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Sample records for extremely poor outcome

  1. EXTREMELY METAL-POOR GALAXIES: THE ENVIRONMENT

    Energy Technology Data Exchange (ETDEWEB)

    Filho, M. E. [Universidad de Las Palmas de Gran Canaria–Universidad de La Laguna, CIE Canarias: Tri-Continental Atlantic Campus, Canary Islands (Spain); Almeida, J. Sánchez; Muñoz-Tuñón, C. [Instituto Astrofísica de Canarias, E-38200 La Laguna, Tenerife (Spain); Nuza, S. E.; Kitaura, F.; Heß, S., E-mail: mfilho@astro.up.pt [Leibniz-Institut für Astrophysik Potsdam (AIP), An der Sternwarte 16, D-14482 Potsdam (Germany)

    2015-04-01

    We have analyzed bibliographical observational data and theoretical predictions, in order to probe the environment in which extremely metal-poor dwarf galaxies (XMPs) reside. We have assessed the H i component and its relation to the optical galaxy, the cosmic web type (voids, sheets, filaments and knots), the overdensity parameter and analyzed the nearest galaxy neighbors. The aim is to understand the role of interactions and cosmological accretion flows in the XMP observational properties, particularly the triggering and feeding of the star formation. We find that XMPs behave similarly to Blue Compact Dwarfs; they preferably populate low-density environments in the local universe: ∼60% occupy underdense regions, and ∼75% reside in voids and sheets. This is more extreme than the distribution of irregular galaxies, and in contrast to those regions preferred by elliptical galaxies (knots and filaments). We further find results consistent with previous observations; while the environment does determine the fraction of a certain galaxy type, it does not determine the overall observational properties. With the exception of five documented cases (four sources with companions and one recent merger), XMPs do not generally show signatures of major mergers and interactions; we find only one XMP with a companion galaxy within a distance of 100 kpc, and the H i gas in XMPs is typically well-behaved, demonstrating asymmetries mostly in the outskirts. We conclude that metal-poor accretion flows may be driving the XMP evolution. Such cosmological accretion could explain all the major XMP observational properties: isolation, lack of interaction/merger signatures, asymmetric optical morphology, large amounts of unsettled, metal-poor H i gas, metallicity inhomogeneities, and large specific star formation.

  2. Toward ab initio extremely metal poor stars

    CERN Document Server

    Ritter, Jeremy S; Milosavljevic, Milos; Bromm, Volker

    2016-01-01

    Extremely metal poor stars have been the focus of much recent attention owing to the expectation that their chemical abundances can shed light on the metal and dust yields of the earliest supernovae. We present our most realistic simulation to date of the astrophysical pathway to the first metal enriched stars. We simulate the radiative and supernova hydrodynamic feedback of a 60 Msun Population III star starting from cosmological initial conditions realizing Gaussian density fluctuations. We follow the gravitational hydrodynamics of the supernova remnant at high spatial resolution through its freely-expanding, adiabatic, and radiative phases, until gas, now metal-enriched, has resumed runaway gravitational collapse. Our findings are surprising: while the Population III progenitor exploded with a low energy of 10^51 erg and injected an ample metal mass of 6 Msun, the first cloud to collapse after the supernova explosion is a dense surviving primordial cloud on which the supernova blastwave deposited metals on...

  3. Outcomes for extremely premature infants.

    Science.gov (United States)

    Glass, Hannah C; Costarino, Andrew T; Stayer, Stephen A; Brett, Claire M; Cladis, Franklyn; Davis, Peter J

    2015-06-01

    Premature birth is a significant cause of infant and child morbidity and mortality. In the United States, the premature birth rate, which had steadily increased during the 1990s and early 2000s, has decreased annually for 7 years and is now approximately 11.39%. Human viability, defined as gestational age at which the chance of survival is 50%, is currently approximately 23 to 24 weeks in developed countries. Infant girls, on average, have better outcomes than infant boys. A relatively uncomplicated course in the intensive care nursery for an extremely premature infant results in a discharge date close to the prenatal estimated date of confinement. Despite technological advances and efforts of child health experts during the last generation, the extremely premature infant (less than 28 weeks gestation) and extremely low birth weight infant (death and disability with 30% to 50% mortality and, in survivors, at least 20% to 50% risk of morbidity. The introduction of continuous positive airway pressure, mechanical ventilation, and exogenous surfactant increased survival and spurred the development of neonatal intensive care in the 1970s through the early 1990s. Routine administration of antenatal steroids during premature labor improved neonatal mortality and morbidity in the late 1990s. The recognition that chronic postnatal administration of steroids to infants should be avoided may have improved outcomes in the early 2000s. Evidence from recent trials attempting to define the appropriate target for oxygen saturation in preterm infants suggests arterial oxygen saturation between 91% and 95% (compared with 85%-89%) avoids excess mortality; however, final analyses of data from these trials have not been published, so definitive recommendations are still pending. The development of neonatal neurocritical intensive care units may improve neurocognitive outcomes in this high-risk group. Long-term follow-up to detect and address developmental, learning, behavioral, and

  4. Outcomes for Extremely Premature Infants

    Science.gov (United States)

    Glass, Hannah C.; Costarino, Andrew T.; Stayer, Stephen A.; Brett, Claire; Cladis, Franklyn; Davis, Peter J.

    2015-01-01

    Premature birth is a significant cause of infant and child morbidity and mortality. In the United States, the premature birth rate, which had steadily increased during the 1990s and early 2000s, has decreased annually for four years and is now approximately 11.5%. Human viability, defined as gestational age at which the chance of survival is 50%, is currently approximately 23–24 weeks in developed countries. Infant girls, on average, have better outcomes than infant boys. A relatively uncomplicated course in the intensive care nursery for an extremely premature infant results in a discharge date close to the prenatal EDC. Despite technological advances and efforts of child health experts during the last generation, the extremely premature infant (less than 28 weeks gestation) and extremely low birth weight infant (ELBW) (premature labor improved neonatal mortality and morbidity in the late 1990s. The recognition that chronic postnatal administration of steroids to infants should be avoided may have improved outcomes in the early 2000s. Evidence from recent trials attempting to define the appropriate target for oxygen saturation in preterm infants suggests arterial oxygen saturation between 91–95% (compared to 85–89%) avoids excess mortality. However, final analyses of data from these trials have not been published, so definitive recommendations are still pending The development of neonatal neurocognitive care visits may improve neurocognitive outcomes in this high-risk group. Long-term follow up to detect and address developmental, learning, behavioral, and social problems is critical for children born at these early gestational ages. The striking similarities in response to extreme prematurity in the lung and brain imply that agents and techniques that benefit one organ are likely to also benefit the other. Finally, since therapy and supportive care continue to change, the outcomes of ELBW infants are ever evolving. Efforts to minimize injury, preserve

  5. A New Type of Extremely Metal Poor Star

    CERN Document Server

    Cohen, J G; Christlieb, N; Shectman, S; Thompson, I; Melendez, J; Reimers, L W D; Cohen, Judith G.; William, Andrew Mc; Christlieb, Norbert; Shectman, Stephen; Thompson, Ian; Melendez, Jorge; Reimers, Lutz Wisotzki & Dieter

    2007-01-01

    We present an abundance analysis for the extremely metal poor star HE1424-0241 based on high dispersion spectra from HIRES at Keck. This star is a giant on the lower red giant branch with [Fe/H] ~ -4.0 dex. Relative to Fe, HE1424-0241 has normal Mg, but it shows a very large deficiency of Si, with epsilon(Si)/epsilon(Fe) ~ 1/10 and epsilon(Si)/epsilon(Mg) ~ 1/25 that of all previously known extremely metal poor giants or dwarfs. It also has a moderately large deficiency of Ca and a smaller deficit of Ti, combined with enhanced Mn and Co and normal or low C. We suggest that in HE1424-0241 we see the effect of a very small number of contributing supernovae, and that the SNII contributing to the chemical inventory of HE1424-0241 were biased in progenitor mass or in explosion characteristics so as to reproduce its abnormal extremely low Si/Mg ratio. HE1424-0241 shows a deficiency of the explosive alpha-burning elements Si, Ca and Ti coupled with a ratio [Mg/Fe] normal for EMP stars; Mg is produced via hydrostatic...

  6. Spatially resolved dust emission of extremely metal-poor galaxies

    OpenAIRE

    Zhou, Luwenjia; Shi, Yong; Diaz-Santos, Taino; Armus, Lee; Helou, George; Stierwalt, Sabrina; Li, Aigen

    2016-01-01

    We present infrared (IR) spectral energy distributions (SEDs) of individual star-forming regions in four extremely metal-poor (EMP) galaxies with metallicity Z ≲ Z_⊙/10 as observed by the Herschel Space Observatory. With the good wavelength coverage of the SED, it is found that these EMP star-forming regions show distinct SED shapes as compared to those of grand design Spirals and higher metallicity dwarfs: they have on average much higher f_(70μm)/f_(160 μm) ratios at a given f_(160 μm)/f_(2...

  7. Supernova Nucleosynthesis and Extremely Metal-Poor Stars

    CERN Document Server

    Tominaga, Nozomu; Maeda, Keiichi; Iwamoto, Nobuyuki; Nomoto, Ken'ichi

    2008-01-01

    We investigate hydrodynamical and nucleosynthetic properties of the jet-induced explosion of a population III $40M_\\odot$ star and compare the abundance patterns of the yields with those of the metal-poor stars. We conclude that (1) the ejection of Fe-peak products and the fallback of unprocessed materials can account for the abundance patterns of the extremely metal-poor (EMP) stars and that (2) the jet-induced explosion with different energy deposition rates can explain the diversity of the abundance patterns of the metal-poor stars. Furthermore, the abundance distribution after the explosion and the angular dependence of the yield are shown for the models with high and low energy deposition rates $\\dot{E}_{\\rm dep}=120\\times10^{51} {\\rm ergs s^{-1}}$ and $1.5\\times10^{51} {\\rm ergs s^{-1}}$. We also find that the peculiar abundance pattern of a Si-deficient metal-poor star HE 1424--0241 can be reproduced by the angle-delimited yield for $\\theta=30^\\circ-35^\\circ$ of the model with $\\dot{E}_{\\rm dep}=120\\ti...

  8. Extremely metal-poor stars in SDSS fields

    CERN Document Server

    Bonifacio, Piercarlo; François, Patrick; Sbordone, Luca; Ludwig, Hans-G; Spite, Monique; Molaro, Paolo; Spite, François; Cayrel, Roger; Hammer, François; Hill, Vanessa; Nonino, Mario; Randich, Sofia; Stelzer, Beate; Zaggia, Simone

    2011-01-01

    Some insight on the first generation of stars can be obtained from the chemical composition of their direct descendants, extremely metal-poor stars (EMP), with metallicity less than or equal to 1/1000 of the solar metalllicity. Such stars are exceedingly rare, the most successful surveys, for this purpose, have so far provided only about 100 stars with 1/1000 the solar metallicity and 4 stars with about 1/10000 of the solar metallicity. The Sloan Digital Sky Survey has the potential to provide a large number of candidates of extremely low metallicity. X-Shooter has the unique capability of performing the necessary follow-up spectroscopy providing accurate metallicities and abundance ratios for several elements (Mg, Al, Ca, Ti, Cr, Sr,...) for EMP candidates. We here report on the results for the first two stars observed in the course of our franco-italian X-Shooter GTO. The two stars were targeted to be of metallicity around -3.0, the analysis of the X-Shooter spectra showed them to be of metallicity around -...

  9. Chemical abundances of distant extremely metal-poor unevolved stars

    CERN Document Server

    Bonifacio, P; Caffau, E; Ludwig, H -G; Spite, M; Hernández, J I González; Behara, N T

    2012-01-01

    Aims: The purpose of our study is to determine the chemical composition of a sample of 16 candidate Extremely Metal-Poor (EMP) dwarf stars, extracted from the Sloan Digital Sky Survey (SDSS). There are two main purposes: in the first place to verify the reliability of the metallicity estimates derived from the SDSS spectra; in the second place to see if the abundance trends found for the brighter nearer stars studied previously also hold for this sample of fainter, more distant stars. Methods: We used the UVES at the VLT to obtain high-resolution spectra of the programme stars. The abundances were determined by an automatic analysis with the MyGIsFOS code, with the exception of lithium, for which the abundances were determined from the measured equivalent widths of the Li I resonance doublet. Results: All candidates are confirmed to be EMP stars, with [Fe/H]<= -3.0. The chemical composition of the sample of stars is similar to that of brighter and nearer samples. We measured the lithium abundance for 12 st...

  10. Spatially resolved dust emission of extremely metal poor galaxies

    CERN Document Server

    Zhou, Luwenjia; Diaz-Santos, Taino; Armus, Lee; Helou, George; Stierwalt, Sabrina; Li, Aigen

    2016-01-01

    We present infrared (IR) spectral energy distributions (SEDs) of individual star-forming regions in four extremely metal poor (EMP) galaxies with metallicity Z around Zsun/10 as observed by the Herschel Space Observatory. With the good wavelength coverage of the SED, it is found that these EMP star-forming regions show distinct SED shapes as compared to those of grand design Spirals and higher metallicity dwarfs: they have on average much higher f70um/f160um ratios at a given f160um/f250um ratio; single modified black-body (MBB) fittings to the SED at \\lambda >= 100 um still reveal higher dust temperatures and lower emissivity indices compared to that of Spirals, while two MBB fittings to the full SED with a fixed emissivity index (beta = 2) show that even at 100 um about half of the emission comes from warm (50 K) dust, in contrast to the cold (~20 K) dust component. Our spatially resolved images further reveal that the far-IR colors including f70um/f160um, f160um/f250um and f250um/f350um are all related to ...

  11. Inefficient star formation in extremely metal poor galaxies.

    Science.gov (United States)

    Shi, Yong; Armus, Lee; Helou, George; Stierwalt, Sabrina; Gao, Yu; Wang, Junzhi; Zhang, Zhi-Yu; Gu, Qiusheng

    2014-10-16

    The first galaxies contain stars born out of gas with few or no 'metals' (that is, elements heavier than helium). The lack of metals is expected to inhibit efficient gas cooling and star formation, but this effect has yet to be observed in galaxies with an oxygen abundance (relative to hydrogen) below a tenth of that of the Sun. Extremely metal poor nearby galaxies may be our best local laboratories for studying in detail the conditions that prevailed in low metallicity galaxies at early epochs. Carbon monoxide emission is unreliable as a tracer of gas at low metallicities, and while dust has been used to trace gas in low-metallicity galaxies, low spatial resolution in the far-infrared has typically led to large uncertainties. Here we report spatially resolved infrared observations of two galaxies with oxygen abundances below ten per cent of the solar value, and show that stars formed very inefficiently in seven star-forming clumps in these galaxies. The efficiencies are less than a tenth of those found in normal, metal rich galaxies today, suggesting that star formation may have been very inefficient in the early Universe.

  12. Spatially resolved dust emission of extremely metal-poor galaxies*

    Science.gov (United States)

    Zhou, Luwenjia; Shi, Yong; Diaz-Santos, Taino; Armus, Lee; Helou, George; Stierwalt, Sabrina; Li, Aigen

    2016-05-01

    We present infrared (IR) spectral energy distributions (SEDs) of individual star-forming regions in four extremely metal-poor (EMP) galaxies with metallicity Z ≲ Z⊙/10 as observed by the Herschel Space Observatory. With the good wavelength coverage of the SED, it is found that these EMP star-forming regions show distinct SED shapes as compared to those of grand design Spirals and higher metallicity dwarfs: they have on average much higher f70μm/f160 μm ratios at a given f160 μm/f250 μm ratio; single modified blackbody (MBB) fittings to the SED at λ ≥ 100 μm still reveal higher dust temperatures and lower emissivity indices compared to that of Spirals, while two MBB fittings to the full SED with a fixed emissivity index (β = 2) show that even at 100 μm, about half of the emission comes from warm (50 K) dust, in contrast to the cold (˜20 K) dust component. Our spatially resolved images furthermore reveal that the far-IR colours including f70 μm/f160 μm, f160 μm/f250 μm and f250 μm/f350 μm are all related to the surface densities of young stars as traced by far-UV, 24 μm and star formation rates (SFRs), but not to the stellar mass surface densities. This suggests that the dust emitting at wavelengths from 70 to 350 μm is primarily heated by radiation from young stars.

  13. Extremely metal-poor star candidates in the SDSS

    Institute of Scientific and Technical Information of China (English)

    Si-Yao Xu; Hua-Wei Zhang; Xiao-Wei Liu

    2013-01-01

    For a sample of metal-poor stars (-3.3 ≤ [Fe/H] ≤-2.2) that have highresolution spectroscopic abundance determinations,we have measured equivalent widths of the Ca Ⅱ K,Mg Ⅰ b and near-infrared Ca Ⅱ triplet lines using low-resolution spectra from the Sloan Digital Sky Survey (SDSS),calculated effective temperatures from (g-z)o color,deduced stellar surface gravities by fitting stellar isochrones,and determined metallicities based on the aforementioned quantities.Metallicities thus derived from the Ca Ⅱ K line are in much better agreement with the results determined from high-resolution spectra than the values given in the SDSS Data Release 7.The metallicities derived from the Mg Ⅰ b lines have a large dispersion owing to the large measurement errors,whereas those deduced from the Ca Ⅱ triplet lines are too high due to both non-local thermodynamical equilibrium (NLTE) effects and measurement errors.Abundances after correction for the NLTE effect for the Mg Ⅰ b lines and Ca Ⅱ triplet lines are also presented.Following this method,we have identified six candidates of ultra-metal-poor stars with [Fe/H] ~-4.0 from a sample of 166 metal-poor star candidates.One of them,SDSS J102915+172927,was recently confirmed to be an ultra-metal-poor ([Fe/H] <-4.0) star with the lowest metallicity ever measured.Follow-up high-resolution spectroscopy for the other five ultra-metal-poor stars in our sample will therefore be of great interest.

  14. Molecular bands in extremely metal-poor stars. Granulation effects

    CERN Document Server

    Bonifacio, Piercarlo; Ludwig, Hans-Günter; Spite, Monique; Plez, Bertrand; Steffen, Matthias; Spite, François

    2013-01-01

    The bands of diatomic molecules are important abundance indicators, especially in metal-poor stars, where they are still measurable in metallicity regimes where the atomic lines of their constituting metallic elements have become vanishingly small. In order to use them for abundance determinations it is imperative to understand the formation of these bands. In this contribution we report on our results obtained using CO5BOLD hydrodynamical simulations. Some effects that are qualitatively different from what found in 1D computations are highlighted. Due to the large number of lines that form the bands, their spectrum synthesis is computationally challenging. We discuss some of the computational strategies we employed to parallelise the computation and possible future developments.

  15. First stars VII. Lithium in extremely metal poor dwarfs

    CERN Document Server

    Bonifacio, P; Sivarani, T; Cayrel, R; Spite, M; Spite, F; Plez, B; Andersen, J; Barbuy, B; Beers, T C; Depagne, E; Hill, V; François, P; Nordström, B; Primas, F

    2006-01-01

    Aims. This study aims to determine the level and constancy of the Spite plateau as definitively as possible from homogeneous high-quality VLT-UVES spectra of 19 of the most metal-poor dwarf stars known. Methods. Our high-resolution (R ~ 43000), high S/N spectra are analysed with OSMARCS 1D LTE model atmospheres and turbospectrum synthetic spectra to determine effective temperatures, surface gravities, and metallicities as well as Li abundances for our stars. Results. Eliminating a cool subgiant and a spectroscopic binary, we find 8 stars to have -3.5 < [Fe/H] < -3.0 and 9 stars with -3.0 < [Fe/H] < -2.5. Our best value for the mean level of the plateau is A(Li) =2.10 +- 0.09. The scatter around the mean is entirely explained by our estimate of the observational error and does not allow for any intrinsic scatter in the Li abundances. In addition, we conclude that a systematic error of the order of 200 K in any of the current temperature scales remains possible. The iron excitation equilibria in our...

  16. Extremely Metal-Poor Star Candidates in the SDSS

    CERN Document Server

    Xu, Siyao; Liu, Xiaowei

    2012-01-01

    For a sample of metal-poor stars (-3.3< [Fe/H] <-2.2) that have high-resolution spectroscopic abundance determinations, we have measured equivalent widths (EW) of the Ca II K, Mg I b and near-infrared (NIR) Ca II triplet lines using low-resolution spectra of the Sloan Digital Sky Survey (SDSS), calculated effective temperatures from (g-z)0 color, deduced stellar surface gravities by fitting stellar isochrones, and determined metallicities based on the aforementioned quantities. Metallicities thus derived from the Ca II K line are in much better agreement with the results determined from high-resolution spectra than the values given in the SDSS Data Release 7 (DR7). The metallicities derived from the Mg I b lines have a large dispersion owing to the large measurement errors, whereas those deduced from the Ca II triplet lines are too high due to both non-local thermodynamical equilibrium (NLTE) effects and measurement errors. Abundances after corrected for the NLTE effect for the Mg I b lines and Ca II tr...

  17. Poor Outcomes in Hepatic Amyloidosis: A Report of 2 Cases

    Science.gov (United States)

    Kertowidjojo, Elizabeth; Zhang, Yue; Patel, Pruthvi

    2016-01-01

    Hepatic amyloidosis is a rare disease entity that results from insoluble amyloid protein deposition in the liver. The disease often presents with vague, nonspecific clinical features. Currently, there is little literature describing treatment outcomes for biopsy-proven hepatic amyloidosis and current treatment guidelines recommend that patients enroll in a clinical trial due to insufficient evidence to suggest an optimal treatment regimen. Here, we present two cases of hepatic amyloidosis at an academic medical center and describe their presentation, treatment, and outcomes. These cases highlight the poor outcomes and difficult management of hepatic amyloidosis. Further understanding and investigation of this rare disease are warranted.

  18. Predictors of Poor Outcome in ANCA-Associated Vasculitis (AAV).

    Science.gov (United States)

    Vega, Luis E; Espinoza, Luis R

    2016-12-01

    It is important to recognize factors that might predict poor outcome and prognosis in patients with AAV. The predictors reported in the literature encompass genetic, histopathological, and clinical ones. Genetic studies (genetic predictors) have found genes that are associated with prediction of poor response to treatment, deterioration of renal function, and risk of mortality. Histopathological studies (histopathological predictors) have shown that sclerotic renal lesions are associated with increased risk of progression to end-stage renal disease and death. Lastly, scores (clinical predictors) obtained with tool as FFS, Maldini risk score, VDI, and emerging new biomarkers could potentially be helpful in assessment of prognosis in the future.

  19. Extremely metal-poor stars in classical dwarf spheroidal galaxies : Fornax, Sculptor, and Sextans

    NARCIS (Netherlands)

    Tafelmeyer, M.; Jablonka, P.; Hill, V.; Shetrone, M.; Tolstoy, E.; Irwin, M. J.; Battaglia, G.; Helmi, A.; Starkenburg, E.; Venn, K. A.; Abel, T.; Francois, P.; Kaufer, A.; North, P.; Primas, F.; Szeifert, T.

    2010-01-01

    We present the results of a dedicated search for extremely metal-poor stars in the Fornax, Sculptor, and Sextans dSphs. Five stars were selected from two earlier VLT/Giraffe and HET/HRS surveys and subsequently followed up at high spectroscopic resolution with VLT/UVES. All of them turned out to hav

  20. Extremely metal-poor stars in classical dwarf spheroidal galaxies : Fornax, Sculptor, and Sextans

    NARCIS (Netherlands)

    Tafelmeyer, M.; Jablonka, P.; Hill, V.; Shetrone, M.; Tolstoy, E.; Irwin, M. J.; Battaglia, G.; Helmi, A.; Starkenburg, E.; Venn, K. A.; Abel, T.; Francois, P.; Kaufer, A.; North, P.; Primas, F.; Szeifert, T.

    2010-01-01

    We present the results of a dedicated search for extremely metal-poor stars in the Fornax, Sculptor, and Sextans dSphs. Five stars were selected from two earlier VLT/Giraffe and HET/HRS surveys and subsequently followed up at high spectroscopic resolution with VLT/UVES. All of them turned out to hav

  1. Citrobacter Peritoneal Dialysis Peritonitis: Rare Occurrence with Poor Outcomes

    Science.gov (United States)

    Chao, Chia-Ter; Lee, Szu-Ying; Yang, Wei-Shun; Chen, Huei-Wen; Fang, Cheng-Chung; Yen, Chung-Jen; Chiang, Chih-Kang; Hung, Kuan-Yu; Huang, Jenq-Wen

    2013-01-01

    Introduction: Non-Pseudomonas gram-negative bacteria are responsible for an increasing proportion of cases of peritoneal dialysis (PD)-related peritonitis. The role of Citrobacter species in the etiology of PD-related peritonitis is often underestimated. In the present study, we aimed to describe the clinical features, laboratory findings, and short- and long-term outcomes in PD-related peritonitis caused by Citrobacter. Methods: A retrospective review of all episodes of PD-related peritonitis caused by Citrobacter from a single center between 1990 and 2010 was performed. Clinical features, microbiological data, and outcomes of these episodes were analyzed. Results: Citrobacter species was responsible for 11 PD-related episodes (1.8% of all peritonitis episodes) in 8 patients. Citrobacter freundii was the most common etiologic species (73%), and mixed growth was found in the other 3 episodes (27%). Approximately half (46%) of the episodes were associated with constipation and/or diarrhea. Of the Citrobacter isolates from all episodes, 54% were resistant to cefazolin, and only 18% were susceptible to cefmetazole. All isolates were susceptible to ceftazidime, cefepime, carbapenem, and aminoglycosides. More than half of the patients (54%) were hospitalized for index peritonitis, and 27% of the episodes involved a change in antibiotic medication. One patient had relapsing peritonitis caused by C. koseri (9%). The mortality rate of PD-related peritonitis caused by Citrobacter was 18%, and 89% of surviving patients developed technique failure requiring a modality switch after an average of 12 months of follow-up (range 1.2-31.2 months). Conclusion: PD-related peritonitis caused by Citrobacter is associated with poor outcomes, including high rates of antibiotic resistance, a high mortality rate, and a high rate of technique failure among survivors during the follow-up period. PMID:23869184

  2. Extremely metal-poor stars in classical dwarf spheroidal galaxies: Fornax, Sculptor and Sextans

    CERN Document Server

    Tafelmeyer, M; Hill, V; Shetrone, M; Tolstoy, E; Irwin, M J; Battaglia, G; Helmi, A; Starkenburg, E; Venn, K A; Abel, T; Francois, P; Kaufer, A; North, P; Primas, F; Szeifert, T

    2010-01-01

    We present the results of a dedicated search for extremely metal-poor stars in the Fornax, Sculptor and Sextans dSphs. Five stars were selected from two earlier VLT/Giraffe and HET/HRS surveys and subsequently followed up at high spectroscopic resolution with VLT/UVES. All of them turned out to have [Fe/H] <= -3 and three stars are below [Fe/H]~-3.5. This constitutes the first evidence that the classical dSphs Fornax and Sextans join Sculptor in containing extremely metal-poor stars and suggests that all of the classical dSphs contain extremely metal-poor stars. One giant in Sculptor at [Fe/H]=-3.96 +- 0.10 is the most metal-poor star ever observed in an external galaxy. We carried out a detailed analysis of the chemical abundances of the alpha, iron peak, and the heavy elements, and we performed a comparison with the Milky Way halo and the ultra faint dwarf stellar populations. Carbon, barium and strontium show distinct features characterized by the early stages of galaxy formation and can constrain the o...

  3. Methylene blue is associated with poor outcomes in vasoplegic shock.

    Science.gov (United States)

    Weiner, Menachem M; Lin, Hung-Mo; Danforth, Dennis; Rao, Srikar; Hosseinian, Leila; Fischer, Gregory W

    2013-12-01

    The purpose of this study was to investigate whether patients who received methylene blue as treatment for vasoplegia during cardiac surgery with cardiopulmonary bypass had decreased morbidity and mortality. Retrospective analysis. Single tertiary care university hospital. Adult patients who suffered from vasoplegia and underwent all types of cardiac surgery with cardiopulmonary bypass at this institution between 2007 and 2008. With IRB approval, the authors reviewed the charts of the identified patients and divided them into 2 groups based on whether they had received methylene blue. Two hundred twenty-six patients were identified who met the inclusion criteria for the study. Fifty-seven of these patients had received methylene blue for vasoplegia. The authors collected data on preoperative and intraoperative variables as well as outcomes. The patients who received methylene blue had higher rates of in-hospital mortality, a compilation of morbidities, as well as renal failure and hyperbilirubinemia. A multiple logistic regression model demonstrated that receiving methylene blue was an independent predictor of in-hospital mortality (p value: 0.007, OR 4.26, 95% CI: 1.49-12.12), compilation of morbidities (p value: 0.001, OR 4.80, 95% CI: 1.85-12.43), and hyperbilirubinemia (p value:methylene blue as treatment for vasoplegia to be independently associated with poor outcomes. While further studies are required, a thorough risk-benefit analysis should be applied before using methylene blue and, perhaps, it should be relegated to rescue use and not as first-line therapy. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. The Extreme Overabundance of Molybdenum in Two Metal-Poor Stars

    CERN Document Server

    Peterson, Ruth C

    2011-01-01

    We report determinations of the molybdenum abundances in five mildly to extremely metal-poor turnoff stars using five Mo II lines near 2000A. In two of the stars, the abundance of molybdenum is found to be extremely enhanced, as high or higher than the neighboring even-Z elements ruthenium and zirconium. Of the several nucleosynthesis scenarios envisioned for the production of nuclei in this mass range in the oldest stars, a high-entropy wind (HEW) acting in a core-collapse supernova seems uniquely capable of the twin aspects of a high molybdenum overproduction confined to a narrow mass range. Whatever the details of the nucleosynthesis mechanism, however, this unusual excess suggests that very few individual nucleosynthesis events were responsible for the synthesis of the light trans-Fe heavy elements in these cases, an unexpected result given that both are only moderately metal-poor.

  5. Proximal location in extremity long bones is a poor prognostic factor for osteosarcoma: A retrospective cohort study of 153 patients.

    Science.gov (United States)

    Cates, Justin M M; Schoenecker, Jonathan G

    2016-08-01

    Osteosarcomas arising in the proximal femur, humerus, and tibia appear to have poorer outcomes than those arising in distal long bones. However, the strength of this association is uncertain, particularly in light of other prognostic factors. Therefore, this retrospective cohort study was performed to compare patient outcomes between proximal and distal tumor location within extremity long bones. A total of 153 patients with conventional high-grade osteosarcoma of the extremity long bones, pelvis, or axial skeleton who had undergone neoadjuvant chemotherapy and surgical resection between 1985 and 2010 were identified in the Surgical Pathology files at Vanderbilt Medical Center. Effect of anatomic location within a proximal long bone was assessed using multivariable Cox proportional hazard regression. Proximal tumor location was a strong predictor of poor prognosis in univariate survival analysis. Multivariate regression analysis showed that after controlling for American Joint Committee on Cancer (AJCC) stage, histologic response to chemotherapy, surgical resection margin status, and histologic type, location in the proximal femur, tibia, and humerus were independent risk factors for death due to osteosarcoma, but not event-free survival. Osteosarcomas of the proximal extremity long bones are associated with decreased disease-specific survival compared to tumors of the distal long bones, even after accounting for other key prognostic covariates.

  6. Poverty Reduction for Extremely Poor Households of Malang City by the Implementation of Program Keluarga Harapan

    Directory of Open Access Journals (Sweden)

    Wimmy Haliim

    2016-11-01

    Full Text Available This research is based on the low access of poor families to basic education and health care in Malang City that have an impact on social welfare and poverty problem. To overcome these problems, Ministry of Social Affairs of the Republic of Indonesia through Malang City Government and Social Department of Malang City implements Program Keluarga Harapan (PKH in the form of conditional cash transfers to the Extremely Poor Households (RTSM. The result showed that the implementation of PKH has been implemented properly and according to the procedure and the number of RTSM recipients of PKH from year to year has decreased. Nevertheless, this program implementation does not significantly impact the number of poor people in the city of Malang in general.

  7. Questions never asked. Positive family outcomes of extremely premature childbirth

    DEFF Research Database (Denmark)

    Lou, Hanne; Pedersen, Birthe D; Hedegaard, Morten

    2009-01-01

    OBJECTIVE: To explore positive aspects of family life after extremely premature childbirth, thereby supplementing current literature on long-term family outcome. DESIGN: Semi-structured, qualitative research interviews were analysed according to the editing strategy described by Miller and Crabtree...... lend to future research on family outcome, as well as the balance they may offer in the information provided to parents of premature children....

  8. Lithium abundances in extremely metal-poor turn-off stars

    CERN Document Server

    Sbordone, L; Caffau, E

    2012-01-01

    We discuss the current status of the sample of Lithium abundances in extremely metal poor (EMP) turn-off (TO) stars collected by our group, and compare it with the available literature results. In the last years, evidences have accumulated of a progressive disruption of the Spite plateau in stars of extremely low metallicity. What appears to be a flat, thin plateau above [Fe/H]\\sim-2.8 turns, at lower metallicities, into a broader distribution for which the plateau level constitutes the upper limit, but more and more stars show lower Li abundances. The sample we have collected currently counts abundances or upper limits for 44 EMP TO stars between [Fe/H]=-2.5 and -3.5, plus the ultra-metal poor star SDSS J102915+172927 at [Fe/H]=-4.9. The "meltdown" of the Spite plateau is quite evident and, at the current status of the sample, does not appear to be restricted to the cool end of the effective temperature distribution. SDSS J102915+172927 displays an extreme Li depletion that contrasts with its otherwise quite...

  9. S-process in low-mass extremely metal-poor stars

    CERN Document Server

    Cruz, Monique A; Weiss, Achim

    2013-01-01

    Extremely metal-poor low-mass stars experience an ingestion of protons into the helium-rich layer during the core He-flash, resulting in the production of neutrons through the reactions ^{12}C(p,\\gamma)^{13}N(\\beta)^{13}C(\\alpha,n)^{16}O. This is a potential site for the production of s-process elements in extremely metal-poor stars not occurring in more metal-rich counterparts. Observationally, the signatures of s-process elements in the two most iron deficient stars observed to date, HE1327-2326 & HE0107-5240, still await for an explanation. We investigate the possibility that low-mass EMP stars could be the source of s-process elements observed in extremely iron deficient stars, either as a result of self-enrichment or in a binary scenario as the consequence of a mass transfer episode. We present evolutionary and post-processing s-process calculations of a 1Msun stellar model with metallicities Z=0, 10^{-8} and 10^{-7}. We assess the sensitivity of nucleosynthesis results to uncertainties in the input ...

  10. Oxygen Overabundance in the Extremely Iron-Poor Star CS29498-043

    CERN Document Server

    Aoki, W; Ryan, S G; Beers, T C; Christlieb, N; Tsangarides, S A; Ando, H; Aoki, Wako; Norris, John E.; Ryan, Sean G.; Beers, Timothy C.; Christlieb, Norbert; Tsangarides, Stelios; Ando, Hiroyasu

    2004-01-01

    An abundance analysis for the carbon-enhanced, extremely iron-poor ([Fe/H] -3.5) star CS29498-043 has been obtained using new high-resolution, high signal-to-noise spectra from the Subaru Telescope. The [O I] forbidden line at 6300A and the O I triplet feature at 7771-7776A are both clearly detected. The overabundance of oxygen is significant ([O/Fe]>2). In addition, Na, Co, and Ni abundances have been newly measured. The abundance pattern from C to Ni of this object is quite similar to that of CS 22949--037, another extremely metal-poor star with large excesses of C, N, O, and the alpha-elements. The abundance patterns of these two stars suggest the existence of supernovae progenitors that ejected relatively little material fromtheir iron cores during the very early era of nucleosynthesis in the Galaxy. Themetallicity in these objects, when one includes the elements C, N, and O in the tally of total metals, is not as low as in the most metal-poor stars, suggesting the existence of quite different formation p...

  11. Outcome of poor response Paediatric AML using early SCT

    DEFF Research Database (Denmark)

    Wareham, Neval E; Heilmann, Carsten; Abrahamsson, Jonas;

    2013-01-01

    treated with SCT. MATERIAL AND METHODS: Treatment was given according to the NOPHO-AML 2004 protocol. All patients received AIET (Cytarabine, Idarubicin, Etoposide, Thioguanine) and AM (Cytarabine, Mitoxantrone) as induction. We included poor response defined as > 15% blasts on day 15 after AIET (n = 17......) or > 5% blasts after AM (n = 14, refractory disease). Poor response patients received intensively timed induction and proceeded to SCT when a donor was available. RESULTS: Thirty-one of 267 evaluable patients (12%) had a poor response. SCT was performed in 25; using matched unrelated donors in 13...

  12. THE ORIGIN OF LOW [α/Fe] RATIOS IN EXTREMELY METAL-POOR STARS

    Energy Technology Data Exchange (ETDEWEB)

    Kobayashi, Chiaki [School of Physics, Astronomy and Mathematics, Centre for Astrophysics Research, University of Hertfordshire, College Lane, Hatfield AL10 9AB (United Kingdom); Ishigaki, Miho N.; Tominaga, Nozomu; Nomoto, Ken' ichi, E-mail: c.kobayashi@herts.ac.uk [Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo, Kashiwa, Chiba 277-8583 (Japan)

    2014-04-10

    We show that the low ratios of α elements (Mg, Si, and Ca) to Fe recently found for a small fraction of extremely metal-poor stars can be naturally explained with the nucleosynthesis yields of core-collapse supernovae, i.e., 13-25 M {sub ☉} supernovae, or hypernovae. For the case without carbon enhancement, the ejected iron mass is normal, consistent with observed light curves and spectra of nearby supernovae. On the other hand, the carbon enhancement requires much smaller iron production, and the low [α/Fe] of carbon-enhanced metal-poor stars can also be reproduced with 13-25 M {sub ☉} faint supernovae or faint hypernovae. Iron-peak element abundances, in particular Zn abundances, are important to put further constraints on the enrichment sources from galactic archaeology surveys.

  13. US Intervention in Failed States: Bad Assumptions=Poor Outcomes

    Science.gov (United States)

    2002-01-01

    NATIONAL DEFENSE UNIVERSITY NATIONAL WAR COLLEGE STRATEGIC LOGIC ESSAY US INTERVENTION IN FAILED STATES: BAD ASSUMPTIONS = POOR ...2002 2. REPORT TYPE 3. DATES COVERED 00-00-2002 to 00-00-2002 4. TITLE AND SUBTITLE US Intervention in Failed States: Bad Assumptions= Poor ...country remains in the grip of poverty , natural disasters, and stagnation. Rwanda Rwanda, another small African country, is populated principally

  14. Poor pregnancy outcome in women with type 2 diabetes

    DEFF Research Database (Denmark)

    Clausen, Tine Dalsgaard; Mathiesen, Elisabeth Reinhardt; Ekbom, Pia

    2005-01-01

    To evaluate the perinatal outcome and the frequency of maternal complications in pregnancies of women with type 2 diabetes during 1996-2001.......To evaluate the perinatal outcome and the frequency of maternal complications in pregnancies of women with type 2 diabetes during 1996-2001....

  15. WHT follow-up observations of extremely metal-poor stars identified from SDSS and LAMOST

    Science.gov (United States)

    Aguado, D. S.; González Hernández, J. I.; Allende Prieto, C.; Rebolo, R.

    2017-09-01

    Aims: We have identified several tens of extremely metal-poor star candidates from SDSS and LAMOST, which we follow up with the 4.2 m William Herschel Telescope (WHT) telescope to confirm their metallicity. Methods: We followed a robust two-step methodology. We first analyzed the SDSS and LAMOST spectra. A first set of stellar parameters was derived from these spectra with the FERRE code, taking advantage of the continuum shape to determine the atmospheric parameters, in particular, the effective temperature. Second, we selected interesting targets for follow-up observations, some of them with very low-quality SDSS or LAMOST data. We then obtained and analyzed higher-quality medium-resolution spectra obtained with the Intermediate dispersion Spectrograph and Imaging System (ISIS) on the WHT to arrive at a second more reliable set of atmospheric parameters. This allowed us to derive the metallicity with accuracy, and we confirm the extremely metal-poor nature in most cases. In this second step we also employed FERRE, but we took a running mean to normalize both the observed and the synthetic spectra, and therefore the final parameters do not rely on having an accurate flux calibration or continuum placement. We have analyzed with the same tools and following the same procedure six well-known metal-poor stars, five of them at [Fe/H] http://cdsarc.u-strasbg.fr (http://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/qcat?J/A+A/605/A40

  16. Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial.

    Science.gov (United States)

    2003-06-01

    Previous studies suggest that undernourished patients with acute stroke do badly. The data, however, are not robust. We aimed to reliably assess the importance of baseline nutritional status as an independent predictor of long-term outcome after stroke in a large prospective cohort enrolled in the Feed Or Ordinary Diet (FOOD) trial, a multicenter randomized trial evaluating various feeding policies. Patients admitted to hospital with a recent stroke were enrolled in the FOOD trial. Data on nutritional status and other clinical predictors of outcome were collected at trial entry. At 6 months, the coordinating center collected data on survival and functional status (modified Rankin Scale). Outcome assessment was done by researchers blinded to baseline assessments and treatment allocation. Between November 1996 and November 2001, 3012 patients were enrolled, and 2955 (98%) were followed up. Of the 275 undernourished patients, 102 (37%) were dead by final follow-up compared with only 445 (20%) of 2194 patients of normal nutritional status (odds ratio [OR], 2.32; 95% CI, 1.78 to 3.02). After adjustment for age, prestroke functional state, and stroke severity, this relationship, although weakened, still held (OR, 1.82; 95% CI, 1.34 to 2.47). Undernourished patients were more likely to develop pneumonia, other infections, and gastrointestinal bleeding during their hospital admission than other patients. These data provide reliable evidence that nutritional status early after stroke is independently associated with long-term outcome. It supports the rationale for the FOOD trial, which continues to recruit and aims to estimate the effect of different feeding regimes on outcome after stroke and thus determine whether the association observed in this study is likely to be causal.

  17. Extremely metal-poor stars from the cosmic dawn in the bulge of the Milky Way

    CERN Document Server

    Howes, L M; Asplund, M; Keller, S C; Yong, D; Nataf, D M; Poleski, R; Lind, K; Kobayashi, C; Owen, C I; Ness, M; Bessell, M S; Da Costa, G S; Schmidt, B P; Tisserand, P; Udalski, A; Szymański, M K; Soszyński, I; Pietrzyński, G; Ulaczyk, K; Wyrzykowski, Ł; Pietrukowicz, P; Skowron, J; Kozłowski, S; Mróz, P

    2015-01-01

    The first stars are predicted to have formed within 200 million years after the Big Bang, initiating the cosmic dawn. A true first star has not yet been discovered, although stars with tiny amounts of elements heavier than helium ('metals') have been found in the outer regions ('halo') of the Milky Way. The first stars and their immediate successors should, however, preferentially be found today in the central regions ('bulges') of galaxies, because they formed in the largest over-densities that grew gravitationally with time. The Milky Way bulge underwent a rapid chemical enrichment during the first 1-2 billion years, leading to a dearth of early, metal-poor stars. Here we report observations of extremely metal-poor stars in the Milky Way bulge, including one star with an iron abundance about 10,000 times lower than the solar value without noticeable carbon enhancement. We confirm that the most metal-poor bulge stars are on tight orbits around the Galactic Centre, rather than being halo stars passing through...

  18. Extremely metal-poor stars from the cosmic dawn in the bulge of the Milky Way.

    Science.gov (United States)

    Howes, L M; Casey, A R; Asplund, M; Keller, S C; Yong, D; Nataf, D M; Poleski, R; Lind, K; Kobayashi, C; Owen, C I; Ness, M; Bessell, M S; Da Costa, G S; Schmidt, B P; Tisserand, P; Udalski, A; Szymański, M K; Soszyński, I; Pietrzyński, G; Ulaczyk, K; Wyrzykowski, Ł; Pietrukowicz, P; Skowron, J; Kozłowski, S; Mróz, P

    2015-11-26

    The first stars are predicted to have formed within 200 million years after the Big Bang, initiating the cosmic dawn. A true first star has not yet been discovered, although stars with tiny amounts of elements heavier than helium ('metals') have been found in the outer regions ('halo') of the Milky Way. The first stars and their immediate successors should, however, preferentially be found today in the central regions ('bulges') of galaxies, because they formed in the largest over-densities that grew gravitationally with time. The Milky Way bulge underwent a rapid chemical enrichment during the first 1-2 billion years, leading to a dearth of early, metal-poor stars. Here we report observations of extremely metal-poor stars in the Milky Way bulge, including one star with an iron abundance about 10,000 times lower than the solar value without noticeable carbon enhancement. We confirm that most of the metal-poor bulge stars are on tight orbits around the Galactic Centre, rather than being halo stars passing through the bulge, as expected for stars formed at redshifts greater than 15. Their chemical compositions are in general similar to typical halo stars of the same metallicity although intriguing differences exist, including lower abundances of carbon.

  19. The Kennicutt-Schmidt Relation in Extremely Metal-Poor Dwarf Galaxies

    CERN Document Server

    Filho, M E; Amorín, R; Muñoz-Tuñón, C; Elmegreen, B G; Elmegreen, D M

    2016-01-01

    The Kennicutt-Schmidt (KS) relation between the gas mass and star formation rate (SFR) describes the star formation regulation in disk galaxies. It is a function of gas metallicity, but the low metallicity regime of the KS diagram is poorly sampled. We have analyzed data for a representative set of extremely metal-poor galaxies (XMPs), as well as auxiliary data, and compared these to empirical and theoretical predictions. The majority of the XMPs possess high specific SFRs, similar to high redshift star-forming galaxies. On the KS plot, the XMP HI data occupy the same region as dwarfs, and extend the relation for low surface brightness galaxies. Considering the HI gas alone, a considerable fraction of the XMPs already fall off the KS law. Significant quantities of 'dark' H$_2$ mass (i.e., not traced by CO) would imply that XMPs possess low star formation efficiencies (SFE$_{\\rm gas}$). Low SFE$_{\\rm gas}$ in XMPs may be the result of the metal-poor nature of the HI gas. Alternatively, the HI reservoir may be ...

  20. Detailed abundances in extremely metal poor dwarf stars extracted from SDSS

    CERN Document Server

    Sbordone, Luca; Caffau, Elisabetta; Ludwig, Hans-Gunther

    2012-01-01

    We report on the result of an ongoing campaign to determine chemical abundances in extremely metal poor (EMP) turn-off (TO) stars selected from the Sloan Digital Sky Survey (SDSS) low resolution spectra. This contribution focuses principally on the largest part of the sample (18 stars out of 29), observed with UVES@VLT and analyzed by means of the automatic abundance analysis code MyGIsFOS to derive atmosphere parameters and detailed compositions. The most significant findings include i) the detection of a C-rich, strongly Mg-enhanced star ([Mg/Fe]=1.45); ii) a group of Mn-rich stars ([Mn/Fe]>-0.4); iii) a group of Ni-rich stars ([Ni/Fe]>0.2). Li is measured in twelve stars, while for three upper limits are derived.

  1. SBS 1150+599A an extremely oxygen-poor planetary nebula in the Galactic halo?

    CERN Document Server

    Tovmassian, G H; Chavushyan, V H; Zharikov, S V; Gutíerrez, C; Prada, F

    2001-01-01

    We report results of a spectrophotometric study of SBS 1150+599A and discuss the nature of this object based upon our data. Our study shows that SBS 1150+599A is most probably a planetary nebula located in the Galactic halo and not a cataclysmic variable as originally proposed by the authors of the Second Byurakan Survey from low resolution spectroscopy. We have further elaborated on the properties of SBS 1150+599A (now becoming PN G135.9+55.9) with tools used for planetary nebula analysis. Our photoionization models show that, in order to match the observational constraints, the oxygen abundance in the nebula is probably extremely low, around 1/500 solar, which is one order of magnitude lower than the most oxygen-poor planetary nebulae known so far. This finding has strong implications on our understanding of the formation of planetary nebulae and of the evolution of the Galactic halo.

  2. Poor pregnancy outcome in women with type 2 diabetes

    DEFF Research Database (Denmark)

    Clausen, Tine D; Mathiesen, Elisabeth; Ekbom, Pia

    2005-01-01

    OBJECTIVE: To evaluate the perinatal outcome and the frequency of maternal complications in pregnancies of women with type 2 diabetes during 1996-2001. RESEARCH DESIGN AND METHODS: Medical records of 61 consecutive singleton pregnancies in women with type 2 diabetes from 1996 to 2001 were studied....... Pregnancy outcome was compared with that of pregnant women with type 1 diabetes during 1996-2000, the background population, and pregnant women with type 2 diabetes during 1980-1992 from the same department. RESULTS: The perinatal mortality in pregnancies complicated by type 2 diabetes (4/61, 6.......6%) was increased four- and ninefold, respectively, and the rate of major congenital malformations (4/60, 6.7%) was more than doubled, although not statistically significant, compared with type 1 diabetic pregnancies and the background population. The glycemic control was similar or better in women with type 2...

  3. Driving: a road to unhealthy lifestyles and poor health outcomes.

    Directory of Open Access Journals (Sweden)

    Ding Ding

    Full Text Available BACKGROUND: Driving is a common part of modern society, but its potential effects on health are not well understood. PURPOSE: The present cross-sectional study (n = 37,570 examined the associations of driving time with a series of health behaviors and outcomes in a large population sample of middle-aged and older adults using data from the Social, Economic, and Environmental Factor Study conducted in New South Wales, Australia, in 2010. METHODS: Multiple logistic regression was used in 2013 to examine the associations of usual daily driving time with health-related behaviors (smoking, alcohol use, diet, physical activity, sedentary behavior, sleep and outcomes (obesity, general health, quality of life, psychological distress, time stress, social functioning, adjusted for socio-demographic characteristics. RESULTS: Findings suggested that longer driving time was associated with higher odds for smoking, insufficient physical activity, short sleep, obesity, and worse physical and mental health. The associations consistently showed a dose-response pattern and more than 120 minutes of driving per day had the strongest and most consistent associations with the majority of outcomes. CONCLUSION: This study highlights driving as a potential lifestyle risk factor for public health. More population-level multidisciplinary research is needed to understand the mechanism of how driving affects health.

  4. Outcomes of arterial vascular extremity trauma in pediatric patients.

    Science.gov (United States)

    Kirkilas, Mary; Notrica, David M; Langlais, Crystal S; Muenzer, Jared T; Zoldos, Jozef; Graziano, Kathleen

    2016-11-01

    Vascular trauma in children, although rare, carries significant risk for repair. Here we report outcomes from a single trauma center for children with extremity vascular trauma, proximal to the digits. Retrospective chart review of patients less than age 18years with an acute, non-iatrogenic traumatic arterial vascular injury of the upper and/or lower extremity between January 2008 and December 2013. Abstracted patient demographics, injury characteristics, surgical management, and disposition were summarized and compared with nonparametric methods. 23 children comprised the study cohort: median age of 8years (IQR: 4.6-12), 61% (n=14) males, 100% survival. Penetrating injuries were the predominate mechanism (n=17, 74%). The median time to presentation was 154min (IQR: 65-330). Acute operations for revascularization included a primary repair (n=15, 65%) or reversed vein graft (n=7, 30%). Fasciotomies were done for 3 (13%) patients. Three amputations were done for failed revascularization. Upper extremity vascular injury (n=15, 65%) was more common. The rate of associated extremity fracture was similar between upper (21%) and lower (33%) extremities (p=0.643). Eight (35%) patients required additional surgery most commonly for debridement, washouts and dressing changes. Three patients' hospital stays were complicated by infection. Impaired function was the most common short- and long-term complication (60%, 75%). Pediatric vascular injuries are commonly associated with penetrating injuries and male gender and occurred more frequently in the upper extremities. Overall patency rates after repair were 87%. Fasciotomies were done in 13% of patients, and the overall surgical amputation rate was 13%. There was no mortality in this cohort; however, multiple operations are commonly required, including the return to OR for washouts, debridements and dressing changes. The most common short- and long-term complication was impaired function. Overall good results are achievable in

  5. Early-Age Evolution of the Milky Way Related by Extremely Metal-Poor Stars

    CERN Document Server

    Komiya, Yutaka; Fujimoto, Masayuki Y

    2009-01-01

    We exploit the recent observations of extremely metal-poor (EMP) stars in the Galactic halo and investigate the constraints on the IMF of the stellar population that left these low-mass survivors of [Fe/H]<-2.5 and the chemical evolution that they took part in. A high-mass IMF with the typical mass~10Msun and the overwhelming contribution of low-mass members of binaries to the EMP survivors are derived from the statistics of carbon-enriched EMP stars with and without the enhancement of s-process elements (Komiya et al. 2007). We first examine the analysis to confirm their results for various assumptions on the mass-ratio distribution function. As compared with the uniform distribution, the increase or decrease function of the mass ratio gives a higher- or lower-mass IMF, and a lower-mass IMF results for the independent distribution with the both members in the same IMF, but the derived ranges of typical mass differ less than by a factor of two and overlap for the extreme cases. Furthermore, we prove that t...

  6. First stars XIII. Two extremely metal-poor RR Lyrae stars?

    CERN Document Server

    Hansen, C J; Bonifacio, P; Spite, M; Andersen, J; Beers, T C; Cayrel, R; Spite, F; Molaro, P; Barbuy, B; Depagne, E; Hill, P Francois V; Plez, B; Sivarani, T

    2011-01-01

    The chemical composition of extremely metal-poor stars (EMP stars; [Fe/H]<~ -3) is a unique tracer of early nucleosynthesis in the Galaxy. As such stars are rare, we wish to find classes of luminous stars which can be studied at high resolution. We aim to determine the detailed chemical composition of the two EMP stars CS30317-056 and CS22881-039, originally thought to be red horizontal-branch (RHB) stars, and compare it to earlier results for EMP stars as well as to nucleosynthesis yields from various supernova (SN) models. In the analysis, we discovered that our targets are in fact the two most metal-poor RR Lyrae stars known. Our detailed abundance analysis, taking into account the variability of the stars, is based on VLT/UVES spectra (R~ 43000) and 1D LTE OSMARCS model atmospheres and synthetic spectra. For comparison with SN models we also estimate NLTE corrections for a number of elements. We derive LTE abundances for the 16 elements O, Na, Mg, Al, Si, S, Ca, Sc, Ti, Cr, Mn, Fe, Co, Ni, Sr and Ba, i...

