range, 1.4–55 months). Extensive lysis of adhesions was required in 69 per cent, 40 per cent experienced minor complications (urinary tract infections, ileus, and so on), and 38 per cent had major complications (myocardial infarction, leak, hernias, respiratory failure). There was one death (3%). The operation failed because of intraoperative circumstances in three patients (8%). Ten patients (26%) had stomas at the time of discharge of which 3 were intended to be permanent and 7 were temporary. Of the latter, 3 were successfully closed, 3 are awaiting closure, and 1 had complete anastomotic failure requiring permanent diversion. Total failure rate was 10.3 per cent; contributing factors included prior radiation and ultra-low anastomoses.

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Nakano, Hideyuki, Tetsuya Togano, Yuta Sakaue, Aki Suetaka, Ryu Iikawa, Rieko Nakano, and Takeo Fukuchi. "Clinical Features of Patients with Exfoliation Glaucoma Requiring Surgical Intervention." Journal of Ophthalmology 2020 (June 19, 2020): 1–7. http://dx.doi.org/10.1155/2020/9423756.

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Purpose. To clarify the clinical features of patients with exfoliation glaucoma (XFG) requiring surgical intervention. Study Design. Retrospective study. Methods. The study included 46 eyes from 36 XFG patients, 85 eyes from 53 primary open-angle glaucoma (POAG) patients, and 54 eyes from 35 normal-tension glaucoma (NTG) patients. Age, duration of previous glaucoma treatment, intraocular pressure, medication scores, visual function, and surgical procedure were compared among the three patient groups. Results. The XFG group had the highest mean age (XFG: 75.7 ± 8.3 years, POAG: 65.8 ± 12.8 years, and NTG: 53.3 ± 12.8 years; p<0.001) and the shortest mean duration of previous treatment with glaucoma medication (XFG: 5.1 ± 3.5 years, POAG: 8.9 ± 6.9 years, and NTG: 8.9 ± 5.9 years; p<0.001). Intraocular pressure and medication scores were slightly higher in the XFG group than in the POAG group, although the differences were not significant. Among XFG patients, trabeculectomy was performed in 20 eyes from 16 patients (55.6%) and trabeculotomy was performed in 16 eyes from 14 patients (44.4%). Both trabeculectomy (3 eyes) and trabeculotomy (14 eyes) were performed in combination with cataract surgery. Conclusions. The XFG patients referred to our department for initial examination were older than the POAG and NTG patients, and their duration of treatment before referral was shorter. Moreover, intraocular pressure and the eye drop medication score were higher in the XFG patients. A significantly higher percentage of XFG patients required surgical intervention compared to patients with other disease types.

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EMONT, C., C. Gay, A. L. Parmentier, S. Koch, S. Ambregna, G. Claudé, P. Sage, P. Zhong, C. Briot, and L. Vuitton. "P532 Measuring endoscopic activity in patients treated with vedolizumab for ulcerative colitis." Journal of Crohn's and Colitis 14, Supplement_1 (January 2020): S455—S456. http://dx.doi.org/10.1093/ecco-jcc/jjz203.660.