  7. Abundance Profiling of Extremely Metal-Poor Stars and Supernova Properties in the Early Universe

    CERN Document Server

    Tominaga, Nozomu; Nomoto, Ken'ichi

    2013-01-01

    The first metal enrichment in the universe was made by a supernova (SN) explosion of a population (Pop) III star and chemical evolution of the universe is recorded in abundance patterns of extremely metal-poor (EMP) stars. Increasing number of the EMP stars are now being discovered. This allows us to statistically constrain properties of SNe of Pop III stars (Pop III SNe). We investigate the properties of Pop III SNe by comparing their nucleosynthetic yields with the abundance patterns of the EMP stars. We focus on the most metal-poor stars with [Fe/H] $\\lsim-3.5$ and present Pop III SN models that reproduce well their individual abundance patterns. From these models we derive relations between abundance ratios and properties of Pop III SNe: [(C+N)/Fe] vs. an ejected Fe mass, and [(C+N)/Mg] vs. a remnant mass. Using fitting formulae, distribution of the abundance ratios of EMP stars is converted to those of the properties of Pop III SNe, which can be compared with SNe in the present day. Large samples of EMP ...

  8. Lithium Abundances of Extremely Metal-Poor Turn-off Stars

    CERN Document Server

    Aoki, Wako; Beers, Timothy C; Christlieb, Norbert; Inoue, Susumu; Perez, Ana E Garcia; Norris, John E; Carollo, Daniela

    2009-01-01

    We have determined Li abundances for eleven metal-poor turn-off stars, among which eight have [Fe/H]<-3, based on LTE analyses of high-resolution spectra obtained with the HDS on the Subaru telescope. The Li abundances for four of these eight stars are determined for the first time by this study. Effective temperatures are determined by a profile analysis of H-alpha and H-beta. While seven stars have Li abundances as high as the Spite Plateau value, the remaining four objects with [Fe/H] <-3 have A(Li)=log(Li/H)+12 ~< 2.0, confirming the existence of extremely metal-poor turn-off stars having low Li abundances, as reported by previous work. The average of the Li abundances for stars with [Fe/H]<-3 is lower by 0.2 dex than that of the stars with higher metallicity. No clear constraint on the metallicity dependence or scatter of the Li abundances is derived from our measurements for the stars with [Fe/H]<-3. Correlations of the Li abundance with effective temperatures, with abundances of Na, Mg a...

  9. Chemical Abundance Analysis of the Extremely Metal-Poor Star HE 1300+0157

    CERN Document Server

    Frebel, A; Aoki, W; Honda, S; Bessell, M S; Takada-Hidai, M; Beers, T C; Christlieb, N; Frebel, Anna; Norris, John E.; Aoki, Wako; Honda, Satoshi; Bessell, Michael S.; Takada-Hidai, Masahide; Beers, Timothy C.; Christlieb, Norbert

    2006-01-01

    We present a detailed chemical abundance analysis of HE 1300+0157, a subgiant with [Fe/H]=-3.9. From a high-resolution, high-S/N Subaru/HDS spectrum we find the star to be enriched in C ([C/Fe]_1D ~ +1.4) and O ([O/Fe]_1D ~ +1.8). With the exception of these species, HE 1300+0157 exhibits an elemental abundance pattern similar to that found in many other very and extremely metal-poor stars. The Li abundance is lower than the Spite-plateau value, in agreement with expectation for its evolutionary status. Of particular interest, no neutron-capture elements are detected in HE 1300+0157. This type of abundance pattern has been found by recent studies in several other metal-poor giants. We suggest that HE 1300+0157 is an unevolved example of this group of stars, which exhibit high C abundances together with low (or absent) abundances of neutron-capture elements. Several potential enrichment scenarios are presented. The low neutron-capture elements, including Sr, Ba, and Pb, suggests that the carbon excess observed...

  10. Kinematics of Extremely Metal-poor Galaxies: Evidence for Stellar Feedback

    CERN Document Server

    Olmo-Garcia, A; Munoz-Tunon, C; Filho, M E; Elmegreen, B G; Elmegreen, D M; Perez-Montero, E; Mendez-Abreu, J

    2016-01-01

    The extremely metal-poor (XMP) galaxies analyzed in a previous paper have large star-forming regions with a metallicity lower than the rest of the galaxy. Such a chemical inhomogeneity reveals the external origin of the metal-poor gas fueling star formation, possibly indicating accretion from the cosmic web. This paper studies the kinematic properties of the ionized gas in these galaxies. Most XMPs have rotation velocity around a few tens of km/s. The star-forming regions appear to move coherently. The velocity is constant within each region, and the velocity dispersion sometimes increases within the star-forming clump towards the galaxy midpoint, suggesting inspiral motion toward the galaxy center. Other regions present a local maximum in velocity dispersion at their center, suggesting a moderate global expansion. The Halpha line wings show a number of faint emission features with amplitudes around a few percent of the main Halpha component, and wavelength shifts between 100 and 400 km/s. The components are ...

  11. On the Dearth of Ultra-faint Extremely Metal-poor Galaxies

    Science.gov (United States)

    Sánchez Almeida, J.; Filho, M. E.; Dalla Vecchia, C.; Skillman, E. D.

    2017-02-01

    Local extremely metal-poor galaxies (XMPs) are of particular astrophysical interest since they allow us to look into physical processes characteristic of the early universe, from the assembly of galaxy disks to the formation of stars in conditions of low metallicity. Given the luminosity–metallicity relationship, all galaxies fainter than Mr ≃ ‑13 are expected to be XMPs. Therefore, XMPs should be common in galaxy surveys. However, they are not common, because several observational biases hamper their detection. This work compares the number of faint XMPs in the SDSS-DR7 spectroscopic survey with the expected number, given the known biases and the observed galaxy luminosity function (LF). The faint end of the LF is poorly constrained observationally, but it determines the expected number of XMPs. Surprisingly, the number of observed faint XMPs (∼10) is overpredicted by our calculation, unless the upturn in the faint end of the LF is not present in the model. The lack of an upturn can be naturally understood if most XMPs are central galaxies in their low-mass dark matter halos, which are highly depleted in baryons due to interaction with the cosmic ultraviolet background and to other physical processes. Our result also suggests that the upturn toward low luminosity of the observed galaxy LF is due to satellite galaxies.

  12. First Stars XIV. Sulphur abundances in extremely metal-poor (EMP) stars

    CERN Document Server

    Spite, Monique; Andrievsky, S M; Korotin, S A; Depagne, E; Spite, F; Bonifacio, P; Ludwig, H -G; Cayrel, R; Francois, P; Hill, V; Plez, B; Andersen, J; Barbuy, B; Beers, T C; Molaro, P; Nordstrom, B; Primas, F

    2010-01-01

    Sulphur is important: the site of its formation is uncertain, and at very low metallicity the trend of [S/Fe] against [Fe/H] is controversial. Below [Fe/H]=-2.0, [S/Fe] remains constant or it decreases with [Fe/H], depending on the author and the multiplet used in the analysis. Moreover, although sulphur is not significantly bound in dust grains in the ISM, it seems to behave differently in DLAs and in old metal-poor stars. We aim to determine precise S abundance in a sample of extremely metal-poor stars taking into account NLTE and 3D effects. NLTE profiles of the lines of the multiplet 1 of SI have been computed using a new model atom for S. We find sulphur in EMP stars to behave like the other alpha-elements, with [S/Fe] remaining approximately constant below [Fe/H]=-3. However, [S/Mg] seems to decrease slightly as a function of [Mg/H]. The overall abundance patterns of O, Na, Mg, Al, S, and K are best matched by the SN model yields by Heger & Woosley. The [S/Zn] ratio in EMP stars is solar, as found a...

  13. Follow-up observations of extremely metal-poor stars identified from SDSS

    CERN Document Server

    Aguado, D S; Hernández, J I González; Carrera, R; Rebolo, Rafael; Shetrone, M; Lambert, D L; Fernández-Alvar, E

    2016-01-01

    The most metal-poor stars in the Milky Way witnessed the early phases of formation of the Galaxy, and have chemical compositions that are close to the pristine mixture from Big Bang nucleosynthesis, polluted by one or few supernovae. Only two dozen stars with ([Fe/H]< -4) are known, and they show a wide range of abundance patterns. It is therefore important to enlarge this sample. We present the first results of an effort to identify new extremely metal-poor stars in the Milky Way halo. Our targets have been selected from low-resolution spectra obtained as part of the Sloan Digital Sky Survey, and followed-up with medium resolution spectroscopy on the 4.2 m William Herschel Telescope and, in a few cases, at high resolution on the the 9.2 m Hobby-Eberly Telescope. Stellar parameters and the abundances of magnesium, calcium, iron, and strontium have been inferred from the spectra using classical model atmospheres. We have also derived carbon abundances from the G band. We find consistency between the metalli...

  14. On the dearth of ultra-faint extremely metal poor galaxies

    CERN Document Server

    Almeida, J Sanchez; Vecchia, C Dalla; Skillman, E D

    2016-01-01

    Local extremely metal-poor (XMP) galaxies are of particular astrophysical interest since they allow us to look into physical processes characteristic of the early Universe, from the assembly of galaxy disks to the formation of stars in conditions of low metallicity. Given the luminosity-metallicity relationship, all galaxies fainter than Mr < -13 are expected to be XMPs. Therefore, XMPs should be common in galaxy surveys. However, they are not, because several observational biases hamper their detection. This work compares the number of faint XMPs in the SDSS-DR7 spectroscopic survey with the expected number, given the known biases and the observed galaxy luminosity function. The faint end of the luminosity function is poorly constrained observationally, but it determines the expected number of XMPs. Surprisingly, the number of observed faint XMPs (around 10) is over-predicted by our calculation, unless the upturn in the faint end of the luminosity function is not present in the model. The lack of an uptur...

  15. THE KENNICUTT–SCHMIDT RELATION IN EXTREMELY METAL-POOR DWARF GALAXIES

    Energy Technology Data Exchange (ETDEWEB)

    Filho, M. E.; Almeida, J. Sánchez; Muñoz-Tuñón, C. [Instituto Astrofísica de Canarias, E-38200 La Laguna, Tenerife (Spain); Amorín, R. [National Institute for Astrophysics, Astronomical Observatory of Rome, Via Frascati 33, I-00040 Monteporzio Catone (Rome) (Italy); Elmegreen, B. G. [IBM, T. J. Watson Research Center, 1101 Kitchawan Road, Yorktown Heights, NY 10598 (United States); Elmegreen, D. M., E-mail: mfilho@astro.up.pt [Department of Physics and Astronomy, Vassar College, Poughkeepsie, NY 12604 (United States)

    2016-04-01

    The Kennicutt–Schmidt (KS) relation between the gas mass and star formation rate (SFR) describes the star formation regulation in disk galaxies. It is a function of gas metallicity, but the low-metallicity regime of the KS diagram is poorly sampled. We have analyzed data for a representative set of extremely metal-poor galaxies (XMPs), as well as auxiliary data, and compared these to empirical and theoretical predictions. The majority of the XMPs possess high specific SFRs, similar to high-redshift star-forming galaxies. On the KS plot, the XMP H i data occupy the same region as dwarfs and extend the relation for low surface brightness galaxies. Considering the H i gas alone, a considerable fraction of the XMPs already fall off the KS law. Significant quantities of “dark” H{sub 2} mass (i.e., not traced by CO) would imply that XMPs possess low star formation efficiencies (SFE{sub gas}). Low SFE{sub gas} in XMPs may be the result of the metal-poor nature of the H i gas. Alternatively, the H i reservoir may be largely inert, the star formation being dominated by cosmological accretion. Time lags between gas accretion and star formation may also reduce the apparent SFE{sub gas}, as may galaxy winds, which can expel most of the gas into the intergalactic medium. Hence, on global scales, XMPs could be H i-dominated, high-specific-SFR (≳10{sup −10} yr{sup −1}), low-SFE{sub gas} (≲10{sup −9} yr{sup −1}) systems, in which the total H i mass is likely not a good predictor of the total H{sub 2} mass, nor of the SFR.

  16. Use of a Cumulative Risk Scale to Predict Poor Intellectual and Academic Outcomes in Childhood Epilepsy.

    Science.gov (United States)

    Kavanaugh, Brian C; Scarborough, Vanessa Ramos; Salorio, Cynthia F

    2016-06-01

    Discrete risk factors for poor outcomes in childhood epilepsy have been identified, but it is unclear whether the combined effect of several risk factors better predicts outcome. The Epilepsy Cumulative Risk Scale was developed to quantify cumulative risk for poor outcomes in childhood epilepsy. Participants included 156 clinic-referred children with epilepsy. The Epilepsy Cumulative Risk Scale was developed using variables previously associated with functional outcomes. Scale utility was examined through its association with intellectual and academic functioning. All Epilepsy Cumulative Risk Scale variables were significantly associated with functioning. The Total Score (ie, cumulative effect) was most strongly correlated with cognition and academic skills. A Total Score ≥ 5 had the best sensitivity and specificity for differentiating those at high risk for poor outcomes. The Epilepsy Cumulative Risk Scale shows promise as a practical, data-driven tool for quantification of cumulative risk for poor outcomes in childhood epilepsy and may be helpful in detecting those needing referral for additional services.

  17. Chronic hyperglycemia is related to poor functional outcome after acute ischemic stroke

    NARCIS (Netherlands)

    Luitse, Merel Ja; Velthuis, Birgitta K; Kappelle, L Jaap; van der Graaf, Yolanda; Biessels, Geert Jan

    2017-01-01

    BACKGROUND: Acute hyperglycemia is associated with poor functional outcome after ischemic stroke, but the association between chronic antecedent hyperglycemia and outcome is unclear. AIM: We assessed the association between chronic hyperglycemia, measured by hemoglobin A1c, and functional outcome in

  18. Kinematics of Extremely Metal-poor Galaxies: Evidence for Stellar Feedback

    Science.gov (United States)

    Olmo-García, A.; Sánchez Almeida, J.; Muñoz-Tuñón, C.; Filho, M. E.; Elmegreen, B. G.; Elmegreen, D. M.; Pérez-Montero, E.; Méndez-Abreu, J.

    2017-01-01

    The extremely metal-poor (XMP) galaxies analyzed in a previous paper have large star-forming regions with a metallicity lower than the rest of the galaxy. Such a chemical inhomogeneity reveals the external origin of the metal-poor gas fueling star formation, possibly indicating accretion from the cosmic web. This paper studies the kinematic properties of the ionized gas in these galaxies. Most XMPs have a rotation velocity around a few tens of km s‑1. The star-forming regions appear to move coherently. The velocity is constant within each region, and the velocity dispersion sometimes increases within the star-forming clump toward the galaxy midpoint, suggesting inspiral motion toward the galaxy center. Other regions present a local maximum in velocity dispersion at their center, suggesting a moderate global expansion. The Hα line wings show a number of faint emission features with amplitudes around a few per cent of the main Hα component, and wavelength shifts between 100 and 400 km s‑1. The components are often paired, so that red and blue emission features with similar amplitudes and shifts appear simultaneously. Assuming the faint emission to be produced by expanding shell-like structures, the inferred mass loading factor (mass loss rate divided by star formation rate) exceeds 10. Since the expansion velocity far exceeds the rotational and turbulent velocities, the gas may eventually escape from the galaxy disk. The observed motions involve energies consistent with the kinetic energy released by individual core-collapse supernovae. Alternative explanations for the faint emission have been considered and discarded.

  19. Discovery of a Gas-Rich Companion to the Extremely Metal-Poor Galaxy DDO 68

    CERN Document Server

    Cannon, John M; McQuinn, Kristen B W; Alfvin, Erik D; Bailin, Jeremy; Ford, H Alyson; Girardi, Léo; Hirschauer, Alec S; Janowiecki, Steven; Salzer, John J; Van Sistine, Angela; Dolphin, Andrew; Elson, E C; Koribalski, Baerbel; Marigo, Paola; Rosenberg, Jessica L; Rosenfield, Philip; Skillman, Evan D; Venkatesan, Aparna; Warren, Steven R

    2014-01-01

    We present HI spectral-line imaging of the extremely metal-poor galaxy DDO 68. This system has a nebular oxygen abundance of only 3% Z$_{\\odot}$, making it one of the most metal-deficient galaxies known in the local volume. Surprisingly, DDO 68 is a relatively massive and luminous galaxy for its metal content, making it a significant outlier in the mass-metallicity and luminosity-metallicity relationships. The origin of such a low oxygen abundance in DDO 68 presents a challenge for models of the chemical evolution of galaxies. One possible solution to this problem is the infall of pristine neutral gas, potentially initiated during a gravitational interaction. Using archival HI spectral-line imaging obtained with the Karl G. Jansky Very Large Array, we have discovered a previously unknown companion of DDO 68. This low-mass (M$_{\\rm HI}$ $=$ 2.8$\\times$10$^{7}$ M$_{\\odot}$), recently star-forming (SFR$_{\\rm FUV}$ $=$ 1.4$\\times$10$^{-3}$ M$_{\\odot}$ yr$^{-1}$, SFR$_{\\rm H\\alpha}$ $<$ 7$\\times$10$^{-5}$ M$_{\\...

  20. The low Sr/Ba ratio on some extremely metal-poor stars

    CERN Document Server

    Spite, M; Bonifacio, P; Caffau, E; François, P; Sbordone, L

    2014-01-01

    It has been noted that, in classical extremely metal-poor (EMP) stars, the abundance ratio of Sr and Ba, is always higher than [Sr/Ba] = -0.5, the value of the solar r-only process; however, a handful of EMP stars have recently been found with a very low Sr/Ba ratio. We try to understand the origin of this anomaly by comparing the abundance pattern of the elements in these stars and in the classical EMP stars. Four stars with very low Sr/Ba ratios were observed and analyzed within LTE approximation through 1D (hydrostatic) model atmosphere, providing homogeneous abundances of nine neutron-capture elements. In CS 22950-173, the only turnoff star of the sample, the Sr/Ba ratio is, in fact, found to be higher than the r-only solar ratio, so the star is discarded. The remaining stars (CS 29493-090, CS 30322-023, HE 305-4520) are cool evolved giants. They do not present a clear carbon enrichment. The abundance patterns of the neutron-capture elements in the three stars are strikingly similar to a theoretical s-pro...

  1. Extremely Metal-Poor Stars and a Hierarchical Chemical Evolution Model

    CERN Document Server

    Komiya, Yutaka

    2011-01-01

    Early phases of the chemical evolution and formation history of extremely metal poor (EMP) stars are investigated using hierarchical galaxy formation models. We build a merger tree of the Galaxy according to the extended Press-Schechter theory. We follow the chemical evolution along the tree, and compare the model results to the metallicity distribution function (MDF) and abundance ratio distribution of the Milky Way halo. We adopt three different initial mass functions (IMFs). In a previous studies, we argue that typical mass of EMP stars should be high-mass(~10Msun) based on studies of binary origin carbon-rich EMP stars. In this study, we show that only the high-mass IMF can explain a observed small number of EMP stars. For relative element abundances, the high-mass IMF and the Salpeter IMF predict similar distributions. We also investigate dependence on nucleosynthetic yields of supernovae (SNe). The theoretical SN yields by Kobayashi et al.(2006) and Chieffi & Limonge (2004) show reasonable agreement...

  2. Leo P: A very low-mass, extremely metal-poor, star-forming galaxy

    Science.gov (United States)

    McQuinn, Kristen B.; Leo P Team

    2017-01-01

    Leo P is a low-luminosity dwarf galaxy just outside the Local Group with properties that make it an ideal probe of galaxy evolution at the faint-end of the luminosity function. Using combined data from 2 Hubble Space Telescope (HST) observing campaigns, the Very Large Array, the Spitzer Space telescope, as well as ground based data, we have constructed a robust evolutionary picture of Leo P. Leo P is one the most metal-poor, gas-rich galaxies ever discovered, has a stellar mass of a 5x105 Msun, comparable gas mass, and a single HII region. The star formation history reconstructed from the resolved stellar populations in Leo P shows it is unquenched, despite its very low mass. Based on the star formation history and metallicity measurements, the galaxy has lost 95% of its oxygen produced via nucleosynthesis, presumably to outflows. The neutral gas in the galaxy shows signs of rotation, although the velocity dispersion is comparable to the rotation velocity. Thus, Leo P bridges the gap between more massive dwarf irregular and less massive dwarf spheroidals on the baryonic Tully-Fisher relation. Furthermore, the galaxy hosts several, extremely dusty AGB candidates which will be probed with new HST and Spitzer observations. If confirmed as AGB stars, these may be our best local proxies for studying chemically unevolved star formation and subsequent dust production in metallicity environments comparable to the early universe.

  3. Extreme spermatogenesis failure: andrological phenotype and intracytoplasmic sperm injection outcomes.

    Science.gov (United States)

    Plouvier, P; Barbotin, A-L; Boitrelle, F; Dewailly, D; Mitchell, V; Rigot, J-M; Lefebvre-Khalil, V; Robin, G

    2017-03-01

    Patients with very low sperm count through direct sperm examination can exhibit extreme oligozoospermia or cryptozoospermia (after centrifugation). The management of these patients is a real challenge for both clinicians and biologists. In this retrospective and comparative cohort study, we compared the andrological phenotype of patients with extreme alterations of spermatogenesis and assessed whether the origin of spermatozoa (testicular or ejaculate) had any influence on intracytoplasmic sperm injection (ICSI) outcomes. A total of 161 ICSI cycles were performed using ejaculated spermatozoa from 75 patients with extreme oligozoospermia (EOS) or cryptozoospermia (CS) and 150 ICSI cycles using extracted testicular spermatozoa from 74 patients with non-obstructive azoospermia (NOA). Physical, hormonal, ultrasound assessments, and ICSI outcomes were performed in each group. Cryptorchidism was significantly more frequent in the NOA group (60.8% vs. 22.6%, p = 0.001). FSH levels were significantly higher [18.9 IU/L (5.9-27.0) vs. 15.3 IU/L (9.0-46.5), p = 0.001] and the majority of inhibin B levels measured were found mostly undetectable in the NOA group as compared to EOS/CS group (31.1% vs. 10.7%, p = 0.0004). Moreover, we found no significant differences in the respect to the fertilization rates (48.9% and 43.3%, p = 0.43), implantation rates (17.4% and 15.9%, p = 0.77), and percentage of top quality embryo (22.4% and 20.4%, p = 0.73) between the two groups. The clinical pregnancy rates per embryo transferred were comparable in both groups (28.3% and 27.4%, p = 0.89). In this study, we showed for the first time a different andrological phenotype between EOS/CS and NOA groups. Indeed, cryptorchidism was significantly more frequent with more severe endocrine parameters found in the NOA group. These results reflect a more profound alteration in spermatogenesis in NOA patients. However, there was no difference in ICSI outcomes between NOA and EOS

  4. Trending Fibrinolytic Dysregulation: Fibrinolysis Shutdown in the Days After Injury Is Associated With Poor Outcome in Severely Injured Children.

    Science.gov (United States)

    Leeper, Christine M; Neal, Matthew D; McKenna, Christine J; Gaines, Barbara A

    2017-09-01

    To trend fibrinolysis after injury and determine the influence of traumatic brain injury (TBI) and massive transfusion on fibrinolysis status. Admission fibrinolytic derangement is common in injured children and adults, and is associated with poor outcome. No studies examine fibrinolysis days after injury. Prospective study of severely injured children at a level 1 pediatric trauma center. Rapid thromboelastography was obtained on admission and daily for up to 7 days. Standard definitions of hyperfibrinolysis (HF; LY30 ≥3), fibrinolysis shutdown (SD; LY30 ≤0.8), and normal (LY30 = 0.9-2.9) were applied. Antifibrinolytic use was documented. Outcomes were death, disability, and thromboembolic complications. Wilcoxon rank-sum and Fisher exact tests were performed. Exploratory subgroups included massively transfused and severe TBI patients. In all, 83 patients were analyzed with median (interquartile ranges) age 8 (4-12) and Injury Severity Score 22 (13-34), 73.5% blunt mechanism, 47% severe TBI, 20.5% massively transfused. Outcomes were 14.5% mortality, 43.7% disability, and 9.8% deep vein thrombosis. Remaining in or trending to SD was associated with death (P = 0.007), disability (P = 0.012), and deep vein thrombosis (P = 0.048). Median LY30 was lower on post-trauma day (PTD)1 to PTD4 in patients with poor compared with good outcome; median LY30 was lower on PTD1 to PTD3 in TBI patients compared with non-TBI patients. HF without associated shutdown was not related to poor outcome, but extreme HF (LY30 >30%, n = 3) was lethal. Also, 50% of massively transfused patients in hemorrhagic shock demonstrated SD physiology on admission. All with HF (fc31.2%) corrected after hemostatic resuscitation without tranexamic acid. Fibrinolysis shutdown is common postinjury and predicts poor outcomes. Severe TBI is associated with sustained shutdown. Empiric antifibrinolytics for children should be questioned; thromboelastography-directed selective use should be considered for

  5. Hyperglycemia in aneurysmal subarachnoid hemorrhage : a potentially modifiable risk factor for poor outcome

    NARCIS (Netherlands)

    Kruyt, Nyika D.; Biessels, Geert Jan; DeVries, J. Hans; Luitse, Merel J. A.; Vermeulen, Marinus; Rinkel, Gabriel J. E.; Vandertop, W. Peter; Roos, Yvo B.

    2010-01-01

    Hyperglycemia after aneurysmal subarachnoid hemorrhage (aSAH) occurs frequently and is associated with delayed cerebral ischemia (DCI) and poor clinical outcome. In this review, we highlight the mechanisms that cause hyperglycemia after aSAH, and we discuss how hyperglycemia may contribute to poor c

  6. The Oldest Stars of the Extremely Metal-Poor Local Group Dwarf Irregular Galaxy Leo A

    Science.gov (United States)

    Schulte-Ladbeck, Regina E.; Hopp, Ulrich; Drozdovsky, Igor O.; Greggio, Laura; Crone, Mary M.

    2002-08-01

    We present deep Hubble Space Telescope (HST) single-star photometry of Leo A in B, V, and I. Our new field of view is offset from the centrally located field observed by Tolstoy et al. in order to expose the halo population of this galaxy. We report the detection of metal-poor red horizontal branch stars, which demonstrate that Leo A is not a young galaxy. In fact, Leo A is as least as old as metal-poor Galactic Globular Clusters that exhibit red horizontal branches and are considered to have a minimum age of about 9 Gyr. We discuss the distance to Leo A and perform an extensive comparison of the data with stellar isochrones. For a distance modulus of 24.5, the data are better than 50% complete down to absolute magnitudes of 2 or more. We can easily identify stars with metallicities between 0.0001 and 0.0004, and ages between about 5 and 10 Gyr, in their post-main-sequence phases, but we lack the detection of main-sequence turnoffs that would provide unambiguous proof of ancient (>10 Gyr) stellar generations. Blue horizontal branch stars are above the detection limits but difficult to distinguish from young stars with similar colors and magnitudes. Synthetic color-magnitude diagrams show it is possible to populate the blue horizontal branch in the halo of Leo A. The models also suggest ~50% of the total astrated mass in our pointing to be attributed to an ancient (>10 Gyr) stellar population. We conclude that Leo A started to form stars at least about 9 Gyr ago. Leo A exhibits an extremely low oxygen abundance, only 3% of solar, in its ionized interstellar medium. The existence of old stars in this very oxygen-deficient galaxy illustrates that a low oxygen abundance does not preclude a history of early star formation. Based on observations made with the NASA/ESA Hubble Space Telescope, obtained from the Space Telescope Science Institute, which is operated by the Association of Universities for Research in Astronomy, Inc., under NASA contract NAS 5-26555.

  7. Poor Reliability and Poor Adherence to Self-Monitoring of Blood Glucose Are Common in Women With Gestational Diabetes Mellitus and May Be Associated With Poor Pregnancy Outcomes.

    Science.gov (United States)

    Cosson, Emmanuel; Baz, Baz; Gary, Françoise; Pharisien, Isabelle; Nguyen, Minh Tuan; Sandre-Banon, Dorian; Jaber, Yahya; Cussac-Pillegand, Camille; Banu, Isabela; Carbillon, Lionel; Valensi, Paul

    2017-09-01

    To evaluate the compliance with self-monitoring of blood glucose (SMBG) and the reliability of diabetes logbooks in women with gestational diabetes mellitus (GDM), as well as the associated determinants and outcomes. We prospectively selected French-speaking women with newly diagnosed GDM who had been referred to our diabetes management program and understood SMBG principles. At the next follow-up visit, we collected SMBG results from glucose meters and logbooks. We analyzed pregnancy outcomes. Data were analyzed over 13 ± 3 days in 91 women. Only 61.5% had performed ≥80% of the required tests. Poor compliance was associated with a family history of diabetes, social deprivation, and non-European origin. The average time between pre- and postprandial tests was 141 ± 20 min, with 46.5% of women performing ≥80% of postprandial measurements 100-140 min after meals. Inadequate timing was associated with ethnicity and higher HbA1c at baseline. A total of 23.1% of women had <90% matched values in diary and meter memory, and a poor concordance was associated with a family history of diabetes. Poor adherence was associated with more preeclampsia (12.2 vs. 1.9%, P = 0.049), and inadequate postprandial test timing with a higher HbA1c at delivery (5.3 ± 0.4 vs. 5.0 ± 0.3% [34 ± 2 vs. 31 ± 2 mmol/mol], P < 0.01), despite more frequent insulin therapy. Although women with GDM are considered to be highly motivated, SMBG adherence and reliability are of concern and may be associated with poor gestational prognosis, suggesting that caregivers should systematically check the glucose meter memory to improve GDM management. © 2017 by the American Diabetes Association.

  8. DISCOVERY OF A GAS-RICH COMPANION TO THE EXTREMELY METAL-POOR GALAXY DDO 68

    Energy Technology Data Exchange (ETDEWEB)

    Cannon, John M.; Alfvin, Erik D. [Department of Physics and Astronomy, Macalester College, 1600 Grand Avenue, Saint Paul, MN 55105 (United States); Johnson, Megan; Koribalski, Baerbel [Australia Telescope National Facility, CSIRO Astronomy and Space Science, P.O. Box 76, NSW 1710, Epping (Australia); McQuinn, Kristen B. W.; Skillman, Evan D. [Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, MN 55455 (United States); Bailin, Jeremy [Department of Physics and Astronomy, University of Alabama, P.O. Box 870324, Tuscaloosa, AL 35487-0324 (United States); Ford, H. Alyson [National Radio Astronomy Observatory, P.O. Box 2, Green Bank, WV 24944 (United States); Girardi, Léo [Osservatorio Astronomico di Padova—INAF, Vicolo dell' Osservatorio 5, I-35122 Padova (Italy); Hirschauer, Alec S.; Janowiecki, Steven; Salzer, John J.; Van Sistine, Angela [Department of Astronomy, Indiana University, 727 East Third Street, Bloomington, IN 47405 (United States); Dolphin, Andrew [Raytheon Company, 1151 E. Hermans Road, Tucson, AZ 85756 (United States); Elson, E. C. [Astrophysics, Cosmology and Gravity Centre (ACGC), Department of Astronomy, University of Cape Town, Private Bag X3, Rondebosch 7701 (South Africa); Marigo, Paola; Rosenfield, Philip [Dipartimento di Fisica e Astronomia Galileo Galilei, Universitá degli Studi di Padova, Vicolo dell' Osservatorio 3, I-35122 Padova (Italy); Rosenberg, Jessica L. [School of Physics, Astronomy, and Computational Science, George Mason University, Fairfax, VA 22030 (United States); Venkatesan, Aparna [Department of Physics and Astronomy, University of San Francisco, 2130 Fulton Street, San Francisco, CA 94117 (United States); Warren, Steven R., E-mail: jcannon@macalester.edu [Department of Astronomy, University of Maryland, CSS Bldg., Rm. 1024, Stadium Drive, College Park, MD 20742-2421 (United States)

    2014-05-20

    We present H I spectral-line imaging of the extremely metal-poor galaxy DDO 68. This system has a nebular oxygen abundance of only ∼3% Z {sub ☉}, making it one of the most metal-deficient galaxies known in the local volume. Surprisingly, DDO 68 is a relatively massive and luminous galaxy for its metal content, making it a significant outlier in the mass-metallicity and luminosity-metallicity relationships. The origin of such a low oxygen abundance in DDO 68 presents a challenge for models of the chemical evolution of galaxies. One possible solution to this problem is the infall of pristine neutral gas, potentially initiated during a gravitational interaction. Using archival H I spectral-line imaging obtained with the Karl G. Jansky Very Large Array, we have discovered a previously unknown companion of DDO 68. This low-mass (M{sub H} {sub I} = 2.8 × 10{sup 7} M {sub ☉}), recently star-forming (SFR{sub FUV} = 1.4 × 10{sup –3} M {sub ☉} yr{sup –1}, SFR{sub Hα} < 7 × 10{sup –5} M {sub ☉} yr{sup –1}) companion has the same systemic velocity as DDO 68 (V {sub sys} = 506 km s{sup –1}; D = 12.74 ± 0.27 Mpc) and is located at a projected distance of ∼42 kpc. New H I maps obtained with the 100 m Robert C. Byrd Green Bank Telescope provide evidence that DDO 68 and this companion are gravitationally interacting at the present time. Low surface brightness H I gas forms a bridge between these objects.

  9. Poor final visual outcome after traumatic hyphema: A retrospective study of associated factors

    Directory of Open Access Journals (Sweden)

    Ayda Khalfan Al Ali

    2012-09-01

    Full Text Available OBJECTIVES: To determine the factors associated with a poor final visual outcome following a non-perforating traumatic hyphema. METHODS: The in-patient records of all traumatic hyphema patients admitted to the Department of Ophthalmology of the Hamad Medical Centre (HMC in Doha, Qatar, were retrospectively reviewed for a four-year period from January 2004 to March 2008. One hundred and seventeen patients who did not meet the exclusion criteria were divided into two groups based on their final visual outcome post-treatment. Group 1 (good outcome consisted of 100 patients with a visual acuity (VA of 6/18 or better and group 2 (worse outcome consisted of 17 patients with a VA of less than 6/18. The two groups were compared to determine the factors associated with a poor final visual outcome. RESULTS: Group 2 patients had an 82.3% incidence of complications after a traumatic hyphema compared with a 21% incidence in group 1. Of these complications, secondary glaucoma and rebleeding were significantly associated with a worse final visual outcome. Trauma from projectiles or blows did not differ significantly in their effect on the final visual outcome, although blow injuries had a greater impact on the final visual outcome. Posterior segment injuries were associated with a worse visual outcome. CONCLUSION: It was concluded that secondary glaucoma, rebleeding, and posterior segment injuries are factors associated with a poor final visual outcome.

  10. Outcomes of extremely low birthweight infants with acidosis at birth.

    Science.gov (United States)

    Randolph, David A; Nolen, Tracy L; Ambalavanan, Namasivayam; Carlo, Waldemar A; Peralta-Carcelen, Myriam; Das, Abhik; Bell, Edward F; Davis, Alexis S; Laptook, Abbot R; Stoll, Barbara J; Shankaran, Seetha; Higgins, Rosemary D

    2014-07-01

    To test the hypothesis that acidosis at birth is associated with the combined primary outcome of death or neurodevelopmental impairment (NDI) in extremely low birthweight (ELBW) infants, and to develop a predictive model of death/NDI exploring perinatal acidosis as a predictor variable. The study population consisted of ELBW infants born between 2002 and 2007 at National Institute of Child Health and Development (NICHD) Neonatal Research Network hospitals. Infants with cord blood gas data and documentation of either mortality prior to discharge or 18-22 month neurodevelopmental outcomes were included. Multiple logistic regression analysis was used to determine the contribution of perinatal acidosis, defined as a cord blood gas with a pHacidosis is significantly associated with death/NDI in ELBW infants. Perinatal acidosis is infrequent in ELBW infants, however, and other factors are more important in predicting death/NDI. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. Effect of extreme obesity on outcomes in laparoscopic hysterectomy.

    Science.gov (United States)

    Siedhoff, Matthew T; Carey, Erin T; Findley, Austin D; Riggins, Lauren E; Garrett, Joanne M; Steege, John F

    2012-01-01

    To estimate the effect of body mass index (BMI) on several outcomes in laparoscopic hysterectomy, in particular in the extremes of obesity. Retrospective cohort study (Canadian Task Force classification II-3). Tertiary-care university-based teaching hospital. Eight hundred thirty-four patients who underwent laparoscopic hysterectomy from January 2007 to October 2011. Laparoscopic hysterectomy for benign indications. Demographic, operative, and postoperative data were abstracted from medical records. The primary outcome was a composite index score that took into account operative time, nonsurgical operating room time, estimated blood loss, length of hospital stay, number of complications, and severity of complications according to the Dindo-Clavien classification. We individually examined elements of the composite index as a secondary outcome. Models were developed to assess the association of BMI with the composite index score and the components of the index, controlling for age, presence of diabetes, tobacco use, surgeon, type of hysterectomy (total vs supracervical), use of robotics, uterine weight, number of additional procedures performed, presence of adhesions requiring lysis, and deeply infiltrating endometriosis as potential confounders. Mean (SD) BMI was 31.4 (8.1). Mean (SD) uterine weight was 345 (388) g. Mean operative time was 150 (61) minutes. Increasing BMI was associated with a worse composite score (p laparoscopic hysterectomy, and the effect is most pronounced in the morbidly obese. These patients may stand to gain the greatest differential benefit from a laparoscopic approach to surgery. However, they should be properly counseled about the challenge that obesity poses to the operation. Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.

  12. Patient Reported Outcomes Measurement Information System (PROMIS) in the upper extremity: the future of outcomes reporting?

    Science.gov (United States)

    Makhni, Eric C; Meadows, Molly; Hamamoto, Jason T; Higgins, John D; Romeo, Anthony A; Verma, Nikhil N

    2017-02-01

    Patient reported outcomes (PROs) serve an integral role in clinical research by helping to determine the impact of clinical care as experienced by the patient. With recent initiatives in health care policy and pay for performance, outcome reporting is now recognized as a policy-driven requirement in addition to a clinical research tool. For outcome measures to satisfy these regulatory requirements and provide value in understanding disease outcomes, they must be responsive and efficient. Recent research has uncovered certain concerns regarding traditional PROs in patients with upper extremity disability and injury. These include lack of consensus regarding selection of PROs for a given diagnoses, inconsistent techniques of administration of the same PROs, and the administrative burden to patients and providers of completing these forms. To address these limitations, emphasis has been placed on streamlining the outcomes reporting process, and, as a result, the National Institutes of Health (NIH) created the Patient Reported Outcomes Measurement Information System (PROMIS). PROMIS forms were created to comprehensively and efficiently measure outcomes across multiple disease states, including orthopedics. These tools exist in computer adaptive testing and short forms with the intention of more efficiently measuring outcomes compared with legacy PROs. The goals of this review are to highlight the main components of PROMIS reporting tools and identify recent use of the scores in the upper extremity literature. The review will also highlight the research and health policy potentials and limitations of implementing PROMIS into everyday orthopedic practice. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  13. MRI findings and spreading patterns of necrotizing external otitis: Is a poor outcome predictable?

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, B.J. [Department of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Han, M.H. [Department of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of) and Clinical Research Institute, Seoul National University Hospital, Seoul (Korea, Republic of) and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul (Korea, Republic of)]. E-mail: hanmh@radcom.snu.ac.kr; Oh, S.H. [Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Song, J.J. [Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Chang, K.-H. [Department of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Clinical Research Institute, Seoul National University Hospital, Seoul (Korea, Republic of); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul (Korea, Republic of)

    2006-06-15

    AIM: To evaluate spreading patterns of necrotizing external otitis (NEO) by magnetic resonance imaging (MRI) and to identify spreading patterns related to a poor outcome. MATERIALS AND METHODS: Fourteen patients with NEO were divided into good and poor outcome groups according to their final clinical outcomes. Initial MRI images were retrospectively reviewed for regional abnormalities, and follow-up MRI images were reviewed for ICA flow void abnormality and for the following five spreading patterns: medial, crossed, anterior, intracranial, and combined. The frequencies of the abnormal flow void or spreading patterns were compared between the good and poor response groups. RESULTS: Seven (50%) and seven (50%) patients were respectively allocated to the good and poor outcome groups. Retrocondylar fat infiltration was the most commonest finding on initial MRI images (93%). The frequencies of the abnormal flow void and spreading patterns in the good and poor groups, respectively, were: abnormal flow void, 0 and four (57%); anterior, two (29%) and three (43%); medial, six (86%) and seven (100%); crossed, six (86%) and seven (100%); intracranial middle cranial fossa, one (14%) and four (57%); intracranial posterior cranial fossa, four (57%) and six (86%); intracranial foramen magnum, one (14%) and six (86%). CONCLUSIONS: NEO almost always involves the retrocondylar fat and spreads via various pathways to extracranial or intracranial spaces. The presence of an abnormal flow void and intracranial dural enhancement, particularly in the middle cranial fossa and foramen magnum, may indicate a poor prognosis.

  14. The s-Process Nucleosynthesis in Extremely Metal-Poor Stars as the Generating Mechanism of Carbon Enhanced Metal-Poor Stars

    CERN Document Server

    Suda, Takuma; Fujimoto, Masayuki Y

    2016-01-01

    The origin of carbon-enhanced metal-poor (CEMP) stars plays a key role in characterising the formation and evolution of the first stars and the Galaxy since the extremely-poor (EMP) stars with [Fe/H] \\leq -2.5 share the common features of carbon enhancement in their surface chemical compositions. The origin of these stars is not yet established due to the controversy of the origin of CEMP stars without the enhancement of s-process element abundances, i.e., so called CEMP-no stars. In this paper, we elaborate the s-process nucleosynthesis in the EMP AGB stars and explore the origin of CEMP stars. We find that the efficiency of the s-process is controlled by O rather than Fe at [Fe/H] \\lesssim -2. We demonstrate that the relative abundances of Sr, Ba, Pb to C are explained in terms of the wind accretion from AGB stars in binary systems.

  15. Narrative Processes in Psychotherapy: differences between Good and Poor Outcome Clients

    Directory of Open Access Journals (Sweden)

    Luis Botella

    2015-12-01

    Full Text Available This paper compares 30 patients with good therapeutic outcome to 30 with poor therapeutic outcome in terms of the differential distribution of (1 Intake Variables (2 Outcome and Process Variables, and (3 Narrative Variables. Results indicated that psychosocial functioning, motivation, pre-therapy symptoms, Working Alliance, total number of therapy sessions, total pre-post symptom reduction, and mean scoring for total working alliance in sessions 3, 4, and 8 discriminated between both groups. Results also showed that almost all narrative variables except some of them discriminated good outcome clients from poor outcome ones from the beginning, midpoint and final stage of their therapeutic process. These results are discussed according to their relevance for clinical practice.

  16. Effects of anticoagulant therapy on pregnancy outcomes in patients with thrombophilia and previous poor obstetric history.

    Science.gov (United States)

    Mutlu, Ilknur; Mutlu, Mehmet Firat; Biri, Aydan; Bulut, Berk; Erdem, Mehmet; Erdem, Ahmet

    2015-04-01

    This study investigates the effects of anticoagulant therapy on pregnancy outcomes in 204 patients with thrombophilia and previous poor obstetric outcomes. Patients with poor obstetric history (pre-eclampsia, intrauterine growth retardation, fetal death, placental abruption, recurrent pregnancy loss) and having hereditary thrombophilia were included in this study. Poor obstetric outcomes were observed more frequently in patients who had not taken anticogulant therapy compared with treated group. Live birth rate, gestational age at birth and Apgar scores were significantly higher in the treated group when compared with the untreated group. There were no significant differences in terms of birthweight, mode of delivery and admission rates to the neonatal intensive care unit (NICU). Low-molecular-weight heparin (LMWH) plus acetylsalicylic acid (ASA) had higher gestational age at birth, Apgar scores, live birth rate and a lower abortion rates when compared with controls; in contrast, no significant difference was observed in terms of birthweight, mode of delivery, obstetric complications and admission rates to NICU. There were no significant differences between control group and both LMWH only and ASA only groups in terms of gestational age at birth, Apgar scores, birthweight, mode of delivery, obstetric complications and admission rates to NICU. Only LMWH group had higher live birth rate as compared with control group. The use of only ASA did not seem to affect the perinatal complication rates and outcomes. In conclusion, anticoagulant therapy with both LMWH and ASA seems to provide better obstetric outcomes in pregnant women with thrombophilia and previous poor obstetric outcomes.

  17. Factors affecting outcome in poor grade subarachnoid haemorrhage: An institutional study

    Science.gov (United States)

    Kranthi, Sannepaneni; Sahu, Barada P.; Aniruddh, Purohit

    2016-01-01

    Context: Poor grade subarachnoid hemorrhage (SAH) is usually associated with unfavorable outcomes and optimal management is deemed complicated. Most centres follow an expectant management strategy or a less aggressive approach till patients improve to good clinical grades. This approach has been associated with higher mortality and morbidity. However, not all patients with poor clinical condition fare badly. Identification and early aggressive management of this select group of patients may lead to favorable outcomes. Settings and Design: Prospective non-randomized study. Materials and Methods: We prospectively analyzed 19 cases presented in WFNS grade 4 and 5 and factors affecting their outcome at a tertiary care centre in south India. This study was aimed at identifying those few poor grade patients who are probable candidates for a good outcome. Statistical Analysis Used: All the variables were analyzed for possible correlations with the SPSS version 13 software. The Chi-square test with a P hydrocephalus underwent extra-ventricular drainage. Statistically significant factors precluding good outcome were the presence of infarcts and thick SAH in the cisterns. Conclusions: Poor grade (WFNS 4 and 5) SAH patients with or without ICH, IVH, if operated within 3 days can give rise to favorable outcome in around 50%. However, presence of patchy infarcts associated with thick subarachnoid blood (Fisher grade 3) precludes long term survival or meaningful recovery. Hence, aggressive management is unlikely to alter the natural history of such patients. PMID:27695539

  18. Chronic hyperglycemia is related to poor functional outcome after acute ischemic stroke.

    Science.gov (United States)

    Luitse, Merel Ja; Velthuis, Birgitta K; Kappelle, L Jaap; van der Graaf, Yolanda; Biessels, Geert Jan

    2017-02-01

    Background Acute hyperglycemia is associated with poor functional outcome after ischemic stroke, but the association between chronic antecedent hyperglycemia and outcome is unclear. Aim We assessed the association between chronic hyperglycemia, measured by hemoglobin A1c, and functional outcome in patients with acute ischemic stroke. Methods We included 812 patients with acute ischemic stroke (mean age 66 ± 14 years; 61.5% male). Patients were categorized per hemoglobin A1c level: no (chronic hyperglycemia (>42 mmol/mol). Poor functional outcome was defined as modified Rankin Scale score > 2 after 3 months. The relation between chronic hyperglycemia and functional outcome was assessed with a Poisson regression analysis and expressed as risk ratios with 95% confidence intervals with no chronic hyperglycemia as the reference. Results Moderate chronic hyperglycemia was present in 234 (28.8%) patients and severe chronic hyperglycemia in 183 (22.5%) patients. Acute hyperglycemia on admission was present in 338 (41.6%) patients. Severe chronic hyperglycemia was associated with poor outcome (risk ratios 1.40; 95% confidence interval 1.09-1.79). After adjustment for age, sex, stroke severity, vascular risk factors, and acute hyperglycemia on admission the risk ratios was 1.35 (95% confidence interval 1.04-1.76). Moderate chronic hyperglycemia was not associated with poor outcome (risk ratios 1.12; 95% confidence interval 0.87-1.44). Conclusion Severe chronic hyperglycemia is associated with poor functional outcome in patients with acute ischemic stroke. This association is independent of hyperglycemia in the acute stage of stroke and of an unfavorable vascular risk factor profile.

  19. Facial Trustworthiness Predicts Extreme Criminal-Sentencing Outcomes.

    Science.gov (United States)

    Wilson, John Paul; Rule, Nicholas O

    2015-08-01

    Untrustworthy faces incur negative judgments across numerous domains. Existing work in this area has focused on situations in which the target's trustworthiness is relevant to the judgment (e.g., criminal verdicts and economic games). Yet in the present studies, we found that people also overgeneralized trustworthiness in criminal-sentencing decisions when trustworthiness should not be judicially relevant, and they did so even for the most extreme sentencing decision: condemning someone to death. In Study 1, we found that perceptions of untrustworthiness predicted death sentences (vs. life sentences) for convicted murderers in Florida (N = 742). Moreover, in Study 2, we found that the link between trustworthiness and the death sentence occurred even when participants viewed innocent people who had been exonerated after originally being sentenced to death. These results highlight the power of facial appearance to prejudice perceivers and affect life outcomes even to the point of execution, which suggests an alarming bias in the criminal-justice system. © The Author(s) 2015.

  20. The functional outcome of lower-extremity fractures with vascular injury.

    Science.gov (United States)

    Lin, C H; Wei, F C; Levin, L S; Su, J I; Yeh, W L

    1997-09-01

    Salvage of lower-extremity Gustilo type IIIC fractures is difficult, time-consuming for the patients and physicians, and not universally successful because of poor functional outcomes. Even if successful with limb salvage, the functional result may be unsatisfactory because of mutilating injuries to muscle and nerve, bone loss, and the presence of chronic infection. From July 1991 until July 1994, revascularizations of open IIIC fractures were attempted for wounds with Mangled Extremity Severity Score (MESS) MESS was able to predict the secondary amputation rate and the functional result. Sixteen of the 17 limb-salvaged patients with MESS MESS = 8 to 10 failed to achieve minimal functional requirements at the 2-year follow-up. Using statistical analysis, we found that the salvaged limbs with MESS MESS > 9. Using our protocol for treatment for IIIC fractures, the threshold for immediate amputation can be raised from MESS = 7 to MESS = 9. Our conclusions are (1) more severely injured limbs have poor functional results, (2) every patient needs subsequent reconstructive surgery, and (3) the MESS may be helpful in decision-making.

  1. Comparison of microsurgery and endovascular treatment on clinical outcome following poor-grade subarachnoid hemorrhage.

    Science.gov (United States)

    Sandström, Niklas; Yan, Bernard; Dowling, Richard; Laidlaw, John; Mitchell, Peter

    2013-09-01

    Poor-grade (World Federation of Neurological Surgeons [WFNS] clinical grading scale grades IV and V) subarachnoid hemorrhage (SAH) is associated with significant morbidity and mortality. However, the correlation between the timing, modality of intervention (clipping or coiling) and the clinical outcome is not clear. This study aims to examine this correlation. Patients presenting with WFNS grades IV and V aneurysmal SAH between 1997 and 2008 to a single centre were studied. An aggressive policy of early intervention was followed, and the selection of endovascular versus microsurgical intervention was made according to angiographic rather than clinical features. Clinical outcomes were graded using the modified Rankin scale (mRS) at 6 month follow-up. One hundred and forty-three poor-grade patients (23.9% of all 598 aneurysmal SAH patients) were studied. Treatment was microsurgical in 83 (58.0%) and endovascular in 60 (42%) patients. Twenty patients (14.0%) were lost to follow-up. Good outcome (mRS 0-2) at 6 months was found in 45 microsurgical patients (63.3%) and 24 endovascular patients (46.1%). This trend towards better clinical outcomes in the microsurgical group was not statistically significant. With an aggressive early treatment policy more than half of the poor-grade SAH patients demonstrated a good clinical outcome. Microsurgery and endovascular treatment, when selected primarily according to angiographic features, were equally likely to achieve good outcome.

  2. Outcomes after expectant management of extremely preterm premature rupture of the membranes.

    Science.gov (United States)

    Dinsmoor, Mara J; Bachman, Rebecca; Haney, Elaine I; Goldstein, Marci; Mackendrick, William

    2004-01-01

    This study was undertaken to assess contemporary outcomes in pregnancies managed expectantly after extremely preterm premature (< or =24 weeks) premature rupture of the membranes (EPPROM). We queried antepartum and ultrasound databases for patients with EPPROM. Data on pregnancy outcome and short-term neonatal outcomes were collected. Forty-six patients with EPPROM were studied. Patients were hospitalized at 24 weeks' gestation and given antibiotics and antenatal steroids. Median gestational age at PPROM was 22.0 weeks (range 16.9-24 weeks); 43 (93%) elected expectant management, 2 of whom later had an intrauterine fetal death. Median latency period to delivery was 13 days (range 0-96 days), with mean gestational age at delivery of 25.8+/-3.4 weeks. Overall survival was 47% (27 of 57 infants), after a median hospital stay of 71 days (range 17-209 days). Ten (37%) of the survivors have serious sequelae. Although significant pregnancy prolongation after previable PPROM occurs in many cases, neonatal outcomes remain poor.

  3. The iScore predicts poor functional outcomes early after hospitalization for an acute ischemic stroke.

    Science.gov (United States)

    Saposnik, Gustavo; Raptis, Stavroula; Kapral, Moira K; Liu, Ying; Tu, Jack V; Mamdani, Muhammad; Austin, Peter C

    2011-12-01

    The iScore is a prediction tool originally developed to estimate the risk of death after hospitalization for an acute ischemic stroke. Our objective was to determine whether the iScore could also predict poor functional outcomes. We applied the iScore to patients presenting with an acute ischemic stroke at multiple hospitals in Ontario, Canada, between 2003 and 2008, who had been identified from the Registry of the Canadian Stroke Network regional stroke center database (n=3818) and from an external data set, the Registry of the Canadian Stroke Network Ontario Stroke Audit (n=4635). Patients were excluded if they were included in the sample used to develop and validate the initial iScore. Poor functional outcomes were defined as: (1) death at 30 days or disability at discharge, in which disability was defined as having a modified Rankin Scale 3 to 5; and (2) death at 30 days or institutionalization at discharge. The prevalence of poor functional outcomes in the Registry of the Canadian Stroke Network and the Ontario Stroke Audit, respectively, were 55.7% and 44.1% for death at 30 days or disability at discharge and 16.9% and 16.2%, respectively, for death at 30 days or institutionalization at discharge. The iScore stratified the risk of poor outcomes in low- and high-risk individuals. Observed versus predicted outcomes showed high correlations: 0.988 and 0.940 for mortality or disability and 0.985 and 0.993 for mortality or institutionalization in the Registry of the Canadian Stroke Network and Ontario Stroke Audit cohorts. The iScore can be used to estimate the risk of death or a poor functional outcome after an acute ischemic stroke.