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Abstract Background Vedolizumab (VDZ) has proven its efficacy in ulcerative colitis (UC). The delay to obtain endoscopic remission with anti-α4β7 integrin is unclear. We aimed to assess the potential of VDZ to induce endoscopic remission and its characteristics in real-life settings. Methods We conducted a pooled analysis with prospective and retrospective data of patients who started VDZ for an active UC in two French hospitals. Patients underwent proctosigmoidoscopies at baseline and at weeks 14, 30 and 54 in the prospective cohort. A central blinded review of all endoscopy recordings was performed by two experts, pooled with some recordings from anti-TNFɑ treated patients. The primary endpoint was the proportion of patients in endoscopic remission (endoscopic Mayo score (eMs) ≤ 1) within 54 weeks. Secondary endpoints included the description of the pattern of mucosal healing and the evolution of UC activity. Characteristics of endoscopic remitters and non-remitters were compared and predictive factors of endoscopic remission were reported in univariate logistic regression. Results Forty-two patients were enrolled, 22 in the prospective cohort and 20 in the retrospective cohort. At baseline, 38 (90.5%) patients had previously experienced anti-TNFɑ, 14 (33.3%) were treated with corticosteroids and 15 (35.7%) with immunosuppressors. Twenty-six (61.9%) patients achieved endoscopic remission after a median time of 14 weeks. Endoscopic response and histologic remission occurred in 27 (64.3%) and 21 (50%) patients within 54 weeks, respectively. No specific pattern of mucosal healing was found with VDZ as compared with anti-TNFɑ treated patients. UC activity steady improved over time. Endoscopic remitters had a lower disease activity at baseline (total Mayo score (tMs) 8.1 vs. 9.5, p = 0.007; UCEIS 4.3 vs. 5.6, p = 0.0005; Nancy’s score 2.8 vs. 3.6, p = 0.004) and at week 14 (tMs 3 vs. 6, p = 0.001; eMs 1.3 vs. 2.5, p = 0.005; UCEIS 2.7 vs. 5.4, p = 0.0007; Nancy’s score 2.2 vs. 3.6, p = 0.001) and needed less treatment optimisation (11.5 vs. 81.3%, p < 0.0001) than non-remitters. In univariate logistic regression, predictors of no endoscopic remission were a high endoscopic activity at baseline (eMs > 2, OR 0.2 IC 95% 0.05–0.86, p = 0,021; UCEIS > 5 OR 0.22 IC 95% 0.06–0.84, p = 0.022) and treatment optimisation (OR 0.03; IC 95% 0.01–0.17, p < 0.001). Conclusion In our series, about two-thirds of UC refractory patients achieved endoscopic remission during the first year. Endoscopic healing was early reported, in half of patients at the end of the first trimester, actually suggesting a rather fast mechanism of action of VDZ on mucosal healing. Baseline UC activity impacted endoscopic remission.

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Taylor, Janielle, Yongli Shuai, Linda Robertson, Daniel Paul Normolle, Robert L. Ferris, Todd Bear, Marci Lee Nilsen, et al. "The effect of locality of residence (LOR) and socioeconomic status (SES) on mortality in patients with squamous cell carcinoma of the head and neck (HNSCC): 20-year experience at the UPMC Hillman Cancer Center." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e19043-e19043. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19043.

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e19043 Background: As cancer centers expand, evaluation of potential disparities in outcomes amongst the catchment area is critically important. We examined the effect of LOR and SES on overall survival (OS) in HNSCC patients treated at HCC, which spans 29 counties in western Pennsylvania with diverse socioeconomic profiles across urban and rural localities. Methods: Retrospective review included patients with primary HNSCC (excluding M1 and recurrent disease) treated at HCC 1997-2018. Using Rural-Urban Commuting Area codes, LOR was classified as urban/suburban or rural according to ZIP code. SES was defined by medium income level (low, moderate (Mod), middle (Mid), Upper) via Federal Financial Institutions Examination Council geocoded census tract data. Kaplan-Meier methods and Cox regression models were used to evaluate OS. Results: 3512 patients were identified. Median age was 61, 72.7% male, 93.2% White, 18% HPV +, 75.5% urban/suburban, and by SES: 4% Low, 21% Mod, 46% Mid, and 19% Upper. Primary site included 35.2% oral cavity, 28.4% oropharynx, 28.1% larynx, 8.3% other, stage was majority III/IVa (61%), 66% had surgery and 54% received multimodality treatment (tx). While median OS differed significantly by race (Black: 5.8 vs. White: 7.3 years, p = 0.0457) and SES (Low: 4.1 vs. Mod: 5.3 vs. Mid: 7.3 vs. Upper: 9.1 years, p < 0.0001), there was no difference by LOR (rural: 7.7 vs. urban/suburban: 7.2 years, p = 0.99). Multivariable Cox Regression showed lower SES was associated with a higher risk of death [(Low vs. Upper, HR: 1.416, 95% CI: 1.023-1.959) (Mod vs. Upper, HR:1.443, 95% CI: 1.214 – 1.716), p = 0.0004], adjusting for LOR and factors associated with OS in univariate analysis (age, smoking status, primary site, staging, tx, HPV status, race, and enrollment on clinical trial). The effect of LOR, race, and enrollment on clinical trial were not significant in multivariate analysis. Conclusions: SES was independently associated with OS in HNSCC patients treated at HCC, while LOR was not associated with OS. The lack of difference by LOR may be partially explained by HCC’s efforts to increase access to care throughout the catchment area by establishing community sites. However, a focus on improving outcomes for lower SES HNSCC patients is needed.