  4. Electrophysiological and MRI study on poor outcome after surgery for cervical myelopathy

    Energy Technology Data Exchange (ETDEWEB)

    Kameyama, Osamu; Kawakita, Hirofumi; Ogawa, Ryokei [Kansai Medical Univ., Moriguchi, Osaka (Japan)

    1995-11-01

    Occasionally, the outcome from laminoplasty for cervical spondylosis is disappointing despite an adequate operation. Before surgery, it is difficult to diagnose the pathological extent of the involvement of the spinal cord. The purpose of this study is to determine the efficacy of magnetic resonance imaging (MRI) and of the motor evoked potentials (MEPs) for the indication of the surgery and prognosis. Retrospectively, we investigated the MEPs and the MRI of 31 patients in surgery for cervical myelopathy, involving 21 with cervical spondylosis and 10 with ossification of the posterior longitudinal ligamentum, and compared the findings from those with a poor outcome (n=3l) with the findings from those with a good outcome (n=32). The MEPs from the thenar muscle and the tibialis anterior were evoked by transcranial magnetic brain stimulation. In the poor-outcome patients, the spinal canal was narrow and lumbar spinal canal stenosis was seen in 5 cases which required lumbar laminectomy. Before operation, the MEPs from the thenar muscle could not be evoked in 5 cases while there was a remarkably prolonged central motor conduction time in the other 26 cases. MRI revealed the deformed spinal cord in the involved area, and the signal intensity of the involved spinal cord in the T2 weighted image was remarkably high. The signal intensity ratio was significantly higher in the poor-outcome patients than in the good-outcome patients. This study suggested that a high signal intensity in the T2 weighted image and a prolonged conduction time or absence of MEPs largely corresponded to the clinical and other investigative features of myelopathy responsible for a poor outcome. (author).

  5. Persistent systemic inflammation is associated with poor clinical outcomes in COPD

    DEFF Research Database (Denmark)

    Agustí, Alvar; Edwards, Lisa D; Rennard, Stephen I

    2012-01-01

    Because chronic obstructive pulmonary disease (COPD) is a heterogeneous condition, the identification of specific clinical phenotypes is key to developing more effective therapies. To explore if the persistence of systemic inflammation is associated with poor clinical outcomes in COPD we assessed...

  6. The distressed (Type D) personality. A risk marker for poor health outcomes in ICD patients

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Schiffer, A A

    2011-01-01

    The distressed (Type D) personality is an emerging risk marker for poor health outcomes in patients with cardiovascular disease. Patients with this personality disposition are typified by a general propensity to experience psychological distress. The contribution focuses on the impact of Type D p...

  7. Prediction of poor outcome within the first 3 days of postanoxic coma.

    NARCIS (Netherlands)

    Zandbergen, E.G.; Hijdra, A.; Koelman, J.H.; Hart, A.A.M.; Vos, P.E.; Verbeek, M.M.; Haan, R.J. de

    2006-01-01

    OBJECTIVE: To determine the optimal timing of somatosensory evoked potential (SSEP) recordings and the additional value of clinical and biochemical variables for the prediction of poor outcome in patients who remain comatose after cardiopulmonary resuscitation (CPR). METHODS: A prospective cohort st

  8. Contrasting predictors of poor antiretroviral therapy outcomes in two South African HIV programmes: a cohort study

    Directory of Open Access Journals (Sweden)

    Hamilton Robin

    2010-07-01

    Full Text Available Abstract Background Many national antiretroviral therapy (ART programmes encourage providers to identify and address baseline factors associated with poor treatment outcomes, including modifiable adherence-related behaviours, before initiating ART. However, evidence on such predictors is scarce, and providers judgement may often be inaccurate. To help address this evidence gap, this observational cohort study examined baseline factors potentially predictive of poor treatment outcomes in two ART programmes in South Africa, with a particular focus on determinants of adherence. Methods Treatment-naïve patients starting ART were enrolled from a community and a workplace ART programme. Potential baseline predictors associated with poor treatment outcomes (defined as viral load > 400 copies/ml or having discontinued treatment by six months were assessed using logistic regression. Exposure variables were organised for regression analysis using a hierarchical framework. Results 38/227 (17% of participants in the community had poor treatment outcomes compared to 47/117 (40% in the workplace. In the community, predictors of worse outcomes included: drinking more than 20 units of alcohol per week, having no prior experience of chronic medications, and consulting a traditional healer in the past year (adjusted odds ratio [aOR] 15.36, 95% CI 3.22-73.27; aOR 2.30, 95%CI 1.00-5.30; aOR 2.27, 95% CI 1.00-5.19 respectively. Being male and knowing someone on ART were associated with better outcomes (aOR 0.25, 95%CI 0.09-0.74; aOR 0.44, 95%CI 0.19-1.01 respectively. In the workplace, predictors of poor treatment outcomes included being uncertain about the health effects of ART and a traditional healer's ability to treat HIV (aOR 7.53, 95%CI 2.02-27.98; aOR 4.40, 95%CI 1.41-13.75 respectively. Longer pre-ART waiting time (2-12 weeks compared to Conclusion Baseline predictors of poor treatment outcomes were largely unique to each programme, likely reflecting

  9. Follow-up observations of extremely metal-poor stars identified from SDSS

    Science.gov (United States)

    Aguado, D. S.; Allende Prieto, C.; González Hernández, J. I.; Carrera, R.; Rebolo, R.; Shetrone, M.; Lambert, D. L.; Fernández-Alvar, E.

    2016-08-01

    Context. The most metal-poor stars in the Milky Way witnessed the early phases of formation of the Galaxy, and have chemical compositions that are close to the pristine mixture from Big Bang nucleosynthesis, polluted by one or few supernovae. Aims: Only two dozen stars with ([Fe/H] cases, at high resolution on the 9.2 m Hobby-Eberly Telescope. Stellar parameters and the abundances of magnesium, calcium, iron, and strontium have been inferred from the spectra using classical model atmospheres. We have also derived carbon abundances from the G band. Results: We find consistency between the metallicities estimated from SDSS and those from new data at the level of 0.3 dex. The analysis of medium resolution data obtained with ISIS on the WHT allows us to refine the metallicities and in some cases measure other elemental abundances. Our sample contains 11 new metal-poor stars with [Fe/H] < -3.0, one of them with an estimated metallicity of [Fe/H] ~ -4.0. We also discuss metallicity discrepancies of some stars in common with previous works in the literature. Only one of these stars is found to be C-enhanced at about [C/Fe] ~ + 1, whereas the other metal-poor stars show C abundances at the level of [C/Fe] ~ + 0.45. Based on observations obtained with the Hobby-Eberly Telescope, which is a joint project of the University of Texas at Austin, the Pennsylvania State University, Stanford University, Ludwig-Maximilians-Universität München, and Georg-August-Universität Göttingen.The reduced spectra as FITS files are only available at the CDS via anonymous ftp to http://cdsarc.u-strasbg.fr (http://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/qcat?J/A+A/593/A10

  10. Hot, Massive Stars in the Extremely Metal-Poor Galaxy, I Zw 18

    Science.gov (United States)

    Heap, Sara R.; Malumuth, Eliot M.

    2010-01-01

    The carbon-enhanced metal-poor galaxy, I Zw 18, is the Rosetta Stone for understanding galaxies in the early universe by providing constraints on the IMF of massive stars, the role of galaxies in reionization of the universe, mixing of newly synthesized material in the ISM, and gamma-ray bursts at low metallicity, and on the earliest generations of stars producing the observed abundance pattern. We describe these constraints as derived from analyses of HST/COS spectra of I Zw 18 including stellar atmosphere analysis and photo-ionization modeling of both the emission and absorption spectra of the nebular material and interstellar medium.

  11. CARMA CO Observations of Three Extremely Metal-Poor, Star-Forming Galaxies

    CERN Document Server

    Warren, Steven R; Cannon, John M; Bolatto, Alberto D; Adams, Elizabeth A K; Bernstein-Cooper, Elijah Z; Giovanelli, Riccardo; Haynes, Martha P; Herrera-Camus, Rodrigo; Jameson, Katie; McQuinn, Kristen B W; Rhode, Katherine L; Salzer, John J; Skillman, Evan D

    2015-01-01

    We present sensitive CO (J = 1 - 0) emission line observations of three metal-poor dwarf irregular galaxies Leo P (Z ~ 3% Z_Solar), Sextans A (Z ~ 7.5% Z_Solar), and Sextans B (Z ~ 7.5% Z_Solar), all obtained with the Combined Array for Millimeter-wave Astronomy (CARMA) interferometer. While no CO emission was detected, the proximity of the three systems allows us to place very stringent (4 sigma) upper limits on the CO luminosity (L_CO) in these metal-poor galaxies. We find the CO luminosities to be L_CO < 2900 K km/s pc^2 for Leo P, L_CO < 12400 K km/s pc^2 for Sextans A, and L_CO < 9700 K km/s pc^2 for Sextans B. Comparison of our results with recent observational estimates of the factor for converting between L_CO and the mass of molecular hydrogen, as well as theoretical models, provides further evidence that either the CO-to-H_2 conversion factor increases sharply as metallicity decreases, or that stars are forming in these three galaxies very efficiently, requiring little molecular hydrogen.

  12. Spectroscopic Studies of Extremely Metal-Poor Stars with Subaru/HDS:I. Observational Data

    CERN Document Server

    Honda, S; Ando, H; Izumiura, H; Kajino, T; Kambe, E; Kawanomoto, S; Noguchi, K; Okita, K; Sadakane, K; Sato, B; Takada-Hidai, M; Takeda, Y; Watanabe, E; Beers, T C; Norris, J E; Ryan, S G

    2004-01-01

    We have obtained high-resolution (R $\\simeq$ 50,000 or 90,000), high-quality (S/N $\\ga$ 100) spectra of 22 very metal-poor stars ([Fe/H] $\\la$ -2.5) with the High Dispersion Spectrograph fabricated for the 8.2m Subaru Telescope. The spectra cover the wavelength range from 3500 to 5100 {\\AA}; equivalent widths are measured for isolated lines of numerous elemental species, including the $\\alpha$ elements, the iron-peak elements, and the light and heavy neutron-capture elements. Errors in the measurements and comparisons with previous studies are discussed. These data will be used to perform detailed abundance analyses in the following papers of this series. Radial velocities are also reported, and are compared with previous studies. At least one moderately r-process-enhanced metal-poor star, HD 186478, exhibits evidence of a small-amplitude radial velocity variation, confirming the binary status noted previously. During the course of this initial program, we have discovered a new moderately r-process-enhanced, ...

  13. The Oldest Stars of the Extremely Metal-Poor Local Group Dwarf Irregular Galaxy Leo A

    CERN Document Server

    Schulte-Ladbeck, R E; Drozdovsky, I O; Greggio, L; Crone, M M; Schulte-Ladbeck, Regina E.; Hopp, Ulrich; Drozdovsky, Igor O.; Greggio, Laura; Crone, Mary M.

    2002-01-01

    We present deep Hubble Space Telescope single-star photometry of Leo A in B, V, and I. Our new field of view is offset from the centrally located field observed by Tolstoy et al. (1998) in order to expose the halo population of this galaxy. We report the detection of metal-poor red horizontal branch stars, which demonstrate that Leo A is not a young galaxy. In fact, Leo A is as least as old as metal-poor Galactic Globular Clusters which exhibit red horizontal branches, and are considered to have a minimum age of about 9 Gyr. We discuss the distance to Leo A, and perform an extensive comparison of the data with stellar isochrones. For a distance modulus of 24.5, the data are better than 50% complete down to absolute magnitudes of 2 or more. We can easily identify stars with metallicities between 0.0001 and 0.0004, and ages between about 5 and 10 Gyr, in their post-main-sequence phases, but lack the detection of main-sequence turnoffs which would provide unambiguous proof of ancient (>10 Gyr) stellar generation...

  14. Blinded Outcome Assessment Was Infrequently Used and Poorly Reported in Open Trials.

    Directory of Open Access Journals (Sweden)

    Brennan C Kahan

    Full Text Available Unblinded outcome assessment can lead to biased estimates of treatment effect in randomised trials. We reviewed published trials to assess how often blinded assessment is used, and whether its use varies according to the type of outcome or assessor.A review of parallel group, individually randomised phase III trials published in four general medical journals (BMJ, Journal of the American Medical Association, The Lancet, and New England Journal of Medicine in 2010.Whether assessment of the primary outcome was blinded, and whether this differed according to outcome or assessor type.We identified 258 eligible trials. Of these, 106 (41% were reported as double-blind, and 152 (59% as partially or fully open-label (that is, they included some groups who were unblinded, such as patients, those delivering the intervention, or those in charge of medical care. Of the 152 open trials, 125 required outcome assessment. Of these 125 trials, only 26% stated that outcome assessment was blinded; 51% gave no information on whether assessment was blinded or not. Furthermore, 18% of trials did not state who performed the assessment. The choice of outcome type (e.g. instrument measured, rated, or naturally occurring event did not appear to influence whether blinded assessment was performed (range 24-32% for the most common outcome types. However, the choice of outcome assessor did influence blinding; independent assessors were blinded much more frequently (71% than participant (5% or physician (24% assessors. Despite this, open trials did not use independent assessors any more frequently than double-blind trials (17% vs. 18% respectively.Blinding of outcome assessors is infrequently used and poorly reported. Increased use of independent assessors could increase the frequency of blinded assessment.

  15. An Elemental Assay of Very, Extremely, and Ultra Metal-Poor Stars

    CERN Document Server

    Hansen, T; Christlieb, N; Beers, T C; Yong, D; Bessell, M S; Frebel, A; Perez, A E Garcia; Placco, V M; Norris, J E; Asplund, M

    2015-01-01

    We present a high-resolution elemental-abundance analysis for a sample of 23 very metal-poor (VMP; [Fe/H] 0. The stars with [C/N] < 0 suggest a larger degree of mixing; the few CEMP-no stars that exhibit this signature are only found at [Fe/H] < -3.4, a metallicity below which we also find the CEMP-no stars with large enhancements in Na, Mg, and Al. We confirm the existence of two plateaus in the absolute carbon abundances of CEMP stars, as suggested by Spite et al. We also present evidence for a "floor" in the absolute Ba abundances of CEMP-no stars at A(Ba)~ -2.0.

  16. Low-energy Population III supernovae and the origin of extremely metal-poor stars

    Science.gov (United States)

    Chen, Ke-Jung; Heger, Alexander; Whalen, Daniel J.; Moriya, Takashi J.; Bromm, Volker; Woosley, S. E.

    2017-06-01

    Some ancient, dim, metal-poor stars may have formed in the ashes of the first supernovae (SNe). If their chemical abundances can be reconciled with the elemental yields of specific Population III (Pop III) explosions, they could reveal the properties of primordial stars. But multidimensional simulations of such explosions are required to predict their yields because dynamical instabilities can dredge material up from deep in the ejecta that would otherwise be predicted to fall back on to the central remnant and be lost in one-dimensional (1D) models. We have performed two-dimensional (2D) numerical simulations of two low-energy Pop III SNe, a 12.4 M⊙ explosion and a 60 M⊙ explosion, and find that they produce elemental yields that are a good fit to those measured in the most iron-poor star discovered to date, SMSS J031300.36-670839.3 (J031300). Fallback on to the compact remnant in these weak explosions accounts for the lack of measurable iron in J031300 and its low iron-group abundances in general. Our 2D explosions produce higher abundances of heavy elements (atomic number Z > 20) than their 1D counterparts due to dredge-up by fluid instabilities. Since almost no 56Ni is ejected by these weak SNe, their low luminosities will prevent their detection in the near-infrared with the James Webb Space Telescope and future 30-m telescopes on the ground. The only evidence that they ever occurred will be in the fossil abundance record.

  17. Risk factors related to poor outcome after methanol poisoning and the relation between outcome and antidotes--a multicenter study.

    Science.gov (United States)

    Paasma, Raido; Hovda, Knut Erik; Hassanian-Moghaddam, Hossein; Brahmi, Nozha; Afshari, Reza; Sandvik, Leiv; Jacobsen, Dag

    2012-11-01

    INTRODUCTION. Thorough prognostic and metabolic studies of methanol poisonings are scarce. Our aims were to evaluate the factors associated with sequelae and death from methanol poisoning, to develop a simple risk-assessment chart to evaluate factors associated with sequelae and death from methanol poisoning, and to compare the antidotes ethanol and fomepizole. PATIENTS AND METHODS. We present a retrospective observational case series of methanol-poisoned patients from Norway (1979 and 2002-2005), Estonia (2001) and Tunisia (2003/2004), and patients from two different centers in Iran (Teheran 2004-2009 and Mashhad 2009-2010) who were identified by a positive serum methanol and had a blood acid-base status drawn on admission. The patients were divided into different groups according to their outcome: Survived, survived with sequelae, and died. RESULTS. A total of 320 patients were identified and 117 were excluded. Of the remaining 203 patients, 48 died, and 34 were discharged with neurological sequelae. A pH < 7.00 was found to be the strongest risk factor for poor outcome, along with coma (Glasgow Coma Scale (GCS) < 8) and a pCO(2) ≥ 3.1 kPa in spite of a pH < 7.00. More patients died despite hyperventilation (low pCO(2)) in the ethanol group. CONCLUSIONS. Low pH (pH < 7.00), coma (GCS < 8), and inadequate hyperventilation (pCO(2) ≥ 3.1 kPa in spite of a pH < 7.00) on admission were the strongest predictors of poor outcome after methanol poisoning. A simple flow-chart may help identify the patients associated with a poor outcome.

  18. High-Resolution Spectroscopy of Extremely Metal-Poor Stars from SDSS/SEGUE: II. Binary Fraction

    CERN Document Server

    Aoki, Wako; Beers, Timothy C; Honda, Satoshi

    2014-01-01

    The fraction of binary systems in various stellar populations of the Galaxy and the distribution of their orbital parameters are important but not well-determined factors in studies of star formation, stellar evolution, and Galactic chemical evolution. While observational studies have been carried out for a large sample of nearby stars, including some metal-poor, Population II stars, almost no constraints on the binary nature for extremely metal-poor (EMP; [Fe/H] < -3.0) stars have yet been obtained. Here we investigate the fraction of double-lined spectroscopic binaries and carbon-enhanced metal-poor (CEMP) stars, many of which could have formed as pairs of low-mass and intermediate-mass stars, to estimate the lower limit of the fraction of binary systems having short periods. The estimate is based on a sample of very metal-poor stars selected from the Sloan Digital Sky Survey, and observed at high spectral resolution in a previous study by Aoki et al. That survey reported three double-lined spectroscopic...

  19. Giant Eruption of the Extremely Metal-Poor LBV in DDO 68

    Science.gov (United States)

    Perepelitsyna, Y. A.; Pustilnik, S. A.

    2017-06-01

    Understanding the evolution of massive stars with metallicities much lower than that of the Sun (e.g., Zresearch until extremely large telescopes (ELTs) are in operation. Meantime, selection of good targets for future ELT research becomes actual. Here we present one of such important targets. The unusual void galaxy DDO68 has several star-forming (SF) regions with the gas metallicity Z = Z⊙/35 [12+log(O/H)=7.14]. In 2008, we discovered a luminous blue variable (LBV) star in its HII-region Knot 3. We present the LBV's V-band lightcurve for the time range of 1988 to 2016 using both our new and published data for Knot 3 brightness as well as the archive data from eleven telescopes. The prerequisite is an accurate estimate of the ‘minimal' (non-variable) V-band light for the Knot 3 underlying HII region. Its subtraction from the variable light of Knot 3 allows us to determine the full amplitude of the LBV variability at the level of δV ≳4m. This implies that the LBV has experienced a very rare event of a giant eruption during the years 2008-2011.

  20. Azathioprine during pregnancy in systemic lupus erythematosus patients is not associated with poor fetal outcome.

    Science.gov (United States)

    Saavedra, Miguel Ángel; Sánchez, Antonio; Morales, Sara; Ángeles, Ulises; Jara, Luis Javier

    2015-07-01

    The objective of this study was to evaluate the risk of adverse fetal outcome in systemic lupus erythematosus (SLE) women exposed to azathioprine during pregnancy. We reviewed the medical records of SLE pregnant women followed from January 2005 to April 2013. The patients were evaluated at least once in each trimester and postpartum. Relevant fetal outcomes were extracted, such as rate of liveborns, fetal loss (spontaneous abortion and stillbirth), term delivery, preterm birth, neonatal death, low birth weight, low birth weight at term, and congenital malformations. A detailed history of drug use during pregnancy was obtained. We studied 178 pregnancies (in 172 women), 87 of them were exposed to azathioprine (AZA-group) and the remaining 91 were not exposed (NO AZA-group). Exposure to other drugs was similar in both groups. The rate of live births, spontaneous abortions mean birth weight, weeks of gestation, rate of birth weight lupus flare, and anti-DNA positive were associated with an increased risk of poor fetal outcome. Our study suggests that the use of azathioprine is safe and lacks of teratogenity in patients with SLE and pregnancy. Exposure to azathioprine during pregnancy is not associated with poor fetal outcome.

  1. DUST-TO-GAS RATIO IN THE EXTREMELY METAL-POOR GALAXY I Zw 18

    Energy Technology Data Exchange (ETDEWEB)

    Herrera-Camus, Rodrigo; Fisher, David B.; Bolatto, Alberto D. [Department of Astronomy and Laboratory of Millimeter Astronomy, University of Maryland, College Park, MD 20742 (United States); Leroy, Adam K. [National Radio Astronomy Observatory, 520 Edgemont Road, Charlottesville, VA 22903-2475 (United States); Walter, Fabian [Max-Planck-Institut fuer Astronomie, Konigstuehl 17, D-69117 Heidelberg (Germany); Gordon, Karl D.; Roman-Duval, Julia [Space Telescope Science Institute, 3700 San Martin Drive, Baltimore, MD 21218 (United States); Donaldson, Jessica; Melendez, Marcio [Department of Astronomy, University of Maryland, College Park, MD 20742 (United States); Cannon, John M. [Department of Physics and Astronomy, Macalester College, 1600 Grand Avenue, Saint Paul, MN 55105 (United States)

    2012-06-20

    The blue compact dwarf galaxy I Zw 18 is one of the most metal-poor systems known in the local universe (12+log(O/H) = 7.17). In this work we study I Zw 18 using data from Spitzer, Herschel Space Telescope, and IRAM Plateau de Bure Interferometer. Our data set includes the most sensitive maps of I Zw 18, to date, in both the far-infrared and the CO J = 1 {yields} 0 transition. We use dust emission models to derive a dust mass upper limit of only M{sub dust} {<=} 1.1 Multiplication-Sign 10{sup 4} M{sub Sun} (3{sigma} limit). This upper limit is driven by the non-detection at 160 {mu}m, and it is a factor of 4-10 times smaller than previous estimates (depending on the model used). We also estimate an upper limit to the total dust-to-gas mass ratio of M{sub Dust}/M{sub gas} {<=} 5.0 Multiplication-Sign 10{sup -5}. If a linear correlation between the dust-to-gas mass ratio and metallicity (measured as O/H) were to hold, we would expect a ratio of 3.9 Multiplication-Sign 10{sup -4}. We also show that the infrared spectral energy distribution is similar to that of starbursting systems.

  2. Dust-to-Gas Ratio in the Extremely Metal Poor Galaxy I ZW 18

    CERN Document Server

    Herrera-Camus, Rodrigo; Bolatto, Alberto D; Leroy, Adam K; Walter, Fabian; Gordon, Karl D; Roman-Duval, Julia; Donaldson, Jessica; Meléndez, Marcio; Cannon, John M

    2012-01-01

    The blue compact dwarf galaxy I Zw 18 is one of the most metal poor systems known in the local Universe (12 + log(O/H) $=$ 7.17). In this work we study I Zw 18 using data from {\\it Spitzer}, {\\it Herschel Space Telescope} and IRAM Plateau de Bure Interferometer. Our data set includes the most sensitive maps of I Zw 18, to date, in both, the far infrared and the CO $J=1\\rightarrow0$ transition. We use dust emission models to derive a dust mass upper limit of only M$_{dust}\\leq1.1\\times10^4$ M$_{\\odot}$ ($3\\sigma$ limit). This upper limit is driven by the non-detection at 160 $\\mu$m, and it is a factor of 4-10 times smaller than previous estimates (depending upon the model used). We also estimate an upper limit to the total dust-to-gas mass ratio of M$_{Dust}$/M$_{gas}\\leq5.0\\times10^{-5}$. If a linear correlation between the dust-to-gas mass ratio and metallicity (measure as O/H) were to hold, we would expect a ratio of 3.9$\\times10^{-4}$. We also show that the infrared SED is similar to that of starbursting s...

  3. Simulating extremely metal-poor gas and DLA metal content at redshift z=7

    CERN Document Server

    Maio, Umberto; Mueller, Volker

    2013-01-01

    We present the first theoretical study of metals in damped Ly-alpha (DLA) systems at redshift z=7. The features of cold, primordial gas are studied by means of N-body, hydro, chemistry simulations, including atomic and molecular non-equilibrium chemistry, cooling, star formation for population III and population II-I regimes, stellar evolution, cosmic metal spreading according to proper yields (for He, C, O, Si, Fe, Mg, S, etc.) and lifetimes, and feedback effects. Theoretical expectations are then compared to recently available constraints from DLA observations. We find that DLA galaxies at z=7 account for 10 per cent of the whole galaxy population and for most of the metal-poor galaxies at these epochs. About 7 per cent of these DLA galaxies contain purely pristine material and 34 per cent of them consist of very weakly polluted gas, being, therefore, suitable candidate s as population III sites. The remaining 59 per cent are enriched above ~10^{-4} Zsun. Additionally, DLA candidates appear to have: gas mas...

  4. Discovery of An Extremely Metal--Poor Galaxy Optical Spectroscopy of UGCA 292

    CERN Document Server

    Van Zee, L

    2000-01-01

    The results of optical spectroscopy of two HII regions in UGCA 292 (CVn I dwA) are presented. UGCA 292 is a nearby (D=3.1 Mpc) gas-rich dwarf irregular galaxy (M_H/L_B ~ 6.9) which was first discovered in a blind HI survey. The derived oxygen abundance is the third lowest of known star-forming galaxies [12 + log(O/H) = 7.30 +/- 0.05], making UGCA 292 one of the nearest metal-poor galaxies known. The derived N/O ratio is similar to that found in other low metallicity galaxies [log(N/O) = -1.47 +/- 0.10], and is indicative of a primary origin for nitrogen. The derived oxygen abundance is consistent with closed-box chemical evolution for this low mass galaxy. The observed blue colors, high gas mass fraction, and low metallicity suggest that UGCA 292 is relatively unevolved. The possibility that future blind HI surveys may yield similar low metallicity galaxies is discussed.

  5. Pain following extremity injury: management, predictions and outcomes

    NARCIS (Netherlands)

    Pierik, Jorien Gerarda Johanna

    2016-01-01

    Chronic pain patients often relate their pain onset to acute injury such as surgery or trauma, drawing attention to the need to prevent the transition from acute to chronic pain. This transition is still a complex and poorly understood developmental process. A range of factors has been associated wi

  6. MRI, MDCT features, and clinical outcome of extremity leiomyosarcomas: experience in 47 patients

    Energy Technology Data Exchange (ETDEWEB)

    Gordon, Robert W.; Shinagare, Atul B. [Brigham and Women' s Hospital, Harvard Medical School, Department of Radiology, Boston, MA (United States); Tirumani, Sree Harsha; Jagannathan, Jyothi P.; Ramaiya, Nikhil H. [Brigham and Women' s Hospital, Harvard Medical School, Department of Radiology, Boston, MA (United States); Dana-Farber Cancer Institute, Harvard Medical School, Department of Imaging, Boston, MA (United States); Kurra, Vikram [Dana-Farber Cancer Institute, Harvard Medical School, Department of Imaging, Boston, MA (United States); Hornick, Jason L. [Brigham and Women' s Hospital, Harvard Medical School, Department of Pathology, Boston, MA (United States)

    2014-05-15

    To describe MRI, MDCT features, and clinical outcome of extremity leiomyosarcomas (LMS). In this IRB-approved, HIPAA-compliant retrospective study, we included 47 patients (23 women, 24 men; mean age: 55.3 years, range: 17-85 years) with pathologically confirmed extremity LMS seen at our adult tertiary cancer center between 2000 and 2012. MRI/MDCT of primary tumors in 23 patients and follow-up in all patients were reviewed by two radiologists in consensus. Clinical data were extracted from electronic medical records. Primary tumors were distributed in bones (6 out of 47), deep soft tissues (24 out of 47), and superficial soft tissues (17 out of 47). On imaging (bone = 4, deep soft tissue = 11, superficial soft tissue = 8), compared with skeletal muscle, they were T1 iso-hypointense and T2 hyperintense. Bone LMS were metaphyseal tumors with cortical destruction (3 out of 4). Deep soft-tissue LMS were large with hemorrhage (7 out of 11) and necrosis (10 out of 11). Superficial soft-tissue LMS were relatively smaller, homogeneously enhancing (6 out of 8) tumors. Distant metastases developed in 32 out of 47 patients (bone LMS [6 out of 6], deep soft-tissue LMS [18 out of 24], superficial soft-tissue LMS [8 out of 17]), commonly to lung (29 out of 47) and bone (14 out of 47). At the time of writing, 22 out of 36 patients (bone LMS [4 out of 6], deep soft-tissue LMS [15 out of 24], superficial soft-tissue LMS [4 out of 17]) have died. There was no statistically significant correlation between metastatic disease and tumor size or grade. Extremity LMS arise in bones and in the deep and superficial soft tissues, frequently metastasize to the lungs, and have a poor prognosis. Superficial LMS tend to have a better prognosis than bone or deep soft-tissue LMS. (orig.)

  7. Does Amniocentesis Increase the Rates of Fetal Loss and Poor Pregnancy Outcomes?

    Directory of Open Access Journals (Sweden)

    Onder Ercan

    2014-12-01

    Full Text Available Aim: To evaluate the risk of fetal loss and poor pregnancy outcomes associated with amniocentesis procedures on patients in our clinic in the last 5 years. Material and Method: This retrospective study was conducted by examining the hospital records and genetic centre records of 387 patients who underwent amniocentesis at the Gynaecology and Obstetrics Clinic of Kahramanmaras Sutcu Imam University Medical Faculty between January 2011 and July 2015. A control group was formed of 250 low-risk patients who attended the clinic and did not have amniocentesis applied. Results:Throughout the study period there were 688 patients with an indication for amniocentesis. Of these, amniocentesis was applied to 387 patients and 43.8% refused the amniocentesis. The most common amniocentesis indication was the scanning test for Downs syndrome (57.6% followed by older maternal age (22.5%. Of the patients who underwent amniocentesis, chromosomal abnormality was determined in 24 (6.2%, the most common of which was Downs syndrome (54%. Fetal loss following amniocentesis was seen in 2 patients (0.5%. When the total poor pregnancy outcomes were examined, a poor outcome was determined in 8 of the amniocentesis group and in 5 of the control group and the difference beween the 2 groups was not statistically significant (p=0.263. Discussion: Amniocentesis is an invasive prenatal test in frequent current use. No increase in pregnancy complications was observed associated with the procedure. Before the application of amniocentesis, the patient must be given detailed information about the procedure and the outcomes.

  8. IVF outcomes in average- and poor-prognosis infertile women according to the number of embryos transferred.

    Science.gov (United States)

    Vega, Mario G; Gleicher, Norbert; Darmon, Sarah K; Weghofer, Andrea; Wu, Yan-Guang; Wang, Qi; Zhang, Lin; Albertini, David F; Barad, David H; Kushnir, Vitaly A

    2016-09-01

    Outcome measures of IVF success, which account for effectiveness of IVF and perinatal outcome risks, have recently been described. The association between number of embryos transferred in average and poor-prognosis IVF patients, and the chances of having good or poor IVF and perinatal outcomes, was investigated. Good IVF and perinatal outcome was defined as the birth of a live, term, normal-weight infant (≥2500 g). Poor IVF and perinatal outcome was defined as no live birth or birth of a very low weight neonate (<1500 g) or severe prematurity (birth at <32 weeks gestation). Each neonate was analysed as a separate outcome. A total of 713 IVF cycles in 504 average and poor-prognosis patients from January 2010 to December 2013 were identified. The odds of having good IVF and perinatal outcomes increased by 28% for each additional embryo transferred. The odds of poor IVF and perinatal outcome decreased by 32% with an additional embryo transferred. The likelihood of live birth with good perinatal outcome in average- and poor-prognosis patients after IVF increases with additional embryos being transferred. These data add to recently reported evidence in favour of multiple embryo transfer in older women and those with average or poor IVF prognosis.

  9. Risk factors for poor outcomes in patients with open-globe injuries.

    Science.gov (United States)

    Page, Rita D; Gupta, Sumeet K; Jenkins, Thomas L; Karcioglu, Zeynel A

    2016-01-01

    The aim of this study was to identify the risk factors that are predictive of poor outcomes in penetrating globe trauma. This retrospective case series evaluated 103 eyes that had been surgically treated for an open-globe injury from 2007 to 2010 at the eye clinic of the University of Virginia. A total of 64 eyes with complete medical records and at least 6 months of follow-up were included in the study. Four risk factors (preoperative best-corrected visual acuity [pre-op BCVA], ocular trauma score [OTS], zone of injury [ZOI], and time lapse [TL] between injury and primary repair) and three outcomes (final BCVA, monthly rate of additional surgeries [MRAS], and enucleation) were identified for analysis. Pre-op BCVA was positively associated with MRAS, final BCVA, and enucleation. Calculated OTS was negatively associated with the outcome variables. No association was found between TL and ZOI with the outcome variables. Further, age and predictor variable-adjusted analyses showed pre-op BCVA to be independently positively associated with MRAS (P=0.008) and with final BCVA (Pglobe injuries. However, no conventional features reliably predict the outcome of traumatized eyes.

  10. Lower extremity amputation in peripheral artery disease: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Swaminathan A

    2014-07-01

    Full Text Available Aparna Swaminathan,1 Sreekanth Vemulapalli,1,2 Manesh R Patel,1,2 W Schuyler Jones1,2 1Department of Medicine, Duke University Medical Center, Durham, NC, USA; 2Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA Abstract: Peripheral artery disease affects over eight million Americans and is associated with an increased risk of mortality, cardiovascular disease, functional limitation, and limb loss. In its most severe form, critical limb ischemia, patients are often treated with lower extremity (LE amputation (LEA, although the overall incidence of LEA is declining. In the US, there is significant geographic variation in the performing of major LEA. The rate of death after major LEA in the US is approximately 48% at 1 year and 71% at 3 years. Despite this significant morbidity and mortality, the use of diagnostic testing (both noninvasive and invasive testing in the year prior to LEA is low and varies based on patient, provider, and regional factors. In this review we discuss the significance of LEA and methods to reduce its occurrence. These methods include improved recognition of the risk factors for LEA by clinicians and patients, strong advocacy for noninvasive and/or invasive imaging prior to LEA, improved endovascular revascularization techniques, and novel therapies. Keywords: peripheral artery disease, lower extremity amputation, mortality

  11. NLTE strontium abundance in a sample of extremely metal poor stars and the Sr/Ba ratio in the early Galaxy

    CERN Document Server

    Andrievsky, S M; Korotin, S A; Francois, P; Spite, M; Bonifacio, P; Cayrel, R; Hill, V

    2011-01-01

    Heavy element abundances in extremely metal-poor stars provide strong constraints on the processes of forming these elements in the first stars. We attempt to determine precise abundances of strontium in a homogeneous sample of extremely metal-poor stars. The abundances of strontium in 54 very or extremely metal-poor stars, was redetermined by abandoning the local thermodynamic equilibrium (LTE) hypothesis, and fitting non-LTE (NLTE) profiles to the observed spectral lines. The corrected Sr abundances and previously obtained NLTE Ba abundances are compared to the predictions of several hypothetical formation processes for the lighter neutron-capture elements. Our NLTE abundances confirm the previously determined huge scatter of the strontium abundance in low metallicity stars. This scatter is also found (and is even larger) at very low metallicities (i. e. early in the chemical evolution). The Sr abundance in the extremely metal-poor (EMP) stars is compatible with the main r-process involved in other processe...

  12. High-resolution spectroscopy of extremely metal-poor stars from SDSS/Segue. II. Binary fraction

    Energy Technology Data Exchange (ETDEWEB)

    Aoki, Wako; Suda, Takuma [National Astronomical Observatory, Mitaka, Tokyo 181-8588 (Japan); Beers, Timothy C. [Department of Physics and JINA Center for the Evolution of the Elements, University of Notre Dame,225 Nieuwland Science Hall, Notre Dame, IN 46656 (United States); Honda, Satoshi, E-mail: aoki.wako@nao.ac.jp, E-mail: takuma.suda@nao.ac.jp, E-mail: tbeers@nd.edu, E-mail: honda@nhao.jp [Center for Astronomy, University of Hyogo, 407-2, Nishigaichi, Sayo-cho, Sayo, Hyogo 679-5313 (Japan)

    2015-02-01

    The fraction of binary systems in various stellar populations of the Galaxy and the distribution of their orbital parameters are important but not well-determined factors in studies of star formation, stellar evolution, and Galactic chemical evolution. While observational studies have been carried out for a large sample of nearby stars, including some metal-poor Population II stars, almost no constraints on the binary nature for extremely metal-poor (EMP; [Fe/H] <−3.0) stars have yet been obtained. Here we investigate the fraction of double-lined spectroscopic binaries and carbon-enhanced metal-poor (CEMP) stars, many of which could have formed as pairs of low-mass and intermediate-mass stars, to estimate the lower limit of the fraction of binary systems having short periods. The estimate is based on a sample of very metal-poor stars selected from the Sloan Digital Sky Survey and observed at high spectral resolution in a previous study by Aoki et al. That survey reported 3 double-lined spectroscopic binaries and 11 CEMP stars, which we consider along with a sample of EMP stars from the literature compiled in the SAGA database. We have conducted measurements of the velocity components for stacked absorption features of different spectral lines for each double-lined spectroscopic binary. Our estimate indicates that the fraction of binary stars having orbital periods shorter than 1000 days is at least 10%, and possibly as high as 20% if the majority of CEMP stars are formed in such short-period binaries. This result suggests that the period distribution of EMP binary systems is biased toward short periods, unless the binary fraction of low-mass EMP stars is significantly higher than that of other nearby stars.

  13. Functional and Clinical Outcomes of Upper Extremity Amputation.

    Science.gov (United States)

    Fitzgibbons, Peter; Medvedev, Gleb

    2015-12-01

    Upper extremity amputation is an uncommon but often necessary procedure. It can be required as a result of trauma, infection, or malignancy. Amputation is a life-changing procedure. Careful planning for it must not only include the level of amputation and assurance of durable soft-tissue coverage of the amputation site, but it must also consider patients' goals and occupations, as well as social factors affecting amputees. The choice of prosthesis is an individual matter, but new technology permits lighter and more multifunctional prostheses. Targeted muscle reinnervation can be used to achieve improved myoelectric signaling and possibly decrease limb pain following amputation. Rehabilitation is crucial to achieving favorable results. Copyright 2015 by the American Academy of Orthopaedic Surgeons.

  14. ABCA Transporter Gene Expression and Poor Outcome in Epithelial Ovarian Cancer

    DEFF Research Database (Denmark)

    Hedditch, Ellen L; Gao, Bo; Russell, Amanda J

    2014-01-01

    -wide association study. Impact of short interfering RNA-mediated gene suppression was determined by colony forming and migration assays. Association with survival was assessed with Kaplan-Meier analysis and log-rank tests. All statistical tests were two-sided. RESULTS: Associations with outcome were observed...... with ABC transporters of the "A" subfamily, but not with multidrug transporters. High-level expression of ABCA1, ABCA6, ABCA8, and ABCA9 in primary tumors was statistically significantly associated with reduced survival in serous ovarian cancer patients. Low levels of ABCA5 and the C-allele of rs536009...... cancer cell growth and migration in vitro, and statin treatment reduced ovarian cancer cell migration. CONCLUSIONS: Expression of ABCA transporters was associated with poor outcome in serous ovarian cancer, implicating lipid trafficking as a potentially important process in EOC....

  15. Association Between Brain-Derived Neurotrophic Factor Genotype and Upper Extremity Motor Outcome After Stroke.

    Science.gov (United States)

    Chang, Won Hyuk; Park, Eunhee; Lee, Jungsoo; Lee, Ahee; Kim, Yun-Hee

    2017-06-01

    The identification of intrinsic factors for predicting upper extremity motor outcome could aid the design of individualized treatment plans in stroke rehabilitation. The aim of this study was to identify prognostic factors, including intrinsic genetic factors, for upper extremity motor outcome in patients with subacute stroke. A total of 97 patients with subacute stroke were enrolled. Upper limb motor impairment was scored according to the upper limb of Fugl-Meyer assessment score at 3 months after stroke. The prediction of upper extremity motor outcome at 3 months was modeled using various factors that could potentially influence this impairment, including patient characteristics, baseline upper extremity motor impairment, functional and structural integrity of the corticospinal tract, and brain-derived neurotrophic factor genotype. Multivariate ordinal logistic regression models were used to identify the significance of each factor. The independent predictors of motor outcome at 3 months were baseline upper extremity motor impairment, age, stroke type, and corticospinal tract functional integrity in all stroke patients. However, in the group with severe motor impairment at baseline (upper limb score of Fugl-Meyer assessment stroke. Brain-derived neurotrophic factor genotype may be a potentially useful predictor of upper extremity motor outcome in patients with subacute stroke with severe baseline motor involvement. © 2017 American Heart Association, Inc.

  16. Prognostic Factors Predicting Poor Outcome in Living-Donor Liver Transplantation for Fulminant Hepatic Failure.

    Science.gov (United States)

    Kim, T-S; Kim, J M; Kwon, C H D; Kim, S J; Joh, J-W; Lee, S-K

    2017-06-01

    Living-donor liver transplantation (LDLT) has been accepted as feasible treatment for fulminant hepatic failure (FHF), although it has generated several debatable issues. In this study, we investigated the prognostic factors predicting fatal outcome after LDLT for FHF. From April 1999 to April 2011, 60 patients underwent LT for acute liver failure, including 42 patients for FHF at Samsung Medical Center, Seoul, Korea. Among 42 patients, 30 patients underwent LDLT for FHF, and the database of these patients was analyzed retrospectively to investigate the prognostic factors after LDLT for FHF. Among 30 patients, 7 patients (23%) died during the in-hospital period within 6 months, and 23 patients (77%) survived until recently. In univariate analyses, donor age (>35 years), graft volume (GV)/standard liver volume (SLV) (120 minutes), hepatic encephalopathy (grade IV), hepato-renal syndrome (HRS), and history of ventilator care were associated with fatal outcome after LDLT for FHF. In multivariate analyses, HRS, GV/SLV (35 years) were significantly associated with fatal outcome. Although the statistical significance was not shown in this analysis (P = .059), hepatic encephalopathy grade IV also appears to be a risk factor predicting fatal outcome. The survival of patients with FHF undergoing LDLT was comparable to that in published data. In this study, HRS, GV/SLV 35 years are the independent poor prognostic factors. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Detection of low Eu abundances in extremely metal-poor stars and the origin of r-process elements

    CERN Document Server

    Ishimaru, Y; Aoki, W; Ryan, S G; Aoki, Wako; Ishimaru, Yuhri; Ryan, Sean G.; Wanajo, Shinya

    2003-01-01

    We report detailed abundance analyses for three extremely metal-poor stars with [Fe/H] lesssim -3 in the Galactic halo, using the Subaru High Dispersion Spectrograph (HDS). All these stars are found to have sub-solar relative abundances of [Eu/Fe], and exhibit the lowest [Eu/H] values at their metallicities. Comparison of these low Eu abundances with our chemical evolution model of the Galactic halo implies the dominant source of Eu to be the low-mass end of the Type II supernova mass range. This suggests that collapsing O-Ne-Mg cores resulting from 8-10 Msun stars are the major r-process site.

  18. The Stellar Abundances for Galactic Archeology (SAGA) Database - Compilation of the Characteristics of Known Extremely Metal-Poor Stars

    CERN Document Server

    Suda, Takuma; Yamada, Shimako; Suwa, Tamon; Ishizuka, Chikako; Komiya, Yutaka; Sorai, Kazuo; Aikawa, Masayuki; Fujimoto, Masayuki Y

    2008-01-01

    We describe the construction of a database of extremely metal-poor (EMP) stars in the Galactic halo whose elemental abundances have been determined. Our database contains detailed elemental abundances, reported equivalent widths, atmospheric parameters, photometry, and binarity status, compiled from papers in the recent literature that report studies of EMP halo stars with [Fe/H] < -2.5. The compilation procedures for this database have been designed to assemble the data effectively from electronic tables available from online journals. We have also developed a data retrieval system that enables data searches by various criteria, and permits the user to explore relationships between the stored variables graphically. Currently, our sample includes 1212 unique stars (many of which are studied by more than one group) with more than 15000 individual reported elemental abundances, covering all of the relevant papers published by December 2007. We discuss the global characteristics of the present database, as re...

  19. Risk factors for poor outcomes in patients with open-globe injuries

    Directory of Open Access Journals (Sweden)

    Page RD

    2016-08-01

    Full Text Available Rita D Page,1 Sumeet K Gupta,1 Thomas L Jenkins,1 Zeynel A Karcioglu1,2 1Department of Ophthalmology, 2Department of Pathology, University of Virginia, Charlottesville, VA, USA Purpose: The aim of this study was to identify the risk factors that are predictive of poor outcomes in penetrating globe trauma.Patients and methods: This retrospective case series evaluated 103 eyes that had been surgically treated for an open-globe injury from 2007 to 2010 at the eye clinic of the University of Virginia. A total of 64 eyes with complete medical records and at least 6 months of follow-up were included in the study. Four risk factors (preoperative best-corrected visual acuity [pre-op BCVA], ocular trauma score [OTS], zone of injury [ZOI], and time lapse [TL] between injury and primary repair and three outcomes (final BCVA, monthly rate of additional surgeries [MRAS], and enucleation were identified for analysis.Results: Pre-op BCVA was positively associated with MRAS, final BCVA, and enucleation. Calculated OTS was negatively associated with the outcome variables. No association was found between TL and ZOI with the outcome variables. Further, age and predictor variable-adjusted analyses showed pre-op BCVA to be independently positively associated with MRAS (P=0.008 and with final BCVA (P<0.001, while the calculated OTS was independently negatively associated with final BCVA (P<0.001, but not uniquely associated with MRAS (P=0.530.Conclusion: Pre-op BCVA and OTS are best correlated with prognosis in open-globe injuries. However, no conventional features reliably predict the outcome of traumatized eyes. Keywords: penetrating globe trauma, eye injuries, prognostic factors, predictors, visual outcome, ocular trauma score

  20. Spectroscopy of superluminous supernova host galaxies. A preference of hydrogen-poor events for extreme emission line galaxies

    CERN Document Server

    Leloudas, G; Kruehler, T; Gorosabel, J; Christensen, L; Mehner, A; Postigo, A de Ugarte; Amorin, R; Thoene, C C; Anderson, J P; Bauer, F E; Gallazzi, A; Helminiak, K G; Hjorth, J; Ibar, E; Malesani, D; Morell, N; Vinko, J; Wheeler, J C

    2014-01-01

    Superluminous supernovae (SLSNe) were only discovered recently due to their preference for occurring in faint dwarf galaxies. Understanding why stellar evolution yields different types of stellar explosions in these environments is fundamental in order to both uncover the elusive progenitors of SLSNe and to study star formation in dwarf galaxies. In this paper, we present the first results of our project to study SUperluminous Supernova Host galaxIES (SUSHIES), focusing on the sample for which we have obtained spectroscopy. We show that SLSNe-I and SLSNe-R (hydrogen-poor) often (~50% in our sample) occur in a class of galaxies that is known as Extreme Emission Line Galaxies (EELGs). The probability of this happening by chance is negligible and we therefore conclude that the extreme environmental conditions and the SLSN phenomenon are related. In contrast, SLSNe-II (hydrogen-rich) occur in more massive, more metal-rich galaxies with softer radiation fields. Therefore, if SLSNe-II constitute a uniform class, th...

  1. Lower extremity amputation in peripheral artery disease: improving patient outcomes

    Science.gov (United States)

    Swaminathan, Aparna; Vemulapalli, Sreekanth; Patel, Manesh R; Jones, W Schuyler

    2014-01-01

    Peripheral artery disease affects over eight million Americans and is associated with an increased risk of mortality, cardiovascular disease, functional limitation, and limb loss. In its most severe form, critical limb ischemia, patients are often treated with lower extremity (LE) amputation (LEA), although the overall incidence of LEA is declining. In the US, there is significant geographic variation in the performing of major LEA. The rate of death after major LEA in the US is approximately 48% at 1 year and 71% at 3 years. Despite this significant morbidity and mortality, the use of diagnostic testing (both noninvasive and invasive testing) in the year prior to LEA is low and varies based on patient, provider, and regional factors. In this review we discuss the significance of LEA and methods to reduce its occurrence. These methods include improved recognition of the risk factors for LEA by clinicians and patients, strong advocacy for noninvasive and/or invasive imaging prior to LEA, improved endovascular revascularization techniques, and novel therapies. PMID:25075192

  2. Hypocalcemic tetany: a simple bedside marker of poor outcome in acute pancreatitis.

    Science.gov (United States)

    Chhabra, Puneet; Rana, Surinder S; Sharma, Vishal; Sharma, Ravi; Bhasin, Deepak K

    2016-01-01

    Hypocalcemia is a marker of poor prognosis in acute pancreatitis (AP) but the prognostic significance of hypocalcemic tetany in patients with AP has not been studied. We aimed to determine the prognostic significance of hypocalcemic tetany in patients with AP. Consecutive patients of AP who presented within 7 days of symptoms were included. Serum calcium levels were measured on admission and the patients were divided into two groups based on the presence (group 1) or absence of hypocalcemia (group 2). Chvostek and Trousseau signs were sought in all patients with hypocalcemia and the outcome measures were compared between patients with normocalcemia, asymptomatic and symptomatic hypocalcemia (tetany). The outcome parameters assessed were persistent organ failure (POF), need for intervention, and mortality. Of 105 patients (53 male; mean age 37.34±12.62 years), 37 (35.2%) had hypocalcemia (group 1) and 68 (64.8%) had normal corrected serum calcium levels (group 2). Patients with hypocalcemia had significantly higher frequency of POF, mortality and need for intervention (Ptetany. Patients with tetany had significantly lower serum corrected calcium and ionized calcium levels compared with patients with asymptomatic hypocalcemia (Ptetany had significantly higher mortality rates compared with patients with asymptomatic hypocalcemia (100% vs. 8%; P=0.00001) as well as POF (100% vs. 32%; P=0.000006). Presence of hypocalcemic tetany in AP patients bears a poor prognosis and is associated with increased mortality.

  3. Jagged1 DNA Copy Number Variation Is Associated with Poor Outcome in Liver Cancer.

    Science.gov (United States)

    Kawaguchi, Kazunori; Honda, Masao; Yamashita, Taro; Okada, Hikari; Shirasaki, Takayoshi; Nishikawa, Masashi; Nio, Kouki; Arai, Kuniaki; Sakai, Yoshio; Yamashita, Tatsuya; Mizukoshi, Eishiro; Kaneko, Shuichi

    2016-08-01

    Notch signaling abnormalities are reported to be involved in the acceleration of malignancy in solid tumors and stem cell formation or regeneration in various organs. We analyzed specific genes for DNA copy number variations in liver cancer cells and investigated whether these factors relate to clinical outcome. Chromosome 20p, which includes the ligand for Notch pathways, Jagged1, was found to be amplified in several types of hepatoma cells, and its mRNA was up-regulated according to α-fetoprotein gene expression levels. Notch inhibition using Jagged1 shRNA and γ-secretase inhibitors produced significant suppression of cell growth in α-fetoprotein-producing cells with suppression of downstream genes. Using in vivo hepatoma models, the administration of γ-secretase inhibitors resulted in reduced tumor sizes and effective Notch inhibition with widespread apoptosis and necrosis of viable tumor cells. The γ-secretase inhibitors suppressed cell growth of the epithelial cell adhesion molecule-positive fraction in hepatoma cells, indicating that Notch inhibitors could suppress the stem cell features of liver cancer cells. Even in clinical liver cancer samples, the expression of α-fetoprotein and Jagged1 showed significant correlation, and amplification of the copy number of Jagged1 was associated with Jagged1 mRNA expression and poor survival after liver cancer surgical resection. In conclusion, amplification of Jagged1 contributed to mRNA expression that activates the Jagged1-Notch signaling pathway in liver cancer and led to poor outcome.

  4. Metal-Poor Stars Observed with the Magellan Telescope. III. New Extremely and Ultra Metal-Poor Stars from SDSS/SEGUE and Insights on the Formation of Ultra Metal-Poor Stars

    CERN Document Server

    Placco, Vinicius M; Lee, Young Sun; Jacobson, Heather R; Beers, Timothy C; Pena, Jose M; Chan, Conrad; Heger, Alexander

    2015-01-01

    We report the discovery of one extremely metal-poor (EMP; [Fe/H]<-3) and one ultra metal-poor (UMP; [Fe/H]<-4) star selected from the SDSS/SEGUE survey. These stars were identified as EMP candidates based on their medium-resolution (R~2,000) spectra, and were followed-up with high-resolution (R~35,000) spectroscopy with the Magellan-Clay Telescope. Their derived chemical abundances exhibit good agreement with those of stars with similar metallicities. We also provide new insights on the formation of the UMP stars, based on comparison with a new set of theoretical models of supernovae nucleosynthesis. The models were matched with 20 UMP stars found in the literature, together with one of the program stars (SDSS J1204+1201), with [Fe/H]=-4.34. From fitting their abundances, we find that the supernovae progenitors, for stars where carbon and nitrogen are measured, had masses ranging from 20.5 M_sun to 28 M_sun and explosion energies from 0.3 to 0.9x10^51 erg. These results are highly sensitive to the carbo...

  5. Responsiveness of SF-36 and Lower Extremity Functional Scale for assessing outcomes in traumatic injuries of lower extremities.