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Mato, Anthony, Barry Fuchs, Daniel Heitjan, Erin Olson, Samantha Jacobs, Rosie Mick, David Zheng, et al. "Systemic Inflammatory Response Syndrome (SIRS) as Predictor of Severe Sepsis (SS) in Hospitalized Patients (pts) with Hematologic Malignancies." Blood 110, no. 11 (November 16, 2007): 633. http://dx.doi.org/10.1182/blood.v110.11.633.633.

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Abstract Pts with hematologic malignancies (HM) are at high risk of developing SS and sepsis-related mortality. The diagnosis of sepsis requires suspicion of infection accompanied by at least two signs of systemic inflammation. The SIRS criteria were devised to improve the early bedside detection of sepsis and provide objective inclusion criteria for clinical research. Cut-point values based on consensus opinion are: HR >90, Temp > 100.4 or <96.8, RR>20, and WBC >12k or <4k. SIRS is defined by the presence of ≥2 abnormalities. Although widely used, SIRS criteria have not been studied in pts with HM because factors such as immunosuppression and other disease characteristics result in clinical and laboratory changes which are thought to potentially invalidate the SIRS criteria. Since HM pts have been excluded from pivotal sepsis trials, clinicians must extrapolate data from other populations to make diagnostic and treatment decisions for HM patients with SS. The purpose of this study was to evaluate the SIRS criteria as predictors of development of SS in pts with HM. Methods: The association between the SIRS and SS was evaluated in hospitalized adult pts (age 18–83) with HM in a prospective single-center, nested case-control study. The primary outcome was SS, defined as an infection resulting in cardiovascular or respiratory failure. Vital signs were performed every eight hours. Of the 547 pts who consented for the study, 54 developed SS (9.9% CI 7.7–12.7%). Using incidence density sampling, 211 controls were selected by matching on length of stay at time of SS. Evidence-based cut-points were then derived for the individual SIRS variables by examining risk estimates based on variable percentiles. Results: At hospital admission, HR, RR, BP, WBC, ANC, age, diagnosis, and transplant status were similar between the groups. In univariable analysis (24° prior to SS), significance of the four individual SIRS variables were: HR (p=.001), RR (p<.001), Temp (p<.001) and WBC (p=.218). Sensitivity, specificity and LR(+) for SIRS scores (1–4) are reported in the Table. In multivariable logistic regression, HR (OR 2.0, CI 1.0–4.1 p=.047), RR (OR 8.3, CI 2.8–24.4 p<.001) and Temp (OR 3.8, CI 1.8–8.0 p=.001) remained significant (ROC area=0.75). Age, diagnosis and transplant status did not modify these risks. WBC and hypothermia did not contribute to the model. Empirically derived cut-points for HR, Temp and RR were: HR (≥109, OR 5.5 2.64–11.5 p <.001), Temp (≥100.2°F, OR 2.71, CI 1.2–6.2, P<.001), (RR> 20, OR 8.3, CI 2.8–24.4 p<.001), ROC area= 0.79 (24° prior to SS). Conclusions: This study is the first to evaluate and define the test characteristics of the SIRS criteria in hospitalized pts with HM. The rationale for excluding HM patients from SS clinical trials based on diagnostic concerns should be revisited when planning future SS studies. Fever, tachycardia and tachypnea seem most predictive in this population. These results suggest that cut-points for significant SIRS variables can be redefined to improve the specificity of the SIRS score. Additional markers for the early detection of SS may further improve upon SIRS in HM pts. SIRS Score Sensitivity % (95 CI) Specificity LR(+) 1 98 (97–99) 12 (8–18) 1.1 2 76 (71–81) 60 (54–66) 1.9 3 39 (33–45) 91 (88–94) 4.3 4 7 (4–11) 99 (99–100) 15.6

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Shea, Thomas C., Christine Walko, Anastasia Ivanova, Julia Whitley, Kamakshi Rao, Don A. Gabriel, Terrance Comeau, et al. "Beneficial Effect of Escalated Doses of Busulfan (BU) Delivered by Targeted Pharmacokinetics and Prolonged Continuous Infusion on Relapse Free and Overall Survival in Matched Related and Unrelated Allogeneic Transplant Patients with Hematologic Malignancies." Blood 118, no. 21 (November 18, 2011): 1940. http://dx.doi.org/10.1182/blood.v118.21.1940.1940.