    Science.gov (United States)

    Pan, Shin-Liang; Liang, Huey-Wen; Hou, Wen-Hsuan; Yeh, Tian-Shin

    2014-11-01

    To assess the responsiveness of one generic questionnaire, Medical Outcomes Study Short Form-36 (SF-36), and one region-specific outcome measure, Lower Extremity Functional Scale (LEFS), in patients with traumatic injuries of lower extremities. A prospective and observational study of patients after traumatic injuries of lower extremities. Assessments were performed at baseline and 3 months later. In-patients and out-patients in two university hospitals in Taiwan. A convenience sample of 109 subjects were evaluated and 94 (86%) were followed. Not applicable. Assessments of responsiveness with distribution-based approach (effect size, standardized response mean [SRM], minimal detectable change) and anchor-based approach (receiver's operating curve analysis, ROC analysis). LEFS and physical component score (PCS) of SF-36 were all responsive to global improvement, with fair-to-good accuracy in discriminating between participants with and without improvement. The area under curve gained by ROC analysis for LEFS and SF-36 PCS was similar (0.65 vs. 0.70, p=0.26). Our findings revealed comparable responsiveness of LEFS and PCS of SF-36 in a sample of subjects with traumatic injuries of lower limbs. Either type of functional measure would be suitable for use in clinical trials where improvement in function was an endpoint of interest. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Discovery of a strongly r-process enhanced extremely metal-poor star LAMOST J110901.22+075441.8

    CERN Document Server

    Li, Haining; Honda, Satoshi; Zhao, Gang; Christlieb, Norbert; Suda, Takuma

    2015-01-01

    We report the discovery of an extremely metal-poor (EMP) giant, LAMOST J110901.22+075441.8, which exhibits large excess of r-process elements with [Eu/Fe] ~ +1.16. The star is one of the newly discovered EMP stars identified from LAMOST low-resolution spectroscopic survey and the high-resolution follow-up observation with the Subaru Telescope. Stellar parameters and elemental abundances have been determined from the Subaru spectrum. Accurate abundances for a total of 23 elements including 11 neutron-capture elements from Sr through Dy have been derived for LAMOST J110901.22+075441.8. The abundance pattern of LAMOST J110901.22+075441.8 in the range of C through Zn is in line with the "normal" population of EMP halo stars, except that it shows a notable underabundance in carbon. The heavy element abundance pattern of LAMOST J110901.22+075441.8 is in agreement with other well studied cool r-II metal-poor giants such as CS 22892-052 and CS 31082-001. The abundances of elements in the range from Ba through Dy well...

  7. Search for Extremely Metal-poor Galaxies in the Sloan Digital Sky Survey (II): high electron temperature objects

    CERN Document Server

    Almeida, J Sanchez; Morales-Luis, A B; Munoz-Tunon, C; Garcia-Benito, R; Nuza, S E; Kitaura, F S

    2016-01-01

    Extremely metal-poor (XMP) galaxies are defined to have gas-phase metallicity smaller than a tenth of the solar value (12 + log[O/H] < 7.69). They are uncommon, chemically and possibly dynamically primitive, with physical conditions characteristic of earlier phases of the Universe. We search for new XMPs in the Sloan Digital Sky Survey (SDSS) in a work that complements Paper I. This time high electron temperature objects are selected; since metals are a main coolant of the gas, metal- poor objects contain high-temperature gas. Using the algorithm k-means, we classify 788677 spectra to select 1281 galaxies having particularly intense [OIII]4363 with respect to [OIII]5007, which is a proxy for high electron temperature. The metallicity of these candidates was computed using a hybrid technique consistent with the direct method, rendering 196 XMPs. A less restrictive noise constraint provides a larger set with 332 candidates. Both lists are provided in electronic format. The selected XMP sample have mean stell...

  8. Oncological outcome and prognostic factors in the therapy of soft tissue sarcoma of the extremities

    Directory of Open Access Journals (Sweden)

    Ingmar Ipach

    2012-11-01

    Full Text Available Uniform conclusions about therapeutic concepts and survival time of bone and soft tissue sarcoma patients are difficult due to the heterogeneity of histological subtypes as well as the different responses to neoadjuvant therapy. The subject of this retrospective study was the analysis of tumour free survival, risk and prognostic factors of sarcoma patients treated by limb sparing techniques or amputation. We included 118 patients with soft tissue sarcoma of the extremities treated primarily or secondarily at our institution between 1990 and 2008 with a minimum follow-up of 12 months. Data about the tumour free survival time, operative techniques and potential prognostic factors were analysed. The tumour-specific and overall survival were significantly influenced by two factors: the grading and distant metastases present at time of diagnosis. Optimal multimodal therapeutic concepts at a specialized Cancer Center decreased the risk of local recurrence. The importance of optimal preoperative and surgical course concerning the oncological long term outcome was investigated. The decrease in local recurrence as a result of multimodal therapeutic concepts at a specialized Cancer Center was confirmed. To evaluate the individual prognosis of a patient, multiple factors have to be considered. Factors for a poor prognosis are primary metastasis, high-grade tumours and several histological entities (e.g. synovial sarcoma, not other specified.

  9. Life expectancies and outcomes in extremely low birth weight neonates

    Directory of Open Access Journals (Sweden)

    Nayeri F, Amini E, Shariat M, Mansoori B

    2008-07-01

    Full Text Available "n Background: Much has changed in neonatal care for extremely low birth weight (ELBW; birth weight <1000g infants over the recent years in Iran, resulting in an increase in their survival rate. We determined neonatal survival and short-term morbidity rates among ELBW infants, and the correlation of these factors with mortality risk. "n"nMethods: All single live-born ELBW babies delivered at Vali-e-Asr Hospital over a four-year period were identified. Data that were prospectively collected included: maternal age, prenatal and perinatal complications, antenatal steroid use, birth weight, gestational age, route of delivery, sex, need for resuscitation, APGAR score, need for mechanical  ventilation, and complications including respiratory distress syndrome (RDS, sepsis, jaundice, intraventricular  hemorrhage (IVH, necrotizing entrocolitis (NEC metabolic and hematologic and cardiac disorders. Information was statistically analyzed and a probability value of <0.05 was considered significant. "n"nResults: A total of 93 neonates were included in the study. The survival rate in the delivery room was 36.6%. The lowest birth weight was 400g, with a mean birth weight of 850.43(±136.48g, and the lowest gestational age was 22 weeks. The mean gestational period was 28.31(±2.77 weeks. The most frequent complication after birth was RDS(69.89% and the least frequent was NEC (6.4%. Short and normal gestation was observed in 44.08% and 48.4% of the neonates, respectively. There was a significant relationship between neonatal mortality and the need for resuscitation after birth, RDS and need for a respirator (p<0.05. "n"nFurthermore, there was significant increase in mortality among neonates with gestational age <30 weeks, birth weight under 750g and lack of steroids before birth (p<0.05. "n"nConclusions: To enhance perinatal and neonatal care and decrease the rate of preterm labor, improved standard resuscitation and increased administration of antenatal

  10. Diabetes and poor outcomes within 6 months after acute ischemic stroke: the China National Stroke Registry.

    Science.gov (United States)

    Jia, Qian; Zhao, Xingquan; Wang, Chunxue; Wang, Yilong; Yan, Yu; Li, Hao; Zhong, Liyong; Liu, Liping; Zheng, Huaguang; Zhou, Yong; Wang, Yongjun

    2011-10-01

    Diabetes mellitus (DM) is an independent risk factor for ischemic stroke. However, controversy exists with regard to the impact of DM on prognosis after ischemic stroke in the Chinese population. We investigated the associations between DM and death, dependency, and stroke recurrence in patients after ischemic stroke onset in a nationwide, prospective registry, the China National Stroke Registry. The China National Stroke Registry consecutively recruited patients hospitalized for acute ischemic stroke in 2007 to 2008 and who were prospectively followed up for clinical and functional outcomes (death, dependency, and stroke recurrence) at 3 and 6 months after disease onset. Multivariable logistic regression was performed to analyze the association between DM and stroke outcomes after adjusting for potential confounding including age, sex, National Institutes of Health Stroke Scale score, glucose level at admission, hypertension, coronary heart disease, smoking, urinary tract infection, and other factors. DM was identified in 3483 (27.0%) of stroke patients. Compared with stroke patients without DM, patients with DM had a significantly higher incidence of death or dependency and of recurrent stroke at 3 and 6 months after stroke onset. DM was an independent risk factor for death or dependency (adjusted odds ratio=1.23; 95% confidence interval, 1.10 to 1.37) in patients with ischemic stroke at 6 months after onset. DM independently predicted poor outcomes in Chinese patients after acute ischemic stroke.

  11. Complement component 5 contributes to poor disease outcome in humans and mice with pneumococcal meningitis.

    Science.gov (United States)

    Woehrl, Bianca; Brouwer, Matthijs C; Murr, Carmen; Heckenberg, Sebastiaan G B; Baas, Frank; Pfister, Hans W; Zwinderman, Aeilko H; Morgan, B Paul; Barnum, Scott R; van der Ende, Arie; Koedel, Uwe; van de Beek, Diederik

    2011-10-01

    Pneumococcal meningitis is the most common and severe form of bacterial meningitis. Fatality rates are substantial, and long-term sequelae develop in about half of survivors. Disease outcome has been related to the severity of the proinflammatory response in the subarachnoid space. The complement system, which mediates key inflammatory processes, has been implicated as a modulator of pneumococcal meningitis disease severity in animal studies. Additionally, SNPs in genes encoding complement pathway proteins have been linked to susceptibility to pneumococcal infection, although no associations with disease severity or outcome have been established. Here, we have performed a robust prospective nationwide genetic association study in patients with bacterial meningitis and found that a common nonsynonymous complement component 5 (C5) SNP (rs17611) is associated with unfavorable disease outcome. C5 fragment levels in cerebrospinal fluid (CSF) of patients with bacterial meningitis correlated with several clinical indicators of poor prognosis. Consistent with these human data, C5a receptor-deficient mice with pneumococcal meningitis had lower CSF wbc counts and decreased brain damage compared with WT mice. Adjuvant treatment with C5-specific monoclonal antibodies prevented death in all mice with pneumococcal meningitis. Thus, our results suggest C5-specific monoclonal antibodies could be a promising new antiinflammatory adjuvant therapy for pneumococcal meningitis.

  12. The use of blood biomarkers to predict poor outcome after acute transient ischemic attack or ischemic stroke.

    Science.gov (United States)

    Whiteley, William; Wardlaw, Joanna; Dennis, Martin; Lowe, Gordon; Rumley, Ann; Sattar, Naveed; Welsh, Paul; Green, Alison; Andrews, Mary; Sandercock, Peter

    2012-01-01

    The prediction of death or disability ("poor outcome") after stroke by validated clinical models might be improved by the addition of blood biomarker measurements. We investigated whether such measurements improved the classification of patients into 4 categories of predicted risk of poor outcome: very high, intermediate high, intermediate low, and very low. We prospectively recruited symptomatic patients within 24 hours of ischemic cerebrovascular events. We measured clinical prognostic variables in each patient. We drew blood soon after admission and measured markers of inflammation, thrombosis, cardiac strain, and cerebral damage. We assessed poor outcome at 3 months with the modified Rankin Scale and recovery of symptoms at 24 hours. We measured the association between blood marker levels and poor outcome after adjustment for stroke severity and age with multivariate logistic regression. Where these associations were statistically significant, we calculated the net reclassification index. We recruited 270 patients with acute ischemic cerebrovascular events. At 3 months, 112 patients had a poor outcome. After adjustment for stroke severity and age, only interleukin-6 and N-terminal pro-brain natriuretic peptide were significantly associated with poor outcome. The addition of either interleukin-6 or N-terminal pro-brain natriuretic peptide to National Institutes of Health Stroke Scale and age did not improve the prediction of a poor outcome. Neither interleukin-6 nor N-terminal pro-brain natriuretic peptide had sufficient predictive power to be of clinical use to predict poor outcome after stroke. The search for better markers to improve the classification of patients across clinically relevant boundaries of predicted probabilities of outcome events needs to continue.

  13. Clinical predictors of poor outcomes among patients with nonvariceal upper gastrointestinal bleeding in Europe.

    Science.gov (United States)

    Lanas, A; Aabakken, L; Fonseca, J; Mungan, Z A; Papatheodoridis, G V; Piessevaux, H; Cipolletta, L; Nuevo, J; Tafalla, M

    2011-06-01

    Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common medical emergency associated with substantial morbidity and mortality. Despite advances in endoscopic and pharmacological treatment during the past two decades, the incidence of mortality associated with NVUGIB has remained relatively constant. To report outcomes and predictive factors for bleeding continuation/re-bleeding and mortality of NVUGIB in clinical practice in different European countries. This observational, retrospective cohort study (NCT00797641; ENERGIB) was conducted in Belgium, Greece, Italy, Norway, Portugal, Spain and Turkey. Eligible patients were hospitalised (new admissions or inpatients), presenting with overt NVUGIB with endoscopy from 1 October to 30 November, 2008. Patients were managed according to routine care, and data regarding bleeding continuation/re-bleeding, pharmacological treatment, surgery and mortality during 30-days after the initial bleed were collected. A multivariate analysis of clinical factors predictive of poor outcomes was conducted. Overall, 2660 patients (64.7% men; mean age 67.7 years) were evaluable. Significant differences across countries in bleeding continuation/re-bleeding (range: 9-15.8%) or death (2.5-8%) at 30 days were explained by clinical factors (number of comorbidities, age > 65 years, history of bleeding ulcers, in-hospital bleeding, type of lesion or type of concomitant medication). Other factors (country, size of hospital, profile of team managing the event, or endoscopic/pharmacological therapy received) did not affect these outcomes. Similar predictors were observed in patients with high-risk stigmata. Differences in the outcomes of nonvariceal upper gastrointestinal bleeding in clinical practice across some European countries are explained mainly by patient-related factors, and not by management factors. © 2011 Blackwell Publishing Ltd.

  14. Elevated APOBEC3B correlates with poor outcomes for estrogen-receptor-positive breast cancers.

    Science.gov (United States)

    Sieuwerts, Anieta M; Willis, Scooter; Burns, Michael B; Look, Maxime P; Meijer-Van Gelder, Marion E; Schlicker, Andreas; Heideman, Marinus R; Jacobs, Heinz; Wessels, Lodewyk; Leyland-Jones, Brian; Gray, Kathryn P; Foekens, John A; Harris, Reuben S; Martens, John W M

    2014-12-01

    Recent observations connected DNA cytosine deaminase APOBEC3B to the genetic evolution of breast cancer. We addressed whether APOBEC3B is associated with breast cancer clinical outcomes. APOBEC3B messenger RNA (mRNA) levels were related in 1,491 primary breast cancers to disease-free (DFS), metastasis-free (MFS), and overall survival (OS). For independent validation, APOBEC3B mRNA expression was associated with patient outcome data in five additional cohorts (over 3,500 breast cancer cases). In univariate Cox regression analysis, increasing APOBEC3B expression as a continuous variable was associated with worse DFS, MFS, and OS (hazard ratio [HR] = 1.20, 1.21, and 1.24, respectively; all P DFS (continuous variable: HR = 1.29, P = .001; dichotomized at the median level, HR = 1.66, P = .0002). This implies that APOBEC3B is a marker of pure prognosis in ER + disease. These findings were confirmed in the analyses of five independent patient sets. In these analyses, APOBEC3B expression dichotomized at the median level was associated with adverse outcomes (METABRIC discovery and validation, 788 and 706 ER + cases, disease-specific survival (DSS), HR = 1.77 and HR = 1.77, respectively, both P DFS, HR = 1.57, P = 2.46E-04; NKI295, 181 ER + cases, DFS, HR = 1.72, P = .054; and BIG 1-98, 1,219 ER + cases, breast-cancer-free interval (BCFI), HR = 1.42, P = 0.0079). APOBEC3B is a marker of pure prognosis and poor outcomes for ER + breast cancer, which strongly suggests that genetic aberrations induced by APOBEC3B contribute to breast cancer progression.

  15. Visual outcomes of bilateral congenital and developmental cataracts in young children in south India and causes of poor outcome

    Directory of Open Access Journals (Sweden)

    Rohit C Khanna

    2013-01-01

    Full Text Available Context: Bilateral pediatric cataracts are important cause of visual impairment in children. Aim: To study the outcome of bilateral pediatric cataract surgery in young children. Setting and Design: Retrospective case series in a tertiary center. Materials and Methods: Records of pediatric cataracts operated between January 2001 and December 2003, with a minimum follow-up of 3 months, were reviewed retrospectively. Statistical Methods: Independent sample t-test, Fisher′s exact test, and logistic regression using SPSS (Statistical Package for Social Science, Chicago, USA version 12. Results: 215/257 (83.7% patients had a minimum follow-up of 3 months. The mean age of presentation to the hospital was 53 months (range: 0-168 months. Congenital cataract was present in 107 patients (58.2% and developmental cataract in 77 patients (41.8%. The mean age at surgery was 55.2 months (range: 1-168 months. Out of 430 eyes, 269 (62.6% had an intraocular lens implanted. The mean duration of follow-up was 13.1 months (range: 3-38 months. Pre-operatively, 102 patients (47.3% had visual acuity 6/18. The most common early post-operative complication was fibrinous uveitis in 57 eyes (13.3% and the most common delayed post-operative complication was posterior capsular opacification in 118 eyes (27.4%. The most important prognostic factor for poor outcome was congenital cataract (odds ratio [OR]: 26.3; 95% confidence interval [CI], 4.4-158.5 and total cataract (OR: 4.8; 95% CI, 1.3-17. Conclusion: Nearly half of the eyes had visual acuity >6/18. The outcome was poorer in congenital cataracts, especially those operated after >1 year of age.

  16. Infratentorial medulloepithelioma with divergent differentiation: Possibly a predictor of poor outcome

    Directory of Open Access Journals (Sweden)

    Indranil Chakrabarti

    2012-01-01

    Full Text Available Medulloepitheliomas (WHO grade IV are rare, malignant embryonal tumors of pediatric population, classified under the central nervous system (CNS primitive neuroectodermal tumors (PNET. Histologically, these tumors are characterized by neoplastic neuroepithelium recapitulating the embryonic neural tube. We describe a rare case of infratentorial medulloepithelioma with divergent differentiation in a 1-year-old male child who presented with headache, vomiting, and seizures. Histopathologic examination of the excised tumor revealed the characteristic neuroepithelium, along with other areas showing primitive neuroectodermal (blastemal cells in sheets, ependymoblastic rosettes, and nodular areas of neuronal differentiation. Possibly, this proliferating immature neuroepithelium is the cause of poor outcome in medulloepitheliomas. Due to the rarity of these tumors, it remains to be established whether infratentorial location or tumors with divergent differentiation are also predictors of adverse prognosis.

  17. Infratentorial medulloepithelioma with divergent differentiation: Possibly a predictor of poor outcome.

    Science.gov (United States)

    Chakrabarti, Indranil; Majumdar, Kaushik; Giri, Amita

    2012-05-01

    Medulloepitheliomas (WHO grade IV) are rare, malignant embryonal tumors of pediatric population, classified under the central nervous system (CNS) primitive neuroectodermal tumors (PNET). Histologically, these tumors are characterized by neoplastic neuroepithelium recapitulating the embryonic neural tube. We describe a rare case of infratentorial medulloepithelioma with divergent differentiation in a 1-year-old male child who presented with headache, vomiting, and seizures. Histopathologic examination of the excised tumor revealed the characteristic neuroepithelium, along with other areas showing primitive neuroectodermal (blastemal) cells in sheets, ependymoblastic rosettes, and nodular areas of neuronal differentiation. Possibly, this proliferating immature neuroepithelium is the cause of poor outcome in medulloepitheliomas. Due to the rarity of these tumors, it remains to be established whether infratentorial location or tumors with divergent differentiation are also predictors of adverse prognosis.

  18. Threshold age and burn size associated with poor outcomes in the elderly after burn injury.

    Science.gov (United States)

    Jeschke, Marc G; Pinto, Ruxandra; Costford, Sheila R; Amini-Nik, Saeid

    2016-03-01

    Elderly burn care represents a vast challenge. The elderly are one of the most susceptible populations to burn injuries, but also one of the fastest growing demographics, indicating a substantial increase in patient numbers in the near future. Despite the need and importance of elderly burn care, survival of elderly burn patients is poor. Additionally, little is known about the responses of elderly patients after burn. One central question that has not been answered is what age defines an elderly patient. The current study was conducted to determine whether there is a cut-off age for elderly burn patients that is correlated with an increased risk for mortality and to determine the burn size in modern burn care that is associated with increased mortality. To answer these questions, we applied appropriate statistical analyses to the Ross Tilley Burn Centre and the Inflammatory and Host Response to Injury databases. We could not find a clear cut-off age that differentiates or predicts between survival and death. Risk of death increased linearly with increasing age. Additionally, we found that the LD50 decreases from 45% total body surface area (TBSA) to 25% TBSA from the age of 55 years to the age of 70 years, indicating that even small burns lead to poor outcome in the elderly. We therefore concluded that age is not an ideal to predictor of burn outcome, but we strongly suggest that burn care providers be aware that if an elderly patient sustains even a 25% TBSA burn, the risk of mortality is 50% despite the implementation of modern protocolized burn care.

  19. Host Factors and Biomarkers Associated with Poor Outcomes in Adults with Invasive Pneumococcal Disease.

    Directory of Open Access Journals (Sweden)

    Shigeo Hanada

    Full Text Available Invasive pneumococcal disease (IPD causes considerable morbidity and mortality. We aimed to identify host factors and biomarkers associated with poor outcomes in adult patients with IPD in Japan, which has a rapidly-aging population.In a large-scale surveillance study of 506 Japanese adults with IPD, we investigated the role of host factors, disease severity, biomarkers based on clinical laboratory data, treatment regimens, and bacterial factors on 28-day mortality.Overall mortality was 24.1%, and the mortality rate increased from 10.0% in patients aged ˂50 years to 33.1% in patients aged ≥80 years. Disease severity also increased 28-day mortality, from 12.5% among patients with bacteraemia without sepsis to 35.0% in patients with severe sepsis and 56.9% with septic shock. The death rate within 48 hours after admission was high at 54.9%. Risk factors for mortality identified by multivariate analysis were as follows: white blood cell (WBC count <4000 cells/μL (odds ratio [OR], 6.9; 95% confidence interval [CI], 3.7-12.8, p < .001; age ≥80 years (OR, 6.5; 95% CI, 2.0-21.6, p = .002; serum creatinine ≥2.0 mg/dL (OR, 4.5; 95% CI, 2.5-8.1, p < .001; underlying liver disease (OR, 3.5; 95% CI, 1.6-7.8, p = .002; mechanical ventilation (OR, 3.0; 95% CI, 1.7-5.6, p < .001; and lactate dehydrogenase ≥300 IU/L (OR, 2.4; 95% CI, 1.4-4.0, p = .001. Pneumococcal serotype and drug resistance were not associated with poor outcomes.Host factors, disease severity, and biomarkers, especially WBC counts and serum creatinine, were more important determinants of mortality than bacterial factors.

  20. Using global gene expression to discriminate thin melanomas with poor outcomes.

    Science.gov (United States)

    Hothem, Zachary; Bayci, Andrew; Thibodeau, Bryan J; Ketelsen, Billie E; Fortier, Laura E; Uzieblo, Alison F; Cosner, Diane; Totoraitis, Kristin; Keidan, Richard D; Wilson, George D

    2017-01-01

    Most melanomas present as thin lesions (≤1.0 mm) with a good prognosis; however, a small percentage of patients with thin lesions experience recurrence or metastasis. The aim of our study was to identify a distinct pattern of gene expression within thin melanomas known to have eventually metastasized to regional lymph nodes or distant sites compared with those that followed the typical course with good response to wide local excision alone. Patients who were disease-free for a minimum of 10 y served as controls (n = 10) to the experimental group who developed metastasis (n = 9). Laser capture microdissection was used to specifically isolate cancer cells from formalin-fixed paraffin-embedded tissue with subsequent gene expression analysis on Affymetrix Human Transcriptome Array 2.0 Arrays. Although gene expression differences were observed between the patients with thin melanoma with poor clinical outcome and those with good clinical outcome, neither the number of genes nor the magnitude of the fold difference was very substantial or significant. Cluster analysis with this subset of genes could definitively separate a subset of the poor responders from the good responders, but there remained a mixed group of tumors that could not be predicted from gene expression alone. Pathway analysis identified cellular processes that were regulated based on the response, including categories commonly associated with melanoma progression. Ultimately, we concluded that there were very few differences between these groups. Future research will be required and investigation of the mutational landscape may be another strategy to uncover genomic changes that drive recurrence and metastasis in thin melanoma.

  1. Systemic Inflammatory Response Syndrome (SIRS) Score Independently Predicts Poor Outcome in Isolated Traumatic Brain Injury.

    Science.gov (United States)

    Jacome, Tomas; Tatum, Danielle

    2017-05-25

    Systemic inflammatory response syndrome (SIRS) is frequently observed after various types of acute cerebral injury and has been linked to clinical deterioration in non-traumatic brain injury (TBI). SIRS scores have also been shown to be predictive of length of stay and mortality in trauma patients. We aimed to determine the prognostic utility of SIRS present at admission in trauma patients with isolated TBI. This was a 5-year retrospective cohort study of adults (≥18 years) with isolated TBI admitted to a Level II trauma center. The prognostic value of SIRS, total SIRS scores, and each SIRS criterion was examined by Χ (2) and logistic regression analyses. Of the 330 patients identified, 50 (15.2%) met SIRS criteria. SIRS was significantly associated with poor outcome (P SIRS score of 2 on admission (P = 0.007) and increased significantly to 6.5 times in patients with a SIRS score of 3 (P = 0.002). Logistic regression demonstrated SIRS and each criterion to be significant independent prognostic factors (SIRS, P = 0.030; body temperature, P = 0.006; tachypnea, P = 0.022, tachycardia P = 0.023). SIRS at admission is an independent predictor of poor outcome in isolated TBI patients. These data demonstrate SIRS to be an important clinical tool that may be used in facilitating prognostication, particularly in elderly trauma patients. Future prospective studies aimed at therapeutic interventions to mitigate SIRS in TBI patients are warranted. Prognostic, Level III.

  2. Mapping Extreme Heat Vulnerability and Health Outcomes to inform the District of Columbia's Climate Adaptation Plan

    Science.gov (United States)

    Declet-Barreto, J.; Wilhelmi, O.; Goggans, A.

    2016-12-01

    In this collaborative engagement, scientists are partnering with the District of Columbia (DC) to develop an extreme heat vulnerability assessment. To do so, we map socio-demographic and built environment indicators of extreme heat vulnerability in Census Tracts in DC neighborhoods. In order to provide information useful for DC public health and urban planning practitioners, we aggregate the indicators into an index of extreme heat vulnerability. We compare the index against heat-related call data from DC's 911 system to better understand the socio-spatial distribution of extreme heat-related health outcomes. Our assessment can help inform the District's Climate Adaptation Plan as well as increase public engagement in reducing vulnerability to extreme heat.

  3. Parent-Adolescent Discrepancies in Perceived Parenting Characteristics and Adolescent Developmental Outcomes in Poor Chinese Families.

    Science.gov (United States)

    Leung, Janet T Y; Shek, Daniel T L

    2014-01-01

    We examined the relationships between parent-adolescent discrepancies in perceived parenting characteristics (indexed by parental responsiveness, parental demandingness, and parental control) and adolescent developmental outcomes (indexed by achievement motivation and psychological competence) in poor families in Hong Kong. A sample of 275 intact families having at least one child aged 11-16 experiencing economic disadvantage were invited to participate in the study. Fathers and mothers completed the Parenting Style Scale and Chinese Parental Control Scale, and adolescents completed the Social-Oriented Achievement Motivation Scale and Chinese Positive Youth Development Scale in addition to paternal and maternal Parenting Style Scale and Chinese Parental Control Scale. Results indicated that parents and adolescents had different perceptions of parental responsiveness, parental demandingness, and paternal control, with adolescents generally perceived lower levels of parenting behaviors than did their parents. While father-adolescent discrepancy in perceived paternal responsiveness and mother-adolescent discrepancy in perceived maternal control negatively predicted adolescent achievement motivation, mother-adolescent discrepancy in perceptions of maternal responsiveness negatively predicted psychological competence in adolescents experiencing economic disadvantage. The present findings provided support that parent-child discrepancies in perceived parenting characteristics have negative impacts on the developmental outcomes of adolescents experiencing economic disadvantage. The present study addresses parent-child discrepancies in perceived parental behaviors as "legitimate" constructs, and explores their links with adolescent psychosocial development, which sheds light for researchers and clinical practitioners in helping the Chinese families experiencing economic disadvantage.

  4. Anti-FSH antibodies associate with poor outcome of ovarian stimulation in IVF.

    Science.gov (United States)

    Haller, Kadri; Salumets, Andres; Uibo, Raivo

    2008-03-01

    FSH is required for spontaneous folliculogenesis and is widely used in ovarian stimulation in IVF. Previously, increased concentrations of antibodies against FSH (anti-FSH) have been demonstrated in infertile women. This study aimed to: (i) assess the possible association of anti-FSH with an adverse outcome of IVF with regard to clinical parameters characterizing the ovarian reserve; and (ii) compare serum and follicular fluid (FF) anti-FSH concentrations in relation to follicle size and endocrine markers. IVF patients (n = 182) subjected to gonadotrophin-releasing hormone-antagonist protocol were assessed for anti-FSH using enzyme-linked immunosorbent assay. Increased concentrations of serum anti-FSH immunoglobulin (Ig)G and IgA were associated with impaired ovarian stimulation outcome, with cut-off values ratio for IgG = 6.95, P = 0.005 and IgA = 3.60, P = 0.039). FF anti-FSH IgG and IgA were positively associated with serum anti-FSH concentrations and FSH concentration in FF. Additionally, FF anti-FSH IgG increased with follicle growth (linear regression coefficient = 0.02, P = 0.022). Collectively, these data suggest that serum anti-FSH antibodies are associated with poor ovarian response to FSH stimulation in IVF, with anti-FSH IgA and IgG potentially exerting a local FSH antagonizing effect in maturing follicles.

  5. Tuberculosis in ageing: high rates, complex diagnosis and poor clinical outcomes

    Science.gov (United States)

    Cruz-Hervert, Luis Pablo; García-García, Lourdes; Ferreyra-Reyes, Leticia; Bobadilla-del-Valle, Miriam; Cano-Arellano, Bulmaro; Canizales-Quintero, Sergio; Ferreira-Guerrero, Elizabeth; Báez-Saldaña, Renata; Téllez-Vázquez, Norma; Nava-Mercado, Ariadna; Juárez-Sandino, Luis; Delgado-Sánchez, Guadalupe; Fuentes-Leyra, César Alejandro; Montero-Campos, Rogelio; Martínez-Gamboa, Rosa Areli; Small, Peter M.; Sifuentes-Osornio, José; Ponce-de-León, Alfredo

    2012-01-01

    Background: worldwide, the frequency of tuberculosis among older people almost triples that observed among young adults. Objective: to describe clinical and epidemiological consequences of pulmonary tuberculosis among older people. Methods: we screened persons with a cough lasting more than 2 weeks in Southern Mexico from March 1995 to February 2007. We collected clinical and mycobacteriological information (isolation, identification, drug-susceptibility testing and IS6110-based genotyping and spoligotyping) from individuals with bacteriologically confirmed pulmonary tuberculosis. Patients were treated in accordance with official norms and followed to ascertain treatment outcomes, retreatment, and vital status. Results: eight hundred ninety-three tuberculosis patients were older than 15 years of age; of these, 147 (16.5%) were 65 years of age or older. Individuals ≥65 years had significantly higher rates of recently transmitted and reactivated tuberculosis. Older age was associated with treatment failure (OR = 5.37; 95% CI: 1.06–27.23; P = 0.042), and death due to tuberculosis (HR = 3.52; 95% CI: 1.78–6.96; P < 0.001) adjusting for sociodemographic and clinical variables. Conclusions: community-dwelling older individuals participate in chains of transmission indicating that tuberculosis is not solely due to the reactivation of latent disease. Untimely and difficult diagnosis and a higher risk of poor outcomes even after treatment completion emphasise the need for specific strategies for this vulnerable group. PMID:22431155

  6. Poor Outcomes in Patients with Primary Malignant Mediastinal Germ-cell Tumors

    Directory of Open Access Journals (Sweden)

    Hui-Hua Hsiao

    2005-12-01

    Full Text Available Primary mediastinal germ-cell tumors (GCTs without gonadal involvement are rare and can be divided into benign mature teratoma and malignant seminoma or nonseminoma. We describe our experience of malignant mediastinal GCTs and compare the presentations and outcome with those of benign teratomas. Four malignant GCTs (1 seminoma, 1 choriocarcinoma, and 2 yolk-sac tumors have been treated in our hospital. All patients were men with obvious symptoms before diagnosis. The patient with seminoma was treated with surgery and radiation, while those with nonseminoma tumors were treated with chemotherapy and/or surgery. Two patients died, one with extended pulmonary metastasis and the other with relapsed disease and high levels of tumor markers. Compared with the nine cases of benign teratomas, the four malignant GCTs showed overwhelming male dominance, advanced symptoms at presentation, and poor outcome. These cases highlight the important role of disease staging and tumor-marker levels in malignant GCTs, and suggest that new treatment strategies for malignant GCTs await further investigation.

  7. A large Venous-Arterial PCO(2) Is Associated with Poor Outcomes in Surgical Patients.

    Science.gov (United States)

    Silva, João M; Oliveira, Amanda M Ribas R; Segura, Juliano Lopes; Ribeiro, Marcel Henrique; Sposito, Carolina Nacevicius; Toledo, Diogo O; Rezende, Ederlon; Malbouisson, Luiz M Sá

    2011-01-01

    Background. This study evaluated whether large venous-arterial CO(2) gap (PCO(2) gap) preoperatively is associated to poor outcome. Method. Prospective study which included adult high-risk surgical patients. The patients were pooled into two groups: wide [P(v-a)CO(2)] versus narrow [P(v-a)CO(2)]. In order to determine the best value to discriminate hospital mortality, it was applied a ROC (receiver operating characteristic) curve for the [P(v-a)CO(2)] values collected preoperatively, and the most accurate value was chosen as cut-off to define the groups. Results. The study included 66 patients. The [P(v-a)CO(2)] value preoperatively that best discriminated hospital mortality was 5.0 mmHg, area = 0.73. Preoperative patients with [P(v-a)CO(2)] more than 5.0 mmHg presented a higher hospital mortality (36.4% versus 4.5% P = 0.004), higher prevalence of circulatory shock (56.8% versus 22.7% P = 0.01) and acute renal failure postoperatively (27.3% versus 4.5% P = 0.02), and longer hospital length of stays 20.0 (14.0-30.0) versus 13.5 (9.0-25.0) days P = 0.01. Conclusions. The PCO(2) gap values more than 5.0 mmHg preoperatively were associated with worse postoperatively outcome.

  8. Deep SDSS Optical Spectroscopy of Distant Halo Stars. III. Chemical analysis of extremely metal-poor stars

    CERN Document Server

    Fernandez-Alvar, E; Beers, T C; Lee, Y S; Masseron, T; Schneider, D P

    2016-01-01

    We present the results of an analysis for 107 extremely metal-poor (EMP) stars with metallicities less than [Fe/H] = -3.0, identified from medium-resolution spectra in SDSS. We follow a methodology based on comparisons of the observed spectra with synthetic spectra. The abundances of Fe, Ca, and Mg are determined by fitting spectral regions dominated by lines of each element. In addition, we present a technique to determine upper limits for elements whose features are not detected in a given spectrum. We also analyse our sample with the SEGUE Stellar Parameter Pipeline, in order to obtain additional determinations of the atmospheric parameters, iron and alpha-element abundances, to compare with ours, and to infer [C/Fe] ratios. We find that, in these moderate to low signal-to-noise and medium-resolution spectra in this metallicity regime, Ca is usually the only element that exhibits lines that are sufficiently strong to reliably measure its abundance. Fe and Mg exhibit weaker features that, in most cases, onl...

  9. First stars XII. Abundances in extremely metal-poor turnoff stars,and comparison with the giants

    CERN Document Server

    Bonifacio, P; Cayrel, R; Hill, V; Spite, F; François, P; Plez, B; Ludwig, H -G; Caffau, E; Molaro, P; Depagne, E; Andersen, J; Barbuy, B; Beers, T C; Nordström, B; Primas, F

    2009-01-01

    CONTEXT:The detailed chemical abundances of extremely metal-poor (EMP) stars are key guides to understanding the early chemical evolution of the Galaxy. Most existing data are, however, for giant stars which may have experienced internal mixing later. AIMS: We aim to compare the results for giants with new, accurate abundances for all observable elements in 18 EMP turnoff stars. METHODS:VLT/UVES spectra at R ~45,000 and S/N~ 130 per pixel (330-1000 nm) are analysed with OSMARCS model atmospheres and the TURBOSPECTRUM code to derive abundances for C, Mg, Si, Ca, Sc, Ti, Cr, Mn, Co, Ni, Zn, Sr, and Ba. RESULTS: For Ca, Ni, Sr, and Ba, we find excellent consistency with our earlier sample of EMP giants, at all metallicities. However, our abundances of C, Sc, Ti, Cr, Mn and Co are ~0.2 dex larger than in giants of similar metallicity. Mg and Si abundances are ~0.2 dex lower (the giant [Mg/Fe] values are slightly revised), while Zn is again ~0.4 dex higher than in giants of similar [Fe/H] (6 stars only). CONCLUSIO...

  10. High-Resolution Spectroscopy of Extremely Metal-Poor Stars from SDSS/SEGUE: I. Atmospheric Parameters and Chemical Compositions

    CERN Document Server

    Aoki, Wako; Lee, Young Sun; Honda, Satoshi; Ito, Hiroko; Takada-Hidai, Masahide; Frebel, Anna; Suda, Takuma; Fujimoto, Masatuki Y; Carollo, Daniela; Sivarani, Thirupathi

    2012-01-01

    Chemical compositions are determined based on high-resolution spectroscopy for 137 candidate extremely metal-poor (EMP) stars selected from the Sloan Digital Sky Survey (SDSS) and its first stellar extension, the Sloan Extension for Galactic Understanding and Exploration (SEGUE). High-resolution spectra with moderate signal-to-noise (S/N) ratios were obtained with the High Dispersion Spectrograph of the Subaru Telescope. Most of the sample (approximately 80%) are main-sequence turn-off stars, including dwarfs and subgiants. Four cool main-sequence stars, the most metal-deficient such stars known, are included in the remaining sample. Good agreement is found between effective temperatures estimated by the SEGUE stellar parameter pipeline, based on the SDSS/SEGUE medium-resolution spectra, and those estimated from the broadband $(V-K)_0$ and $(g-r)_0$ colors. Our abundance measurements reveal that 70 stars in our sample have [Fe/H] $ +0.7$) among the 25 giants in our sample is as high as 36%, while only a lowe...

  11. Rest-frame ultraviolet-to-optical spectral characteristics of extremely metal-poor and metal-free galaxies

    CERN Document Server

    Inoue, Akio K

    2011-01-01

    Finding the first generation of galaxies in the early Universe is the greatest step forward for understanding galaxy formation and evolution. For strategic survey of such galaxies and interpretation of the obtained data, this paper presents an ultraviolet-to-optical spectral model of galaxies with a great care of the nebular emission. In particular, we present a machine-readable table of intensities of 119 nebular emission lines from Ly$\\alpha$ to the rest-frame 1 $\\mu$m as a function of metallicity from zero to the Solar one. Based on the spectral model, we present criteria of broad-band colours and equivalent widths of Ly$\\alpha$, He {\\sc ii} $\\lambda1640$, H$\\alpha$, H$\\beta$, [O {\\sc iii}] $\\lambda5007$ to select extremely metal-poor and metal-free galaxies although these criteria have uncertainty caused by the Lyman continuum escape fraction and the star formation duration. The criteria of broad-band colours will be useful to select candidates for spectroscopic follow-up from drop-out galaxies. We propos...

  12. Probing the Site for r-Process Nucleosyntheis with Abundances of Barium and Magnesium in Extremely Metal-Poor Stars

    CERN Document Server

    Tsujimoto, T; Yoshii, Y; Tsujimoto, Takuji; Shigeyama, Toshikazu; Yoshii, Yuzuru

    2000-01-01

    We suggest that if the astrophysical site for r-process nucleosynthesis in the early Galaxy is confined to a narrow mass range of Type II supernova (SN II) progenitors, with a lower mass limit of Mms = 20 Msun, a unique feature in the observed distribution of [Ba/Mg] vs.[Mg/H] for extremely metal-poor stars can be adequately reproduced. We associate this feature, a bifurcation of the observed elemental ratios into two branches in the Mg abundance interval -2.7 20 Msun. The second branch, which we call the ``i''-branch, is associated with the elemental abundance ratios of stars which were formed in the dense shells of the interstellar medium swept up by SNe II with Mms < 20 Msun that do not synthesize r-process elements, and applies to stars with observed Mg abundances in the range [Mg/H] < -2.7. The Ba abundances in these stars reflect those of the interstellar gas at the (later) time of their formation. The existence of a [Ba/Mg] i-branch strongly suggests that SNe II which are associated with stars o...

  13. A combination mode of climate variability responsible for extremely poor recruitment of the Japanese eel (Anguilla japonica)

    Science.gov (United States)

    Lin, Yong-Fu; Wu, Chau-Ron; Han, Yu-San

    2017-03-01

    Satellite data and assimilation products are used to investigate fluctuations in the catch of Japanese eel (Anguilla japonica) in eastern Asian countries. It has been reported that the salinity front has extended farther south, which has shifted the eel’s spawning grounds to a lower latitude, resulting in smaller eel catches in 1983, 1992, and 1998. This study demonstrates that interannual variability in the eel catch is strongly correlated with the combination mode (C-mode), but not with the El Niño–Southern Oscillation. These eels continue to spawn within the North Equatorial Current (NEC), but the salinity front shifts south during a canonical El Niño. On the other hand, the spawning grounds accompanied by the salinity front extend farther south during the C-mode of climate variability, and eel larvae fail to join the nursery in the NEC, resulting in extremely poor recruitment in East Asia. We propose an appropriate sea surface temperature index to project Japanese eel larval catch.

  14. Poor peripheral blood stem cell mobilization affects long-term outcomes in multiple myeloma patients undergoing autologous stem cell transplantation.

    Science.gov (United States)

    Moreb, Jan S; Byrne, Michael; Shugarman, Ilicia; Zou, Fei; Xiong, Sican; May, William S; Norkin, Maxim; Hiemenz, John; Brown, Randall; Cogle, Christopher; Wingard, John R; Hsu, Jack W

    2017-05-29

    Peripheral blood stem cell (PBSC) mobilization is routinely undertaken prior to autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM). A number of studies have identified risk factors for poor PBSC mobilization, however, little data exists to correlate mobilization with disease-specific outcomes in this patient population. Prospective work in MM has demonstrated similar outcomes in a homogenous patient population. In this single institution analysis, we retrospectively studied the impact of poor PBSC mobilization on progression free survival (PFS) and OS in MM patients undergoing PBSC mobilization. Poor mobilizers are defined as patients that collected  10 mcg/kg/day) and/or plerixafor can significantly improve mobilization and ASCT chances in this population. These data indicate that poor mobilization can be predictable and is associated with more aggressive disease biology and worse outcomes, warranting intensive post-ASCT management. © 2017 Wiley Periodicals, Inc.

  15. Influence of obstetric management on outcome of extremely preterm growth retarded infants

    NARCIS (Netherlands)

    Schaap, A.H.P.; Wolf, H.; Bruinse, H.W.; Ouden, A.L. den; Smolders-de Haas, H.; Ertbruggen, I. van; Treffers, P.E.

    1997-01-01

    Aim - To describe the long term outcome of extremely preterm growth retarded infants in relation to obstetric management and various perinatal events. Methods - A cohort study was undertaken in two tertiary care centres with different obstetric management. All infants with fetal growth retardation d

  16. 1H-NMR metabolomic biomarkers of poor outcome after hemorrhagic shock are absent in hibernators.

    Directory of Open Access Journals (Sweden)

    Lori K Bogren

    Full Text Available Hemorrhagic shock (HS following trauma is a leading cause of death among persons under the age of 40. During HS the body undergoes systemic warm ischemia followed by reperfusion during medical intervention. Ischemia/reperfusion (I/R results in a disruption of cellular metabolic processes that ultimately lead to tissue and organ dysfunction or failure. Resistance to I/R injury is a characteristic of hibernating mammals. The present study sought to identify circulating metabolites in the rat as biomarkers for metabolic alterations associated with poor outcome after HS. Arctic ground squirrels (AGS, a hibernating species that resists I/R injury independent of decreased body temperature (warm I/R, was used as a negative control.Male Sprague-Dawley rats and AGS were subject to HS by withdrawing blood to a mean arterial pressure (MAP of 35 mmHg and maintaining the low MAP for 20 min before reperfusing with Ringers. The animals' temperature was maintained at 37 ± 0.5 °C for the duration of the experiment. Plasma samples were taken immediately before hemorrhage and three hours after reperfusion. Hydrophilic and lipid metabolites from plasma were then analyzed via 1H-NMR from unprocessed plasma and lipid extracts, respectively. Rats, susceptible to I/R injury, had a qualitative shift in their hydrophilic metabolic fingerprint including differential activation of glucose and anaerobic metabolism and had alterations in several metabolites during I/R indicative of metabolic adjustments and organ damage. In contrast, I/R injury resistant AGS, regardless of season or body temperature, maintained a stable metabolic homeostasis revealed by a qualitative 1H-NMR metabolic profile with few changes in quantified metabolites during HS-induced global I/R.An increase in circulating metabolites indicative of anaerobic metabolism and activation of glycolytic pathways is associated with poor prognosis after HS in rats. These same biomarkers are absent in AGS after HS

  17. Severe disease presentation and poor outcomes among pediatric systemic lupus erythematosus patients in South Africa.

    Science.gov (United States)

    Lewandowski, L B; Schanberg, L E; Thielman, N; Phuti, A; Kalla, A A; Okpechi, I; Nourse, P; Gajjar, P; Faller, G; Ambaram, P; Reuter, H; Spittal, G; Scott, C

    2016-08-03

    poor renal outcomes compared to North American peers. Our study revealed a severe disease phenotype in the PULSE cohort resulting in poor outcomes in this high-risk population. © The Author(s) 2016.

  18. Deep SDSS optical spectroscopy of distant halo stars. III. Chemical analysis of extremely metal-poor stars

    Science.gov (United States)

    Fernández-Alvar, E.; Allende Prieto, C.; Beers, T. C.; Lee, Y. S.; Masseron, T.; Schneider, D. P.

    2016-09-01

    Aims: We present the results of an analysis of 107 extremely metal-poor (EMP) stars with metallicities lower than [Fe/H] =- 3.0, identified in medium-resolution spectra in the Sloan Digital Sky Survey (SDSS). Our analysis provides estimates of the stellar effective temperatures and surface gravities, as well as iron, calcium, and magnesium abundances. Methods: We followed the same method as in previous papers of this series. The method is based on comparisons of the observed spectra with synthetic spectra. The abundances of Fe, Ca, and Mg were determined by fitting spectral regions that are dominated by lines of each element. In addition, we present a technique to determine upper limits for elements whose features are not detected in a given spectrum. We also analyzed our sample with the SEGUE stellar parameter pipeline to obtain additional determinations of the atmospheric parameters and iron and alpha-element abundances, which we thend compare with ours. In addition, we used these parameters to infer [C/Fe] ratios. Results: Ca is typically the only element in these spectra with a moderate to low signal-to-noise ratio and medium resolution in this metallicity regime with lines that are sufficiently strong to reliably measure its abundance. Fe and Mg exhibit weaker features that in most cases only provide upper limits. We measured [Ca/Fe] and [Mg/Fe] for EMP stars in the SDSS spectra and conclude that most of the stars exhibit the typical enhancement level for α-elements, ~+0.4, although some stars for which only [Fe/H] upper limits could be estimated indicate higher [α/Fe] ratios. We also find that 26% of the stars in our sample can be classified as carbon-enhanced metal-poor (CEMP) stars and that the frequency of CEMP stars also increases with decreasing metallicity, as has been reported for previous samples. We identify a rare, bright (g = 11.90) EMP star, SDSS J134144.61+474128.6, with [Fe/H] =- 3.27, [C/Fe] = + 0.95, and elevated magnesium ([Mg/Fe] =+ 0

  19. A large Venous-Arterial PCO2 Is Associated with Poor Outcomes in Surgical Patients

    Science.gov (United States)

    Silva, João M.; Oliveira, Amanda M. Ribas R.; Segura, Juliano Lopes; Ribeiro, Marcel Henrique; Sposito, Carolina Nacevicius; Toledo, Diogo O.; Rezende, Ederlon; Malbouisson, Luiz M. Sá

    2011-01-01

    Background. This study evaluated whether large venous-arterial CO2 gap (PCO2 gap) preoperatively is associated to poor outcome. Method. Prospective study which included adult high-risk surgical patients. The patients were pooled into two groups: wide [P(v-a)CO2] versus narrow [P(v-a)CO2]. In order to determine the best value to discriminate hospital mortality, it was applied a ROC (receiver operating characteristic) curve for the [P(v-a)CO2] values collected preoperatively, and the most accurate value was chosen as cut-off to define the groups. Results. The study included 66 patients. The [P(v-a)CO2] value preoperatively that best discriminated hospital mortality was 5.0 mmHg, area = 0.73. Preoperative patients with [P(v-a)CO2] more than 5.0 mmHg presented a higher hospital mortality (36.4% versus 4.5% P = 0.004), higher prevalence of circulatory shock (56.8% versus 22.7% P = 0.01) and acute renal failure postoperatively (27.3% versus 4.5% P = 0.02), and longer hospital length of stays 20.0 (14.0–30.0) versus 13.5 (9.0–25.0) days P = 0.01. Conclusions. The PCO2 gap values more than 5.0 mmHg preoperatively were associated with worse postoperatively outcome. PMID:22007204

  20. Neonatal status: an objective scoring method for identifying infants at risk for poor outcome.

    Science.gov (United States)

    Salamy, A; Davis, S; Eldredge, L; Wakeley, A; Tooley, W H

    1988-01-01

    The likelihood of sustaining neurological, sensory or cognitive deficits is considerably greater for very low birthweight (VLBW) infants who require intensive care in early postnatal life than those without major neonatal illness. Identifying which, if any, medical events are responsible for an adverse outcome is most difficult in the face of multiple concurrent complications. In this research, a principal components analysis was performed in order to arrive at a set of orthogonal variables which succinctly described clinical involvement in the nursery. With this procedure, a single hypothetical factor depicting neonatal status (NS) was computed. Principal component scores were then generated for NS and assigned to 252 VLBW (less than 1500 g) infants. These subjects were followed prospectively from birth to 4 years of age. Standardized measures of neurological, sensory and intellectual function were regularly administered. Neonatal status was shown to be significantly correlated with the various test results and predictive of long-term development. When subjects were divided into quartiles with respect to NS, a specific subgroup was identified as "at high risk" for poor outcome. Those subjects falling into the lower quartile incurred more neurological abnormalities persisting beyond the first year. They also suffered a higher incidence of intracranial hemorrhage and sensori-neural hearing loss. In addition, the lower 25%, as a group, scored well below all others on traditional tests of mental ability. These differences were sustained throughout infancy and early childhood and could not be attributed to a number of demographic variables including sex, gestational age, birthweight, Apgar scores or parental educational level.

  1. Inflammatory and metalloproteinases profiles predict three-month poor outcomes in ischemic stroke treated with thrombolysis.

    Science.gov (United States)

    Gori, Anna Maria; Giusti, Betti; Piccardi, Benedetta; Nencini, Patrizia; Palumbo, Vanessa; Nesi, Mascia; Nucera, Antonia; Pracucci, Giovanni; Tonelli, Paolina; Innocenti, Eleonora; Sereni, Alice; Sticchi, Elena; Toni, Danilo; Bovi, Paolo; Guidotti, Mario; Tola, Maria Rosaria; Consoli, Domenico; Micieli, Giuseppe; Tassi, Rossana; Orlandi, Giovanni; Sessa, Maria; Perini, Francesco; Delodovici, Maria Luisa; Zedde, Maria Luisa; Massaro, Francesca; Abbate, Rosanna; Inzitari, Domenico

    2017-09-01

    Inflammatory mediators and metalloproteinases are altered in acute ischemic stroke (AIS) and play a detrimental effect on clinical severity and hemorrhagic transformation of the ischemic brain lesion. Using data from the Italian multicenter observational MAGIC (MArker bioloGici nell'Ictus Cerebrale) Study, we evaluated the effect of inflammatory and metalloproteinases profiles on three-month functional outcome, hemorrhagic transformation and mortality in 327 patients with AIS treated with intravenous thrombolys in according to SITS-MOST (Safe Implementation of Thrombolysis in Stroke-MOnitoring STudy) criteria. Circulating biomarkers were assessed at baseline and 24 h after thrombolysis. Adjusting for age, sex, baseline glycemia and National Institute of Health Stroke Scale, history of atrial fibrillation or congestive heart failure, and of inflammatory diseases or infections, baseline alpha-2macroglobulin (A2M), baseline serum amyloid protein (SAP) and pre-post tissue-plasminogen activator (tPA) variations (Δ) of metalloproteinase 9, remained significantly and independently associated with three-month death [OR (95% CI):A2M:2.99 (1.19-7.53); SAP:5.46 (1.64-18.74); Δmetalloproteinase 9:1.60 (1.12-2.27)]. The addition of baseline A2M and Δmetalloproteinase 9 or baseline SAP and Δmetalloproteinase 9 (model-2 or model-3) to clinical variables (model-1) significantly improved the area under curve for prediction of death [model-2 with A2M: p = 0.0205; model-3 with SAP: p = 0.001]. In conclusion, among AIS patients treated with thrombolysis, circulating A2M, SAP and Δmetalloproteinase 9 are independent markers of poor outcome. These results may prompt controlled clinical research about agents antagonizing their effect.

  2. Thrombocytosis is a marker of poor outcome in community-acquired pneumonia.

    Science.gov (United States)

    Prina, Elena; Ferrer, Miquel; Ranzani, Otavio T; Polverino, Eva; Cillóniz, Catia; Moreno, Encarnación; Mensa, Josep; Montull, Beatriz; Menéndez, Rosario; Cosentini, Roberto; Torres, Antoni

    2013-03-01

    Thrombocytosis, often considered a marker of normal inflammatory reaction of infections, has been recently associated with increased mortality in hospitalized patients with community-acquired pneumonia (CAP). We assessed the characteristics and outcomes of patients with CAP and thrombocytosis (platelet count ≥ 4 × 105/mm3) compared with thrombocytopenia (platelet count < 105/mm3) and normal platelet count. We prospectively analyzed 2,423 consecutive, hospitalized patients with CAP. We excluded patients with immunosuppression, neoplasm, active TB, or hematologic disease. Fifty-three patients (2%) presented with thrombocytopenia, 204 (8%) with thrombocytosis, and 2,166 (90%) had normal platelet counts. Patients with thrombocytosis were younger (P < .001); those with thrombocytopenia more frequently had chronic heart and liver disease (P < .001 for both). Patients with thrombocytosis presented more frequently with respiratory complications, such as complicated pleural effusion and empyema (P < .001), whereas those with thrombocytopenia presented more often with severe sepsis (P < .001), septic shock (P = .009), need for invasive mechanical ventilation (P < .001), and ICU admission (P = .011). Patients with thrombocytosis and patients with thrombocytopenia had longer hospital stays (P = .004), and higher 30-day mortality (P = .001) and readmission rates (P = .011) than those with normal platelet counts. Multivariate analysis confirmed a significant association between thrombocytosis and 30-day mortality (OR, 2.720; 95% CI, 1.589-4.657; P < .001). Adding thrombocytosis to the confusion, respiratory rate, and BP plus age ≥65 years score slightly improved the accuracy to predict mortality (area under the receiver operating characteristic curve increased from 0.634 to 0.654, P = .049). Thrombocytosis in patients with CAP is associated with poor outcome, complicated pleural effusion, and empyema. The presence of thrombocytosis in CAP should encourage ruling out

  3. The extremely metal-poor galaxy DDO 68: the luminous blue variable, Hα shells and the most luminous stars

    Science.gov (United States)

    Pustilnik, S. A.; Makarova, L. N.; Perepelitsyna, Y. A.; Moiseev, A. V.; Makarov, D. I.

    2017-03-01

    This paper presents new results from the ongoing study of the unusual Lynx-Cancer void galaxy DDO 68, which has star-forming regions of record low metallicity [12+log (O/H) ∼7.14]. The results include the following. (i) A new spectrum and photometry have been obtained with the 6-m SAO RAS telescope (BTA) for the luminous blue variable (LBV = DDO68-V1). Photometric data sets were complemented with others based on the Sloan Digital Sky Survey (SDSS) and the Hubble Space Telescope (HST) archive images. (ii) We performed an analysis of the DDO 68 supergiant shell (SGS) and the prominent smaller Hα arcs/shells visible in the HST image coupled with kinematic maps in Hα obtained with the Fabry-Perot interferometer (FPI) at the BTA. (iii) We compiled a list of about 50 of the most luminous stars (-9.1 mag science to be investigated with the next generation of giant telescopes. We have confirmed earlier hints of significant variation of the LBV optical light, deriving its amplitude as ΔV ≳ 3.7 mag for the first time. New data suggest that in 2008-2010 the LBV reached MV = -10.5 mag and probably underwent a giant eruption. We argue that the structure of star-forming complexes along the SGS ('Northern Ring') perimeter provides evidence for sequential induced star-formation episodes caused by the shell gas instabilities and gravitational collapse. The variability of some luminous extremely metal-poor stars in DDO 68 can currently be monitored with medium-size telescopes at sites with superb seeing.

  4. Synuclein gamma predicts poor clinical outcome in colon cancer with normal levels of carcinoembryonic antigen

    Directory of Open Access Journals (Sweden)

    Xing Xiaofang

    2010-07-01

    Full Text Available Abstract Background Synuclein gamma (SNCG, initially identified as a breast cancer specific gene, is aberrantly expressed in many different malignant tumors but rarely expressed in matched nonneoplastic adjacent tissues. In this study, we investigated the prognostic potential of SNCG in colon cancer particularly in the patients with normal carcinoembryonic antigen (CEA levels. Methods SNCG levels were assessed immunohistochemically in cancer tissues from 229 colon adenocarcinoma patients with a mean follow-up of 44 months. Correlations between SNCG levels and clinicopathologic features, preoperative serum CEA level, and clinical outcome were analyzed statistically using SPSS. Results SNCG levels in colon adenocarcinoma were closely associated with intravascular embolus and tumor recurrence but independent of preoperative serum CEA levels. SNCG expression was an independent prognostic factor of a shorter disease-free survival (DFS and overall survival (OS (P P = 0.001, P = 0.001, 0.002 for 97 patients with normal preoperative serum CEA level. Conclusions Our results suggest for the first time that SNCG is a new independent predicator for poor prognosis in patients with colon adenocarcinoma, including those with normal CEA levels. Combination of CEA with SNCG improves prognostic evaluation for patients with colon adenocarcinoma.

  5. Prognostic indicators of poor outcome in horses with laminitis at a tertiary care hospital

    Science.gov (United States)

    Orsini, James A.; Parsons, Corrina Snook; Capewell, Linda; Smith, Gary

    2010-01-01

    This retrospective study investigated the factors associated with a poor outcome (death by euthanasia or from other causes) in horses treated for laminitis at a tertiary care hospital. Cases (n = 247) were defined as patients with laminitis that were euthanized or that died of other causes during hospitalization. Controls (n = 344) were patients with laminitis that survived to be discharged from the hospital. In the final multivariate analysis, the factors significantly associated with an increased risk for death and their respective odds ratios (OR) were as follows: Thoroughbred (OR = 1.57); racehorse (OR = 1.76); treatment with flunixin meglumine (OR = 1.76); vascular pathology (OR = 2.12); distal displacement of the third phalanx (OR = 2.68); pneumonia (OR = 2.87); and lameness of Obel grade II (OR = 2.99), grade III (OR = 9.63), or grade IV (OR = 20.48). The use of glue-on shoes significantly reduced the risk for death (OR = 0.36). PMID:20808574

  6. Large kidneys predict poor renal outcome in subjects with diabetes and chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Vendrely Benoit

    2010-03-01

    Full Text Available Abstract Background Renal hypertrophy occurs early in diabetic nephropathy, its later value is unknown. Do large kidneys still predict poor outcome in patients with diabetes and Chronic Kidney Disease (CKD? Methods Seventy-five patients with diabetes and CKD according to a Glomerular Filtration Rate (GFR, by 51Cr-EDTA clearance below 60 mL/min/1.73 m2 or an Albumin Excretion Rate above 30 mg/24 H, had an ultrasound imaging of the kidneys and were cooperatively followed during five years by the Diabetology and Nephrology departments of the Centre Hospitalier Universitaire de Bordeaux. Results The patients were mainly men (44/75, aged 62 ± 13 yrs, with long-standing diabetes (duration:17 ± 9 yrs, 55/75 type 2, and CKD: initial GFR: 56.5 (8.5-209 mL/min/1.73 m2, AER: 196 (20-2358 mg/24 H. Their mean kidney lenght (108 ± 13 mm, 67-147 was correlated to the GFR (r = 0.23, p Conclusions Large kidneys still predict progression in advanced CKD complicating diabetes. In these patients, ultrasound imaging not only excludes obstructive renal disease, but also provides information on the progression of the renal disease.

  7. High clusterin expression correlates with a poor outcome in stage II colorectal cancers.

    LENUS (Irish Health Repository)

    Kevans, David

    2012-02-01

    The role of clusterin in tumor growth and progression remains unclear. Overexpression of cytoplasmic clusterin has been studied in aggressive colon tumors; however, no correlation between clusterin expression and survival in colorectal cancer has been identified to date. We assessed levels of clusterin expression in a group of stage II colorectal cancer patients to assess its utility as a prognostic marker. The study included 251 patients with stage II colorectal cancer. Tissue microarrays were constructed and immunohistochemistry done and correlated with clinical features and long term outcome. Dual immunofluorescence and confocal microscopy were used with terminal deoxynucleotidyl-transferase-mediated dUTP nick-end labeling probes and clusterin antibody to assess the degree of co localization. Percentage epithelial cytoplasmic staining was higher in tumor compared with nonadjacent normal mucosa (P < 0.001). Within the stromal compartment, percentage cytoplamic staining and intensity was lower in tumor tissue compared with normal nonadjacent mucosa (P < or = 0.001). Survival was significantly associated with percentage epithelial cytoplasmic staining (P < 0.001), epithelial cytoplasmic staining intensity (P < 0.001), percentage stromal cytoplasmic staining (P = 0.002), and stromal cytoplasmic staining intensity (P < 0.001). Clusterin levels are associated with poor survival in stage II colorectal cancer.

  8. Inflammatory markers and poor outcome after stroke: a prospective cohort study and systematic review of interleukin-6.

    Directory of Open Access Journals (Sweden)

    William Whiteley

    2009-09-01

    Full Text Available BACKGROUND: The objective of this study was to determine whether: (a markers of acute inflammation (white cell count, glucose, interleukin-6, C-reactive protein, and fibrinogen are associated with poor outcome after stroke and (b the addition of markers to previously validated prognostic models improves prediction of poor outcome. METHODS AND FINDINGS: We prospectively recruited patients between 2002 and 2005. Clinicians assessed patients and drew blood for inflammatory markers. Patients were followed up by postal questionnaire for poor outcome (a score of>2 on the modified Rankin Scale and death through the General Register Office (Scotland at 6 mo. We performed a systematic review of the literature and meta-analysis of the association between interleukin-6 and poor outcome after stroke to place our study in the context of previous research. We recruited 844 patients; mortality data were available in 844 (100% and functional outcome in 750 (89%. After appropriate adjustment, the odds ratios for the association of markers and poor outcome (comparing the upper and the lower third were interleukin-6, 3.1 (95% CI: 1.9-5.0; C-reactive protein, 1.9 (95% CI: 1.2-3.1; fibrinogen, 1.5 (95% CI: 1.0-2.36; white cell count, 2.1 (95% CI: 1.3-3.4; and glucose 1.3 (95% CI: 0.8-2.1. The results for interleukin-6 were similar to other studies. However, the addition of inflammatory marker levels to validated prognostic models did not materially improve model discrimination, calibration, or reclassification for prediction of poor outcome after stroke. CONCLUSIONS: Raised levels of markers of the acute inflammatory response after stroke are associated with poor outcomes. However, the addition of these markers to a previously validated stroke prognostic model did not improve the prediction of poor outcome. Whether inflammatory markers are useful in prediction of recurrent stroke or other vascular events is a separate question, which requires further study. Please

  9. Foramen magnum meningiomas: surgical results and risks predicting poor outcomes based on a modified classification.

    Science.gov (United States)

    Li, Da; Wu, Zhen; Ren, Cong; Hao, Shu-Yu; Wang, Liang; Xiao, Xin-Ru; Tang, Jie; Wang, Yong-Gang; Meng, Guo-Lu; Zhang, Li-Wei; Zhang, Jun-Ting

    2017-03-01

    tumor P/R. Multivariate logistic regression analysis identified nontotal resection (OR 4.06, 95% CI 1.16-14.2, p = 0.029) and pathological mitosis (OR 6.29, 95% CI 1.47-27.0, p = 0.013) as independent risks for poor outcome (KPS score < 80). CONCLUSIONS The modified classification helped to predict surgical outcome and P/R in addition to the position of the lower cranial nerves. Preoperative imaging studies and neurological function should be reviewed carefully to establish an individualized management strategy to improve long-term outcome.

  10. Relation between change in blood pressure in acute stroke and risk of early adverse events and poor outcome

    DEFF Research Database (Denmark)

    Sandset, Else C; Murray, Gordon D; Bath, Philip M W;

    2012-01-01

    The Scandinavian Candesartan Acute Stroke Trial (SCAST) found no benefits of candesartan in acute stroke. In the present analysis we aim to investigate the effect of change in blood pressure during the first 2 days of stroke on the risk of early adverse events and poor outcome.......The Scandinavian Candesartan Acute Stroke Trial (SCAST) found no benefits of candesartan in acute stroke. In the present analysis we aim to investigate the effect of change in blood pressure during the first 2 days of stroke on the risk of early adverse events and poor outcome....

  11. Biomarkers of Endothelial Activation Are Associated with Poor Outcome in Critical Illness.

    Directory of Open Access Journals (Sweden)

    Carmen Mikacenic

    Full Text Available Endothelial activation plays a role in organ dysfunction in the systemic inflammatory response syndrome (SIRS. Angiopoietin-1 (Ang-1 promotes vascular quiescence while angiopoietin-2 (Ang-2 mediates microvascular leak. Circulating levels of Ang-1 and Ang-2 in patients with SIRS could provide insight on risks for organ dysfunction and death distinct from inflammatory proteins. In this study, we determined if biomarkers of endothelial activation and inflammation exhibit independent associations with poor outcomes in SIRS.We studied 943 critically ill patients with SIRS admitted to an Intensive Care Unit (ICU of an academic medical center. We measured plasma levels of endothelial markers (Ang-1, Ang-2, soluble vascular cell adhesion molecule-1 (sVCAM-1 and inflammatory markers (interleukin-6 (IL-6, interleukin-8 (IL-8, granulocyte-colony stimulating factor (G-CSF, soluble tumor necrosis factor receptor-1 (sTNFR-1 within 24 hours of enrollment. We tested for associations between each marker and 28 day mortality, shock, and day 3 sequential organ failure assessment (SOFA score. For 28 day mortality, we performed sensitivity analysis for those subjects with sepsis and those with sterile inflammation. We used multivariate models to adjust for clinical covariates and determine if associations identified with endothelial activation markers were independent of those observed with inflammatory markers.Higher levels of all biomarkers were associated with increased 28 day mortality except levels of Ang-1 which were associated with lower mortality. After adjustment for comorbidities and sTNFR-1 concentration, a doubling of Ang-1 concentration was associated with lower 28 day mortality (Odds ratio (OR = 0.81; p<0.01, shock (OR = 0.82; p<0.001, and SOFA score (β = -0.50; p<0.001, while Ang-2 concentration was associated with increased mortality (OR = 1.55; p<0.001, shock (OR = 1.51; p<0.001, and SOFA score (β = +0.63; p<0.001. sVCAM-1 was not independently

  12. Minimal Clinically Important Difference of Patient Reported Outcome Measures of Lower Extremity Injuries in Orthopedics

    Science.gov (United States)

    Çelik, Derya; Çoban, Özge; Kılıçoğlu, Önder

    2017-01-01

    Purpose: MCID scores for outcome measures are frequently used evidence-based guides to gage meaningful changes. To conduct a systematic review of the quality and content of the the minimal clinically important difference (MCID) relating to 16 patient-rated outcome measures (PROM) used in lower extremity. Methods: We conducted a systematic literature review on articles reporting MCID in lower extremity outcome measures and orthopedics from January 1, 1980, to May 10, 2016. We evaluated MCID of the 16 patient reported outcome measures (PROM) which were Harris Hip Score (HHS), Oxford Hip Score (OHS), Hip Outcome Score (HOS), Hip Disability and Osteoarthritis Outcome Score (HOOS), The International Knee Documentation Committee Subjective Knee Form (IKDC), The Lysholm Scale, The Western Ontario Meniscal Evaluation Tool (WOMET), The Anterior Cruciate Ligament Quality of Life Questionnaire (ACL-QOL), The Lower Extremity Functional Scale (LEFS), The Western Ontario and Mcmaster Universities Index (WOMAC), Knee İnjury And Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), Kujala Anterior Knee Pain Scale, The Victorian Institute of Sports Assessment Patellar Tendinosis (Jumper’s Knee) (VİSA-P), Tegner Activity Rating Scale, Marx Activity Rating Scale, Foot And Ankle Outcome Score (FAOS), The Foot Function Index (FFI), Foot And Ankle Ability Measure (FAAM), The Foot And Ankle Disability Index Score and Sports Module, Achill Tendon Total Rupture Score(ATRS), The Victorian İnstitute Of Sports Assesment Achilles Questionnaire(VİSA-A), American Orthopaedic Foot and Ankle Society (AOFAS). A search of the PubMed/MEDLINE, PEDro and Cochrane Cen¬tral Register of Controlled Trials and Web of Science databases from the date of inception to May 1, 2016 was conducted. The terms “minimal clinically important difference,” “minimal clinically important change”, “minimal clinically important improvement” “were combined with one of the PROM as mentioned above

  13. Persistent systemic inflammation is associated with poor clinical outcomes in COPD: a novel phenotype.

    Directory of Open Access Journals (Sweden)

    Alvar Agustí

    Full Text Available BACKGROUND: Because chronic obstructive pulmonary disease (COPD is a heterogeneous condition, the identification of specific clinical phenotypes is key to developing more effective therapies. To explore if the persistence of systemic inflammation is associated with poor clinical outcomes in COPD we assessed patients recruited to the well-characterized ECLIPSE cohort (NCT00292552. METHODS AND FINDINGS: Six inflammatory biomarkers in peripheral blood (white blood cells (WBC count and CRP, IL-6, IL-8, fibrinogen and TNF-α levels were quantified in 1,755 COPD patients, 297 smokers with normal spirometry and 202 non-smoker controls that were followed-up for three years. We found that, at baseline, 30% of COPD patients did not show evidence of systemic inflammation whereas 16% had persistent systemic inflammation. Even though pulmonary abnormalities were similar in these two groups, persistently inflamed patients during follow-up had significantly increased all-cause mortality (13% vs. 2%, p<0.001 and exacerbation frequency (1.5 (1.5 vs. 0.9 (1.1 per year, p<0.001 compared to non-inflamed ones. As a descriptive study our results show associations but do not prove causality. Besides this, the inflammatory response is complex and we studied only a limited panel of biomarkers, albeit they are those investigated by the majority of previous studies and are often and easily measured in clinical practice. CONCLUSIONS: Overall, these results identify a novel systemic inflammatory COPD phenotype that may be the target of specific research and treatment.

  14. Plasma Proenkephalin and Poor Long-Term Outcome in Renal Transplant Recipients.

    Science.gov (United States)

    Kieneker, Lyanne M; Hartmann, Oliver; Struck, Joachim; Bergmann, Andreas; Gansevoort, Ron T; Joosten, Michel M; van den Berg, Else; de Boer, Rudolf A; Bakker, Stephan J L

    2017-08-01

    Proenkephalin (pro-ENK), a stable and reliable surrogate marker for unstable enkephalins, was found to be associated with acute kidney injury and chronic renal failure in previous studies. We aimed to investigate whether pro-ENK is linked to chronic kidney injury and poor long-term outcome in renal transplant recipients (RTR). We included 664 stable RTR and 95 healthy kidney donors. Pro-ENK was measured in plasma with a double monoclonal sandwich immunoassay. Graft failure was defined as return to dialysis therapy or retransplantation. Median pro-ENK was 110 pmol/L (interquartile range [IQR], 85-148 pmol/L) in RTR and 48 pmol/L (IQR, 42-55 pmol/L) in kidney donors. Pro-ENK was correlated with estimated glomerular filtration rate (GFR) (rs = -0.80, P risk (hazard ratio [HR] per standard deviation increment of the logarithm of pro-ENK; 95% confidence interval [CI]) of graft failure (HR, 4.80; 95% CI, 3.55-6.48) and mortality (HR, 1.50; 95% CI, 1.22-1.85). After adjustment of age, sex, and estimated GFR, the association of pro-ENK with graft failure remained significant (HR, 2.36; 95% CI, 1.37-4.06), whereas no significant association of pro-ENK with risk of all-cause mortality was observed (HR, 1.34; 95% CI, 0.90-2.09). Plasma pro-ENK is associated with kidney function as reflected by correlations with measured GFR in both RTR and kidney donors. In addition, pro-ENK was independently associated with increased risk of graft failure in RTR. Pro-ENK may aid in identification of RTR at risk for late graft failure.

  15. Vineland Adaptive Behavior Scales as a summary of functional outcome of extremely low-birthweight children.

    Science.gov (United States)

    Rosenbaum, P; Saigal, S; Szatmari, P; Hoult, L

    1995-07-01

    This study reports moderate to high Pearson correlations between Vineland Adaptive Behavior Scale (VABS) subscale and total scores and a variety of cognitive, academic and motor performance tests on a population of extremely low-birthweight infants assessed at eight years of age. The subscales describe adaptive behaviour in daily living, communication, motor function and socialization, as well as an adaptive behaviour composite score. Because it can provide a norm-referenced description of functional outcomes and can be used to assess all children regardless of disability, the authors believe that the VABS should be applied uniformly by all groups reporting school-age outcome of neonatal intensive-care populations.

  16. Delivery outcomes for nulliparous women at the extremes of maternal age - a cohort study.

    LENUS (Irish Health Repository)

    Vaughan, DA

    2013-06-12

    OBJECTIVE: To examine the associations between extremes of maternal age (≤17 years or ≥40 years) and delivery outcomes. DESIGN: Retrospective cohort study. SETTING: Urban maternity hospital in Ireland. POPULATION: A total of 36 916 nulliparous women with singleton pregnancies who delivered between 2000 and 2011. METHODS: The study population was subdivided into five maternal age groups based on age at first booking visit: ≤17 years, 18-19 years, 20-34 years, 35-39 years and women aged ≥40 years. Logistic regression analyses were performed to examine the associations between extremes of maternal age and delivery outcomes, adjusting for potential confounding factors. MAIN OUTCOME MEASURES: Preterm birth, admission to the neonatal unit, congenital anomaly, caesarean section. RESULTS: Compared with maternal age 20-34 years, age ≤17 years was a risk factor for preterm birth (adjusted odds ratio [adjOR] 1.83, 95% confidence interval [95% CI] 1.33-2.52). Babies born to mothers ≥40 years were more likely to require admission to the neonatal unit (adjOR 1.35, 95% CI 1.06-1.72) and to have a congenital anomaly (adjOR 1.71, 95% CI 1.07-2.76). The overall caesarean section rate in nulliparous women was 23.9% with marked differences at the extremes of maternal age; 10.7% at age ≤17 years (adjOR 0.46, 95% CI 0.34-0.62) and 54.4% at age ≥40 years (adjOR 3.24, 95% CI 2.67-3.94). CONCLUSIONS: Extremes of maternal age need to be recognised as risk factors for adverse delivery outcomes. Low caesarean section rates in younger women suggest that a reduction in overall caesarean section rates may be possible.

  17. The effects of frame, appeal, and outcome extremity of antismoking messages on cognitive processing.

    Science.gov (United States)

    Leshner, Glenn; Cheng, I-Huei

    2009-04-01

    Research on the impact of antismoking advertisements in countermarketing cigarette advertising is equivocal. Although many studies examined how different message appeal types influence people's attitudes and behavior, there have been few studies that have explored the mechanism of how individuals attend to and remember antismoking information. This study examined how message attributes of antismoking TV ads (frame, appeal type, and outcome extremity) interacted to influence people's attention (secondary task reaction time) and memory (recognition). Antismoking public service announcements were chosen that were either loss- or gain-framed, had either a health or social appeal, or had either a more or less extreme outcome described in the message. Among the key findings were that loss-framed messages with more extreme outcomes required the most processing resources (i.e., had the slowest secondary task reaction times) and were the best remembered (i.e., were best recognized). These findings indicate ways that different message attributes affect individuals' cognitive processing, and they are discussed in light of prior framing and persuasion research.

  18. Risk for poor outcomes in older patients discharged from an emergency department: feasibility of four screening instruments.

    NARCIS (Netherlands)

    Buurman, B.M.; Berg, W. van den; Korevaar, J.C.; Milisen, K.; Haan, R.J. de; Rooij, S.E. de

    2011-01-01

    Objectives: To compare the prognostic value of four screening instruments used to detect the risk for poor outcomes [in terms of likelihood of recurrent emergency department (ED) visits, hospitalizations, or mortality] for older patients discharged home from an ED in the Netherlands. Methods: This i

  19. Risk for poor outcomes in older patients discharged from an emergency department: feasibility of four screening instruments

    NARCIS (Netherlands)

    B.M. Buurman; W. van den Berg; J.C. Korevaar; K. Milisen; R.J. de Haan; S.E. de Rooij

    2011-01-01

    To compare the prognostic value of four screening instruments used to detect the risk for poor outcomes [in terms of likelihood of recurrent emergency department (ED) visits, hospitalizations, or mortality] for older patients discharged home from an ED in the Netherlands. This is a prospective cohor

  20. Parent-teacher disagreement regarding behavioral and emotional problems in referred children is not a risk factor for poor outcome

    NARCIS (Netherlands)

    Ferdinand, Robert F.; van der Ende, Jan; Verhulst, Frank C.

    2007-01-01

    Objective To investigate whether parent-teacher disagreement regarding the presence of psychopathology predicts poor outcome in children who have been referred to mental health services Methods A total of 532 6- to 12-year-old children who had been referred to an outpatient department for child and

  1. TERT promoter mutations are a major indicator of poor outcome in differentiated thyroid carcinomas.

    Science.gov (United States)

    Melo, Miguel; da Rocha, Adriana Gaspar; Vinagre, João; Batista, Rui; Peixoto, Joana; Tavares, Catarina; Celestino, Ricardo; Almeida, Ana; Salgado, Catarina; Eloy, Catarina; Castro, Patrícia; Prazeres, Hugo; Lima, Jorge; Amaro, Teresina; Lobo, Cláudia; Martins, Maria João; Moura, Margarida; Cavaco, Branca; Leite, Valeriano; Cameselle-Teijeiro, José Manuel; Carrilho, Francisco; Carvalheiro, Manuela; Máximo, Valdemar; Sobrinho-Simões, Manuel; Soares, Paula

    2014-05-01

    Telomerase promoter mutations (TERT) were recently described in follicular cell-derived thyroid carcinomas (FCDTC) and seem to be more prevalent in aggressive cancers. We aimed to evaluate the frequency of TERT promoter mutations in thyroid lesions and to investigate the prognostic significance of such mutations in a large cohort of patients with differentiated thyroid carcinomas (DTCs). This was a retrospective observational study. We studied 647 tumors and tumor-like lesions. A total of 469 patients with FCDTC treated and followed in five university hospitals were included. Mean follow-up (±SD) was 7.8 ± 5.8 years. Predictive value of TERT promoter mutations for distant metastasization, disease persistence at the end of follow-up, and disease-specific mortality. TERT promoter mutations were found in 7.5% of papillary carcinomas (PTCs), 17.1% of follicular carcinomas, 29.0% of poorly differentiated carcinomas, and 33.3% of anaplastic thyroid carcinomas. Patients with TERT-mutated tumors were older (P < .001) and had larger tumors (P = .002). In DTCs, TERT promoter mutations were significantly associated with distant metastases (P < .001) and higher stage (P < .001). Patients with DTC harboring TERT promoter mutations were submitted to more radioiodine treatments (P = .009) with higher cumulative dose (P = .004) and to more treatment modalities (P = .001). At the end of follow-up, patients with TERT-mutated DTCs were more prone to have persistent disease (P = .001). TERT promoter mutations were significantly associated with disease-specific mortality [in the whole FCDTC (P < .001)] in DTCs (P < .001), PTCs (P = .001), and follicular carcinomas (P < .001). After adjusting for age at diagnosis and gender, the hazard ratio was 10.35 (95% confidence interval 2.01-53.24; P = .005) in DTC and 23.81 (95% confidence interval 1.36-415.76; P = .03) in PTCs. TERT promoter mutations are an indicator of clinically aggressive tumors, being correlated with worse outcome and

  2. Plasma HSPA12B is a potential predictor for poor outcome in severe sepsis.

    Directory of Open Access Journals (Sweden)

    Ran Zhang

    Full Text Available INTRODUCTION: Endothelium-derived molecules may be predictive to organ injury. Heat shock protein (HSP A12B is mainly located in endothelial cells, which can be detected in the plasma of septic patients. Whether it is correlated with prognosis of sepsis remains unclear. METHODS: Extracellular HSPA12B (eHSPA12B was determined in plasma of septic mice at 6 h, 12 h, 24 h and 48 h after cecal ligation and puncture (CLP. It was also detected in plasma of patients with severe sepsis, sepsis, systemic inflammatory response syndrome and healthy volunteers. The predictive value for prognosis of severe sepsis was assessed by receiver operating curve (ROC and Cox regression analyses. RESULTS: eHSPA12B was elevated in plasma of CLP mice at 6 h and peaked at 24 h after surgery. A total of 118 subjects were included in the clinical section, including 66 patients with severe sepsis, 21 patients with sepsis, 16 patients with SIRS and 15 volunteers. Plasma eHSPA12B was significantly higher in patients with severe sepsis than in patients with sepsis, SIRS and volunteers. The level of eHSPA12B was also higher in non-survivals than survivals with severe sepsis. The area under the curve (AUC of eHSPA12B in predicting death among patients with severe sepsis was 0.782 (0.654-0.909 in ROC analysis, much higher than that of IL-6 and IL-10. Cox regression analysis showed that cardiovascular diseases, IL-6 and eHSPA12B were risk factors for mortality in patients with severe sepsis. Survival curve demonstrated a strikingly significant difference between 28-day survival rates of patients with an eHSPA12B lower or not lower than 1.466 ng/ml. CONCLUSIONS: Plasma eHSPA12B is elevated in both septic mice and patients. It may be a good predictor for poor outcome in patients with severe sepsis.

  3. Severe pathological manifestation of cerebral amyloid angiopathy correlates with poor outcome from cerebral amyloid angiopathy related intracranial hemorrhage

    Institute of Scientific and Technical Information of China (English)

    TANG Ya-juan; WANG Shuo; ZHU Ming-wei; SUN Yi-lin; ZHAO Ji-zong

    2013-01-01

    Background Cerebral amyloid angiopathy (CAA) is one of the main causes of spontaneous intracranial hemorrhage (ICH).No established link is available between pathological scores of CAA and its outcome.This study aimed to identify the correlations between pathological severity and poor postoperative outcome in the Chinese population.Methods Between May 2006 and April 2011,367 consecutive patients who underwent surgery for CAA-related ICH in 71 hospitals throughout the mainland of China were enrolled in this study.Twelve months after surgery,we evaluated these patients' outcomes according to the modified Rankin Scale (mRS) and statistically correlated risk factors (demographics,medical history,pathological results,and surgical details) that are associated with a favorable (mRS <3)and poor (mRS >3) outcome groups.Results Risk factors for poor postoperative outcome in 367 patients with CAA-related ICH included advanced age (OR 1.034,95% Cl 1.001-1.067,P=-0.042),CAA pathology severity (OR 2.074,95% CI 7.140-16.25,P <0.001),lobar hematoma (OR 0.225,95% Cl 0.104-0.486,P <0.001),presence of intraventricular hemorrhage (OR 0.478,95% CI 0.229-1.001,P=-0.050),and/or subarachnoid hemorrhage (OR 2.629,95% CI,1.051-6.577,P=-0.039).Conclusions Poor postoperative outcome of patients with CAA-related ICH was more related to the severe pathological manifestation instead of other factors.Prior ischemia may present an early stage of CAA.

  4. Emergency medicine task shifting: Quick dash outcome scores of upper extremity injury management

    Directory of Open Access Journals (Sweden)

    D.S. Frank*

    2013-12-01

    Results and conclusions: There were a total of 25 initial candidates, of which only 17 were able to complete the survey. Using the Quick DASH Outcome Measure, our 17 patients had a mean score of 29.5 (range 5.0– 56.8. When compared to the standardized Quick DASH outcomes (no work limitation at 27.5 vs. work limited by injury at 52.6 the non-physician clinicians appear to be performing upper extremity repairs with good outcomes. The key variable to successful repair was the initial injury type. Although accommodations needed to be made to the standard Quick DASH protocol, the tool appears to be usable in non-traditional settings.

  5. The reproductive life plan as a strategy to decrease poor birth outcomes.

    Science.gov (United States)

    Malnory, Margaret E; Johnson, Teresa S

    2011-01-01

    The purpose of this article is to discuss the importance of implementing a life course perspective model that includes a reproductive life plan to improve health outcomes, especially in populations at risk for adverse outcomes. A reproductive life plan is a comprehensive strategy that can be incorporated into nursing practice at all levels to improve birth outcomes. Health care providers, especially nurses, should incorporate reproductive life planning into their daily encounters with patients.

  6. Neurodevelopmental Outcomes Among Extremely Preterm Infants 6.5 Years After Active Perinatal Care in Sweden.

    Science.gov (United States)

    Serenius, Fredrik; Ewald, Uwe; Farooqi, Aijaz; Fellman, Vineta; Hafström, Maria; Hellgren, Kerstin; Maršál, Karel; Ohlin, Andreas; Olhager, Elisabeth; Stjernqvist, Karin; Strömberg, Bo; Ådén, Ulrika; Källén, Karin

    2016-10-01

    Active perinatal care increases the rate of survival of extremely preterm infants, but there are concerns that improved survival might increase the rate of disabled survivors. To determine the neurodevelopmental outcomes of a national cohort of children 6.5 years of age who had been born extremely preterm (WISC-IV), and the mean (SD) scores of the children who had been born extremely preterm were compared with those of the controls. Clinical examinations and parental questionnaires were used for diagnosis of cerebral palsy, hearing and vision impairments, and cognition for the children who were not assessed with the WISC-IV. Of 486 eligible infants who were born extremely preterm, 441 (90.7%) were assessed at 6.5 years of age (59 by medical record review only) alongside 371 controls. The adjusted mean (SD) full-scale WISC-IV score was 14.2 (95% CI, 12.1-16.3) points lower for children who had been born extremely preterm than for controls. Cognitive disability was moderate for 18.8% of extremely preterm children and 2.2% of controls (P < .001), and it was severe for 11.1% of extremely preterm children and 0.3% of controls (P < .001). Cerebral palsy was observed in 9.5% of extremely preterm children and 0.0% of controls (P < .001), blindness was observed in 2.0% of extremely preterm children and 0.0% of controls (P < .001), and hearing impairment was observed in 2.1% of extremely preterm children and 0.5% of controls (P = .07). Overall, 36.1% (95% CI, 31.7%-40.6%) of extremely preterm children had no disability, 30.4% (95% CI 26.3%-34.8%) had mild disability, 20.2% (95% CI, 16.6%-24.2%) had moderate disability, and 13.4% (95% CI, 10.5%-16.9%) had severe disability. For extremely preterm children, moderate or severe overall disability decreased with gestational age at birth (adjusted odds ratio per week, 0.65 [95% CI, 0.54-0.79]; P < .001) and increased from 26.6% to 33.5% (P = .01) for children assessed both at 2.5 and 6.5 years. Of the

  7. Predictors of poor neurologic outcome in patients after cardiac arrest treated with hypothermia: a retrospective study

    NARCIS (Netherlands)

    Bisschops, L.L.A.; Alfen, N. van; Bons, S.; Hoeven, J.G. van der; Hoedemaekers, C.W.E.

    2011-01-01

    INTRODUCTION: Outcome studies in patients with anoxic-ischemic encephalopathy focus on the early and reliable prediction of an outcome no better than a vegetative state or severe disability. We determined the effect of mild therapeutic hypothermia on the validity of the currently used clinical pract

  8. Can routine clinical data identify older patients at risk of poor healthcare outcomes on admission to hospital?

    Science.gov (United States)

    Ibrahim, Kinda; Owen, Charlotte; Patel, Harnish P; May, Carl; Baxter, Mark; Sayer, Avan A; Roberts, Helen C

    2017-08-10

    Older patients who are at risk of poor healthcare outcomes should be recognised early during hospital admission to allow appropriate interventions. It is unclear whether routinely collected data can identify high-risk patients. The aim of this study was to define current practice with regard to the identification of older patients at high risk of poor healthcare outcomes on admission to hospital. Interviews/focus groups were conducted to establish the views of 22 healthcare staff across five acute medicine for older people wards in one hospital including seven nurses, four dieticians, seven doctors, and four therapists. In addition, a random sample of 60 patients' clinical records were reviewed to characterise the older patients, identify risk assessments performed routinely on admission, and describe usual care. We found that staff relied on their clinical judgment to identify high risk patients which was influenced by a number of factors such as reasons for admission, staff familiarity with patients, patients' general condition, visible frailty, and patients' ability to manage at home. "Therapy assessment" and patients' engagement with therapy were also reported to be important in recognising high-risk patients. However, staff recognised that making clinical judgments was often difficult and that it might occur several days after admission potentially delaying specific interventions. Routine risk assessments carried out on admission to identify single healthcare needs included risk of malnutrition (completed for 85% patients), falls risk (95%), moving and handling assessments (85%), and pressure ulcer risk assessments (88%). These were not used collectively to highlight patients at risk of poor healthcare outcomes. Thus, patients at risk of poor healthcare outcomes were not explicitly identified on admission using routinely collected data. There is a need for an early identification of these patients using a valid measure alongside staff clinical judgment to

  9. Predictors of poor perinatal outcome following maternal perception of reduced fetal movements--a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Philip J Dutton

    Full Text Available BACKGROUND: Maternal perception of reduced fetal movement (RFM is associated with increased risk of stillbirth and fetal growth restriction (FGR. RFM is thought to represent fetal compensation to conserve energy due to insufficient oxygen and nutrient transfer resulting from placental insufficiency. OBJECTIVE: To identify predictors of poor perinatal outcome after maternal perception of reduced fetal movements (RFM. DESIGN: Prospective cohort study. METHODS: 305 women presenting with RFM after 28 weeks of gestation were recruited. Demographic factors and clinical history were recorded and ultrasound performed to assess fetal biometry, liquor volume and umbilical artery Doppler. A maternal serum sample was obtained for measurement of placentally-derived or modified proteins including: alpha fetoprotein (AFP, human chorionic gonadotrophin (hCG, human placental lactogen (hPL, ischaemia-modified albumin (IMA, pregnancy associated plasma protein A (PAPP-A and progesterone. Factors related to poor perinatal outcome were determined by logistic regression. RESULTS: 22.1% of pregnancies ended in a poor perinatal outcome after RFM. The most common complication was small-for-gestational age infants. Pregnancy outcome after maternal perception of RFM was related to amount of fetal activity while being monitored, abnormal fetal heart rate trace, diastolic blood pressure, estimated fetal weight, liquor volume, serum hCG and hPL. Following multiple logistic regression abnormal fetal heart rate trace (Odds ratio 7.08, 95% Confidence Interval 1.31-38.18, (OR diastolic blood pressure (OR 1.04 (95% CI 1.01-1.09, estimated fetal weight centile (OR 0.95, 95% CI 0.94-0.97 and log maternal serum hPL (OR 0.13, 95% CI 0.02-0.99 were independently related to pregnancy outcome. hPL was related to placental mass. CONCLUSION: Poor perinatal outcome after maternal perception of RFM is closely related to factors which are connected to placental dysfunction. Novel tests of

  10. Ageing, deep vein thrombosis and male gender predict poor outcome after acute Achilles tendon rupture.

    Science.gov (United States)

    Arverud, E Domeij-; Anundsson, P; Hardell, E; Barreng, G; Edman, G; Latifi, A; Labruto, F; Ackermann, P W

    2016-12-01

    Patients with an acute Achilles tendon rupture (ATR) take a long time to heal, have a high incidence of deep vein thrombosis (DVT) and widely variable functional outcomes. This variation in outcome may be explained by a lack of knowledge of adverse factors, and a subsequent shortage of appropriate interventions. A total of 111 patients (95 men, 16 women; mean age 40.3, standard deviation 8.4) with an acute total ATR were prospectively assessed. At one year post-operatively a uniform outcome score, Achilles Combined Outcome Score (ACOS), was obtained by combining three validated, independent, outcome measures: Achilles tendon Total Rupture Score, heel-rise height test, and limb symmetry heel-rise height. Predictors of ACOS included treatment; gender; age; smoking; body mass index; time to surgery; physical activity level pre- and post-injury; symptoms; quality of life and incidence of DVT. There were three independent variables that correlated significantly with the dichotomised outcome score (ACOS), while there was no correlation with other factors. An age of less than 40 years old was the strongest independent predictor of a good outcome one year after ATR (odds ratio (OR) 0.20, 95% confidence interval (CI) 0.08 to 0.51), followed by female gender (OR) 4.18, 95% CI 1.01 to 17.24). Notably, patients who did not have a DVT while immobilised post-operatively had a better outcome (OR 0.31, 95% CI 0.12 to 0.80). Over the age of 40 years, male gender and having a DVT while immobilised are independent negative predictors of outcome in patients with an acute ATR. Cite this article: Bone Joint J 2016;98-B:1635-41. ©2016 The British Editorial Society of Bone & Joint Surgery.

  11. Predicting poor outcome in patients with intentional carbon monoxide poisoning and acute respiratory failure: A retrospective study

    Directory of Open Access Journals (Sweden)

    Chih-Hao Shen

    2015-01-01

    Full Text Available Purpose: Intentional carbon monoxide (CO poisoning has become the commonly used method of suicide in some Asian countries. The objective of this study was to identify the predictors that impact the outcome of intentional CO-poisoned patients with acute respiratory failure. Materials and Methods: This is a retrospective observational study of 796 consecutive patients diagnosed with acute CO poisoning that presented to the emergency department (ED. Patients who were CO poisoned with intentional exposure and acute respiratory failure were enrolled and divided into two groups. The poor outcome group consisted of in-hospital death, the presence of persistent neurological sequelae, and the presence of delayed neurologic sequelae. The good outcome group consisted of other enrolled patients. Demographic and clinical data of the two groups were extracted for analysis. Results: A total of 148 patients were enrolled in this study. Of the eligible subjects, 67.6% (100 were identified with positive toxicology screening results. On arriving ED, parameters associated with patients with a poor outcome included hypotension, myocardial injury, prolonged lag times from the first ED arrival to initiation of hyperbaric oxygen therapy, higher white blood cell count, and higher serum levels of blood urea nitrogen, creatine kinase, and troponin-I (P < 0.05. Positive toxicology screening result did not relate to the outcome. Multivariate analysis showed that the myocardial injury was an independent factor for poor outcome (odds ratio, 2.750; 95% confidence interval, 1.168-6.474; P = 0.021. Conclusions: Myocardial injury is an independent predictor of in-hospital death and neurologic sequelae in patients with intentional CO poisoning and acute respiratory failure.

  12. Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers: randomised controlled trial

    DEFF Research Database (Denmark)

    Tonnesen, H; Rosenberg, J; Nielsen, Hans Jørgen;

    1999-01-01

    liver disease admitted for elective colorectal surgery. INTERVENTIONS: Withdrawal from alcohol consumption for 1 month before operation (disulfiram controlled) compared with continuous drinking. MAIN OUTCOME MEASURES: Postoperative complications requiring treatment within the first month after surgery...

  13. Preoperative factors predicting poor outcomes following laparoscopic choledochotomy: a multivariate analysis study

    Science.gov (United States)

    Ye, Xiaoming; Hong, Xiaoming; Ni, Kaiyuan; Teng, Xiaoping; Xie, Kaigang

    2013-01-01

    Background Laparoscopic surgery for common bile duct stones varies procedurally from a transcystic approach to laparoscopic choledochotomy (LC) with or without biliary drainage. However, LC is a difficult procedure with higher documented morbidity than the transcystic approach. We retrospectively investigated risk factors for adverse outcomes of LC. Methods We used logistic regression models to assess 4 categories of adverse outcomes: overall, complications, conversion to open operation and failed surgical clearance. We calculated the area under the receiver operating characteristic curve to evaluate diagnostic accuracy. Results We included 201 patients who underwent LC in our analysis. Adverse outcomes occurred in 48 (23.9%) patients, complications occurred in 43 (21.4%), retained stones were observed in 8 (4%), and conversion to laparotomy occurred in 7 (3.5%). Multivariate analysis showed that total bilirubin (BIL) and the presence of medical risk factors (MRFs) were significant predictors of adverse outcomes and complications. We calculated the probability of adverse outcomes (p) using the following formula: logit(p) = 0.977 (MRFs) + 0.014 (BIL) − 2.919. p = EXP (logit(p)) ÷ [1+EXP (logit(p))]. According to their logit(p), all patients were divided into a low-risk group (logit(p) ≤ −1.32, n = 130) and a high-risk group (logit(p) > −1.32, n = 71). Patients in the low-risk group had about a 1 in 10 chance (12 of 130) of adverse outcomes developing. Of the 71 patients in the high-risk group, 36 (50.7%) experienced adverse outcomes. Conclusion High BIL and the presence of MRFs could predict adverse outcomes in patients undergoing LC. PMID:23883491

  14. Pathways to poor educational outcomes for HIV/AIDS-affected youth in South Africa.

    Science.gov (United States)

    Orkin, Mark; Boyes, Mark E; Cluver, Lucie D; Zhang, Yuning

    2014-01-01

    A recent systematic review of studies in the developing world has critically examined linkages from familial HIV/AIDS and associated factors such as poverty and child mental health to negative child educational outcomes. In line with several recommendations in the review, the current study modelled relationships between familial HIV/AIDS, poverty, child internalising problems, gender and four educational outcomes: non-enrolment at school, non-attendance, deficits in grade progression and concentration problems. Path analyses reveal no direct associations between familial HIV/AIDS and any of the educational outcomes. Instead, HIV/AIDS-orphanhood or caregiver HIV/AIDS-sickness impacted indirectly on educational outcomes via the poverty and internalising problems that they occasioned. This has implications for evidence-based policy inferences. For instance, by addressing such intervening variables generally, rather than by seeking to target families affected by HIV/AIDS, interventions could avoid exacerbating stigmatisation, while having a more direct and stronger impact on children's educational outcomes. This analytic approach also suggests that future research should seek to identify causal paths, and may include other intervening variables related to poverty (such as child housework and caring responsibilities) or to child mental health (such as stigma and abuse), that are linked to both familial HIV/AIDS and educational outcomes.

  15. Metastatic adenocarcinoma of prostate in a 28-year-old male: The outcome is poor in young patients?

    Directory of Open Access Journals (Sweden)

    Renu Madan

    2015-01-01

    Full Text Available Prostate cancer is common in older patients. Rarity in younger population limits the study of natural history and prognosis in this population. Most of the published data has reported poor outcome in younger patients with metastatic prostate cancer. Here, we report a case of prostate cancer in 28-year-old male who presented with bone metastasis. After bilateral inguinal orchidectomy, he was started on anti-androgen therapy and received palliative radiotherapy for bone metastasis. There was only a slight decrease in prostate-specific antigen (PSA level and pelvic disease post treatment. Subsequently, he was started on opioid analgesics (by World Health Organization, WHO, step ladder in view of persistent pain. The index case is being presented for its rarity and probable poor outcome in young patients and to stress on the fact that the possibility of primary prostatic adenocarcinoma should be investigated in a male presenting with bone metastasis irrespective of the age.

  16. Using Predictive Modelling to Identify Students at Risk of Poor University Outcomes

    Science.gov (United States)

    Jia, Pengfei; Maloney, Tim

    2015-01-01

    Predictive modelling is used to identify students at risk of failing their first-year courses and not returning to university in the second year. Our aim is twofold. Firstly, we want to understand the factors that lead to poor first-year experiences at university. Secondly, we want to develop simple, low-cost tools that would allow universities to…

  17. Poor Renal Outcome of Antineutrophil Cytoplasmic Antibody Negative Pauci-immune Glomerulonephritis in Taiwanese

    Directory of Open Access Journals (Sweden)

    Peir-Haur Hung

    2006-01-01

    Conclusion: This study illustrates the necessity for pathologic diagnosis of pauci-immune GN despite ANCA negativity. The poor prognosis associated with ANCA negativity in this study may be partly due to delayed diagnosis since these patients frequently lacked systemic involvement.

  18. Plasma Proenkephalin and Poor Long-Term Outcome in Renal Transplant Recipients

    NARCIS (Netherlands)

    Kieneker, Lyanne M; Hartmann, Oliver; Struck, Joachim; Bergmann, Andreas; Gansevoort, Ron T; Joosten, Michel M; van den Berg, Else; de Boer, Rudolf A; Bakker, Stephan J L

    BACKGROUND: Proenkephalin (pro-ENK), a stable and reliable surrogate marker for unstable enkephalins, was found to be associated with acute kidney injury and chronic renal failure in previous studies. We aimed to investigate whether pro-ENK is linked to chronic kidney injury and poor long-term

  19. Experimental Intervention Research on Students with Specific Poor Comprehension: A Systematic Review of Treatment Outcomes

    Science.gov (United States)

    Lee, Sung Hee; Tsai, Shu-Fei

    2017-01-01

    Students with specific poor comprehension (SPC) can sound out words accurately, but have difficulty understanding what they read. However, most existing reading intervention studies on students with reading disabilities did not differentiate students with SPC from other types of students with reading disabilities who accompany with decoding…

  20. Even Four Minutes of Poor Quality of CPR Compromises Outcome in a Porcine Model of Prolonged Cardiac Arrest

    Science.gov (United States)

    Li, Heng; Zhang, Lei; Yang, Zhengfei; Huang, Zitong; Chen, Bihua; Li, Yongqin; Yu, Tao

    2013-01-01

    Objective. Untrained bystanders usually delivered suboptimal chest compression to victims who suffered from cardiac arrest in out-of-hospital settings. We therefore investigated the hemodynamics and resuscitation outcome of initial suboptimal quality of chest compressions compared to the optimal ones in a porcine model of cardiac arrest. Methods. Fourteen Yorkshire pigs weighted 30 ± 2 kg were randomized into good and poor cardiopulmonary resuscitation (CPR) groups. Ventricular fibrillation was electrically induced and untreated for 6 mins. In good CPR group, animals received high quality manual chest compressions according to the Guidelines (25% of animal's anterior-posterior thoracic diameter) during first two minutes of CPR compared with poor (70% of the optimal depth) compressions. After that, a 120-J biphasic shock was delivered. If the animal did not acquire return of spontaneous circulation, another 2 mins of CPR and shock followed. Four minutes later, both groups received optimal CPR until total 10 mins of CPR has been finished. Results. All seven animals in good CPR group were resuscitated compared with only two in poor CPR group (P CPR group. Conclusions. In a porcine model of prolonged cardiac arrest, even four minutes of initial poor quality of CPR compromises the hemodynamics and survival outcome. PMID:24364028

  1. Nerve Transfers to Restore Upper Extremity Function in Cervical Spinal Cord Injury: Update and Preliminary Outcomes.

    Science.gov (United States)

    Fox, Ida K; Davidge, Kristen M; Novak, Christine B; Hoben, Gwendolyn; Kahn, Lorna C; Juknis, Neringa; Ruvinskaya, Rimma; Mackinnon, Susan E

    2015-10-01

    Cervical spinal cord injury can result in profound loss of upper extremity function. Recent interest in the use of nerve transfers to restore volitional control is an exciting development in the care of these complex patients. In this article, the authors review preliminary results of nerve transfers in spinal cord injury. Review of the literature and the authors' cases series of 13 operations in nine spinal cord injury nerve transfer recipients was performed. Representative cases were reviewed to explore critical concepts and preliminary outcomes. The nerve transfers used expendable donors (e.g., teres minor, deltoid, supinator, and brachialis) innervated above the level of the spinal cord injury to restore volitional control of missing function such as elbow extension, wrist extension, and/or hand function (posterior interosseous nerve or anterior interosseous nerve/finger flexors reinnervated). Results from the literature and the authors' patients (after a mean postsurgical follow-up of 12 months) indicate gains in function as assessed by both manual muscle testing and patients' self-reported outcomes measures. Nerve transfers can provide an alternative and consistent means of reestablishing volitional control of upper extremity function in people with cervical level spinal cord injury. Early outcomes provide evidence of substantial improvements in self-reported function despite relatively subtle objective gains in isolated muscle strength. Further work to investigate the optimal timing and combination of nerve transfer operations, the combination of these with traditional treatments (tendon transfer and functional electrical stimulation), and measurement of outcomes is imperative for determining the precise role of these operations. Therapeutic, IV.

  2. Gasdermin B expression predicts poor clinical outcome in HER2-positive breast cancer

    Science.gov (United States)

    Hergueta-Redondo, Marta; Sarrio, David; Molina-Crespo, Ángela; Vicario, Rocío; Bernadó-Morales, Cristina; Martínez, Lidia; Rojo-Sebastián, Alejandro; Serra-Musach, Jordi; Mota, Alba; Martínez-Ramírez, Ángel; Castilla, Maria Ángeles; González-Martin, Antonio; Pernas, Sonia; Cano, Amparo; Cortes, Javier; Nuciforo, Paolo G.; Peg, Vicente; Palacios, José; Pujana, Miguel Ángel; Arribas, Joaquín; Moreno-Bueno, Gema

    2016-01-01

    Around, 30–40% of HER2-positive breast cancers do not show substantial clinical benefit from the targeted therapy and, thus, the mechanisms underlying resistance remain partially unknown. Interestingly, ERBB2 is frequently co-amplified and co-expressed with neighbour genes that may play a relevant role in this cancer subtype. Here, using an in silico analysis of data from 2,096 breast tumours, we reveal a significant correlation between Gasdermin B (GSDMB) gene (located 175 kilo bases distal from ERBB2) expression and the pathological and clinical parameters of poor prognosis in HER2-positive breast cancer. Next, the analysis of three independent cohorts (totalizing 286 tumours) showed that approximately 65% of the HER2-positive cases have GSDMB gene amplification and protein over-expression. Moreover, GSDMB expression was also linked to poor therapeutic responses in terms of lower relapse free survival and pathologic complete response as well as positive lymph node status and the development of distant metastasis under neoadjuvant and adjuvant treatment settings, respectively. Importantly, GSDMB expression promotes survival to trastuzumab in different HER2-positive breast carcinoma cells, and is associated with trastuzumab resistance phenotype in vivo in Patient Derived Xenografts. In summary, our data identifies the ERBB2 co-amplified and co-expressed gene GSDMB as a critical determinant of poor prognosis and therapeutic response in HER2-positive breast cancer. PMID:27462779

  3. Clinical Outcomes of Extreme Lateral Interbody Fusion in the Treatment of Adult Degenerative Scoliosis

    Directory of Open Access Journals (Sweden)

    Adam M. Caputo

    2012-01-01

    Full Text Available Introduction. The use of extreme lateral interbody fusion (XLIF and other lateral access surgery is rapidly increasing in popularity. However, limited data is available regarding its use in scoliosis surgery. The objective of this study was to evaluate the clinical outcomes of adults with degenerative lumbar scoliosis treated with XLIF. Methods. Thirty consecutive patients with adult degenerative scoliosis treated by a single surgeon at a major academic institution were followed for an average of 14.3 months. Interbody fusion was completed using the XLIF technique with supplemental posterior instrumentation. Validated clinical outcome scores were obtained on patients preoperatively and at most recent follow-up. Complications were recorded. Results. The study group demonstrated improvement in multiple clinical outcome scores. Oswestry Disability Index scores improved from 24.8 to 19.0 (P < 0.001. Short Form-12 scores improved, although the change was not significant. Visual analog scores for back pain decreased from 6.8 to 4.6 (P < 0.001 while scores for leg pain decreased from 5.4 to 2.8 (P < 0.001. A total of six minor complications (20% were recorded, and two patients (6.7% required additional surgery. Conclusions. Based on the significant improvement in validated clinical outcome scores, XLIF is effective in the treatment of adult degenerative scoliosis.