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Abstract Abstract 1940 INTRODUCTION: Dose escalation of chemotherapy and radiation in conditioning regimens has been associated with lower relapse rates but not significantly improved overall survival in allogeneic transplants because of higher treatment related mortality. The advent of IV BU has allowed more precise dosing of this drug and permitted dose escalation to a greater degree than in the past. METHODS: Test dose (.8 mg/kg) IV BU was administered one week prior to start of the conditioning regimen and the desired AUC calculated from the Bu clearance. Starting at a standard AUC of 4800/24 hours, target dose levels were escalated in 20% increments to 5760, 6912, 7603 and 8663 uM-min/24 hours. BU was administered from day −7 to −3 by 90 hour continuous infusion accompanied by fludarabine, 30 mg/m2/d on days −7 to −3. All pts received tacrolimus and either alemtuzamab alone or ATG+/− low dose MTX for GVH prohylaxis. Standard antibiotic prophylaxis and supportive care was provided. RESULTS: 55 high risk pts, median age 39 (22–54), 20 MRD, 35 MUD, 26 AML, 7 ALL, 2 APL, 1 biphenotypic leukemia, 8 MDS, 5 NHL, 2 HD, 1 CLL, 1 CML, 1 CMML, 1 MF were enrolled on this IRB approved study. 30 patients received alemtuzamab, 19 ATG + MTX and 6 MTX only. Mean achieved AUCs were 4973(14 pts), 5638(7 pts), 7131(25 pts), 7053(7 pts), and 8680(2 pts) uM-min/24 hrs. The MTD was dose level 3 (target 6912, achieved 7131 uM-min). Grade 4 DLTs were grade 4 mucositis in 2/2 at level 5 and 1/7 at level 4 and 1/7 reversible VOD at level 4. One additional grade 5 toxicity was seen at dose level 1(liver failure), level 2 (mucositis) and level 3 (VOD). The incidence of grade 4 or 5 VOD was 2/55 or 4%. Median AUC for the entire group was 6312 uMol-min with the median in the group below the overall median being 5484 and the group above the median being 7394 uMol-min/24 hours; a 35% difference in dose between the lower and higher median values and a 54% increase over a standard AUC dose of 4800 uMol-min. When analyzed by AUC, pts above the median had a higher median overall survival (OS), 353 days vs 183 days (HR.48, p =.058) for those below the median and longer relapse-free survival (RFS), 818 vs 187 days (HR.47, p =.039). When divided by AUC in tertiles (median AUC values of 5106 (19 pts), 6431 (19 pts), and 7693 (17 pts) uMol-min/24 hrs respectively), the median OS in days for each group were 298, 353, and Not Reached and median RFS were 191, 353, and 818 days. Three group comparison using Cox model yielded p-values of.063 and.053 levels for RFS and OS, respectively. 2-year OS and RFS for the below and above median groups were.27 and.20 and.62 and.57, respectively. 2-year OS and RFS for the lowest, medium and highest AUC groups in the tertile analysis were.24 and.20.41 and.35, and.70 and.63, respectively. In multivariable analysis, higher AUC dose, use of ATG rather than alemtuzamab and having a MUD all demonstrated a trend toward improved outcomes with AUC being the strongest predictor. CONCLUSION: High AUC levels of busulfan can be safely achieved with targeted PK dosing and continuous IV infusion leading to improved overall survival and decreased relapse rates in patients undergoing allogeneic transplantation with either ATG or alemtuzamab as part of their GVHD prophylaxis. Disclosures: Shea: Otsuka Pharmaceuticals: Research Funding.

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Sexton, T., E. Creamer, M. Turley, E. Smyth, and E. Humphreys. "Persistent environmental reservoirs for Vancomycin-resistant enterococci requiring repeated decontamination to achieve eradication." British Journal of Infection Control 3, no. 3 (June 2002): 10–13. http://dx.doi.org/10.1177/175717740200300303.