  4. Should schools expect poor physical and mental health, social adjustment, and participation outcomes in students with disability?

    Directory of Open Access Journals (Sweden)

    Sharmila Vaz

    Full Text Available The literature on whether students with disabilities have worse physical and mental health, social adjustment, and participation outcomes when compared to their peers without disabilities is largely inconclusive. While the majority of case control studies showed significantly worse outcomes for students with disabilities; the proportion of variance accounted for is rarely reported. The current study used a population cross-sectional approach to determine the classification ability of commonly used screening and outcome measures in determining the disability status. Furthermore, the study aimed to identify the variables, if any, that best predicted the presence of disability. Results of univariate discriminant function analyses suggest that across the board, the sensitivity of the outcome/screening tools to correctly identify students with a disability was 31.9% higher than the related Positive Predictive Value (PPV. The lower PPV and Positive Likelihood Ratio (LR+ scores suggest that the included measures had limited discriminant ability (17.6% to 40.3% in accurately identifying students at-risk for further assessment. Results of multivariate analyses suggested that poor health and hyperactivity increased the odds of having a disability about two to three times, while poor close perceived friendship and academic competences predicted disability with roughly the same magnitude. Overall, the findings of the current study highlight the need for researchers and clinicians to familiarize themselves with the psychometric properties of measures, and be cautious in matching the function of the measures with their research and clinical needs.

  5. Vascular thoracic outlet syndrome. Longer posterior rib stump causes poor outcome

    NARCIS (Netherlands)

    Geven, Leontien I.; Smit, Andries J.; Ebels, Tjark

    2006-01-01

    Objective: To assess the role of the relative length of the posterior rib stump in outcome after transaxittary first rib resection for thoracic outlet syndrome. Methods: All patients with a transaxittary first rib resection between January 1990 and February 2004 were selected. Relative rib stump len

  6. Impact of hypothermia on predictors of poor outcome : How do we decide to redirect care?

    NARCIS (Netherlands)

    Bonifacio, S. L.; deVries, L. S.; Groenendaal, F.

    2015-01-01

    Therapeutic hypothermia is now considered the standard of care for neonates with neonatal encephalopathy due to perinatal asphyxia. Outcomes following hypothermia treatment are favorable, as demonstrated in recent meta-analyses, but 45-50% of these neonates still suffer major disability or die due t

  7. Elevated APOBEC3B Correlates with Poor Outcomes for Estrogen-Receptor-Positive Breast Cancers

    NARCIS (Netherlands)

    A.M. Sieuwerts (Anieta); S. Willis (Scooter); M.J. Burns (Michael); M.P. Look (Maxime); M.E.M.-V. Gelder (Marion E. Meijer-Van); A. Schlicker (Andreas); D.A.M. Heideman (Danielle); H. Jacobs (Heinz); L. Wessels (Lodewyk); B. Leyland-Jones (Brian); K.P. Gray (Kathryn); J.A. Foekens (John); R.S. Harris (Reuben); J.W.M. Martens (John)

    2014-01-01

    textabstractRecent observations connected DNA cytosine deaminase APOBEC3B to the genetic evolution of breast cancer. We addressed whether APOBEC3B is associated with breast cancer clinical outcomes. APOBEC3B messenger RNA (mRNA) levels were related in 1,491 primary breast cancers to disease-free (DF

  8. Impaired microcirculation predicts poor outcome of patients with acute myocardial infarction complicated by cardiogenic shock

    NARCIS (Netherlands)

    C.A. den Uil; W.K. Lagrand; M. van der Ent; L.S.D. Jewbali; J.M. Cheng; P.E. Spronk; M.L. Simoons

    2010-01-01

    We investigated the relationship between sublingual perfused capillary density (PCD) as a measure of tissue perfusion and outcome (i.e. occurrence of organ failure and mortality) in patients with cardiogenic shock from acute myocardial infarction. We performed a prospective study in 68 patients. Usi

  9. Cognitive performance and poor long-term functional outcome after young stroke

    NARCIS (Netherlands)

    Synhaeve, N.E.; Schaapsmeerders, P.; Arntz, R.M.; Maaijwee, N.A.M.M.; Rutten-Jacobs, L.C.A.; Schoonderwaldt, H.C.; Dorresteijn, L.D.; Kort, P.L. de; Dijk, E.J. van; Kessels, R.P.C.; Leeuw, F.E. de

    2015-01-01

    OBJECTIVE: To investigate the influence of cognitive performance on long-term functional outcome after ischemic stroke (IS) in young adults aged 18 through 50 years (young IS). METHODS: This study is part of a prospective cohort study among 277 stroke survivors with a young IS admitted to our depart

  10. Obesity Is Common in Axial Spondyloarthritis and Is Associated with Poor Clinical Outcome

    NARCIS (Netherlands)

    Maas, Fiona; Arends, Suzanne; van der Veer, Eveline; Wink, Freke; Efde, Monique; Bootsma, Hendrika; Brouwer, Elisabeth; Spoorenberg, Anneke

    2016-01-01

    Objective. To assess the prevalence of overweight and obesity in a large cohort of patients with axial spondyloarthritis (axSpA) in comparison with the general population. To explore the relationship of body mass index (BMI) with clinical outcome in axSpA. Methods. Patients from the Groningen Leeuwa

  11. Foster Care Placement, Poor Parenting, and Negative Outcomes among Homeless Young Adults

    Science.gov (United States)

    Tyler, Kimberly A.; Melander, Lisa A.

    2010-01-01

    Although homeless youth with and without foster care histories both face adverse life circumstances, little is known about how these two groups compare in terms of their early histories and whether they face similar outcomes. As such, we compared those with and without a history of foster care placement to determine if the associations between a…

  12. Usefulness of the Seattle Heart Failure Model to identify adults with congenital heart disease at high risk of poor outcome.

    Science.gov (United States)

    Stefanescu, Ada; Macklin, Eric A; Lin, Elaine; Dudzinski, David M; Johnson, Jacob; Kennedy, Kevin F; Jacoby, Daniel; DeFaria Yeh, Doreen; Lewis, Gregory D; Yeh, Robert W; Liberthson, Richard; Lui, George; Bhatt, Ami B

    2014-03-01

    Our objective was to determine whether the Seattle Heart Failure Model (SHFM) differentiates patients with adult congenital heart disease (ACHD) at high versus low risk for cardiovascular outcomes and poor exercise capacity. The ACHD population is growing and presents increasingly for care in the community and at tertiary centers. Few strategies exist to identify the patients with ACHD at high risk for heart failure and mortality.We studied 153 adults with transposition of the great arteries, Ebstein anomaly, tetralogy of Fallot, double outlet right ventricle, and single ventricle from 2 ACHD centers. The primary outcome was cardiovascular death, with a secondary composite outcome of death, transplant, ventricular assist device, cardiovascular admission, and treatment for arrhythmia. We defined risk groups based on SHFM 5-year predicted survival: high (predicted survival risk (>85%). Ten patients had the primary outcome of death, and 46 the combined end point. The hazard of death in the SHFM high- versus the intermediate-risk group was 7.09 (95% confidence interval 1.5 to 33.4, p = 0.01; no deaths in the low-risk group) and the hazard of the composite outcome between the high- versus low-risk group was 6.64 (95% confidence interval 2.5 to 17.6, p = 0.0001). Kaplan-Meier survival analysis showed greater probability of all-cause mortality (p = 0.003) in the high-risk group. In conclusion, the SHFM can help identify subjects with ACHD at risk for adverse outcome and poor cardiopulmonary efficiency. This may add to the care of patients with ACHD in the community and streamline care at tertiary centers. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Poor regenerative outcome after skeletal muscle necrosis induced by Bothrops asper venom: alterations in microvasculature and nerves.

    Directory of Open Access Journals (Sweden)

    Rosario Hernández

    Full Text Available BACKGROUND: Viperid snakebite envenoming is characterized by prominent local tissue damage, including muscle necrosis. A frequent outcome of such local pathology is deficient skeletal muscle regeneration, which causes muscle dysfunction, muscle loss and fibrosis, thus provoking permanent sequelae that greatly affect the quality of life of patients. The causes of such poor regenerative outcome of skeletal muscle after viperid snakebites are not fully understood. METHODOLOGY/PRINCIPAL FINDINGS: A murine model of muscle necrosis and regeneration was adapted to study the effects of the venom and isolated toxins of Bothrops asper, the medically most important snake in Central America. Gastrocnemius muscle was injected with either B. asper venom, a myotoxic phospholipase A(2 (Mtx, a hemorrhagic metalloproteinase (SVMP, or saline solution. At various time intervals, during one month, tissue samples were collected and analyzed by histology, and by immunocytochemical and immunohistochemical techniques aimed at detecting muscle fibers, collagen, endothelial cells, myoblasts, myotubes, macrophages, TUNEL-positive nuclei, and axons. A successful regenerative response was observed in muscle injected with Mtx, which induces myonecrosis but does not affect the microvasculature. In contrast, poor regeneration, with fibrosis and atrophic fibers, occurred when muscle was injected with venom or SVMP, both of which provoke necrosis, microvascular damage leading to hemorrhage, and poor axonal regeneration. CONCLUSIONS/SIGNIFICANCE: The deficient skeletal muscle regeneration after injection of B. asper venom is likely to depend on the widespread damage to the microvasculature, which affects the removal of necrotic debris by phagocytes, and the provision of nutrients and oxygen required for regeneration. In addition, deficient axonal regeneration is likely to contribute to the poor regenerative outcome in this model.

  14. Factors leading to poor outcome of noninvasive positive pressure ventilation in acute exacerbation of chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    Ashok Kumar; Anoop Kumar; Kelash Rai; Shaista Ghazal; Nadeem Rizvi; Sunil Kumar; Sadhna Notani

    2015-01-01

    Objective:To determine frequency of factors leading to poor outcome of non-invasive positive pressure ventilation in acute exacerbation of chronic obstructive pulmonary disease. Methods:This cross sectional study was conducted at our center between May 2012 and November 2012. A total of 195 diagnosed patients of acute exacerbation of chronic obstructive pulmonary disease meeting the inclusion criteria were selected from the ER department. At the time of admission age was inquired BP, respiratory rate and oxygen saturation will be noted and pedal edema was assessed and investigations were sent for pH assessment. Noninvasive positive pressure ventilation (NIPPV) using BiPAP was applied in spontaneous mode by the help of oronasal mask. Presence of respiratory rate (less than 12/min), systolic blood pressure140 bpm was taken as poor outcome. Results:The average age of the cases was 61.9±9.3 years with male to female ratio being 1.5:1. NIPPV was successful in 151 (77.4%) cases and 44 (22.6%) cases were underwent endotracheal intubation. About 38 (44.7%) of patients with oxygen saturation (82%-86%) had poor prognosis. A total of 40 (55.6%) of patients with pH range 7.20-7.26, required endotracheal intubation, 43 (66.2%) with pedal edema underwent endotracheal intubation. While 29 (24.16%) patients of age>60 years needed endotracheal intubation. Conclusions:In this study, NIPPV was successful in 77.4%cases and 22.6%cases were underwent endotracheal intubation. Pedal edema was the most common factor leading to poor outcomes while age>60 years was the least common factor, 66.2%and 24.2%respectively.

  15. Extreme Preterm Premature Rupture of Membranes: Risk Factors and Feto Maternal Outcomes

    Directory of Open Access Journals (Sweden)

    Nihal Al Riyami

    2013-03-01

    Full Text Available Objectives: Preterm premature rupture of membranes (PPROM is defined as a rupture of the amniotic membranes occurring before 37 weeks of gestation and before the onset of labor. Extreme PPROM occurs prior to 26 weeks gestation and contributes to an increased risk of prematurity, leading to maternal and fetal complications. This study aims to estimate the risk factors associated with various maternal complications and to determine the worst outcomes in Omani females with extreme PPROM.Methods: A retrospective cohort study was conducted on 44 women with extreme PPROM, who delivered at Sultan Qaboos University Hospital (SQUH from January 2006 to December 2011. Women with incomplete information, multiple gestations, or a preterm delivery resulting from medical intervention, as well as women who delivered elsewhere were excluded from the study.Results: Forty-four women with extreme PPROM were included in our study. The results revealed the most important risk factor to be history of infection, which was noted in 24 study participants. The mean maternal age was 30 years. The mean gestational age at PPROM and at delivery were 20.7±3.2 (range: 16-26 weeks and 29.7±7.6 weeks (range: 17-40 weeks, respectively. The maternal complications observed in this study included; infection which was seen in 20 (45% patients, antepartum hemorrhage in 11 (25% patients, and cesarean section which was required in 12 (27% patients. There was no significant association between risk factors such as gestational age at delivery, parity, maternal age at PPROM, or maternal Body Mass Index (BMI and cesarean section rate. Infection played a major role, both as a risk factor and in causing extreme PPROM, which in turn increased in 12 patients (27%. In the multivariable model for predicting the need for cesarean section (gestational age at delivery, parity, maternal age at PPROM in years and maternal BMI, none of the factors were statistically significant.Conclusion: Overall

  16. Molecular analysis of childhood primitive neuroectodermal tumors defines markers associated with poor outcome

    DEFF Research Database (Denmark)

    Scheurlen, W G; Schwabe, G C; Joos, S

    1998-01-01

    PURPOSE: The diagnostic and prognostic significance of well-defined molecular markers was investigated in childhood primitive neuroectodermal tumors (PNET). MATERIALS AND METHODS: Using microsatellite analysis, Southern blot analysis, and fluorescence in situ hybridization (FISH), 30 primary tumors......: In our study, amplification of c-myc was a poor-prognosis marker in PNET. LOH of chromosome 17p was associated with metastatic disease. Molecular analysis of primary tumors using these markers may be useful for stratification of children with PNET in future prospective studies. The other aberrations...... investigated were not of significant prognostic value, but may provide an entry point for future large-scale molecular studies....

  17. Shock as a determinant of poor patient-centered outcomes in implantable cardioverter defibrillator patients

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Van Den Broek, Krista C; Van Den Berg, Martha

    2010-01-01

    as an outcome, and compare the influence of ICD shock with other factors (e.g., heart failure and psychological factors) as determinants of outcomes, with a view to providing recommendations for clinical practice and future research. Based on the large-scale primary and secondary prevention trials (i.e., CABG......-PATCH, CIDS, AVID, AMIOVIRT, SCD-HeFT, MADIT-II, and DEFINITE), evidence for an association between ICD shocks and quality of life is mixed, with some indication that the influence of shocks may depend largely on the interval between shocks and assessment of quality of life. In order to improve the clinical...... management of ICD patients, we need to adopt a more rigorous and standardized methodology in future studies in order to be able to draw firm conclusions about the impact of ICD shocks on individual patients. We also need to acknowledge that the impact of shocks on psychological functioning and quality...

  18. Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers: randomised controlled trial

    DEFF Research Database (Denmark)

    Tonnesen, H; Rosenberg, J; Nielsen, Hans Jørgen;

    1999-01-01

    often in the intervention group. Surgical stress responses were lower in the intervention group (P LT / =0.05). CONCLUSIONS: One month of preoperative abstinence reduces postoperative morbidity in alcohol abusers. The mechanism is probably reduced preclinical organ dysfunction and reduction......OBJECTIVE: To evaluate the influence of preoperative abstinence on postoperative outcome in alcohol misusers with no symptoms who were drinking the equivalent of at least 60 g ethanol/day. DESIGN: Randomised controlled trial. Setting: Copenhagen, Denmark. SUBJECTS: 42 alcoholic patients without...... liver disease admitted for elective colorectal surgery. INTERVENTIONS: Withdrawal from alcohol consumption for 1 month before operation (disulfiram controlled) compared with continuous drinking. MAIN OUTCOME MEASURES: Postoperative complications requiring treatment within the first month after surgery...

  19. Neurodevelopmental Outcomes of Extremely Preterm Infants Randomized to Stress Dose Hydrocortisone.

    Directory of Open Access Journals (Sweden)

    Nehal A Parikh

    Full Text Available To compare the effects of stress dose hydrocortisone therapy with placebo on survival without neurodevelopmental impairments in high-risk preterm infants.We recruited 64 extremely low birth weight (birth weight ≤1000 g infants between the ages of 10 and 21 postnatal days who were ventilator-dependent and at high-risk for bronchopulmonary dysplasia. Infants were randomized to a tapering 7-day course of stress dose hydrocortisone or saline placebo. The primary outcome at follow-up was a composite of death, cognitive or language delay, cerebral palsy, severe hearing loss, or bilateral blindness at a corrected age of 18-22 months. Secondary outcomes included continued use of respiratory therapies and somatic growth.Fifty-seven infants had adequate data for the primary outcome. Of the 28 infants randomized to hydrocortisone, 19 (68% died or survived with impairment compared with 22 of the 29 infants (76% assigned to placebo (relative risk: 0.83; 95% CI, 0.61 to 1.14. The rates of death for those in the hydrocortisone and placebo groups were 31% and 41%, respectively (P = 0.42. Randomization to hydrocortisone also did not significantly affect the frequency of supplemental oxygen use, positive airway pressure support, or need for respiratory medications.In high-risk extremely low birth weight infants, stress dose hydrocortisone therapy after 10 days of age had no statistically significant effect on the incidence of death or neurodevelopmental impairment at 18-22 months. These results may inform the design and conduct of future clinical trials.ClinicalTrials.gov NCT00167544.

  20. Spectroscopic Studies of Extremly Metal-Poor Stars with Subaru/HDS:II.The r-process Elements, Including Thorium

    CERN Document Server

    Honda, S; Kajino, T; Ando, H; Beers, T C; Izumiura, H; Sadakane, K; Takada-Hidai, M

    2004-01-01

    We present the abundance analyses for the neutron-capture elements, and discuss the observed abundance distributions in very metal-poor stars with excesses of r-process elements. As has been found by previous abundance studies, the star-to-star scatter in the abundances of neutron-capture elements are very large. The abundance patterns of the heavy neutron-capture elements (56 $\\leq$ Z $\\leq$ 70) in seven objects with moderate to large excesses of the neutron-capture elements are similar to that of the solar system r-process component. These results strongly suggest that the heavy neutron-capture elements in these objects are primarily synthesized by the r-process. On the other hand, the abundance ratios of the light neutron-capture elements (38 $\\leq$ Z $\\leq$ 46) exhibit a rather large dispersion. Our inspection of the correlation between Sr and Ba abundances in very metal-poor stars reveals that the dispersion of the Sr abundances clearly decreases with increasing Ba abundance. This results support previou...

  1. LAMP3 and TP53 overexpression predicts poor outcome in laryngeal squamous cell carcinoma.

    Science.gov (United States)

    Qiu, Xiaoxia; You, Yiwen; Huang, Jianfei; Wang, Xudong; Zhu, Huijun; Wang, Zhiwei

    2015-01-01

    Lysosomal associated membrane protein 3 (LAMP3) is a newly identified tumor-specific and hypoxia-induced protein. It is a downstream target gene of tumor suppressor TP53 and its expression has been associated with hypoxia-induced metastasis and poor overall survival in cervical, breast and gastrointestinal cancers. However, little is known of LAMP3 protein expression in laryngeal squamous cell carcinoma (LSCC) and its prognostic value. We determined protein expression of LAMP3 and TP53 in LSCC tissues (n=117) by immunohistochemistry analysis on tissue microarray (TMA), their expression was correlated with patients' clinical parameters and overall survival. LAMP3 and TP53 protein expression was significantly higher in cancerous tissues compared to adjacent normal surgical margin tissues. Both high LAMP3 and high TP53 protein expression was significantly associated with tumor stage and size. Significant correlation between LAMP3 and TP53 expression was observed. Patients with high LAMP3 or high TP53 expression had a poor overall survival. Our data suggest that both epithelial LAMP3 expression and TP53 expression are independent prognostic markers for LSCC.

  2. Loss of estrogen receptor Beta expression in follicular thyroid carcinoma predicts poor outcome.

    Science.gov (United States)

    Heikkilä, Annukka; Hagström, Jaana; Mäenpää, Hanna; Louhimo, Johanna; Siironen, Päivi; Heiskanen, Ilkka; Haglund, Caj; Arola, Johanna

    2013-04-01

    Well-differentiated follicular thyroid carcinomas (FTCs) usually act indolently, while aggressively acting tumors are difficult to detect early enough. Estrogen receptors (ERs) have prognostic significance in many cancers. Thyroid diseases, including neoplasms, are associated with the female sex. The prognostic significance of ERs in FTCs has not been reported previously. We studied the role of ERα and ERβ in 83 cases of follicular thyroid adenoma (FTA) and 43 FTC cases, including seven cases of poorly differentiated FTC, obtained from the Department of Surgery, Helsinki University Central Hospital between 1990 and 2009. Patient follow-up was conducted until March 2011. Expression of ERα, ERβ, and MIB-1/Ki-67 was investigated by immunohistochemistry and correlated with clinicopathological characteristics, including survival. Two major observations were apparent. First, ERβ expression was significantly higher in FTA than in FTC, and it was a stronger differential diagnostic marker than MIB-1/Ki-67. Second, low ERβ expression correlated with poor survival in FTC. All cancer-specific deaths due to FTC were among low ERβ-score patients. ERβ is a differential marker for malignancy and could thus be used as a preoperative tool. FTC patients with a low ERβ score need more thorough follow-up and may benefit from more aggressive treatment.

  3. Downregulation of RKIP is associated with poor outcome and malignant progression in gliomas.

    Directory of Open Access Journals (Sweden)

    Olga Martinho

    Full Text Available Malignant gliomas are highly infiltrative and invasive tumors, which precludes the few treatment options available. Therefore, there is an urgent need to elucidate the molecular mechanisms underlying gliomas aggressive phenotype and poor prognosis. The Raf Kinase Inhibitory protein (RKIP, besides regulating important intracellular signaling cascades, was described to be associated with progression, metastasis and prognosis in several human neoplasms. Its role in the prognosis and tumourigenesis of gliomas remains unclear. In the present study, we found that RKIP protein is absent in a low frequency (10%, 20/193 of glioma tumors. Nevertheless, the absence of RKIP expression was an independent prognostic marker in glioma. Additionally, by in vitro downregulation of RKIP, we found that RKIP inhibition induces a higher viability and migration of the cells, having no effect on cellular proliferation and angiogenesis, as assessed by in vivo CAM assay. In conclusion, this is the largest series studied so far evaluating the expression levels of this important cancer suppressor protein in glioma tumors. Our results suggest that in a subset of tumors, the absence of RKIP associates with highly malignant behavior and poor survival of patients, which may be a useful biomarker for tailored treatment of glioma patients.

  4. Small for gestational age and poor fluid intelligence in childhood predict externalizing behaviors among young adults born at extremely low birth weight.

    Science.gov (United States)

    Lahat, Ayelet; Van Lieshout, Ryan J; Saigal, Saroj; Boyle, Michael H; Schmidt, Louis A

    2015-02-01

    Although infants born at extremely low birth weight (ELBW; birth weight intelligence. As young adults, a subset of ELBW survivors free of major neurosensory impairments provided self-reports of personality characteristics related to psychopathology. Data from 66 participants indicated that, as predicted, the association between ELBW and externalizing behaviors was moderated by fluid intelligence. Specifically, ELBW individuals with poor fluid intelligence who were born small for gestational age (birth weight intelligence might be a cognitive mechanism contributing to the development of psychopathology among nonimpaired individuals who were born at ELBW and small for gestational age.

  5. Predictive value of cardiac magnetic resonance imaging-derived myocardial strain for poor outcomes in patients with acute myocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Won; Jeong, Yeon Joo; Lee, Gee Won; Lee, Nam Kyung; Lee, Hye Won; Kim, Jin You [Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan (Korea, Republic of); Choi, Bum Sung; Choo, Ki Seok [Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of)

    2017-08-01

    To evaluate the utility of cardiovascular magnetic resonance (CMR)-derived myocardial strain measurement for the prediction of poor outcomes in patients with acute myocarditis We retrospectively analyzed data from 37 patients with acute myocarditis who underwent CMR. Left ventricular (LV) size, LV mass index, ejection fraction and presence of myocardial late gadolinium enhancement (LGE) were analyzed. LV circumferential strain (EccSAX), radial strain (ErrSAX) from mid-ventricular level short-axis cine views and LV longitudinal strain (EllLV), radial strain (ErrLax) measurements from 2-chamber long-axis views were obtained. In total, 31 of 37 patients (83.8%) underwent follow-up echocardiography. The primary outcome was major adverse cardiovascular event (MACE). Incomplete LV functional recovery was a secondary outcome. During an average follow-up of 41 months, 11 of 37 patients (29.7%) experienced MACE. Multivariable Cox proportional hazard regression analysis, which included LV mass index, LV ejection fraction, the presence of LGE, EccSAX, ErrSAX, EllLV, and ErrLax values, indicated that the presence of LGE (hazard ratio, 42.88; p = 0.014), together with ErrLax (hazard ratio, 0.77 per 1%, p = 0.004), was a significant predictor of MACE. Kaplan-Meier analysis demonstrated worse outcomes in patient with LGE and an ErrLax value ≤ 9.48%. Multivariable backward regression analysis revealed that ErrLax values were the only significant predictors of LV functional recovery (hazard ratio, 0.54 per 1%; p = 0.042). CMR-derived ErrLax values can predict poor outcomes, both MACE and incomplete LV functional recovery, in patients with acute myocarditis, while LGE is only a predictor of MACE.

  6. [Developmental dysplasia of the hip in children with a psychomotor disorder. A risk factor for a poor outcome?].

    Science.gov (United States)

    Pipa-Muñiz, Iván; de Los Llanos Rodríguez-Rodríguez, María; Felgueroso-Juliana, M Blanca; Riera-Campillo, Manuela; González-Herranz, Pedro

    2016-09-01

    Orthopaedic treatment of developmental dysplasia of the hip (DDH) has a high success rate in cases that are diagnosed early. However, the outcomes of these patients are not really known when they are subsequently diagnosed with some type of cerebral impairment. A retrospective observational study was conducted on cases of DDH with a poor outcome after orthopaedic treatment, being unknown if they had any type of psychomotor disorder. The patients were clinically and radiologically assessed, and afterwards received neurological valuation by the Child Neurology Unit. Of the 325 cases of DDH diagnosed in 293 patients, 10 patients (3%) with 16 hips with DDH were diagnosed of any cerebral impairment. All them were initially treated orthopedically. Clinical and radiologically evolution was succesful only in 4 cases (25%) being necessary any surgical procedure in the remaining 12 cases. After surgical treatment we got an improvement in the Acetabular Index (p=0.005) and Reimers Extrusion Index (p=0.042). Neck-shaft angle and Wiberg CE angle also improved but this difference was not statically significant. Cerebral impairment was diagnosed at 2,5 years of age and the begining of walking was delayed at 2.4 years of age. Cerebral impairment can lead to an unfavourable outcome in the treatment of DDH, with the relative risk of a poor outcome being 7.2 times higher in these patients. An unfavourable outcome with conventional treatment of DDH must make us suspect the presence of some type of neurological disorder, particularly if there is a delay in walking. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Postnatal transitional weight loss and adverse outcomes in extremely premature neonates

    Directory of Open Access Journals (Sweden)

    Rita P. Verma

    2017-03-01

    Full Text Available The early postnatal weight loss (EPWL is highly variable in the extremely low birth weight infants (birth weight <1000 g, ELBW. It is reported to be unassociated with adverse outcomes within a range of 3- 21% of birth weight. Its wide range might have contributed to this lack of association. The aim of our paper is to study the effects of maximum EPWL, graded as low, medium and large on clinical outcomes in ELBW infants. In a retrospective cohort observational study EPWL was measured as maximum weight loss from birth weight (MWL in ELBW infants and grouped as low (5-12% moderate (18.1-12% and high (18-25%. The clinical course and complications of infants were compared between the groups. Gestational age (GA was highest and surfactant administration, peak inspiratory pressure requirement, fluid intake, urinary output, oxygen dependent days and the number of oxygen dependent infants at age 28 days were lower in the low MWL compared to the high MWL group. However, all these significant P-values declined after controlling for GA. Diabetes mellitus and pregnancy associated hypertension were not noted in mothers in high MWL group, whereas 38% of mothers in low MWL group suffered from the latter (P=0.05. Maximum postnatal transitional weight loss, assessed in the range of low, moderate and high, is not associated with adverse outcomes independent of gestational age in ELBW infants. Maternal hypertension decreases EPWL in them.

  8. Adult social outcomes of extremely low birth weight survivors of childhood sexual abuse.

    Science.gov (United States)

    Lund, J I; Day, K L; Schmidt, L A; Saigal, S; Van Lieshout, R J

    2016-12-01

    Preterm birth and exposure to childhood sexual abuse (CSA) are early physiological and psychological adversities that have been linked to reduced social functioning across the lifespan. However, the joint effects of being born preterm and being exposed to CSA on adult social outcomes remains unclear. We sought to determine the impact of exposure to both preterm birth and CSA on adult social functioning in a group of 179 extremely low birth weight (ELBW; 2500 g) participants in the fourth decade of life. Social outcome data from a prospective, longitudinal, population-based Canadian birth cohort initiated between the years of 1977 and 1982 were examined. At age 29-36 years, ELBW survivors who experienced CSA reported poorer relationships with their partner, worse family functioning, greater loneliness, lower self-esteem and had higher rates of avoidant personality problems than those who had not experienced CSA. Birth weight status was also found to moderate associations between CSA and self-esteem (P=0.032), loneliness (P=0.021) and family functioning (P=0.060), such that the adverse effects of CSA were amplified in ELBW survivors. Exposure to CSA appears to augment the adult social risks associated with perinatal adversity. Individuals born preterm and exposed to CSA appear to be a group at particularly high risk for adverse social outcomes in adulthood.

  9. Obesity stigma as a determinant of poor birth outcomes in women with high BMI: a conceptual framework.

    Science.gov (United States)

    DeJoy, Sharon Bernecki; Bittner, Krystle

    2015-04-01

    Obesity stigma has been linked to poor health outcomes on an individual and population basis. However, little research has been conducted on the role of chronic or recent obesity stigma in the health disparities experienced by pregnant women with high body mass index. The purpose of this article is to discuss poor birth outcomes in this population from an integrated perinatal health framework perspective, incorporating obesity stigma as a social determinant. In studies of non-pregnant populations, obesity stigma has been associated with stress, unhealthy coping strategies, psychological disorders, and exacerbations of physical illness. This article examines the mechanisms by which obesity stigma influences health outcomes and suggests how they might apply to selected complications of pregnancy, including macrosomia, preterm birth and cesarean delivery. Given the rates of obesity and associated pregnancy complications in the United States, it is critical to examine the determinants of those problems from a life course and multiple determinants perspective. This paper offers a conceptual framework to guide exploratory research in this area, incorporating the construct of obesity stigma.

  10. Caregiver-Child Verbal Interactions in Child Care: A Buffer against Poor Language Outcomes when Maternal Language Input is Less.

    Science.gov (United States)

    Vernon-Feagans, Lynne; Bratsch-Hines, Mary E

    2013-12-01

    Recent research has suggested that high quality child care can buffer young children against poorer cognitive and language outcomes when they are at risk for poorer language and readiness skills. Most of this research measured the quality of parenting and the quality of the child care with global observational measures or rating scales that did not specify the exact maternal or caregiver behaviors that might be causally implicated in the buffering of these children from poor outcomes. The current study examined the actual language by the mother to her child in the home and the verbal interactions between the caregiver and child in the child care setting that might be implicated in the buffering effect of high quality childcare. The sample included 433 rural children from the Family Life Project who were in child care at 36 months of age. Even after controlling for a variety of covariates, including maternal education, income, race, child previous skill, child care type, the overall quality of the home and quality of the child care environment; observed positive caregiver-child verbal interactions in the child care setting interacted with the maternal language complexity and diversity in predicting children's language development. Caregiver-child positive verbal interactions appeared to buffer children from poor language outcomes concurrently and two years later if children came from homes where observed maternal language complexity and diversity during a picture book task was less.

  11. Caregiver-Child Verbal Interactions in Child Care: A Buffer against Poor Language Outcomes when Maternal Language Input is Less

    Science.gov (United States)

    Vernon-Feagans, Lynne; Bratsch-Hines, Mary E.

    2013-01-01

    Recent research has suggested that high quality child care can buffer young children against poorer cognitive and language outcomes when they are at risk for poorer language and readiness skills. Most of this research measured the quality of parenting and the quality of the child care with global observational measures or rating scales that did not specify the exact maternal or caregiver behaviors that might be causally implicated in the buffering of these children from poor outcomes. The current study examined the actual language by the mother to her child in the home and the verbal interactions between the caregiver and child in the child care setting that might be implicated in the buffering effect of high quality childcare. The sample included 433 rural children from the Family Life Project who were in child care at 36 months of age. Even after controlling for a variety of covariates, including maternal education, income, race, child previous skill, child care type, the overall quality of the home and quality of the child care environment; observed positive caregiver-child verbal interactions in the child care setting interacted with the maternal language complexity and diversity in predicting children’s language development. Caregiver-child positive verbal interactions appeared to buffer children from poor language outcomes concurrently and two years later if children came from homes where observed maternal language complexity and diversity during a picture book task was less. PMID:24634566

  12. Outcome of multimodality treatment of Ewing′s sarcoma of the extremities

    Directory of Open Access Journals (Sweden)

    Tiwari Akshay

    2010-01-01

    Full Text Available Background: The management of Ewing′s sarcoma family of tumors (ESFT, Ewing′s sarcoma/primitive neuroectodermal tumor has been established as a multimodality treatment. Advances in imaging and diagnostics, chemotherapy, surgical techniques, radiotherapy and prosthetic technology have resulted in drastic changes in the outcome of this disease, with most of the recent studies having 5-year survival rates of more than 60%. The Indian patients present at a more advanced stage and the compliance of treatment is suboptimal. While there is plenty of data in the world literature on the outcome of Ewing′s sarcoma, there is paucity of data in Indian patients. Therefore, we conducted the present study to analyze the outcome of multimodality treatment of ESFT of the extremities at a tertiary nonprofit institute over a decade. Materials and Methods: 34 patients who had histopathologically proven diagnosis of Ewing′s sarcoma of the extremities and had received treatment at our institute from 1997 through 2007 were included for analysis. The majority of patients had involvement of the femur (35%, followed by tibia (17%, fibula and foot (15% each, humerus (12% and soft tissue of thigh (6%. Twenty-nine patients presented with localized disease (Enneking stage II B while five patients presented with metastases (Enneking stage III. All patients received Vincristine, Actinomycine D, Cyclofosfamide + Ifosfamide and Etoposide (VAC+IE-based chemotherapy and local treatment was offered to all but three patients having multicentric disease. The local treatment offered were, radiation (n= 15, surgery (n= 12 both surgery and radiation (n=4. All patients were analyzed for oncological outcome (event-free and overall survival, local and systemic relapses by clinical and imaging evaluation and functional outcome by using the musculoskeletal tumor society (MSTS score. These outcomes were correlated with age, sex, size of tumor, stage at presentation, modality of local

  13. CIAPIN1 nuclear accumulation predicts poor clinical outcome in epithelial ovarian cancer

    Directory of Open Access Journals (Sweden)

    Cai Xiaolan

    2012-06-01

    Full Text Available Abstract Background Epithelial ovarian cancer (EOC is an aggressive disease with poor prognosis. The expression of cytokine-induced apoptosis inhibitor 1 (CIAPIN1 correlates with the malignant progression of several cancers. However, the relationship between the subcellular localization of CIAPIN1 and clinical characteristics in EOC remains unclear. Methods Immunohistochemistry was performed to detect CIAPIN1 expression in 108 EOC tissues. CIAPIN1 expressions in eight fresh EOC tissues were detected by Western blotting. The relationship between CIAPIN1 subcellular expression and patients’ clinicopathological features, including prognosis, was evaluated. Immunohistochemistry and immunofluorescence were employed to assess the CIAPIN1 subcellular localization in the EOC cell lines A2780 and HO8910. In addition, all patients were followed up to assess the prognostic value of CIAPIN1 in patients with EOC. Results CIAPIN1 is highly expressed in EOC, but is present at low levels in paired non-cancerous ovarian epithelial tissues. The results of Western blotting were in accordance with the immunohistochemical results. Poor differentiation of the tumors and EOC cell lines correlated with higher levels of CIAPIN1 nuclear expression. CIAPIN1 nuclear expression significantly correlated with the Federation International of Gynecology and Obstetrics (FIGO stage and histological differentiation (P = 0.034 and P P  Conclusions CIAPIN1 might play a crucial role in the differentiation of EOC cells. Elevated expression of nuclear CIAPIN1 negatively correlated with the survival of EOC patients, suggesting that nuclear CIAPIN1 might serve as a prognostic biomarker for EOC patients.

  14. Cancer-associated fibroblasts predict poor outcome and promote periostin-dependent invasion in oesophageal adenocarcinoma.

    Science.gov (United States)

    Underwood, Timothy J; Hayden, Annette L; Derouet, Mathieu; Garcia, Edwin; Noble, Fergus; White, Michael J; Thirdborough, Steve; Mead, Abbie; Clemons, Nicholas; Mellone, Massimiliano; Uzoho, Chudy; Primrose, John N; Blaydes, Jeremy P; Thomas, Gareth J

    2015-02-01

    Interactions between cancer cells and cancer-associated fibroblasts (CAFs) play an important role in tumour development and progression. In this study we investigated the functional role of CAFs in oesophageal adenocarcinoma (EAC). We used immunochemistry to analyse a cohort of 183 EAC patients for CAF markers related to disease mortality. We characterized CAFs and normal oesophageal fibroblasts (NOFs) using western blotting, immunofluorescence and gel contraction. Transwell assays, 3D organotypic culture and xenograft models were used to examine the effects on EAC cell function and to dissect molecular mechanisms regulating invasion. Most EACs (93%) contained CAFs with a myofibroblastic (α-SMA-positive) phenotype, which correlated significantly with poor survival [p = 0.016; HR 7. 1 (1.7-29.4)]. Primary CAFs isolated from EACs have a contractile, myofibroblastic phenotype and promote EAC cell invasion in vitro (Transwell assays, p ≤ 0.05; organotypic culture, p < 0.001) and in vivo (p ≤ 0.05). In vitro, this pro-invasive effect is modulated through the matricellular protein periostin. Periostin is secreted by CAFs and acts as a ligand for EAC cell integrins αvβ3 and αvβ5, promoting activation of the PI3kinase-Akt pathway. In patient samples, periostin expression at the tumour cell-stromal interface correlates with poor overall and disease-free survival. Our study highlights the importance of the tumour stroma in EAC progression. Paracrine interaction between CAF-secreted periostin and EAC-expressed integrins results in PI3 kinase-Akt activation and increased tumour cell invasion. Most EACs contain a myofibroblastic CAF-rich stroma; this may explain the aggressive, highly infiltrative nature of the disease, and suggests that stromal targeting may produce therapeutic benefit in EAC patients.

  15. Elevated MED28 expression predicts poor outcome in women with breast cancer

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    Horvath Steve

    2010-06-01

    Full Text Available Abstract Background MED28 (also known as EG-1 and magicin has been implicated in transcriptional control, signal regulation, and cell proliferation. MED28 has also been associated with tumor progression in in vitro and in vivo models. Here we examined the association of MED28 expression with human breast cancer progression. Methods Expression of MED28 protein was determined on a population basis using a high-density tissue microarray consisting of 210 breast cancer patients. The association and validation of MED28 expression with histopathological subtypes, clinicopathological variables, and disease outcome was assessed. Results MED28 protein expression levels were increased in ductal carcinoma in situ and invasive ductal carcinoma of the breast compared to non-malignant glandular and ductal epithelium. Moreover, MED28 was a predictor of disease outcome in both univariate and multivariate analyses with higher expression predicting a greater risk of disease-related death. Conclusions We have demonstrated that MED28 expression is increased in breast cancer. In addition, although the patient size was limited (88 individuals with survival information MED28 is a novel and strong independent prognostic indicator of survival for breast cancer.

  16. Poor Outcomes of Complicated Pouch-Related Fistulas after Ileal Pouch-Anal Anastomosis Surgery

    DEFF Research Database (Denmark)

    Kjaer, M D; Kjeldsen, J; Qvist, N

    2016-01-01

    BACKGROUND AND AIMS: Development of a pouch-related fistula tract is an uncommon but highly morbid complication to restorative proctocolectomy with ileal pouch-anal anastomosis. Pouch failure with permanent ileostomy is reported in 21%-30% of patients, yet the factors contributing to pouch excision...... with diagnosed pouch-related fistulas were registered with information related to fistula classification, treatments, and outcome. RESULTS AND CONCLUSION: The final analysis included 48 (10.7%) of the 447 total ileal pouch-anal anastomosis patients with complicated pouch-related fistulas. Pouch-vaginal fistulas......, pouch-perianal fistulas, and other pouch-related fistulas were observed in 19 (63%), 29 (60%), and 10 (21%) patients, respectively, corresponding to an accumulated risk of 8%, 6%, and 2%, respectively. Time from ileal pouch-anal anastomosis surgery to fistula presentation was 24 (0.2-212) months...

  17. Maternal Obesity: Lifelong Metabolic Outcomes for Offspring from Poor Developmental Trajectories During the Perinatal Period.

    Science.gov (United States)

    Zambrano, Elena; Ibáñez, Carlos; Martínez-Samayoa, Paola M; Lomas-Soria, Consuelo; Durand-Carbajal, Marta; Rodríguez-González, Guadalupe L

    2016-01-01

    The prevalence of obesity in women of reproductive age is increasing in developed and developing countries around the world. Human and animal studies indicate that maternal obesity adversely impacts both maternal health and offspring phenotype, predisposing them to chronic diseases later in life including obesity, dyslipidemia, type 2 diabetes mellitus, and hypertension. Several mechanisms act together to produce these adverse health effects including programming of hypothalamic appetite-regulating centers, increasing maternal, fetal and offspring glucocorticoid production, changes in maternal metabolism and increasing maternal oxidative stress. Effective interventions during human pregnancy are needed to prevent both maternal and offspring metabolic dysfunction due to maternal obesity. This review addresses the relationship between maternal obesity and its negative impact on offspring development and presents some maternal intervention studies that propose strategies to prevent adverse offspring metabolic outcomes.

  18. Impaired High-Density Lipoprotein Anti-Oxidant Function Predicts Poor Outcome in Critically Ill Patients.

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    Lore Schrutka

    Full Text Available Oxidative stress affects clinical outcome in critically ill patients. Although high-density lipoprotein (HDL particles generally possess anti-oxidant capacities, deleterious properties of HDL have been described in acutely ill patients. The impact of anti-oxidant HDL capacities on clinical outcome in critically ill patients is unknown. We therefore analyzed the predictive value of anti-oxidant HDL function on mortality in an unselected cohort of critically ill patients.We prospectively enrolled 270 consecutive patients admitted to a university-affiliated intensive care unit (ICU and determined anti-oxidant HDL function using the HDL oxidant index (HOI. Based on their HOI, the study population was stratified into patients with impaired anti-oxidant HDL function and the residual study population.During a median follow-up time of 9.8 years (IQR: 9.2 to 10.0, 69% of patients died. Cox regression analysis revealed a significant and independent association between impaired anti-oxidant HDL function and short-term mortality with an adjusted HR of 1.65 (95% CI 1.22-2.24; p = 0.001 as well as 10-year mortality with an adj. HR of 1.19 (95% CI 1.02-1.40; p = 0.032 when compared to the residual study population. Anti-oxidant HDL function correlated with the amount of oxidative stress as determined by Cu/Zn superoxide dismutase (r = 0.38; p<0.001.Impaired anti-oxidant HDL function represents a strong and independent predictor of 30-day mortality as well as long-term mortality in critically ill patients.

  19. Impairment of heart rate recovery after peak exercise predicts poor outcome after pediatric heart transplantation.

    Science.gov (United States)

    Giardini, Alessandro; Fenton, Matthew; Derrick, Graham; Burch, Michael

    2013-09-10

    A blunted heart rate recovery (HRR) from peak exercise is associated with adverse outcome in adults with ischemic heart disease. We assessed HRR after pediatric heart transplantation (HTx) and its prognostic use. Between 2004 and 2010 we performed 360 maximal exercise tests (median, 2 tests/patient; range, 1-7) in 128 children (66 men; age at test, 14 ± 3 years) who received HTx (age, 8.5 ± 5.1 years) because of cardiomyopathy (66%) or congenital heart defects (34%). The change in heart rate from peak exercise to 1 minute of recovery was measured as HRR and was expressed as Z score calculated from reference data obtained in 160 healthy children. HRR was impaired soon after HTx (average in first 2 years Z=-1.9 ± 3.5) but improved afterward (Z=+0.52/y), such that HRR Z score normalized in most patients by 6 years after HTx (average, 0.6 ± 1.8). A subsequent decline in HRR Z score was noted from 6 years after HTx (rate of Z=-0.11/y). After 27 ± 15 months from the most recent exercise test, 19 patients died or were re-heart transplantation. For the follow-up after 6 years, HRR Z score was the only predictor of death/re-heart transplantation (P=0.003). Patients in the lowest quartile of HRR Z score had a much higher 5-year event rate (event-free rate, 29% versus 84%; hazard ratio, 7.0; P=0.0013). HRR is blunted soon after HTx but normalizes at ≈ 6 years, potentially as a result of parasympathetic reinnervation of the graft, but then declines. This late decline in HRR Z score is associated with worse outcome.

  20. Outcome of management of complicated extragonadal teratoma in a resource poor setting

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    L O Abdur-Rahman

    2013-01-01

    Full Text Available Background: Extragonadal teratomas (EXGTs are ubiquitous in the human body; hence, they have varied presentation. In underdeveloped areas presentation and management are affected by socio-economic, cultural and health facilities factors. The aim of this study was to review the outcome of management of complicated EXGT in a tertiary health centre. Materials and Methods: A review data of paediatric patients with EXGT was done between January 1999 and December 2012. Variables reviewed were bio-data, mode of presentation and site of tumour, comorbidity, treatments and outcome. The data was analysed with Statistical Package for Social Sciences (SPSS (R version 16.0. Results: There were 21 complicated EXGT (77.8% among 27 children, age ranges from 4 days to 16 years (median = 2 years. Male:Female ratio of 1:2. The complications per region of the body at presentation were cervical 4 (66.7%, mediastinal 2 (100%, abdominal 3 (75% and sacrococcygeal 12 (75%. The complications were respiratory distress 6, intestinal obstruction 5, faecal incontinence 2, bladder outlet obstruction 3, malignant transformation 5, ruptured sacrococcygeal teratoma 2, ulcerated tumour 2, anaemia 3 and malnutrition 3. There were 5 (23.8% progressive disease post-excision outside our facility. Excision biopsy was successful in 19 (85% patients two of which had neoadjuvant cytotoxic therapy. Overall mortality was 5 (23.8% (septicaemia, anaemia, respiratory distress, renal failure and post-excision mortality was 11.8% (endotracheal tube blockage and progressive disease. Conclusion: Delay presentation (due to local belief, ignorance and poverty malnutrition, sepsis, malignant transformation characterised presentation of children in this study and the lack of paediatric intensive care unit facility and intensivists compromised survival of children with EXGT.

  1. First Stars XI. Chemical composition of the extremely metal-poor dwarfs in the binary CS 22876--032

    CERN Document Server

    Hernández, J I González; Ludwig, H -G; Caffau, E; Spite, M; Spite, F; Cayrel, R; Molaro, P; Hill, V; François, P; Plez, B; Beers, T C; Sivarani, T; Andersen, J; Barbuy, B; Depagne, E; Nordström, B; Primas, F

    2007-01-01

    We have used high-resolution, high-S/N ratio spectra from the UVES spectrograph at the ESO VLT telescope. Long-term radial-velocity measurements and broad-band photometry allow us to determine improved orbital elements and stellar parameters for both components. We use OSMARCS 1D models and the {{\\scshape turbospectrum}} spectral synthesis code to determine the abundances of Li, O, Na, Mg, Al, Si, Ca, Sc, Ti, Cr, Mn, Fe, Co and Ni. We also use the CO$^5$BOLD model atmosphere code to compute the 3D abundance corrections, especially for Li and O. We find a metallicity of [Fe/H]$\\sim -3.6$ for both stars, using 1D models with 3D corrections of $\\sim -0.1$ dex from averaged 3D models. We determine the oxygen abundance from the near-UV OH bands; the 3D corrections are large, -1 and -1.5 dex for the secondary and primary respectively, and yield [O/Fe] $\\sim 0.8$, close to the high-quality results obtained from the [OI] 630 nm line in metal-poor giants. Other [$\\alpha$/Fe] ratios are consistent with those measured i...

  2. HIGH-RESOLUTION SPECTROSCOPY OF EXTREMELY METAL-POOR STARS IN THE LEAST EVOLVED GALAXIES: BOÖTES II

    Energy Technology Data Exchange (ETDEWEB)

    Ji, Alexander P.; Frebel, Anna [Department of Physics and Kavli Institute for Astrophysics and Space Research, Massachusetts Institute of Technology, Cambridge, MA 02139 (United States); Simon, Joshua D. [Observatories of the Carnegie Institution of Washington, 813 Santa Barbara St., Pasadena, CA 91101 (United States); Geha, Marla, E-mail: alexji@mit.edu [Astronomy Department, Yale University, New Haven, CT 06520 (United States)

    2016-01-20

    We present high-resolution Magellan/MIKE spectra of the four brightest confirmed red giant stars in the ultra-faint dwarf galaxy Boötes II (Boo II). These stars all inhabit the metal-poor tail of the Boo II metallicity distribution function. The chemical abundance pattern of all detectable elements in these stars is consistent with that of the Galactic halo. However, all four stars have undetectable amounts of neutron-capture elements Sr and Ba, with upper limits comparable to the lowest ever detected in the halo or in other dwarf galaxies. One star exhibits significant radial velocity variations over time, suggesting it to be in a binary system. Its variable velocity has likely increased past determinations of the Boo II velocity dispersion. Our four stars span a limited metallicity range, but their enhanced α-abundances and low neutron-capture abundances are consistent with the interpretation that Boo II has been enriched by very few generations of stars. The chemical abundance pattern in Boo II confirms the emerging trend that the faintest dwarf galaxies have neutron-capture abundances distinct from the halo, suggesting the dominant source of neutron-capture elements in halo stars may be different than in ultra-faint dwarfs.

  3. Aberrant DNA Methylation Is Associated with a Poor Outcome in Juvenile Myelomonocytic Leukemia.

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    Hirotoshi Sakaguchi

    Full Text Available Juvenile myelomonocytic leukemia (JMML, an overlap of myelodysplastic / myeloproliferative neoplasm, is an intractable pediatric myeloid neoplasm. Epigenetic regulation of transcription, particularly by CpG methylation, plays an important role in tumor progression, mainly by repressing tumor-suppressor genes. To clarify the clinical importance of aberrant DNA methylation, we studied the hypermethylation status of 16 target genes in the genomes of 92 patients with JMML by bisulfite conversion and the pryosequencing technique. Among 16 candidate genes, BMP4, CALCA, CDKN2A, and RARB exhibited significant hypermethylation in 72% (67/92 of patients. Based on the number of hypermethylated genes, patients were stratified into three cohorts based on an aberrant methylation score (AMS of 0, 1-2, or 3-4. In the AMS 0 cohort, the 5-year overall survival (OS and transplantation-free survival (TFS were good (69% and 76%, respectively. In the AMS 1-2 cohort, the 5-year OS was comparable to that in the AMS 0 cohort (68%, whereas TFS was poor (6%. In the AMS 3-4 cohort, 5-year OS and TFS were markedly low (8% and 0%, respectively. Epigenetic analysis provides helpful information for clinicians to select treatment strategies for patients with JMML. For patients with AMS 3-4 in whom hematopoietic stem cell transplantation does not improve the prognosis, alternative therapies, including DNA methyltransferase inhibitors and new molecular-targeting agents, should be established as treatment options.

  4. High expression of GPR116 indicates poor survival outcome and promotes tumor progression in colorectal carcinoma.

    Science.gov (United States)

    Yang, Li; Lin, Xiao-Lu; Liang, Wei; Fu, Seng-Wang; Lin, Wen-Feng; Tian, Xiao-Qing; Gao, Yun-Jie; Chen, Hao-Yan; Dai, Jun; Ge, Zhi-Zheng

    2017-07-18

    Previous studies have found that G-protein-coupled receptor 116 (GPR116) is a regulator of breast cancer metastasis. However, the role of GPR116 in colorectal carcinoma (CRC) carcinogenesis and progression is unknown. In this study, We found GPR116 expression was significantly up-regulated in CRC specimens compared with corresponding non-cancerous tissues. Increased GPR116 expression in CRC was correlated with histological differentiation and distant metastasis. In addition, high expression of GPR116 was significantly associated with poor overall survival of CRC patients, which was also confirmed by GSE14333, GSE17536 and GSE33113 datasets from the Gene Expression Omnibus (GEO). Furthermore, we demonstrated that the ability of proliferation and invasion of CRC cell lines HCT116 and LOVO was markedly reduced after transfected with siRNA-GPR116. Meanwhile, GPR116 may drive EMT in CRC cells through AKT/EKR signaling pathway, resulting in metastasis. Thus, GPR116 may be a novel reliable prognostic indicator and a risk factor in CRC progression.