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V ancomycin-resistant enterococci (VRE) are increasingly recognised nosocomial pathogens in clinical areas with high antibiotic usage. Patients with chronic renal failure, including those requiring haemodialysis, are at particular risk. Investigation and control of an outbreak of VRE in two renal wards, highlighting mattresses as reservoirs and environmental measures to control VRE are reported in this paper. Outbreak control measures included standard isolation in accordance with the Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). Patients were screened on admission and weekly using a rectal swab. The inanimate environment including mattresses was also screened. Enhanced environmental decontamination was performed on a daily basis. The outbreak continued over a 20-week period with most cases occurring in the first 6 weeks. The results of screening indicated that 59 (13%) of 451 patients and 54 (8.3%) of 647 environmental samples were positive for VRE. VRE was isolated from 35 (8%) of 433 mattresses, 12 (8.1%) of 148 environmental ledges, 4 (8%) of 50 toilets, and 3 (18.8%) of 16 items of cleaning equipment. Molecular typing indicated that a predominant strain was also implicated in mattress contamination, thus highlighting a potential and important reservoir for transmission of VRE. Difficulty with eradication of VRE from the environment was encountered despite enhanced cleaning regimens and a doubling of use of disinfectant was necessary. Restriction of antibiotics, hand hygiene, hygiene and education are the cornerstone of VRE prevention and control. Lessons from this outbreak highlight the role of the environment in VRE transmission and the need for attention to the environment, especially mattress decontamination.

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Anthoorathodi, Jubina Bency, Aqueen Joju, Ann Mereena Reji, Anupama Pallivalappil Asokan, Anzeem Naseem, Aparna Cherian, and Arunima Beena Sisupalan. "Cross sectional study on the prevalence of polypharmacy and potentially inappropriate medications among elderly patients in a tertiary care centre in central Kerala." International Journal Of Community Medicine And Public Health 8, no. 3 (February 24, 2021): 1415. http://dx.doi.org/10.18203/2394-6040.ijcmph20210836.

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Background: Polypharmacy or the concurrent use of multiple medications, is on the rise, especially in the elderly population as they suffer from multiple co-morbidities. Polypharmacy has been reported to increase the risks for inappropriate medication intake. Objectives: The aim was to investigate the prevalence of polypharmacy and usage of potentially inappropriate medication using Beer’s criteria and to find out the various risk factors of polypharmacy in hospitalised elderly.Methods: A cross sectional study was done in patients aged 60 years and above using a pre designed semi structured questionnaire and from their case records to assess the pattern of polypharmacy by different socio-demographic characteristics and also to found out the risk factors of polypharmacy.Results: 50 patients aged 60 and above were involved in our study out of which, 46% were females and 54% were males. Mean age of our study population was 71.5±8.3. Among them, 30 were hypertensive, 27 were diabetic, 9 of them had dyslipidaemia and 8 of them had coronary artery disease Mean number of medication use was 5.1±4.1. Polypharmacy was observed in 42% of the patients. 20% patients received potentially inappropriate drugs from Beer’s list. We also found significant association of polypharmacy with diabetes mellitus and hypertension.Conclusions: The present study has shown polypharmacy and usage of potentially inappropriate medication as an emerging public health concern. Diabetes mellitus and hypertension were found to be risk factors of polypharmacy. Deprescription should be integrated into clinical care and prescribers need to be educated about Beers criteria and encouraged for rational prescription.

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van der Hulle, T., P. L. den Exter, G. Meyer, B. Planquette, S. Soler, M. Monreal, D. Jimenez, et al. "Risk of Recurrent Venous Thromboembolism and Major Bleeding in Cancer-Associated Incidental Pulmonary Embolism Amongst Treated and Untreated Patients: A Pooled Analysis of 926 Patients." Blood 124, no. 21 (December 6, 2014): 590. http://dx.doi.org/10.1182/blood.v124.21.590.590.