  5. Validation of a Dutch risk score predicting poor outcome in adults with bacterial meningitis in Vietnam and Malawi.

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    Ewout S Schut

    Full Text Available We have previously developed and validated a prognostic model to predict the risk for unfavorable outcome in Dutch adults with bacterial meningitis. The aim of the current study was to validate this model in adults with bacterial meningitis from two developing countries, Vietnam and Malawi. Demographic and clinical characteristics of Vietnamese (n = 426, Malawian patients (n = 465 differed substantially from those of Dutch patients (n = 696. The Dutch model underestimated the risk of poor outcome in both Malawi and Vietnam. The discrimination of the original model (c-statistic [c] 0.84; 95% confidence interval 0.81 to 0.86 fell considerably when re-estimated in the Vietnam cohort (c = 0.70 or in the Malawian cohort (c = 0.68. Our validation study shows that new prognostic models have to be developed for these countries in a sufficiently large series of unselected patients.

  6. Evaluation of pediatric lower extremity fractures managed with external fixation: outcomes in a deployed environment.

    Science.gov (United States)

    Eichinger, Josef K; McKenzie, Colin S; Devine, John G

    2012-01-01

    External fixation of pediatric lower extremity fractures is usually reserved for severe, open fractures in polytraumatized patients, but it is often the only available treatment option for deployed military surgeons. We analyzed the outcomes and complications of 17 consecutive pediatric long bone fractures treated with external fixation at a Forward Surgical Team facility in an austere environment during Operation Enduring Freedom in Afghanistan during a 12-month period. Treatment consisted of uniplanar external fixation for 12 femoral shaft fractures (11 closed), 4 tibial shaft fractures (all open), and 1 subtrochanteric fracture (closed) in 14 males and 3 females with an average age of 7.4 years. All 17 fractures went on to union with no incidences of refracture. Complications included 1 broken pin and 3 pin site infections treated with wound care and oral antibiotics. In a deployed environment, external fixation is the treatment method of choice for lower extremity fractures by virtue of patient, environment, equipment, and mission factors. This case series validates the usage of a simple, uniplanar external fixator for a variety of open and closed pediatric long bone fractures as evidenced by the successful union rate and low number of complications.

  7. Extreme macrosomia--obstetric outcomes and complications in birthweights >5000 g.

    Science.gov (United States)

    Hehir, Mark P; Mchugh, Ann F; Maguire, Patrick J; Mahony, Rhona

    2015-02-01

    Management of extremely large birthweight infants presents challenges during the period of labour and delivery. We sought to examine outcomes in infants with extreme macrosomia (birthweight > 5000 g), at an institution where the management of labour is standardised. This is a retrospective analysis of prospectively gathered data on all infants with a birthweight >5000 g delivered at a tertiary level institution from 2008 to 2012. Details of labour characteristics and outcomes were examined; these were compared according to parity. During the study period, there were 46 128 deliveries at the hospital and 182 infants with a birthweight >5000 g, giving an incidence of 0.4%. The majority of women (133/182) were multiparous. Among nulliparas, 47% (23/49) had a vaginal delivery, while 53% (26/49) had a caesarean delivery. 86% (97/113) of multiparas had a vaginal delivery, and 14% (16/113) had a caesarean delivery. 43% (69/162) required induction of labour. This was more common in nulliparous compared with multiparous women (58% [29/49] vs 30% [40/133], P = 0.005, OR = 3.4, 95% CI = 1.7-6.6). A total of 30% (49/162) of women had their labour accelerated with oxytocin. There were higher rates of oxytocin use in nulliparas than in multiparas (55% [27/49] vs 16.5% [22/133], P macrosomia affects 0.4% of pregnancies in contemporary practice. Multiparas have a low rate of caesarean section. Infants delivered vaginally are at increased risk of shoulder dystocia and associated complications. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  8. Presence of Systemic Inflammatory Response Syndrome Predicts a Poor Clinical Outcome in Dogs with a Primary Hepatitis.

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    Scott Kilpatrick

    Full Text Available Primary hepatopathies are a common cause of morbidity and mortality in dogs. The underlying aetiology of most cases of canine hepatitis is unknown. Consequently, treatments are typically palliative and it is difficult to provide accurate prognostic information to owners. In human hepatology there is accumulating data which indicates that the presence of systemic inflammatory response syndrome (SIRS is a common and debilitating event in patients with liver diseases. For example, the presence of SIRS has been linked to the development of complications such as hepatic encephalopathy (HE and is associated with a poor clinical outcome in humans with liver diseases. In contrast, the relationship between SIRS and clinical outcome in dogs with a primary hepatitis is unknown. Seventy dogs with histologically confirmed primary hepatitis were enrolled into the study. Additional clinical and clinicopathological information including respiratory rate, heart rate, temperature, white blood cell count, sodium, potassium, sex, presence of ascites, HE score, alanine aminotransferase (ALT, alkaline phosphatase (ALP, bilirubin and red blood cell concentration were available in all cases. The median survival of dogs with a SIRS score of 0 or 1 (SIRS low was 231 days compared to a median survival of 7 days for dogs with a SIRS score of 2, 3 or 4 (SIRS high (p<0.001. A Cox proportional hazard model, which included all other co-variables, revealed that a SIRS high score was an independent predictor of a poor clinical outcome. The effect of modulating inflammation on treatment outcomes in dogs with a primary hepatitis is deserving of further study.

  9. Leiomyosarcoma with alternative lengthening of telomeres is associated with aggressive histologic features, loss of ATRX expression, and poor clinical outcome.

    Science.gov (United States)

    Liau, Jau-Yu; Tsai, Jia-Huei; Jeng, Yung-Ming; Lee, Jen-Chieh; Hsu, Hung-Han; Yang, Ching-Yao

    2015-02-01

    Leiomyosarcoma is an aggressive soft tissue sarcoma with poor patient survival. Recently, it was shown that 53% to 62% of leiomyosarcomas use the alternative lengthening of telomeres (ALT) as their telomere maintenance mechanism. The molecular basis of this mechanism has not been elucidated. Studies of pancreatic neuroendocrine tumor have suggested that the inactivation of either α-thalassemia/mental retardation syndrome X-linked (ATRX) or death domain-associated (DAXX) protein is associated with the ALT phenotype. In this study, we sought to determine the clinicopathologic features of leiomyosarcoma with the ALT phenotype and the possible relationship between this phenotype and ATRX/DAXX expression. Telomerase reverse transcriptase gene (TERT) promoter mutation analysis was also performed. Ninety-two leiomyosarcomas derived from the uterus, retroperitoneum/intra-abdomen, and various other sites were analyzed. Telomere-specific fluorescence in situ hybridization revealed that 59% (51/86) of leiomyosarcomas had the ALT phenotype. Loss of ATRX expression was observed in 33% of the tumors (30/92), and all but 2 ATRX-deficient tumors were ALT positive. Both the ALT phenotype and loss of ATRX expression were associated with epithelioid/pleomorphic cell morphology, tumor necrosis, and poor differentiation. None of the 92 cases lost DAXX expression. No TERT promoter mutation was detected (n=39). For survival analysis, poor differentiation, high FNCLCC grade, tumor size, and ALT phenotype were correlated with poor overall survival in univariate analysis. Tumor size and ALT phenotype remained independent prognostic factors in multivariate analysis. We concluded that the ALT phenotype in the leiomyosarcoma is associated with aggressive histologic features, loss of ATRX expression, and poor clinical outcome.

  10. Elevated serum creatinine and low albumin are associated with poor outcomes in patients with liposarcoma.

    Science.gov (United States)

    Panotopoulos, Joannis; Posch, Florian; Funovics, Philipp T; Willegger, Madeleine; Scharrer, Anke; Lamm, Wolfgang; Brodowicz, Thomas; Windhager, Reinhard; Ay, Cihan

    2016-03-01

    Low serum albumin levels and impaired kidney function have been associated with decreased survival in patients with a variety of cancer types. In a retrospective cohort study, we analyzed 84 patients with liposarcoma treated at from May 1994 to October 2011. Uni- and multivariable Cox proportional hazard models and competing risk analyses were performed to evaluate the association between putative biomarkers with disease-specific and overall survival. The median age of the study population was 51.7 (range 19.6-83.8) years. In multivariable analysis adjusted for AJCC tumor stage, serum creatinine was highly associated with disease-specific survival (Subdistribution Hazard ratio (SHR) per 1 mg/dl increase = 2.94; 95%CI 1.39-6.23; p = 0.005). High albumin was associated with improved overall and disease-specific survival (Hazard Ratio (HR) per 10 units increase = 0.50; 95%CI 0.26-0.95; p = 0.033 and SHR = 0.64; 95%CI 0.42-1.00; p = 0.049). The serum albumin-creatinine-ratio emerged to be associated with both overall and disease-specific survival after adjusting for AJCC tumor stage (HR = 0.95; 95%CI 0.92-0.99; p = 0.011 and SHR = 0.96; 95%CI 0.93-0.99; p = 0.08). Our study provides evidence for a tumor-stage-independent association between higher creatinine and lower albumin with worse disease-specific survival. Low albumin and a high albumin-creatinine-ratio independently predict poor overall survival. Our work identified novel prognostic biomarkers for prognosis of patients with liposarcoma.

  11. Upregulation of IGF-1R expression during neoadjuvant therapy predicts poor outcome in breast cancer patients.

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    Sandra Heskamp

    Full Text Available The insulin-like growth factor 1 receptor (IGF-1R may be involved in the development of resistance against conventional cancer treatment. The aim of this study was to assess whether IGF-1R expression of breast tumors changes during neoadjuvant therapy and to study whether these changes were associated with survival.Paraffin embedded tumor tissue was collected from pretreatment biopsies and surgical resections of 62 breast cancer patients who were treated with neoadjuvant chemotherapy or endocrine therapy. IGF-1R expression was determined immunohistochemically and compared before and after treatment.High membranous IGF-1R expression at diagnosis correlated significantly with ER positivity, low tumor stage (stage I/II and longer overall survival (p < 0.05. After neoadjuvant treatment, membranous IGF-1R expression remained the same in 41 (65% tumors, was upregulated in 11 (18% tumors and downregulated in 11 (18% tumors. Changes in membranous IGF-1R expression were associated with overall survival (log-rank test: p = 0.013, multivariate cox-regression: p = 0.086. Mean overall survival time for upregulation, no change, and downregulation in IGF-1R expression was 3.0 ± 0.5 years, 7.3 ± 1.0 years and 15.0 ± 1.8 years, respectively. Changes in other parameters were not significantly associated with survival.Neoadjuvant therapy can induce changes in IGF-1R expression. Upregulation of IGF-1R expression after neoadjuvant treatment is a poor prognostic factor in breast cancer patients, providing a rationale for incorporating anti-IGF-1R drugs in the management of these patients.

  12. RETRACTED: Downregulation of miR-204 expression correlates with poor clinical outcome of glioma patients.

    Science.gov (United States)

    Ye, Zhen-Nan; Liu, Jing-Peng; Wu, Ling-Yun; Zhang, Xiang-Sheng; Zhuang, Zong; Chen, Qiang; Lu, Yue; Liu, Ce-Gang; Zhang, Zi-Huan; Zhang, Hua-Sheng; Hou, Wen-Zhong; Hang, Chun-Hua

    2017-05-01

    Glioma is the most common type of malignant neoplasm in the central nervous system, with high incidence and mortality rate. MicroRNAs, as a class of small noncoding RNAs, play an important role in carcinogenesis and correlate with glioma diagnosis and prognosis. In this study, we investigated the microRNA-204 (miR-204) concentration in glioma tissues and its relation to the expression of ezrin and bcl-2 mRNA, as well as its potential predictive and prognostic values in glioma. The concentrations of miR-204 were significantly lower in glioma tissues than in nontumor brain tissues and also were lower in high-grade than in low-grade gliomas (World Health Organization grades III and IV versus grades I and II). The miR-204 concentration was inversely correlated with the ezrin and bcl-2 concentrations. The miR-204 concentration was classified as high or low according to the median value, and low miR-204 correlated with higher World Health Organization grade, larger tumor, and worse Karnofsky performance score. Kaplan-Meier survival analysis demonstrated that patients with low miR-204 expression had shorter progression-free survival and overall survival than patients with high miR-204 expression. In addition, univariate and multivariate analyses showed that miR-204 expression was an independent prognostic feature of overall survival and progression-free survival. In conclusion, our study indicates that miR-204 is downregulated in glioma and may be a biomarker of poor prognosis in patients with this cancer. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Alkaline Phosphatase: The Next Independent Predictor of the Poor 90-Day Outcome in Alcoholic Hepatitis

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    Beata Kasztelan-Szczerbinska

    2013-01-01

    Full Text Available Aim. Determination of risk factors relevant to 90-day prognosis in AH. Comparison of the conventional prognostic models such as Maddrey’s modified discriminant function (mDF and Child-Pugh-Turcotte (CPT score with newer ones: the Glasgow Alcoholic Hepatitis Score (GAHS; Age, Bilirubin, INR, Creatinine (ABIC score, Model for End-Stage Liver Disease (MELD, and MELD-Na in the death prediction. Patients and Methods. The clinical and laboratory variables obtained at admission were assessed. The mDF, CPT, GAHS, ABIC, MELD, and MELD-Na scores’ different areas under the curve (AUCs and the best threshold values were compared. Logistic regression was used to assess predictors of the 90-day outcome. Results. One hundred sixteen pts fulfilled the inclusion criteria. Twenty (17.4% pts died and one underwent orthotopic liver transplantation (OLT within 90 days of follow-up. No statistically significant differences in the models‘ performances were found. Multivariate logistic regression identified CPT score, alkaline phosphatase (AP level higher than 1.5 times the upper limit of normal (ULN, and corticosteroids (CS nonresponse as independent predictors of mortality. Conclusions. The CPT score, AP > 1.5 ULN, and the CS nonresponse had an independent impact on the 90-day survival in AH. Accuracy of all studied scoring systems was comparable.

  14. Endocarditis and spondylodiscitis associated with tunneled cuffed hemodialysis catheters: hospitalizations with poor outcomes.

    Science.gov (United States)

    Rocha, Ana; Castro, Rui; Santos, Josefina

    2015-04-01

    Patients undergoing chronic hemodialysis using tunneled cuffed catheters (TCCs) are at increased risk of metastatic infections, namely endocarditis and spondydodiscitis, and mortality is high in this group. The aim of this study was to determine the clinical features, causative organisms, its susceptibility and outcomes in patients hospitalized with these infections from a single center. All consecutive patients with TCC and endocarditis and/or spondylodiscitis treated at the authors' institution between 2005 and 2011 were selected retrospectively. A total of 7 cases of endocarditis and 7 cases of spondylodiscitis were diagnosed. Concurrent infection was present in 1 patient. The mean age was 63.4 years, 53.8% were male, 23% had diabetes and 31% had previous immunosuppression. The average time on hemodialysis was 24 months. Those patients with endocarditis presented with fever, and 43% had previous valvular disease; mitral valve involvement was the most common. Early surgery was performed in 2 patients.Concerning spondylodiscitis, the median time from first symptom to diagnosis was 48 days. The first manifestation was back pain in 86% percent of patients, and 71% had an epidural or paraspinous abscess demonstrated by neuroimaging. One patient underwent surgical drainage of the abscess. Regarding both infections, staphylococcus aureus was the most common causative agent with a lower rate of negative blood cultures. All patients received intravenous antibiotics for a mean duration of six weeks. The mortality rate was 46%. A high index of suspicion is critical in the early recognition and management of both of these infections.

  15. Stressful life events are associated with a poor in vitro fertilization (IVF) - outcome: a prospective study

    DEFF Research Database (Denmark)

    Ebbesen, Signe Maria Schneevoigt; Zachariae, Robert; Mehlsen, Mimi Yung

    2009-01-01

    BACKGROUND: There is preliminary evidence to suggest an impact of stress on chances of achieving a pregnancy with in-vitro fertilization (IVF). The majority of the available research has focused on stress related to infertility and going through IVF-treatment, and it is still unclear whether non......-fertility-related, naturally occurring stressors may influence IVF pregnancy chances. Our aim was to explore the association between IVF-outcome and negative, i.e. stressful, life-events during the previous 12 months. METHODS: Prior to IVF, 809 women (mean age: 31.2 years) completed the List of Recent Events (LRE......) and questionnaires measuring perceived stress and depressive symptoms. RESULTS: Women who became pregnant reported fewer non-fertility-related negative life-events prior to IVF (Mean: 2.5; SD: 2.5) than women who did not obtain a pregnancy (Mean: 3.0; SD: 3.0) (t(465.28) = 2.390, P = 0.017). Logistic regression...

  16. Perioperative neutrophil to lymphocyte ratio as a predictor of poor cardiac surgery patient outcomes

    Science.gov (United States)

    Giakoumidakis, Konstantinos; Fotos, Nikolaos V; Patelarou, Athina; Theologou, Stavros; Argiriou, Mihalis; Chatziefstratiou, Anastasia A; Katzilieri, Christina; Brokalaki, Hero

    2017-01-01

    Purpose The purpose of the present study was to investigate the association between the perioperative neutrophil to lymphocyte ratio (NLR) and cardiac surgery patient outcomes. Patients and methods A retrospective cohort study of 145 patients who underwent cardiac surgery in a tertiary hospital of Athens, Greece, from January to March 2015, was conducted. By using a structured short questionnaire, this study reviewed the electronic hospital database and the medical and nursing patient records for data collection purposes. The statistical significance was two-tailed, and p-values care unit (ICU) (p=0.002), and in-hospital (p=0.018), and likewise with delayed tracheal extubation (p≤0.001). Furthermore, patients with elevated NLR during the second postoperative day had significantly higher in-hospital mortality (p=0.018), increased incidence of pneumonia (p=0.022), higher probability of readmission to the ICU (p=0.002), prolonged ICU LOS (p≤0.001), and delayed tracheal extubation (p≤0.001). Conclusion Increased perioperative NLR seems to be associated with significantly higher mortality and morbidity in cardiac surgery patients. At the same time, NLR is a significant and inexpensive biomarker for the early identification of patients at high risk for complications. In addition, NLR levels could lead clinicians to perform measures for the optimal therapeutic patient approach. PMID:28243161

  17. Eosinophilia predicts poor clinical outcomes in recent-onset arthritis: results from the ESPOIR cohort

    Science.gov (United States)

    Guellec, Dewi; Milin, Morgane; Cornec, Divi; Tobon, Gabriel J; Marhadour, Thierry; Jousse-Joulin, Sandrine; Chiocchia, Gilles; Vittecocq, Olivier; Devauchelle-Pensec, Valérie; Saraux, Alain

    2015-01-01

    Objectives To determine the prevalence of eosinophilia in patients with recent-onset arthritis suggestive of rheumatoid arthritis (RA) and to describe their features and outcomes. Methods We performed an ancillary study of data from a French prospective multicentre cohort study monitoring clinical, laboratory and radiographic data in patients with inflammatory arthritis of 6 weeks to 6 months duration. We determined the proportion of patients with eosinophilia, defined as a count >500/mm3, at baseline and after 3 years. Features of patients with and without baseline eosinophilia were compared. Results Baseline eosinophilia was evidenced in 26 of 804 (3.2%) patients; their mean eosinophil count was 637.7±107/mm3. Baseline eosinophilia was ascribed to atopic syndrome in 6 of 26 (23.1%) patients. After 3 years, patients with eosinophilia had higher Health Assessment Questionnaire scores (0.9 vs 0.5, p=0.004), higher patient visual analogue scale activity score and morning stiffness intensity (p=0.05), and were more often taking disease-modifying antirheumatic drugs (p=0.02). Baseline eosinophilia was not associated with presence of extra-articular manifestations. Conclusions Eosinophilia is rare in recent-onset arthritis suggestive of RA, and is usually directly related to the rheumatic disease. Our data suggest that patients with mild eosinophilia at diagnosis could respond worse to the treatment than those without. PMID:26509068

  18. Perinatal Factors Associated with Poor Neurocognitive Outcome in Early School Age Congenital Diaphragmatic Hernia Survivors

    Science.gov (United States)

    Benjamin, Jennifer R.; Gustafson, Kathryn E.; Smith, P. Brian; Ellingsen, Kirsten M.; Tompkins, K. Brooke; Goldberg, Ronald N.; Cotten, C. Michael; Goldstein, Ricki F.

    2013-01-01

    Objective Determine predictors of neurocognitive outcome in early school age congenital diaphragmatic hernia (CDH) survivors. Study design Prospective study of infants with CDH at Duke University Medical Center. Neurocognitive delay (NCD) at school age (4 to 7 years) was defined as a score < 80 in any of the following areas: Verbal Scale IQ, Performance Scale IQ, Expressive Language, or Receptive Language. Logistic regression, Fisher’s exact, and the Wilcoxon rank sum test were used to examine the relationship between NCD at early school age and 6 demographic and 18 medical variables. Results Of 43 infants with CDH, twenty seven (63%) survived to hospital discharge, and 16 (59%) returned for school age testing at a median age of 4.9 years. Seven (44%) of the children evaluated had NCD. Patch repair (p=0.01), extracorporeal membrane oxygenation (ECMO; p=0.02), days on ECMO (p=0.01), days of mechanical ventilation (p=0.049), and post-operative use of inhaled nitric oxide (p=0.02) were found to be associated with NCD at early school age. Conclusions CDH survivors are at risk for neurocognitive delay persisting into school age. Perinatal factors such as patch repair and ECMO treatment may aid in identifying CDH survivors at high risk for continued learning difficulties throughout childhood. PMID:23583126

  19. Below-Knee Amputation Failure and Poor Functional Outcomes Are Higher Than Predicted in Contemporary Practice.

    Science.gov (United States)

    Columbo, Jesse A; Nolan, Brian W; Stucke, Ryland S; Rzucidlo, Eva M; Walker, Karen L; Powell, Richard J; Suckow, Bjoern D; Stone, David H

    2016-11-01

    The perceived functional benefit of below-knee amputation (BKA) must be carefully weighed against the need for potential reinterventions. This study sought to examine the contemporary clinical and functional outcomes of patients undergoing BKA in the endovascular era. All patients who underwent BKA from January 2008 to December 2014 at a single tertiary medical center were retrospectively reviewed. Demographics, comorbidities, ambulation status, and transcutaneous oximetry (TcPO2) values were recorded. Study end points included freedom from conversion to above-knee amputation (AKA), freedom from conversion to AKA or death, BKA healing, and ambulation. Statistical modeling was performed to determine associations with BKA failure. Over the study interval, 130 limbs underwent BKA in 120 patients. Transcutaneous oximetry studies were obtained in 65% (n = 85). Thirty-eight percent (n = 46) of all BKA patients went on to heal and ambulate. Twenty-five percent (n = 33) required reintervention, 24 with conversion to AKA, and 9 with BKA revision. One-year freedom from conversion to AKA was 76% and was decreased among those with lower TcPO2 levels (60% TcPO2 amputation, most patients failed to postoperatively ambulate. Those with decreased TcPO2 levels (amputation. These findings highlight the need for careful patient selection and for a shared decision-making model in this frail population.

  20. Gender-Based Analysis of Perioperative Outcomes Associated with Lower Extremity Bypass

    Science.gov (United States)

    JAIN, ASHISH K.; VELAZQUEZ-RAMIREZ, GABRIELA; GOODNEY, PHILIP P.; EDWARDS, MATTHEW S.; CORRIERE, MATTHEW A.

    2017-01-01

    We analyzed gender-based differences in preoperative factors, procedural characteristics, and 30-day outcomes after lower extremity bypass (LEB). LEB procedures were identified from the American College of Surgeons National Surgical Quality Improvement Program Participant User File. Groupwise comparisons of preoperative and procedural variables were made using chi square, t tests, and nonparametric methods; gender influences on mortality, systemic, and surgical site complications were evaluated using logistic regression. Women (4,107 of 11,011 [37.3%]) were older and had greater prevalence of hypertension, diabetes, chronic obstructive pulmonary disease, rest pain, dialysis, previous stroke, open/infected wound, and dependent functional status (P < 0.01 for all comparisons). Women more commonly underwent emergent and extra-anatomic procedures but had lower rates of venous conduit or tibial level outflow use. Univariable associations between female gender and risk of 30-day mortality, systemic, and surgical site complications were identified; only the association with surgical site complications remained significant in multivariable modeling (OR, 1.8; 95% CI, 1.6 to 2.1; P < 0.0001). Gender-based differences in demographic, comorbidity, and procedural factors may contribute to disparities in perioperative outcomes associated with LEB. Female gender may be associated with increased risk for surgical site complications, but 30-day mortality and systemic complication rates in women may reflect effects of confounding factors rather than gender-specific influence. PMID:21944345

  1. Oxygen Uptake Efficiency Slope Predicts Poor Outcome in Patients With Idiopathic Pulmonary Arterial Hypertension.

    Science.gov (United States)

    Tang, Yi; Luo, Qin; Liu, Zhihong; Ma, Xiuping; Zhao, Zhihui; Huang, Zhiwei; Gao, Liu; Jin, Qi; Xiong, Changming; Ni, Xinhai

    2017-06-30

    Few published studies have evaluated the power of the oxygen uptake efficiency slope (OUES) to predict outcomes in patients with idiopathic pulmonary arterial hypertension (IPAH), who typically die of right-sided heart failure. Our study sought to evaluate the power of OUES to predict clinical worsening and mortality in patients with IPAH. Patients with newly diagnosed IPAH who underwent symptom-limited cardiopulmonary exercise testing from November 11, 2010, to June 25, 2015, in our hospital were prospectively enrolled and followed for up to 66 months. Clinical worsening and mortality were recorded. A total of 210 patients with IPAH (159 women; mean age, 32±10 years) were studied with a median follow-up of 41 months. Thirty-one patients died, 1 patient underwent lung transplantation, and 85 patients presented with clinical worsening. The univariate analysis revealed that OUES, OUESI (OUESI=OUES/body surface area), peak oxygen uptake (V˙O2), peak V˙O2/kg, ventilation (V˙E)/carbon dioxide output (V˙CO2) slope, peak systolic blood pressure, heart rate recovery, pulmonary vascular resistance, cardiac index, N-terminal prohormone brain natriuretic peptide, and World Health Organization functional class were all predictive of clinical worsening and mortality (all P0.52 m(-2) (41.9% versus 89.8%, P<0.0001). The OUES, a submaximal parameter obtained from cardiopulmonary exercise testing, provides prognostic information for predicting clinical worsening and mortality in patients with IPAH. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  2. Integrated Classification of Prostate Cancer Reveals a Novel Luminal Subtype with Poor Outcome.

    Science.gov (United States)

    You, Sungyong; Knudsen, Beatrice S; Erho, Nicholas; Alshalalfa, Mohammed; Takhar, Mandeep; Al-Deen Ashab, Hussam; Davicioni, Elai; Karnes, R Jeffrey; Klein, Eric A; Den, Robert B; Ross, Ashley E; Schaeffer, Edward M; Garraway, Isla P; Kim, Jayoung; Freeman, Michael R

    2016-09-01

    Prostate cancer is a biologically heterogeneous disease with variable molecular alterations underlying cancer initiation and progression. Despite recent advances in understanding prostate cancer heterogeneity, better methods for classification of prostate cancer are still needed to improve prognostic accuracy and therapeutic outcomes. In this study, we computationally assembled a large virtual cohort (n = 1,321) of human prostate cancer transcriptome profiles from 38 distinct cohorts and, using pathway activation signatures of known relevance to prostate cancer, developed a novel classification system consisting of three distinct subtypes (named PCS1-3). We validated this subtyping scheme in 10 independent patient cohorts and 19 laboratory models of prostate cancer, including cell lines and genetically engineered mouse models. Analysis of subtype-specific gene expression patterns in independent datasets derived from luminal and basal cell models provides evidence that PCS1 and PCS2 tumors reflect luminal subtypes, while PCS3 represents a basal subtype. We show that PCS1 tumors progress more rapidly to metastatic disease in comparison with PCS2 or PCS3, including PSC1 tumors of low Gleason grade. To apply this finding clinically, we developed a 37-gene panel that accurately assigns individual tumors to one of the three PCS subtypes. This panel was also applied to circulating tumor cells (CTC) and provided evidence that PCS1 CTCs may reflect enzalutamide resistance. In summary, PCS subtyping may improve accuracy in predicting the likelihood of clinical progression and permit treatment stratification at early and late disease stages. Cancer Res; 76(17); 4948-58. ©2016 AACR.

  3. Health-Related Outcomes among the Poor: Medicaid Expansion vs. Non-Expansion States.

    Directory of Open Access Journals (Sweden)

    Xuesong Han

    Full Text Available States' decisions not to expand Medicaid under the Affordable Care Act (ACA could potentially affect access to care and health status among their low-income residents.The 2010-2012 nationally representative Medical Expenditure Panel Survey data were analyzed in 2015 to compare 9755 low-income adults aged 18-64 years from Medicaid-expanding states with 7455 adults from nonexpanding states. Multivariate logistic regression models were fitted to evaluate the differences in access to care, receipt of preventive services, quality of care, attitudes about health and self-reported health status by Medicaid expansion status. The differences in care utilization and medical expenditures between the two groups were examined using a 2-part modeling approach.Compared to their counterparts in Medicaid expansion states, low income adults in the nonexpanding states were more likely to be black and reside in rural areas and were less likely to have a usual source of care (prevalence ratio[PR] 0.86, 95% confidence interval[CI] 0.82-0.91 and recommended preventive services such as dental checkups (PR = 0.86; CI = 0.79-0.94, routine checks (PR = 0.89; CI = 0.83-0.95, flu vaccinations (PR = 0.89; CI = 0.81-0.98, and blood pressure checks (PR = 0.96; CI = 0.94-0.99. They also had less care utilization, fewer prescriptions, and less medical expenditures, but more out-of-pocket expenditures (all p-value <0.05.Low-income adults in Medicaid nonexpanding states, who are disproportionately represented by blacks and rural residents, were worse off for multiple health-related outcomes compared to their counterparts in Medicaid expanding states at the baseline of ACA implementation, suggesting that low income adults residing in nonexpanding states may benefit markedly from the expansion of Medicaid.

  4. Factors Leading to a Poor Functional Outcome in Spinal Meningioma Surgery: Remarks on 173 Cases.

    Science.gov (United States)

    Raco, Antonino; Pesce, Alessandro; Toccaceli, Giada; Domenicucci, Maurizio; Miscusi, Massimo; Delfini, Roberto

    2017-04-01

    Spinal meningiomas are common spinal tumors, in most cases benign and with a good surgical prognosis. However, specific location, infiltration of spinal cord, vascular encasement, or spinal root involvement can bring a less favorable prognosis. To correlate these data with clinical/functional outcome. Two hundred twenty-four consecutive patients with spinal meningiomas treated from 1976 to 2013 in our institution were analyzed; among these, 51 were excluded for incomplete clinical data or follow-up. The remaining 173 cases were classified in regards to sex, age, symptoms, axial location, Simpson grade resection, and functional pre-/postoperative status. Most recurring onset symptoms were pain (32.9%) and motor deficit (31.8%); thoracic spine was the most severely affected (69.8%). Functional improvement on the follow-up was observed in 86.7% of cases; 6.4% of patients resulted stable and 6.9% worsened. A low functional grade before surgery was connected to a lesser improvement after. Anterolateral meningiomas were the most represented (42.2%); a gross total resection (Simpson grades I and II) was conducted in 98.8%, and a macroscopically complete removal without dural resection or coagulation (Simpson grade III) was performed in 1.2%. Of the meningiomas, 98.3% were classified as WHO grade I. Recurrence rate was 2.3%, and 7 cases presented complications (4 of 7 required surgical procedure). We can affirm that negative prognostic factors in our study were anterior or anterolateral axial location, prolonged presentation before diagnosis, WHO grade >I, Simpson grade resections II and III, sphincter involvement, and worse functional grade at onset.

  5. Urinary L-FABP predicts poor outcomes in critically ill patients with early acute kidney injury.

    Science.gov (United States)

    Parr, Sharidan K; Clark, Amanda J; Bian, Aihua; Shintani, Ayumi K; Wickersham, Nancy E; Ware, Lorraine B; Ikizler, T Alp; Siew, Edward D

    2015-03-01

    Biomarker studies for early detection of acute kidney injury (AKI) have been limited by nonselective testing and uncertainties in using small changes in serum creatinine as a reference standard. Here we examine the ability of urine L-type fatty acid-binding protein (L-FABP), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), and kidney injury molecule-1 (KIM-1) to predict injury progression, dialysis, or death within 7 days in critically ill adults with early AKI. Of 152 patients with known baseline creatinine examined, 36 experienced the composite outcome. Urine L-FABP demonstrated an area under the receiver-operating characteristic curve (AUC-ROC) of 0.79 (95% confidence interval 0.70-0.86), which improved to 0.82 (95% confidence interval 0.75-0.90) when added to the clinical model (AUC-ROC of 0.74). Urine NGAL, IL-18, and KIM-1 had AUC-ROCs of 0.65, 0.64, and 0.62, respectively, but did not significantly improve discrimination of the clinical model. The category-free net reclassification index improved with urine L-FABP (total net reclassification index for nonevents 31.0%) and urine NGAL (total net reclassification index for events 33.3%). However, only urine L-FABP significantly improved the integrated discrimination index. Thus, modest early changes in serum creatinine can help target biomarker measurement for determining prognosis with urine L-FABP, providing independent and additive prognostic information when combined with clinical predictors.

  6. Loss of cell-surface laminin anchoring promotes tumor growth and is associated with poor clinical outcomes.

    Science.gov (United States)

    Akhavan, Armin; Griffith, Obi L; Soroceanu, Liliana; Leonoudakis, Dmitri; Luciani-Torres, Maria Gloria; Daemen, Anneleen; Gray, Joe W; Muschler, John L

    2012-05-15

    Perturbations in the composition and assembly of extracellular matrices (ECM) contribute to progression of numerous diseases, including cancers. Anchoring of laminins at the cell surface enables assembly and signaling of many ECMs, but the possible contributions of altered laminin anchoring to cancer progression remain undetermined. In this study, we investigated the prominence and origins of defective laminin anchoring in cancer cells and its association with cancer subtypes and clinical outcomes. We found loss of laminin anchoring to be widespread in cancer cells. Perturbation of laminin anchoring originated from several distinct defects, which all led to dysfunctional glycosylation of the ECM receptor dystroglycan. In aggressive breast and brain cancers, defective laminin anchoring was often due to suppressed expression of the glycosyltransferase LARGE. Reduced expression of LARGE characterized a broad array of human tumors in which it was associated with aggressive cancer subtypes and poor clinical outcomes. Notably, this defect robustly predicted poor survival in patients with brain cancers. Restoring LARGE expression repaired anchoring of exogenous and endogenous laminin and modulated cell proliferation and tumor growth. Together, our findings suggest that defects in laminin anchoring occur commonly in cancer cells, are characteristic of aggressive cancer subtypes, and are important drivers of disease progression.

  7. Predictors of Poor Pregnancy Outcomes Among Antenatal Care Attendees in Primary Health Care Facilities in Cross River State, Nigeria: A Multilevel Model.

    Science.gov (United States)

    Ameh, Soter; Adeleye, Omokhoa A; Kabiru, Caroline W; Agan, Thomas; Duke, Roseline; Mkpanam, Nkese; Nwoha, Doris

    2016-08-01

    Objectives Pregnancy carries a high risk for millions of women and varies by urban-rural location in Nigeria, a country with the second highest maternal deaths in the world. Addressing multilevel predictors of poor pregnancy outcomes among antenatal care (ANC) attendees in primary health care (PHC) facilities could reduce the high maternal mortality rate in Nigeria. This study utilised the "Risk Approach" strategy to (1) compare the risks of poor pregnancy outcomes among ANC attendees by urban-rural location; and (2) determine predictors of poor pregnancy outcomes among ANC attendees in urban-rural PHC facilities in Cross River State, Nigeria. Methods A cross-sectional survey was conducted in 2011 among 400 ANC attendees aged 15-49 years recruited through multistage sampling. Data on risk factors of poor pregnancy outcomes were collected using interviewer-administered questionnaires and clinic records. Respondents were categorised into low, medium or high risk of poor pregnancy outcomes, based on their overall risk scores. Predictors of poor pregnancy outcomes were determined by multilevel ordinal logistic regression. Results A greater proportion of the women in the rural areas were below the middle socio-economic quintile (75 vs. 4 %, p facilities had a low overall risk of poor pregnancy outcomes than those in the rural facilities (64 vs. 50 %, p = 0.034). Pregnant women in the urban areas had decreased odds of being at high risk of poor pregnancy outcomes versus the combined medium and low risks compared with those in the rural areas (OR 0.55, 95 % CI 0.09-0.65). Conclusions for Practice Pregnant women attending antenatal care in rural PHC facilities are more at risk of poor pregnancy outcomes than those receiving care in the urban facilities. Health programmes that promote safe pregnancy should target pregnant women in rural settings.

  8. Malaria infection, poor nutrition and indoor air pollution mediate socioeconomic differences in adverse pregnancy outcomes in Cape Coast, Ghana.

    Directory of Open Access Journals (Sweden)

    Adeladza K Amegah

    Full Text Available BACKGROUND: The epidemiological evidence linking socioeconomic deprivation with adverse pregnancy outcomes has been conflicting mainly due to poor measurement of socioeconomic status (SES. Studies have also failed to evaluate the plausible pathways through which socioeconomic disadvantage impacts on pregnancy outcomes. We investigated the importance of maternal SES as determinant of birth weight and gestational duration in an urban area and evaluated main causal pathways for the influence of SES. METHODS: A population-based cross-sectional study was conducted among 559 mothers accessing postnatal services at the four main health facilities in Cape Coast, Ghana in 2011. Information on socioeconomic characteristics of the mothers was collected in a structured questionnaire. RESULTS: In multivariate linear regression adjusting for maternal age, parity and gender of newborn, low SES resulted in 292 g (95% CI: 440-145 reduction in birth weight. Important SES-related determinants were neighborhood poverty (221 g; 95% CI: 355-87, low education (187 g; 95% CI: 355-20, studentship during pregnancy (291 g; 95% CI: 506-76 and low income (147 g; 95% CI: 277-17. In causal pathway analysis, malaria infection (6-20%, poor nutrition (2-51% and indoor air pollution (10-62% mediated substantial proportions of the observed effects of socioeconomic deprivation on birth weight. Generalized linear models adjusting for confounders indicated a 218% (RR: 3.18; 95% CI: 1.41-7.21 risk increase of LBW and 83% (RR: 1.83; 95% CI: 1.31-2.56 of PTB among low income mothers. Low and middle SES was associated with 357% (RR: 4.57; 95% CI: 1.67-12.49 and 278% (RR: 3.78; 95% CI: 1.39-10.27 increased risk of LBW respectively. Malaria infection, poor nutrition and indoor air pollution respectively mediated 10-21%, 16-44% and 31-52% of the observed effects of socioeconomic disadvantage on LBW risk. CONCLUSION: We provide evidence of the effects of socioeconomic deprivation

  9. Outcome of oscillating saw open osteotomy in two-stage lower extremity bone transport with monolateral frame.

    Science.gov (United States)

    Corona, Pablo S; Ramirez-Nuñez, Luis J; Amat, Carles; Carrera, Luis

    2017-07-25

    Bone transport techniques have been widely used to solve massive bone defects due to trauma, osteomyelitis or bone tumors. The technique of bone interruption to achieve better new bone formation is a subject of debate. Low-energy osteotomy (LEO) techniques have been proposed as the gold standard. Some authors reject open osteotomy with an oscillating saw (OOS osteotomy), based on the danger of bone tissue thermal necrosis and periosteal damage. To date, however, there is no strong clinical evidence to discourage this high-energy (HEO) bone interruption technique. The aim of this study was to determine outcomes in using OOS osteotomy in a series of patients, where monolateral-frame bone transport has been used to resolve segmental bone defects of the lower extremity. The minimum accepted follow-up was 1 year. The primary endpoints were radiographic evidence of regenerated bone quality (Li classification) and final outcome (Cattaneo clinical system assessment). Further, we analyzed associated complications, and compared results with other published series. We hypothesized that OOS osteotomy produces results no less favorable than those achieved with other, low-energy techniques. A total of 54 patients, with an average bone defect of 8.58cm (CI95% 7.01-10.16), were enrolled in the study. In terms of regeneration quality, 84% of the regenerated segment shapes were associated with good outcomes; only 16% exhibited a shape (hypotrophic) predictive of a poor outcome. Regarding functional assessment, following the Cattaneo system, we found a total of 90% good or excellent results. Finally, the Bone Healing Index (BHI) in our series averaged 21.09 days per cm. The main complication observed was pin-track infection, occurring in 45% of the cases. According our data, the superiority of an LEO technique over HEO techniques is yet to be confirmed; it appears that any open osteotomy is effective, performed well and in a proper clinical setting, and that many factors other than

  10. Abundance analysis of SDSS J134338.67+484426.6; an extremely metal-poor star from the MARVELS pre-survey

    Science.gov (United States)

    Susmitha Rani, A.; Sivarani, T.; Beers, T. C.; Fleming, S.; Mahadevan, S.; Ge, J.

    2016-05-01

    We present an elemental-abundance analysis of an extremely metal-poor (EMP; [Fe/H] EMP stars that are this bright or brighter. Our high-resolution spectroscopic analysis shows that this star is a subgiant with [Fe/H] = -3.42, having `normal' carbon and no enhancement of neutron-capture abundances. Strontium is underabundant, [Sr/Fe] = -0.47, but the derived lower limit on [Sr/Ba] indicates that Sr is likely enhanced relative to Ba. This star belongs to the sparsely populated class of α-poor EMP stars that exhibit low ratios of [Mg/Fe], [Si/Fe], and [Ca/Fe] compared to typical halo stars at similar metallicity. The observed variations in radial velocity from several epochs of (low- and high-resolution) spectroscopic follow-up indicate that SDSS J134338.67+484426.6 is a possible long-period binary. We also discuss the abundance trends in EMP stars for r-process elements, and compare with other magnesium-poor stars.

  11. Type 2 diabetes mellitus and obesity are independent risk factors for poor outcome in patients with high-grade glioma.

    Science.gov (United States)

    Chambless, Lola B; Parker, Scott L; Hassam-Malani, Laila; McGirt, Matthew J; Thompson, Reid C

    2012-01-01

    Type 2 diabetes mellitus (DM) and obesity are known risk factors for poor outcomes in patients with systemic malignancies but are not well-studied in the brain tumor population. In this study we asked if type 2 DM and elevated body mass index (BMI) are independent risk factors for poor prognosis in patients with high-grade glioma (HGG.). We conducted a retrospective cohort study of 171 patients surgically treated for HGG at a single institution. BMI and records of pre-existing type 2 DM were obtained from medical histories. Variables associated with survival in a univariate analysis were included in the multivariate Cox model if P 0.05 were then removed from the multivariate model in a step-wise fashion. Mean age at diagnosis was 55.0 ± 17.3 years. Fifteen (8.8%) patients had a history of type 2 DM. Fifty-eight (35.8%) patients had a BMI 30. Radiation therapy, temozolomide, and higher KPS score were independently associated with prolonged survival while increasing age was associated with decreased survival. DM (P = 0.001) and increasing BMI (P = 0.003) were found to be independently associated with decreased survival. Diabetics had a decreased median overall survival (312 vs. 470 days, P = 0.003) and PFS (106 vs. 166 days, P = 0.04) compared to non-diabetics. Increasing BMI (30) was also associated with decreased median PFS: 195 vs. 165 vs. 143 days, respectively. Pre-existing DM and elevated BMI are independent risk factors for poor outcome in patients with HGG.

  12. The Surgical Treatment and Outcome of Nonmetastatic Extremity Osteosarcoma with Pathological Fractures

    Institute of Scientific and Technical Information of China (English)

    Zhi-Ping Deng; Yi Ding; Ajay Puri; Edward H M Wang; Ashish Gulia; Claire Durban; Xiao-Hui Niu

    2015-01-01

    Background:Recent studies have suggested that the presence of a pathological fracture does not impact on oncologic outcomes and the feasibility of limb salvage surgery (LSS) in appropriately selected patients when combined with neoadjuvant chemotherapy.These have largely been single institutional studies with limited numbers.The Eastern Asian Musculoskeletal Oncology Group reviewed the data from three large volume Asian orthopedic oncology centers to determine whether the presence of a pathologic fracture affected outcomes in osteosarcoma patients.Methods:A retrospective review of the data was conducted.Ninety-five cases ofnonmetastatic extremity osteosarcoma with a pathological fracture and 887 cases without fracture treated during the same period were compared.Results:In the fracture group,the LSS rate was 62.1%,and the rate of amputation was 37.9%.In the nonfracture group,the LSS rate was 74.7%,and the amputation was 25.3%.In patients with a pathologic fracture,the rate of local recurrence for LSS and amputation groups was 8.5% and 2.8%,respectively.In this group,the 5-year survival in the LSS group was 66% as against.46.8% in the amputation group.Conclusions:Our study suggests that surgically treated patients with pathologic fractures in osteosarcoma have adequate local control and do not have a poorer outcome compared to patients without a fracture.Though osteosarcoma with a pathologic fracture is not a contraindication for limb salvage,appropriate case selection is important when deciding local control options to ensure adequate oncologic clearance.

  13. Extremely low frequency electromagnetic field exposure affects fertilization outcome in swine animal model.

    Science.gov (United States)

    Bernabò, N; Tettamanti, E; Russo, V; Martelli, A; Turriani, M; Mattoli, M; Barboni, B

    2010-06-01

    Modern society continuously exposes the population to electromagnetic radiation, the effects of which on human health, in particular reproduction, are still unknown. The aim of this research was to assess the effect of acute (1h) exposure of boar spermatozoa to a 50 Hz extremely low frequency electromagnetic field (ELF-EMF) on early fertility outcome. The effect of intensities ranging from 0 to 2 mT on morpho-functional integrity of capacitated spermatozoa was examined in vitro. The oviducts containing or without spermatozoa were then exposed to the minimum in vivo, TD(50,) and maximum intensities determined in vitro, 4h before ovulation. The effects of ELF-EMF on spermatozoa in terms of early embryo development were evaluated after 12h and 6 days. It was found that in vitro ELF-EMF > 0.5 mT induced a progressive acrosome damage, thus compromising the ability of spermatozoa to undergo acrosomal reaction after zona pellucida stimulation and reducing the in vitro fertilization outcome. These effects became evident at 0.75 mT and reached the plateau at 1 mT. Under in vivo conditions, the ELF-EMF intensity of 1 mT was able to compromise sperm function, significantly reducing the fertilization rate. In addition, the exposure of oviducts to fields > or = 0.75 mT in the absence of spermatozoa was able to negatively affect early embryo development. In fact, it was found to cause a slowdown in the embryo cleavage. In conclusion, it was demonstrated how and at which intensities ELF-EMF negatively affect early fertility outcome in a highly predictive animal model.

  14. Increasing F2-isoprostanes in the first month after birth predicts poor respiratory and neurodevelopmental outcomes in very preterm infants

    Science.gov (United States)

    Matthews, MA; Aschner, JL; Stark, AR; Moore, PE; Slaughter, JC; Steele, S; Beller, A; Milne, GL; Settles, O; Chorna, O; Maitre, NL

    2017-01-01

    OBJECTIVE This study examined the association between increased early oxidative stress, measured by F2-isoprostanes (IsoPs), and respiratory morbidity at term equivalent age and neurological impairment at 12 months of corrected age (CA). STUDY DESIGN Plasma samples were collected from 136 premature infants on days 14 and 28 after birth. All participants were infants born at ≤28 weeks of gestational age enrolled into the Prematurity and Respiratory Outcomes Program (PROP) study. Respiratory morbidity was determined at 40 weeks of postmenstrual age (PMA) by the Respiratory Severity Index (RSI), a composite measure of oxygen and pressure support. Neurodevelopmental assessment was performed using the Developmental Assessment of Young Children (DAYC) at 12 months of CA. Multivariable logistic regression models estimated associations between IsoP change, RSI and DAYC scores. Mediation analysis was performed to determine the relationship between IsoPs and later outcomes. RESULTS Developmental data were available for 121 patients (90% of enrolled) at 12 months. For each 50-unit increase in IsoPs, regression modeling predicted decreases in cognitive, communication and motor scores of − 1.9, − 1.2 and − 2.4 points, respectively (Ppreterm infants at risk for respiratory morbidity at term equivalent age and worse developmental outcomes at 12 months of CA. Poor neurodevelopment is largely independent of respiratory morbidity. PMID:27171764

  15. The Value of Pain Coping Constructs in Subcategorising Back Pain Patients according to Risk of Poor Outcome

    Directory of Open Access Journals (Sweden)

    Nicholas Harland

    2013-01-01

    Full Text Available Background. Subcategorising patients with chronic low back pain (CLBP could improve patient outcomes and facilitate prioritisation of treatment resources. Objective. This study aimed to develop a subcategorising method for individuals with CLBP using the Coping Strategies Questionnaire 24 (CSQ24 and to investigate the methods potential validity. Methods. 196 patients were recruited from a physiotherapy outpatients department. All participants completed a battery of questionnaires before and after treatment including the CSQ24 and a measure of pain, disability, and mood. At discharge participants also completed a global subjective outcomes scale consisting of a 6-point Likert scale. All participants received usual physiotherapy. Results. Cut-off values for the CSQ24 were calculated using triangulation of the findings from three different statistical methods. Cut-off values were identified for the Catastrophising and Cognitive Coping subscales of the CSQ24. Participants were categorised into low, medium, and high risk of a poor outcome. The cut-off values for these were ≥21 on Cognitive Coping and ≤9 on Catastrophising for low risk and ≤15 on Cognitive Coping for high risk, with all other patients being classified as being at moderate risk. Conclusion. Further validation is required before this approach can be recommended for clinical practice.

  16. Sarcomatoid mesothelioma: future advances in diagnosis, biomolecular assessment, and therapeutic options in a poor-outcome disease.

    Science.gov (United States)

    Galetta, Domenico; Catino, Annamaria; Misino, Andrea; Logroscino, Antonio; Fico, Maria

    2016-01-01

    Malignant pleural mesothelioma (MPM) is the most frequent pleural neoplasm, with asbestos exposure as one of the recognized carcinogen agents, causative in 80% of cases. The prognosis is poor; median survival of untreated cases is 6-9 months, with fewer than 5% of patients surviving 5 years. Sarcomatoid mesothelioma (SM) represents the subtype with the worst outcome and median survival ranging from 3.5 to 8 months. In the last few years, an accurate differentiation between the subtypes of MPM has become a crucial issue, due to differences in chemosensitivity and clinical outcome, and several studies have evaluated different immunohistochemical markers to better define the diagnosis. The different and worse outcome of patients with SM and, in general, nonepithelioid subtypes makes it intriguing to select these cases to better study the biomolecular profile in order to find factors linked to prognosis and/or predictive of therapeutic response. Considering recent studies on miRNA and genetic mapping, further investigation of this rare subtype might represent a field for basic and clinical-translational research providing for more tailored therapies.

  17. Short- and Long-term Pulmonary Outcome of Palivizumab in Children Born Extremely Prematurely.

    Science.gov (United States)

    Prais, Dario; Kaplan, Eytan; Klinger, Gil; Mussaffi, Huda; Mei-Zahav, Meir; Bar-Yishay, Ephraim; Stafler, Patrick; Steuer, Guy; Sirota, Lea; Blau, Hannah

    2016-03-01

    Palivizumab reduces the severity of respiratory syncytial virus infection in premature infants, but whether there is a protective effect beyond the preschool age is unknown. This study sought to assess the short- and long-term effects of palivizumab immunization on respiratory morbidity and pulmonary function at school age in children born extremely prematurely. Infants born before 29 weeks' gestation in 2000 to 2003 were assessed at school age by parental questionnaire, hospital chart review, and lung function tests. Children born immediately before the introduction of routine palivizumab prophylaxis were compared with age-matched children who received palivizumab prophylaxis during the first respiratory syncytial virus season. Sixty-three children with a mean age 8.9 years were included: 30 had received palivizumab and 33 had not (control subjects). The groups were similar in terms of gestational age, birth weight, need for mechanical ventilation, and oxygen supplementation. Fifty-three percent of the palivizumab group, compared with 39% of the control group, had bronchopulmonary dysplasia (P = .14). Wheezing occurred in the first 2 years of life in 27% of the palivizumab group and in 70% of control subjects (P = .008); respective hospitalization rates were 33% and 70% (P = .001). At school age, rates of hyperresponsiveness (provocative concentration leading to a 20% fall in FEV1 < 1 mg/mL) were 33% and 48%, respectively (P = .38). Spirometry, lung volumes, diffusion, and exhaled nitric oxide were within normal limits, with no significant differences between groups. Palivizumab prophylaxis was associated with reduced wheezing episodes and hospitalizations during the first 2 years of life in children born extremely prematurely. However, it did not affect pulmonary outcome at school age. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  18. Prior contralateral amputation predicts worse outcomes for lower extremity bypasses performed in the intact limb

    Science.gov (United States)

    Baril, Donald T.; Goodney, Philip P.; Robinson, William P.; Nolan, Brian W.; Stone, David H.; Li, YouFu; Cronenwett, Jack L.; Schanzer, Andres

    2013-01-01

    Introduction To date, history of a contralateral amputation as a potential predictor of outcomes after lower extremity bypass (LEB) for critical limb ischemia (CLI) has not been studied. We sought to determine if a prior contralateral lower extremity amputation predicts worse outcomes in patients undergoing LEB in the remaining intact limb. Methods A retrospective analysis of all patients undergoing infrainguinal LEB for CLI between 2003 and 2010 within hospitals comprising the Vascular Study Group of New England was performed. Patients were stratified according to whether or not they had previously undergone a contralateral major or minor amputation before LEB. Primary end points included major amputation and graft occlusion at 1 year postoperatively. Secondary end points included in-hospital major adverse events, discharge status, and mortality at 1 year. Results Of 2636 LEB procedures, 228 (8.6%) were performed in the setting of a prior contralateral amputation. Patients with a prior amputation compared to those without were younger (66.5 vs 68.7; P = .034), more like to have congestive heart failure (CHF; 25% vs 16%; P = .002), hypertension (94% vs 85%; P = .015), renal insufficiency (26% vs 14%; P = .0002), and hemodialysis-dependent renal failure (14% vs 6%; P = .0002). They were also more likely to be nursing home residents (8.0% vs 3.6%; P = .036), less likely to ambulate without assistance (41% vs 80%; P amputation experienced increased rates of graft occlusion (38% vs 17%; P amputation (16% vs 7%; P amputation was an independent predictor of both major amputation (odds ratio, 1.73; confidence interval, 1.06–2.83; P = .027) and graft occlusion (odds ratio, 1.93; confidence interval, 1.39–2.68; P amputations who present with CLI in the intact limb represent a high-risk population, even among patients with advanced peripheral arterial disease. When considering LEB in this setting, both physicians and patients should expect increased rates of

  19. Decreased uric acid levels correlate with poor outcomes in acute ischemic stroke patients, but not in cerebral hemorrhage patients.