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Abstract Introduction Incidental pulmonary embolism (IPE) is defined as a pulmonary embolism diagnosed on a CT-scan performed for reasons other than a clinical suspicion of PE. Generally identified on staging scans, IPE has been estimated to occur in 3.1% of all cancer patients and is a growing challenge for clinicians and patients. Nevertheless, knowledge about the treatment and prognosis of cancer-associated IPE is scarce. In order to determine the outcome more accurately, and to identify clinical characteristics related to the prognosis, we pooled individual patient data from eleven observational studies and ongoing registries. Methods A systematic literature search aiming to identify studies reporting on patients diagnosed with cancer-associated IPE was performed. Authors of selected studies were invited to participate. Incidence rates of objectively diagnosed symptomatic recurrent venous thromboembolism (VTE), major bleeding and mortality during 6-month follow-up were pooled. Individual patient data was collected to perform subgroup analyses, for which all patients were considered as one cohort. Hazard ratios (HR) were adjusted for age, sex and cancer stage. Results Individual patient data of 926 cancer patients with IPE from 11 observational studies and ongoing registries were included (Table 1). The overall pooled 6-month risk of symptomatic recurrent VTE was 5.8% (95%CI 3.7-8.3), of major bleeding 4.7% (95%CI 3.0-6.8) and of mortality 37% (95%CI 28-47). The VTE recurrence risk was comparable in patients treated with VKA and LMWH with incidence rates of 6.4% (95%CI 2.2-12) and 6.2% (95%CI 3.5-9.6), HR 0.89 (95%CI 0.27-2.9). In contrast, this incidence rate was 12% (95%CI 4.7-23) in patients who were left untreated, HR 2.9 (95%CI 0.65-13; Figure 1). The risk of major bleeding was significantly higher in patients treated with VKA compared to those treated with LMWH, 13% (95%CI 6.4-20) versus 3.9% (95%CI 2.3-5.9), HR of 3.2 (95%CI 1.4-7.4) (Figure 2). The 6-month mortality was 37% (95%CI 29-44) in patients treated with LMWH, 28% (95%CI 18-40) in those treated with VKA and 47% (95%CI 28-66) amongst untreated patients. The all-cause mortality at 6 months was significantly higher for patients with a central thrombus (either central or lobar) compared to those with a more peripheral IPE (either segmental or subsegmental); 42% (95%CI 33-52) versus 30% (95%CI 25-36, HR 1.8 (95%CI 1.4-2.3). Conclusions The most important finding of this study is the 12% 6-month risk of symptomatic recurrent VTE in patients with cancer-associated IPE who did not receive anticoagulant treatment, which is more than double the risk of patients who were anticoagulated. These numbers recall the effect size of anticoagulants used in symptomatic PE and support the judicious initiation of anticoagulant treatment in cancer-associated IPE. The association between more centrally-located thrombi and mortality following IPE is a new finding that parallels outcomes for symptomatic PE, and one which may further support similar management. Regarding the choice of anticoagulant, VKA were associated with a significantly higher risk of major bleeding than LMWH, with a comparable risk of recurrent VTE. The findings of this observational study should be preferably confirmed in a randomized trial. Figure 1: Figure 1:. The 6-month risk of recurrent venous thromboembolism related to anticoagulant treatment. Figure 2: The 6-month risk of major bleeding related to anticoagulant treatment. Figure 2:. The 6-month risk of major bleeding related to anticoagulant treatment. Abstract 590. Table 1: Baseline characteristics Treatment All patients n=926 (100%) LMWH n=732 (79%) VKA n=100 (11%) No treatment n=53 (6%) Other treatment n=41 (4%) Mean age (SD) 65 (12) 64 (12) 68 (12) 65 (14) 68 (13) Male sex, n (%) 491 (53) 378 (52) 60 (60) 31 (58) 22 (54) Cancer stage, n (%) Metastatic 501 (54) 400 (55) 56 (56) 33 (62) 12 (29) Non-metastatic 192 (21) 143 (20) 34 (34) 12 (23) 3 (7.3) Unspecified 233 (25) 189 (26) 10 (10) 8 (15) 26 (63) Cancer type, n (%) Lung 176 (19) 135 (18) 16 (16) 18 (34) 7 (17) Colorectal 185 (20) 150 (20) 20 (20) 9 (17) 6 (15) Other gastrointestinal 187 (20) 147 (20) 15 (15) 13 (25) 12 (29) Breast 65 (7.0) 52 (7.1) 10 (10) 1 (1.9) 2 (4.9) Gynaecological 64 (6.9) 56 (7.7) 5 (5.0) 0 (0) 3 (7.3) Other 206 (22) 155 (21) 31 (31) 10 (19) 10 (24) Haematological 43 (4.6) 37 (5.1) 3 (3.0) 2 (3.8) 1 (2.4) Largest artery involved, n (%) Central 292 (32) 230 (31) 30 (30) 11 (21) 21 (51) Peripheral 495 (53) 395 (54) 62 (62) 29 (55) 9 (22) Unspecified 139 (15) 107 (15) 8 (8.0) 13 (25) 11 (27) Disclosures No relevant conflicts of interest to declare.

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