    Science.gov (United States)

    Wu, Hongliang; Jia, Qian; Liu, Gaifen; Liu, Liping; Pu, Yuehua; Zhao, Xingquan; Wang, Chunxue; Wang, Yilong; Wang, Yongjun

    2014-03-01

    The relationship between uric acid and stroke prognosis is ambiguous. Some studies have explored this relationship in acute stroke but have different results. In this study, we explored the relationship between uric acid levels and 1-year outcomes and vascular events of acute ischemic stroke patients and cerebral hemorrhage patients. In all, 1452 continued first, acute ischemic stroke patients and 380 continued cerebral hemorrhage patients were admitted to our hospitals. Serum uric acid concentrations were measured in 1351 ischemic stroke patients and 380 cerebral hemorrhage patients at admission. We evaluated the relationship between uric acid levels and outcomes (modified Rankin scale [mRS] > 2, all-cause death, vascular events, stroke recurrent) at 14 days, 90 days, and 1 year after stroke onset. The median uric acid concentration was 303.0 μmol/L in ischemic stroke patients and 269 μmol/L in cerebral hemorrhage patients. In univariate analysis, uric acid levels were not correlated with outcomes in cerebral hemorrhage patients. We used multiple logistic regression analysis to show that lower serum uric acid levels independently predicted poor functional outcomes (mRS >2) at 1 year after ischemic stroke onset (odds ratio [OR] = .335, 95% confidence interval [CI]: .164-.684, P = .003). Also, lower serum uric acid levels were independently correlated with vascular events in the first year in ischemic stroke patients. By multiple cox proportional hazards analysis, we obtained data which reveal that serum uric acid levels were not correlated with all-cause death (OR = .992, 95% CI: .683-1.443, P = .969) in ischemic stroke patients. Serum uric acid may be neuroprotective in acute ischemic stroke patients. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  20. Poor outcomes in a cohort of HIV-infected adolescents undergoing treatment for multidrug-resistant tuberculosis in Mumbai, India.

    Directory of Open Access Journals (Sweden)

    Petros Isaakidis

    Full Text Available BACKGROUND: Little is known about the treatment of multidrug-resistant tuberculosis (MDR-TB in HIV-co-infected adolescents. This study aimed to present the intermediate outcomes of HIV-infected adolescents aged 10-19 years receiving second-line anti-TB treatment in a Médecins Sans Frontières (MSF project in Mumbai, India. METHODS: A retrospective review of medical records of 11 adolescents enrolled between July 2007 and January 2013 was undertaken. Patients were initiated on either empirical or individualized second-line ambulatory anti-TB treatment under direct observation. RESULTS: The median age was 16 (IQR 14-18 years and 54% were female. Five (46% adolescents had pulmonary TB (PTB, two (18% extrapulmonary disease (EPTB and four (36% had both. Median CD4 count at the time of MDR-TB diagnosis was 162.7 cells/µl (IQR: 84.8-250.5. By January 2013, eight patients had final and 3 had interim outcomes. Favourable results were seen in four (36.5% patients: one was cured and three were still on treatment with negative culture results. Seven patients (64% had poor outcomes: four (36.5% died and three (27% defaulted. Three of the patients who died never started on antiretroviral and/or TB treatment and one died 16 days after treatment initiation. Two of the defaulted died soon after default. All patients (100% on-treatment experienced adverse events (AEs: two required permanent discontinuation of the culprit drug and two were hospitalized due to AEs. No patient required permanent discontinuation of the entire second-line TB or antiretroviral regimens. CONCLUSIONS: Early mortality and mortality after default were the most common reasons for poor outcomes in this study. Early mortality suggests the need for rapid diagnosis and prompt treatment initiation, and adolescents might benefit from active contact-tracing and immediate referral. Default occurred at different times, suggesting the need for continuous, intensified and individualized psychosocial

  1. Decreased expression of RNA interference machinery, Dicer and Drosha, is associated with poor outcome in ovarian cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Merritt, William M.; Lin, Yvonne G.; Han, Liz Y.; Kamat, Aparna A.; Spannuth, Whitney A.; Schmandt, Rosemarie; Urbauer, Diana; Pennacchio, Len A.; Cheng, Jan-Fang; Zeidan, Alexandra; Wang, Hua; Mueller, Peter; Lenburg, Marc E.; Gray, Joe W.; Mok, Samuel; Birrer, Michael J.; Lopez-Berestein, Gabriel; Coleman, Robert L.; Bar-Eli, Menashe; Sood, Anil K.

    2008-05-06

    The clinical and functional significance of RNA interference (RNAi) machinery, Dicer and Drosha, in ovarian cancer is not known and was examined. Dicer and Drosha expression was measured in ovarian cancer cell lines (n=8) and invasive epithelial ovarian cancer specimens (n=111) and correlated with clinical outcome. Validation was performed with previously published cohorts of ovarian, breast, and lung cancer patients. Anti-Galectin-3 siRNA and shRNA transfections were used for in vitro functional studies. Dicer and Drosha mRNA and protein levels were decreased in 37% to 63% of ovarian cancer cell lines and in 60% and 51% of human ovarian cancer specimens, respectively. Low Dicer was significantly associated with advanced tumor stage (p=0.007), and low Drosha with suboptimal surgical cytoreduction (p=0.02). Tumors with both high Dicer and Drosha were associated with increased median patient survival (>11 years vs. 2.66 years for other groups; p<0.001). In multivariate analysis, high Dicer (HR=0.48; p=0.02), high-grade histology (HR=2.46; p=0.03), and poor chemoresponse (HR=3.95; p<0.001) were identified as independent predictors of disease-specific survival. Findings of poor clinical outcome with low Dicer expression were validated in separate cohorts of cancer patients. Galectin-3 silencing with siRNA transfection was superior to shRNA in cell lines with low Dicer (78-95% vs. 4-8% compared to non-targeting sequences), and similar in cell lines with high Dicer. Our findings demonstrate the clinical and functional impact of RNAi machinery alterations in ovarian carcinoma and support the use of siRNA constructs that do not require endogenous Dicer and Drosha for therapeutic applications.

  2. CD44 enhances tumor formation and lung metastasis in experimental osteosarcoma and is an additional predictor for poor patient outcome.

    Science.gov (United States)

    Gvozdenovic, Ana; Arlt, Matthias J E; Campanile, Carmen; Brennecke, Patrick; Husmann, Knut; Li, Yufei; Born, Walter; Muff, Roman; Fuchs, Bruno

    2013-04-01

    Formation of metastases in the lungs is the major cause of death in patients suffering from osteosarcoma (OS). Metastases at presentation and poor response to preoperative chemotherapy are strong predictors for poor patient outcome. The elucidation of molecular markers that promote metastasis formation and/or chemoresistance is therefore of importance. CD44 is a plasma membrane glycoprotein that binds to the extracellular matrix component hyaluronan (HA) and has been shown to be involved in metastasis formation in a variety of other tumors. Here we investigated the role of CD44 expression on OS tumor formation and metastasis. High CD44 expression, evaluated with a tissue microarray including samples from 53 OS patients and stained with a pan-CD44 antibody (Hermes3), showed a tendency (p lung metastases and high CD44 expression had significantly poorer prognosis than patients with low CD44 expression. Overexpression of the standard CD44 isoform (CD44s) and its HA-binding defective mutant R41A in osteoblastic SaOS-2 cells resulted in HA-independent higher migration rates and increased chemoresistance, partially dependent on HA. In an orthotopic mouse model of OS, overexpression of CD44s in SaOS-2 cells resulted in an HA-dependent increased primary tumor formation and increased numbers of micrometastases and macrometastases in the lungs. In conclusion, although CD44 failed to be an independent predictor for patient outcome in this limited cohort of OS patients, increased CD44 expression was associated with even worse survival in patients with chemoresistance and with lung metastases. CD44-associated chemoresistance was also observed in vitro, and increased formation of lung metastases was found in vivo in SCID mice. Copyright © 2013 American Society for Bone and Mineral Research.

  3. Podocalyxin-like protein is expressed in glioblastoma multiforme stem-like cells and is associated with poor outcome.

    Directory of Open Access Journals (Sweden)

    Zev A Binder

    Full Text Available Glioblastoma multiforme (GBM is the most common primary malignant adult brain tumor and is associated with poor survival. Recently, stem-like cell populations have been identified in numerous malignancies including GBM. To identify genes whose expression is changed with differentiation, we compared transcript profiles from a GBM oncosphere line before and after differentiation. Bioinformatic analysis of the gene expression profiles identified podocalyxin-like protein (PODXL, a protein highly expressed in human embryonic stem cells, as a potential marker of undifferentiated GBM stem-like cells. The loss of PODXL expression upon differentiation of GBM stem-like cell lines was confirmed by quantitative real-time PCR and flow cytometry. Analytical flow cytometry of numerous GBM oncosphere lines demonstrated PODXL expression in all lines examined. Knockdown studies and flow cytometric cell sorting experiments demonstrated that PODXL is involved in GBM stem-like cell proliferation and oncosphere formation. Compared to PODXL-negative cells, PODXL-positive cells had increased expression of the progenitor/stem cell markers Musashi1, SOX2, and BMI1. Finally, PODXL expression directly correlated with increasing glioma grade and was a marker for poor outcome in patients with GBM. In summary, we have demonstrated that PODXL is expressed in GBM stem-like cells and is involved in cell proliferation and oncosphere formation. Moreover, high PODXL expression correlates with increasing glioma grade and decreased overall survival in patients with GBM.

  4. Comparison of IVF Outcomes between Minimal Stimulation and High-Dose Stimulation for Patients with Poor Ovarian Reserve

    Directory of Open Access Journals (Sweden)

    Tal Lazer

    2014-01-01

    Full Text Available We examined whether treatment with minimum-dose stimulation (MS protocol enhances clinical pregnancy rates compared to high-dose stimulation (HS protocol. A retrospective cohort study was performed comparing IVF and pregnancy outcomes between MS and HS gonadotropin-antagonist protocol for patients with poor ovarian reserve (POR. Inclusion criteria included patients with an anti-Müllerian hormone (AMH ≤8 pmol/L and/or antral follicle count (AFC ≤5 on days 2-3 of the cycle. Patients from 2008 exclusively had a HS protocol treatment, while patients in 2010 had treatment with a MS protocol exclusively. The MS protocol involved letrozole at 2.5 mg over 5 days, starting from day 2, overlapping with gonadotropins, starting from the third day of letrozole at 150 units daily. GnRH antagonist was introduced once one or more follicles reached 14 mm or larger. The HS group received gonadotropins (≥300 IU/day throughout their antagonist cycle. Clinical pregnancy rate was significantly higher in the MS protocol compared to the HS protocol (P=0.007. Furthermore, the live birth rate was significantly higher in the MS group compare to the HS group (P=0.034. In conclusion, the MS IVF protocol is less expensive (lower gonadotropin dosage and resulted in a higher clinical pregnancy rate and live birth rate than a HS protocol for poor responders.

  5. Autoimmune hemolytic anemia as a risk factor of poor outcome in patients with splenic marginal zone lymphoma.

    Science.gov (United States)

    Fodor, Aniko; Molnar, Miklos Zsolt; Krenacs, Laszlo; Bagdi, Eniko; Csomor, Judit; Matolcsy, Andras; Demeter, Judit

    2009-12-01

    Splenic marginal zone lymphoma is a rare disease, accounting for 1% of all lymphomas. We reviewed our single center experience of 13 patients with splenic marginal zone lymphoma (SMZL). Based on the prognostic model developed by Intergruppo Italiano Linfomi, 31% (4/13) of our patients had good, 38% (5/13) had intermediate and 31% (4/13) had a poor prognosis. The presence of two out of three prognostic factors (anemia, elevated LDH, low serum albumin) assignes the patient into the high risk category. In patients with anemia and an elevated LDH due to hemolysis, the outcome seems to be especially poor. Three out of 13 (23%) cases were complicated by autoimmune hemolytic anemia. All patients with autoimmune hemolytic anaemia (AIHA) died 7-28 months after the diagnosis. The mean follow-up time of those nine patients who are still alive is longer than 5 years (36-100 months). Patients with AIHA had significantly (p < 0.001) worse survival than those without AIHA. The main finding of our study is that the presence of AIHA is an adverse prognostic factor in SMZL.

  6. Abundance analysis of SDSS J134338.67+484426.6; an extremely metal-poor star from the MARVELS pre-survey

    CERN Document Server

    Rani, A Susmitha; Beers, T C; Fleming, S; Mahadevan, S; Ge, J

    2016-01-01

    We present an elemental-abundance analysis of an extremely metal-poor (EMP; [Fe/H] < -3.0) star, SDSS J134338.67+484426.6, identified during the course of the MARVELS spectroscopic pre-survey of some 20000 stars to identify suitable candidates for exoplanet searches. This star, with an apparent magnitude V = 12.14, is the lowest metallicity star found in the pre-survey, and is one of only ~20 known EMP stars that are this bright or brighter. Our high-resolution spectroscopic analysis shows that this star is a subgiant with [Fe/H] = -3.42, having "normal" carbon and no enhancement of neutron-capture abundances. Strontium is under-abundant, [Sr/Fe] =-0.47, but the derived lower limit on [Sr/Ba] indicates that Sr is likely enhanced relative to Ba. This star belongs to the sparsely populated class of alpha-poor EMP stars that exhibit low ratios of [Mg/Fe], [Si/Fe], and [Ca/Fe] compared to typical halo stars at similar metallicity. The observed variations in radial velocity from several epochs of (low- and high...

  7. A multiprofessional perspective on the principal barriers to universal health coverage and universal access to health in extremely poor territories: the contributions of nursing1

    Science.gov (United States)

    de França, Viviane Helena; Modena, Celina Maria; Confalonieri, Ulisses Eugenio Cavalcanti

    2016-01-01

    Objective: to investigate the knowledge of managers and health professionals, social workers and education professionals regarding the principal barriers to universal health coverage and universal access to health on the part of the extremely poor population; and to point to the contributions made by nursing for the promotion of this right. Method: a qualitative study whose reference was, for ensuring the right to health, the reorientation of the Brazilian Unified Health System (SUS) towards universal coverage and access in these territories. Interviews were held with 27 members of the multi-professional team of a municipality with high social vulnerability. The data were worked on using thematic content analysis. Results: the following were ascertained as the principal barriers to universal health coverage and access to health: failures in the expansion and strengthening of the services; absence of diagnosis of the priority demands; shortage of technology, equipment, and material and human resources; poor local infrastructure; and actions with low resolutive power and absence of interdepartmental policies. Within the multi-professional team, nursing acts in the SUS in unique health actions and social practices in these territories, presenting an in-depth perspective on this harsh reality, being able to contribute with indispensable support for confronting these disparities in universal health coverage and universal access to health. Conclusion: nursing's in-depth understanding regarding these barriers is essential for encouraging the processes reorienting the SUS, geared towards equality in the right to health. PMID:27143541

  8. First stars VI - Abundances of C, N, O, Li, and mixing in extremely metal-poor giants. Galactic evolution of the light elements

    CERN Document Server

    Spite, M; Plez, B; Hill, V; Spite, F; Depagne, E; François, P; Bonifacio, P; Barbuy, B; Beers, T; Andersen, J; Molaro, P; Nordström, B; Primas, F

    2004-01-01

    We have investigated the poorly-understood origin of nitrogen in the early Galaxy by determining N abundances in 35 extremely metal-poor halo giants (22 stars have [Fe/H]<-3.0) using the C and O abundances determined in Paper V. Because any dredge-up of CNO processed material to the surface may complicate the interpretation of CNO abundances in giants, we have also measured the surface abundance of lithium. Our sample shows a clear dichotomy between two groups of stars. The first group shows evidence of C to N conversion through CN cycling and strong Li dilution, a signature of mixing. The second group shows no evidence for C to N conversion, and Li is only moderately diluted, and we conclude that their C and N abundances are very close to those of the gas from which they formed in the early Galaxy. These "unmixed" stars reflect the abundances in the early Galaxy: the [C/Fe] ratio is constant (about +0.2 dex) and the [C/Mg] ratio is close to solar at low metallicity, favouring a high C production by massiv...

  9. First stars IX -Mixing in extremely metal-poor giants. Variation of the 12C/13C, [Na/Mg] and [Al/Mg] ratios

    CERN Document Server

    Spite, M; Hill, V; Spite, F; François, P; Plez, B; Bonifacio, P; Molaro, P; Depagne, E; Andersen, J; Barbuy, B; Beers, T C; Nordström, B; Primas, F

    2006-01-01

    Extremely metal-poor (EMP) stars preserve a fossil record of the composition of the ISM when the Galaxy formed. It is crucial, however, to verify whether internal mixing has modified their surface. We aim to understand the CNO abundance variations found in some, but not all EMP field giants analysed earlier. Mixing beyond the first dredge-up of standard models is required, and its origin needs clarification.The 12C/13C ratio is the most robust diagnostic of deep mixing, because it is insensitive to the adopted stellar parameters and should be uniformly high in near-primordial gas. We have measured 12C and 13C abundances in 35 EMP giants from high-quality VLT/UVES spectra. Correlations with other abundance data are used to study the depth of mixing.The 12C/13C ratio is found to correlate with [C/Fe] (and Li/H), and clearly anti-correlate with [N/Fe]. Evidence for such deep mixing is observed in giants above log L/Lsolar = 2.6, brighter than in less metal-poor stars, but matching the bump in the luminosity func...

  10. Improved neurosensory outcome at 8 years of age of extremely low birthweight children born in Victoria over three distinct eras

    OpenAIRE

    Doyle, L; Anderson, P.; t and,

    2005-01-01

    Aim: To determine neurosensory outcome at 8 years of age of extremely low birthweight (ELBW) children born in the 1990s, how it varies with birth weight, and how it compares with ELBW children born in the 1980s and 1970s.

  11. Occupational extremely low-frequency magnetic field exposure and selected cancer outcomes in a prospective Dutch cohort

    NARCIS (Netherlands)

    Koeman, T.; Brandt, P.A. van den; Slottje, P.; Schouten, L.J.; Goldbohm, R.A.; Kromhout, H.; Vermeulen, R.

    2014-01-01

    Purpose: To investigate the association between exposure to occupational extremely low-frequency magnetic fields (ELF-MF) and the risk of a priori selected cancer outcomes within the prospective Netherlands Cohort Study. Methods: 120,852 men and women aged 55-69 years at time of enrollment in 1986

  12. Presence of Systemic Inflammatory Response Syndrome Predicts a Poor Clinical Outcome in Dogs with a Primary Hepatitis.

    Science.gov (United States)

    Kilpatrick, Scott; Dreistadt, Margaret; Frowde, Polly; Powell, Roger; Milne, Elspeth; Smith, Sionagh; Morrison, Linda; Gow, Adam G; Handel, Ian; Mellanby, Richard J

    2016-01-01

    Primary hepatopathies are a common cause of morbidity and mortality in dogs. The underlying aetiology of most cases of canine hepatitis is unknown. Consequently, treatments are typically palliative and it is difficult to provide accurate prognostic information to owners. In human hepatology there is accumulating data which indicates that the presence of systemic inflammatory response syndrome (SIRS) is a common and debilitating event in patients with liver diseases. For example, the presence of SIRS has been linked to the development of complications such as hepatic encephalopathy (HE) and is associated with a poor clinical outcome in humans with liver diseases. In contrast, the relationship between SIRS and clinical outcome in dogs with a primary hepatitis is unknown. Seventy dogs with histologically confirmed primary hepatitis were enrolled into the study. Additional clinical and clinicopathological information including respiratory rate, heart rate, temperature, white blood cell count, sodium, potassium, sex, presence of ascites, HE score, alanine aminotransferase (ALT), alkaline phosphatase (ALP), bilirubin and red blood cell concentration were available in all cases. The median survival of dogs with a SIRS score of 0 or 1 (SIRS low) was 231 days compared to a median survival of 7 days for dogs with a SIRS score of 2, 3 or 4 (SIRS high) (pdogs with a primary hepatitis is deserving of further study.

  13. Small dense low density lipoprotein particles are associated with poor outcome after angioplasty in peripheral artery disease.

    Directory of Open Access Journals (Sweden)

    Vincenzo Jacomella

    Full Text Available PURPOSE: In patients suffering from symptomatic peripheral artery disease (PAD, percutaneous revascularization is the treatment of choice. However, restenosis may occur in 10 to 60% in the first year depending on a variety of factors. Small dense low density lipoprotein (sdLDL particles are associated with an increased risk for cardiovascular events, but their role in the process of restenosis is not known. We conducted a prospective study to analyze the association of sdLDL particles with the outcome of balloon angioplasty in PAD. The composite primary endpoint was defined as improved walking distance and absence of restenosis. METHODS: Patients with angiographically documented PAD of the lower extremities who were scheduled for lower limb revascularization were consecutively recruited for the study. At baseline and at three month follow-up triglyceride, total cholesterol, LDL size and subclasses and HDL cholesterol and ankle-brachial index (ABI were measured. Three months after the intervention duplex sonography was performed to detect restenosis. RESULTS: Sixty-four patients (53% male with a mean age of 68.6±9.9 years were included. The proportion of small- dense LDL particles (class III and IV was significantly lower (33.1±11.0% vs. 39.4±12.1%, p = 0.038 in patients who reached the primary end-point compared with those who did not. Patients with improved walking distance and without restenosis had a significantly higher LDL size at baseline (26.6±1.1 nm vs. 26.1±1.1 nm, p = 0.046 and at follow-up (26.7±1.1 nm vs. 26.2±0.9 nm, p = 0.044 than patients without improvement. CONCLUSIONS: Small-dense LDL particles are associated with worse early outcome in patients undergoing percutaneous revascularization for symptomatic PAD.

  14. Maltreatment and Mental Health Outcomes among Ultra-Poor Children in Burkina Faso: A Latent Class Analysis

    Science.gov (United States)

    Ismayilova, Leyla; Gaveras, Eleni; Blum, Austin; Tô-Camier, Alexice; Nanema, Rachel

    2016-01-01

    Objectives Research about the mental health of children in Francophone West Africa is scarce. This paper examines the relationships between adverse childhood experiences, including exposure to violence and exploitation, and mental health outcomes among children living in ultra-poverty in rural Burkina Faso. Methods This paper utilizes baseline data collected from 360 children ages 10–15 and 360 of their mothers recruited from twelve impoverished villages in the Nord Region of Burkina, located near the Sahel Desert and affected by extreme food insecurity. We used a Latent Class Analysis to identify underlying patterns of maltreatment. Further, the relationships between latent classes and mental health outcomes were tested using mixed effected regression models adjusted for clustering within villages. Results About 15% of the children in the study scored above the clinical cut-off for depression, 17.8% for posttraumatic stress disorder (PTSD), and 6.4% for low self-esteem. The study identified five distinct sub-groups (or classes) of children based on their exposure to adverse childhood experiences. Children with the highest exposure to violence at home, at work and in the community (Abused and Exploited class) and children not attending school and working for other households, often away from their families (External Laborer class), demonstrated highest symptoms of depression and trauma. Despite living in adverse conditions and working to assist families, the study also identified a class of children who were not exposed to any violence at home or at work (Healthy and Non-abused class). Children in this class demonstrated significantly higher self-esteem (b = 0.92, SE = 0.45, pfamily-level poverty and violence in the family. PMID:27764155

  15. Common Factors and Outcome in Late Upper Extremity Amputations After Military Injury

    Science.gov (United States)

    2014-04-01

    are no quality studies that attempt to define an upper extremity limb salvage in a consistent way such as the Lower Extremity Assessment Project study...their prosthetic arm frequently despite all of them receiving multiple prostheses. This percentage is lower than the 76% found in a previous study that...following limb - threatening lower limb trauma: lessons learned from the Lower Extremity Assessment Project (LEAP). J Am Acad Orthop Surg. 2006;14:S205

  16. Risk factors for poor patient-reported quality of life outcomes after posterior lumbar interbody fusion: An analysis of two-year follow-up.

    Science.gov (United States)

    Makino, Takahiro; Kaito, Takashi; Fujiwara, Hiroyasu; Honda, Hirotsugu; Sakai, Yusuke; Takenaka, Shota; Yoshikawa, Hideki; Yonenobu, Kazuo

    2017-02-28

    A retrospective review of prospectively collected data. This study aimed to identify risk factors for poor patient-reported quality of life (QOL) outcomes, based on five categories (pain-related disorders, lumbar spine dysfunction, gait disturbance, social life dysfunction, and psychological disorders) of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), after posterior lumbar interbody fusion (PLIF) at the two-year follow-up. Many studies have been reported on patient QOL outcomes after lumbar surgery; however, few reports have focused on risk factors for poor postoperative QOL outcomes in terms of the various disabilities and dysfunctions after PLIF. One hundred consecutive patients (39 men and 61 women; mean age 69.6 [44-84] years) who underwent single- or two-level PLIF for degenerative spondylolisthesis and/or foraminal stenosis with a two-year follow-up were included. The effectiveness of surgery in each category of the JOABPEQ was evaluated. Demographic and clinical data and radiographic parameters were reviewed. Risk factors for poor postoperative QOL outcomes in each category of the JOABPEQ were investigated by multivariate logistic regression analysis. Older age and spinopelvic malalignment (preoperative high pelvic tilt or postoperative decrease in lumbar lordosis [= postoperative increase in the mismatch between pelvic incidence and lumbar lordosis]) were risk factors for poor postoperative QOL outcomes in all categories of the JOABPEQ, except for lumbar spine dysfunction. In contrast, increase in number of PLIF segments, non-union, and radiographic adjacent segment degeneration (ASD) were risk factors for poor postoperative QOL outcomes in lumbar spine dysfunction and gait disturbance. The risk factors for poor QOL outcomes after PLIF differed among the five categories of the JOABPEQ. In particular, surgery-related factors (e.g., increase in number of PLIF segments, non-union, and radiographic ASD) had a negative impact

  17. Ketones and lactate increase cancer cell “stemness”, driving recurrence, metastasis and poor clinical outcome in breast cancer

    Science.gov (United States)

    Tsirigos, Aristotelis; Lin, Zhao; Pavlides, Stephanos; Wang, Chengwang; Flomenberg, Neal; Knudsen, Erik S; Howell, Anthony; Pestell, Richard G

    2011-01-01

    Previously, we showed that high-energy metabolites (lactate and ketones) “fuel” tumor growth and experimental metastasis in an in vivo xenograft model, most likely by driving oxidative mitochondrial metabolism in breast cancer cells. To mechanistically understand how these metabolites affect tumor cell behavior, here we used genome-wide transcriptional profiling. Human breast cancer cells (MCF7) were cultured with lactate or ketones, and then subjected to transcriptional analysis (exon-array). Interestingly, our results show that treatment with these high-energy metabolites increases the transcriptional expression of gene profiles normally associated with “stemness”, including genes upregulated in embryonic stem (ES) cells. Similarly, we observe that lactate and ketones promote the growth of bonafide ES cells, providing functional validation. The lactate- and ketone-induced “gene signatures” were able to predict poor clinical outcome (including recurrence and metastasis) in human breast cancer patients. Taken together, our results are consistent with the idea that lactate and ketone utilization in cancer cells promotes the “cancer stem cell” phenotype, resulting in significant decreases in patient survival. One possible mechanism by which high-energy metabolites might induce stemness is by increasing the pool of Acetyl-CoA, leading to increased histone acetylation and elevated gene expression. Thus, our results mechanistically imply that clinical outcome in breast cancer could simply be determined by epigenetics and energy metabolism, rather than by the accumulation of specific “classical” gene mutations. We also suggest that high-risk cancer patients (identified by the lactate/ketone gene signatures) could be treated with new therapeutics that target oxidative mitochondrial metabolism, such as the anti-oxidant and “mitochondrial poison” metformin. Finally, we propose that this new approach to personalized cancer medicine be termed

  18. BCL9/9L-β-catenin Signaling is Associated With Poor Outcome in Colorectal Cancer

    Directory of Open Access Journals (Sweden)

    Andreas E. Moor

    2015-12-01

    Full Text Available BCL9/9L proteins enhance the transcriptional output of the β-catenin/TCF transcriptional complex and contribute critically to upholding the high WNT signaling level required for stemness maintenance in the intestinal epithelium. Here we show that a BCL9/9L-dependent gene signature derived from independent mouse colorectal cancer (CRC models unprecedentedly separates patient subgroups with regard to progression free and overall survival. We found that this effect was by and large attributable to stemness related gene sets. Remarkably, this signature proved associated with recently described poor prognosis CRC subtypes exhibiting high stemness and/or epithelial-to-mesenchymal transition (EMT traits. Consistent with the notion that high WNT signaling is required for stemness maintenance, ablating Bcl9/9l-β-catenin in murine oncogenic intestinal organoids provoked their differentiation and completely abrogated their tumorigenicity, while not affecting their proliferation. Therapeutic strategies aimed at targeting WNT responses may be limited by intestinal toxicity. Our findings suggest that attenuating WNT signaling to an extent that affects stemness maintenance without disturbing intestinal renewal might be well tolerated and prove sufficient to reduce CRC recurrence and dramatically improve disease outcome.

  19. Hypermethylation of the VTRNA1-3 Promoter is Associated with Poor Outcome in Lower Risk Myelodysplastic Syndrome Patients

    Directory of Open Access Journals (Sweden)

    Alexandra Søgaard Helbo

    2015-10-01

    Full Text Available Myelodysplastic syndrome (MDS is a heterogeneous group of clonal hematopoietic disorders. MDS is frequently associated with deletions on chromosome 5q as well as aberrant DNA methylation patterns including hypermethylation of key tumor suppressors. We have previously shown that hypermethylation and silencing of the non-coding RNA VTRNA2-1 are correlated with poor outcomes in acute myeloid leukemia patients. In this study, we find that VTRNA1-2 and VTRNA1-3, both located on chromosome 5q, can be regulated and silenced by promoter DNA methylation, and that the hypomethylating agent 5-aza-2-deoxycytidine causes reactivation these genes. In normal hematopoiesis, we find that vault RNAs (vtRNAs show differential methylation between various hematopoietic cell populations, indicating that allele-specific methylation events may occur during hematopoiesis. In addition, we show that VTRNA1-3 promoter hypermethylation is frequent in lower risk MDS patients and is associated with a decreased overall survival.

  20. Activation of less affected corticospinal tract and poor motor outcome in hemiplegic pediatric patients: a diffusion tensor tractography imaging study

    Directory of Open Access Journals (Sweden)

    Jin Hyun Kim

    2015-01-01

    Full Text Available The less affected hemisphere is important in motor recovery in mature brains. However, in terms of motor outcome in immature brains, no study has been reported on the less affected corticospinal tract in hemiplegic pediatric patients. Therefore, we examined the relationship between the condition of the less affected corticospinal tract and motor function in hemiplegic pediatric patients. Forty patients with hemiplegia due to perinatal or prenatal injury (13.7 ± 3.0 months and 40 age-matched typically developing controls were recruited. These patients were divided into two age-matched groups, the high functioning group (20 patients and the low functioning group (20 patients using functional level of hemiplegia scale. Diffusion tensor tractography images showed that compared with the control group, the patient group of the less affected corticospinal tract showed significantly increased fiber number and significantly decreased fractional anisotropy value. Significantly increased fiber number and significantly decreased fractional anisotropy value in the low functioning group were observed than in the high functioning group. These findings suggest that activation of the less affected hemisphere presenting as increased fiber number and decreased fractional anisotropy value is related to poor motor function in pediatric hemiplegic patients.

  1. Activation of less affected corticospinal tract and poor motor outcome in hemiplegic pediatric patients: a diffusion tensor tractography imaging study.

    Science.gov (United States)

    Kim, Jin Hyun; Son, Su Min

    2015-12-01

    The less affected hemisphere is important in motor recovery in mature brains. However, in terms of motor outcome in immature brains, no study has been reported on the less affected corticospinal tract in hemiplegic pediatric patients. Therefore, we examined the relationship between the condition of the less affected corticospinal tract and motor function in hemiplegic pediatric patients. Forty patients with hemiplegia due to perinatal or prenatal injury (13.7 ± 3.0 months) and 40 age-matched typically developing controls were recruited. These patients were divided into two age-matched groups, the high functioning group (20 patients) and the low functioning group (20 patients) using functional level of hemiplegia scale. Diffusion tensor tractography images showed that compared with the control group, the patient group of the less affected corticospinal tract showed significantly increased fiber number and significantly decreased fractional anisotropy value. Significantly increased fiber number and significantly decreased fractional anisotropy value in the low functioning group were observed than in the high functioning group. These findings suggest that activation of the less affected hemisphere presenting as increased fiber number and decreased fractional anisotropy value is related to poor motor function in pediatric hemiplegic patients.

  2. Three-dimensional hydrodynamical CO5BOLD model atmospheres of red giant stars. IV. Oxygen diagnostics in extremely metal-poor red giants with infrared OH lines

    CERN Document Server

    Dobrovolskas, V; Bonifacio, P; Caffau, E; Ludwig, H -G; Steffen, M; Spite, M

    2015-01-01

    Context. Although oxygen is an important tracer of Galactic chemical evolution, measurements of its abundance in the atmospheres of the oldest Galactic stars are still scarce and rather imprecise. At the lowest end of the metallicity scale, oxygen can only be measured in giant stars and in most of cases such measurements rely on a single forbidden [O I] 630 nm line that is very weak and frequently blended with telluric lines. Although molecular OH lines located in the ultraviolet and infrared could also be used for the diagnostics, oxygen abundances obtained from the OH lines and the [O I] 630 nm line are usually discrepant to a level of ~0.3-0.4 dex. Aims. We study the influence of convection on the formation of the infrared (IR) OH lines and the forbidden [O I] 630 nm line in the atmospheres of extremely metal-poor (EMP) red giant stars. Methods. We used high-resolution and high signal-to-noise ratio spectra of four EMP red giant stars obtained with the VLT CRIRES spectrograph. For each EMP star, 4-14 IR OH...

  3. The IMF of Extremely Metal-Poor Stars and the Probe into the Star-Formation Process of the Milky Way

    CERN Document Server

    Komiya, Yutaka; Habe, Asao; Fujimoto, Masayuki Y

    2007-01-01

    We discuss the star formation history of the Galaxy, based on the observations of extremely metal-poor stars (EMP) in the Galactic halo, to gain an insight into the evolution and structure formation in the early universe. The initialmass function (IMF) of EMP stars is derived from the observed fraction of carbon-enhanced EXP (CEMP) stars among the EMP survivors, which are thought to originate from the evolution in the close binary systems with mass transfer. Relying upon the theory of the evolution of EMP stars and of their binary evolution, we find that stars of metallicity [Fe/H]<-2.5 were formed at typical mass of ~10M_sun. The top heavy IMF thus obtained is applied to study the early chemical evolution of the Galaxy. We construct the merging history of our Galaxy semi-analytically and derive the metallicity distribution function (MDF) of low-mass EMP stars that survive to date with taking into account the contribution of binary systems. It is shown that the resultant MDF can well reproduce the observed...

  4. The Abundance Evolution of Oxygen, Sodium and Magnesium in Extremely Metal-Poor Intermediate Mass Stars: Implications for the Self-Polution Scenario in Globular Clusters

    CERN Document Server

    Denissenkov, P A

    2003-01-01

    We present full stellar evolution and parametric models of the surface abundance evolution of O16, Ne22, Na23 and the magnesium isotopes in an extremely metal-poor intermediate mass star M_ZAMS=5M_sun, Z=0.0001. O16 and Ne22 are injected into the envelope by the third dredge-up following thermal pulses on the asymptotic giant branch. These species and the initially present Mg24 are depleted by hot bottom burning (HBB) during the interpulse phase. As a result, Na23, Mg25 and Mg26 are enhanced. If the HBB temperatures are sufficiently high for this process to deplete oxygen efficiently, Na23 is first produced and then depleted during the interpulse phase. Although the simultaneous depletion of O16 and enhancement of Na23 is possible, the required fine tuning of the dredge-up and HBB casts some doubt on the robustness of this process as the origin of the O-Na anti-correlation observed in globular cluster stars. However, a very robust prediction of our models are low Mg24/Mg25 and Mg24/Mg26 ratios whenever signif...

  5. Oxygen and light element synthesis by neutron-capture reactions in metal-free and extremely metal-poor AGB stars

    CERN Document Server

    Nishimura, Takanori; Suda, Takuma; Fujimoto, Masayuki Y

    2009-01-01

    The metal-free (Pop. III) and extremely metal-poor (EMP) stars of low- and intermediate-masses experience mixing of hydrogen into the helium convection during the early TP-AGB phase, differently from the meal-rich stars. We study the nucleosynthesis in the helium convective zone with 13C formed from mixed protons as neutron source by using a nuclear network from H through S. In the absence or scarcity of the pristine metals, the neutron-recycling reactions, 12C(n,g)13C(a,n)16O and also 16O(n,g)17O(a,n)20Ne promote the synthesis of O and light elements, including their neutron-rich isotopes and the odd atomic number elements. Based on the results, we demonstrate that the peculiar abundance patterns of C through Al observed for the three most iron-deficient, carbon-rich stars can be reproduced in terms of the nucleosynthesis in Pop. III, AGB stars in the different mass range. We argue that these three stars were born as the low-mass members of Pop. III binaries and later subject to the surface pollution by the ...

  6. Comparative outcome of bomb explosion injuries versus high-powered gunshot injuries of the upper extremity in a civilian setting.

    Science.gov (United States)

    Luria, Shai; Rivkin, Gurion; Avitzour, Malka; Liebergall, Meir; Mintz, Yoav; Mosheiff, Ram

    2013-03-01

    Explosion injuries to the upper extremity have specific clinical characteristics that differ from injuries due to other mechanisms. To evaluate the upper extremity injury pattern of attacks on civilian targets, comparing bomb explosion injuries to gunshot injuries and their functional recovery using standard outcome measures. Of 157 patients admitted to the hospital between 2000 and 2004, 72 (46%) sustained explosion injuries and 85 (54%) gunshot injuries. The trauma registry files were reviewed and the patients completed the DASH Questionnaire (Disabilities of Arm, Shoulder and Hand) and SF-12 (Short Form-12) after a minimum period of 1 year. Of the 157 patients, 72 (46%) had blast injuries and 85 (54%) had shooting injuries. The blast casualties had higher Injury Severity Scores (47% vs. 22% with a score of > 16, P = 0.02) and higher percent of patients treated in intensive care units (47% vs. 28%, P = 0.02). Although the Abbreviated Injury Scale score of the upper extremity injury was similar in the two groups, the blast casualties were found to have more bilateral and complex soft tissue injuries and were treated surgically more often. No difference was found in the SF-12 or DASH scores between the groups at follow up. The casualties with upper extremity blast injuries were more severely injured and sustained more bilateral and complex soft tissue injuries to the upper extremity. However, the rating of the local injury to the isolated limb is similar, as was the subjective functional recovery.

  7. Host-directed therapies for improving poor treatment outcomes associated with the middle east respiratory syndrome coronavirus infections

    Directory of Open Access Journals (Sweden)

    Alimuddin Zumla

    2015-11-01

    Full Text Available Three years after its first discovery in Jeddah Saudi Arabia, the novel zoonotic pathogen of humans, the Middle East Respiratory Syndrome Coronavirus (MERS-CoV continues to be a major threat to global health security.1 Sporadic community acquired cases of MERS continue to be reported from the Middle East. The recent nosocomial outbreaks in hospitals in Seoul, Korea and at the National Guard Hospital in Riyadh, Saudi Arabia indicate the epidemic potential of MERS-CoV. Currently there are no effective anti-MERS-CoV anti-viral agents or therapeutics and MERS is associated with a high mortality rate (40% in hospitalised patients. A large proportion of MERS patients who die have a range of pulmonary pathology ranging from pneumonia to adult respiratory distress syndrome with multi-organ failure, compounded by co-morbidities, reflecting a precarious balance of interactions between the host-immune system and MERS-CoV. Whilst we wait for new MERS-CoV specific drugs, therapeutics and vaccines to be developed, there is a need to advance a range of Host-Directed Therapies. A range of HDTs are available, including commonly used drugs with good safety profiles, which could augment host innate and adaptive immune mechanisms to MERS-CoV, modulate excessive inflammation and reduce lung tissue destruction. We discuss the rationale and potential of using Host-Directed Therapies for improving the poor treatment outcomes associated with MERS. Carefully designed randomized controlled trials will be needed to determine whether HDTs could benefit patients with MERS. The recurrent outbreaks of MERS-CoV infections at hospitals in the Middle East present unique opportunities to conduct randomized clinical trials. The time has come for a more coordinated global response to MERS and a multidisciplinary global MERS-CoV response group is required to take forward priority research agendas.

  8. Ascites bacterial burden and immune cell profile are associated with poor clinical outcomes in the absence of overt infection.

    Directory of Open Access Journals (Sweden)

    Kevin J Fagan

    Full Text Available Bacterial infections, most commonly spontaneous bacterial peritonitis in patients with ascites, occur in one third of admitted patients with cirrhosis, and account for a 4-fold increase in mortality. Bacteria are isolated from less than 40% of ascites infections by culture, necessitating empirical antibiotic treatment, but culture-independent studies suggest bacteria are commonly present, even in the absence of overt infection. Widespread detection of low levels of bacteria in ascites, in the absence of peritonitis, suggests immune impairment may contribute to higher susceptibility to infection in cirrhotic patients. However, little is known about the role of ascites leukocyte composition and function in this context. We determined ascites bacterial composition by quantitative PCR and 16S rRNA gene sequencing in 25 patients with culture-negative, non-neutrocytic ascites, and compared microbiological data with ascites and peripheral blood leukocyte composition and phenotype. Bacterial DNA was detected in ascitic fluid from 23 of 25 patients, with significant positive correlations between bacterial DNA levels and poor 6-month clinical outcomes (death, readmission. Ascites leukocyte composition was variable, but dominated by macrophages or T lymphocytes, with lower numbers of B lymphocytes and natural killer cells. Consistent with the hypothesis that impaired innate immunity contributes to susceptibility to infection, high bacterial DNA burden was associated with reduced major histocompatibility complex class II expression on ascites (but not peripheral blood monocytes/macrophages. These data indicate an association between the presence of ascites bacterial DNA and early death and readmission in patients with decompensated cirrhosis. They further suggest that impairment of innate immunity contributes to increased bacterial translocation, risk of peritonitis, or both.

  9. Prostate Tumor Overexpressed 1 (PTOV1 Is a Novel Prognostic Marker for Nasopharyngeal Carcinoma Progression and Poor Survival Outcomes.

    Directory of Open Access Journals (Sweden)

    Qi Yang

    Full Text Available Prostate tumor overexpressed 1 (PTOV1 has been reported to contribute to increased cancer proliferation. However, the clinical significance of PTOV1 in the development and progression of nasopharyngeal carcinoma (NPC is unclear. Our study aimed to investigate the expression pattern of PTOV1 in NPC and its correlation with clinicopathological features of patients.Western blotting and real-time PCR were conducted to examine PTOV1 expression levels in NPC cell lines and biopsy tissues compared with normal controls. Immunohistochemistry (IHC was performed to analyze PTOV1 protein expression in paraffin-embedded tissues from 123 patients. Statistical analyses were applied to evaluate the clinical significance of PTOV1 expression.PTOV1 mRNA and protein levels were upregulated in NPC cell lines and clinical samples. IHC analyses showed that PTOV1 was highly expressed in 68 (55.3% of 123 NPC specimens. Statistical analysis revealed that PTOV1 expression was significantly correlated with clinical stage (P < 0.001, T classification (P = 0.042 and N classification (P = 0.001. Patients with a higher PTOV1 expression had shorter overall survival compared with those with a lower PTOV1 expression level, especially in lower N stage patients. Multivariate analyses suggested that PTOV1 expression was an independent prognostic marker for survival in NPC patients.Our data demonstrated that PTOV1 overexpression is associated with poor survival outcomes of NPC patients, especially in N0-1 patients. Hence, PTOV1 may help to detect early lymph node metastasis of NPC patients and serve as an independent prognostic biomarker for human NPC.

  10. Overexpression of vascular endothelial growth factor indicates poor outcomes of glioma: a systematic review and meta-analysis

    Science.gov (United States)

    Chen, Wenjie; He, Deshen; Li, Zuyun; Zhang, Xin; Pan, Denghua; Chen, Gang

    2015-01-01

    Background: Accumulated studies have revealed that vascular endothelial growth factor (VEGF) plays an essential role in the progression of glioma, but the prognostic significance of VEGF expression for patients with glioma remains unknown. Method and material: A literature search of public databases (PubMed, ISI Web of Science, Science Direct, Cochrane Central Register of Controlled Trials, Wiley Online Library, China National Knowledge Infrastructure, China Biology Medicine disc, Chongqing VIP and Wan Fang Data) was conducted. A meta-analysis was performed to evaluate the association between the overexpression of VEGF and the survival for the glioma patients. Subsequently we evaluated the impact of VEGF expression on the pathological grade of glioma. Results: A total of 32 articles with 2307 cases contributed to this analysis, of which 31 reported overall survival (OS) and 5 reported progression-free survival (PFS). In this meta-analysis, VEGF overexpression significantly identified the unfavorable outcome on OS (HR = 1.647, 95% CI: 1.324~2.048, P < 0.001, Z = 4.48) but not on PFS (HR = 1.021, 95% CI: 0.974~1.070, P = 0.393). Subgroup analyses also revealed that high level of VEGF was associated with the poor OS for the patients with glioma according to region, case number, specimen type, method to detect VEGF and statistical method. Furthermore, the significant correlation was achieved between VEGF expression and the pathological grade of glioma (r = 0.307, P < 0.001). Conclusion: This study suggests that VEGF expression is significantly correlated with the glioma progression and may be a valuable prognostic factor on OS for the glioma patients. PMID:26309522

  11. The Modified Early Warning Score (MEWS): an instant physiological prognostic indicator of poor outcome in acute pancreatitis.

    Science.gov (United States)

    Suppiah, Aravind; Malde, Deep; Arab, Tameem; Hamed, Mazin; Allgar, Victoria; Morris-Stiff, Gareth; Smith, Andrew

    2014-11-28

    The Modified Early Warning Score (MEWS) is a bedside scoring system that is non-invasive, simple and repeatable to reflect dynamic changes in physiological state. This study aims to assess accuracy of MEWS and determine an optimal MEWS value in predicting severity in acute pancreatitis (AP). A prospective database of consecutive admissions with AP to a single institution was analysed to determine value of MEWS in identifying severe acute pancreatitis (SAP) and predicting poor outcome. Receiver operator curves (ROC) were used to determine optimal accuracy. Sensitivity, specificity, negative predictive value (NPV), and positive predictive values (PPV) were calculated for the optimal MEWS values obtained. One-hundred and 42 patients with AP were included. The optimal highest MEWS per 24 hours period (hMEWS) and mean MEWS per 24 hour period (mMEWS) in predicting SAP as determined by ROC were 2.5 and 1.625 respectively; with hMEWS ≥3 and mMEWS >1 utilised in this cohort as MEWS scores are whole numbers. On admission, sensitivity, specificity, NPV, PPV, and accuracy of hMEWS ≥3 was 95.5%, 90.8%, 99.0%, 65.6% and 92.0%; and for mMWES >1 was 95.5%, 87.5%, 99.0%, 58.3% and 88.7%, both superior than the Imrie score: 31.5%, 92.1%, 88.9%, 40.0% and 83.5%. The accuracy of hMEWS ≥3 and mMEWS >1 increased over the subsequent 72 hours (days 0-2) from 92 to 96%, and 89% to 94%, respectively. MEWS provides a novel, easy, instant, repeatable, reliable prognostic score that may be superior to existing scoring systems. A larger cohort is required to validate these findings.

  12. Interleukin 10 gene -1082A/G polymorphism is associated with osteosarcoma risk and poor outcomes in the Chinese population.

    Science.gov (United States)

    Cui, Yan; Zhu, Jia-Jun; Ma, Cheng-Bin; Cui, Kai; Wang, Feng; Ni, Sheng-Hui; Zhang, Zhi-Yu

    2016-04-01

    Interleukin-10 (IL-10) is a multifunctional cytokine that participates in the development and progression of various malignant tumors. However, data regarding the role of IL-10 polymorphisms in osteosarcoma development are not available. A case-control study was conducted in 260 patients with osteosarcoma and 260 healthy controls to investigate the possible association between IL-10 polymorphisms and the risk of osteosarcoma. Our results indicate the IL-10 -1082A/G (rs1800896) polymorphism is significantly associated with an increased risk of osteosarcoma in all genetic models (AG vs. AA, odds ratio (OR) = 1.56; 95 % confidence interval (CI) = 1.28-2.32, P = 0.017; GG vs. AA, OR = 1.62, 95 % CI 1.24-2.61, P = 0.013; AG + GG vs. CC, OR = 1.76, 95 % CI = 1.31-3.01, P = 0.019). However, the genotype and allele frequencies of IL-10 -819C/T (rs1800871) and -592A/C (rs1800872) polymorphisms in osteosarcoma patients did not significantly differ from controls. Further analyses revealed that the IL-10 -1082A/G (rs1800896) genotypes were associated with advanced tumor stages and metastasis in osteosarcoma patients. Additionally, a statistically significant association between the IL-10 -1082A/G (rs1800896) genotype and poor survival in osteosarcoma patients was observed. Our results demonstrate that the IL-10 -1082A/G (rs1800896) genotype is associated with an increased susceptibility and worse outcome for osteosarcoma patients in the Chinese Han population.

  13. Factors of Hamilton Depression Rating Scale (17 items) at 2 weeks correlated with poor outcome at 1 year in patients with ischemic stroke.

    Science.gov (United States)

    Yuan, Huaiwu; Zhang, Ning; Wang, Chunxue; Luo, Ben Yan; Shi, Yuzhi; Li, Jingjing; Zhou, Yong; Wang, Yilong; Zhang, Tong; Zhou, Juan; Zhao, Xingquan; Wang, Yongjun

    2014-02-01

    There was fewer paper about the relation between the Hamilton Depression Rating Scale (17 Items, HDRS-17) factors and stroke outcomes. Our aim was to investigate the influence of total score and factors of HDRS-17 on outcome of ischemic stroke at 1 year. A total of 1,953 patients with acute ischemic stroke were enrolled into a multicentered and prospective cohort study. The HDRS-17 was used to assess symptoms at 2 weeks after ischemic stroke. The Modified Ranking Scale (mRS) scores of 3-6 points and 0-2 points were regarded as poor outcome and benign outcome, respectively. At 1 year, 1,753 (89.8 %) patients had mRS score data. After adjusting for the confounders, patients with a total HDRS-17 score of ≥ 8 had a worse outcome at 1 year (OR = 1.62, 95 % CI 1.18-2.23). Symptoms of suicide (OR = 1.89, 95 % CI 1.27-2.83), decreased or loss of interest of work (OR = 1.89, 95 % CI 1.38-2.58), retardation (OR = 1.74, 95 % CI 1.27-2.38), psychic anxiety (OR = 1.72, 95 % CI 1.26-2.34), and agitation (OR = 1.61, 95 % CI 1.08-2.40) increased the risks for poor outcome by >60 %, respectively. Depressed mood, somatic anxiety, somatic symptoms-gastrointestinal, and early insomnia also increased the risk for poor outcome by nearly 50 %, respectively. A total HDRS-17 score of ≥ 8, and suicide, decreased or loss of interest of work, anxiety, agitation, retardation, depressed mood, somatic anxiety, somatic symptoms-gastrointestinal, and early insomnia of the HDRS-17 factors at 2 weeks after ischemic stroke increase the risk for poor outcome at 1 year.

  14. Changes in management policies for extremely preterm births and neonatal outcomes from 2003 to 2012

    DEFF Research Database (Denmark)

    Bonet, Mercedes; Cuttini, M; Piedvache, A

    2017-01-01

    OBJECTIVE: to investigate changes in maternity and neonatal unit policies towards extremely preterm infants (EPTI) between 2003 and 2012 and concurrent trends in their mortality and morbidity in ten European regions. DESIGN: population-based cohort studies in 2003 (MOSAIC study) and 2011/12 (EPIC...

  15. Low Serum Levels of Brain-Derived Neurotrophic Factor Were Associated with Poor Short-Term Functional Outcome and Mortality in Acute Ischemic Stroke.

    Science.gov (United States)

    Wang, Jing; Gao, Li; Yang, Yan-Long; Li, Yu-Qian; Chang, Tao; Man, Ming-Hao; Zhang, Xing-Ye; Guo, Shao-Chun; Li, Li-Hong

    2016-11-04

    Circulating brain-derived neurotrophic factor (BDNF) has been highlighted as being a key regulator of rehabilitation-induced recovery after stroke. The aim of this study was to evaluate the association between serum levels of BDNF and functional outcome and mortality events in a 3-month follow-up study in a cohort of patients with an acute ischemic stroke (AIS). From January 2015 to December 2015, consecutive first-ever AIS patients admitted to the Department of Emergency of our hospital were identified. Serum BDNF levels were measured at admission. Functional outcome was evaluated at 3 months using the modified Rankin scale (m-Rankin). We used logistic regression models to assess the relationship between BDNF levels and functional outcome or mortality. In this study, 204 patients were included. Patients with poor outcomes and non-survivors had significantly lower BDNF levels on admission (P BDNF levels in the lowest interquartile (≤1st 9.2 ng/ml) was an independent predictor of functional outcome (odds ratios [OR] = 3.75; 95 % confidence interval [CI], 2.43-8.12) and mortality (OR = 4.04; 95 % CI, 2.07-9.14). The area under the receiver operating characteristic curve of BDNF was 0.77 (95 % CI, 0.70-0.84) for functional outcome and 0.79 (95 % CI, 0.71-0.86) for mortality. The findings indicated that low serum levels of BDNF at admission were significantly associated with poor short-term functional outcome and mortality, suggesting that BDNF may serve as a biomarker of poor function outcome after stroke.

  16. Long-Term Maternal Stress and Post-traumatic Stress Symptoms Related to Developmental Outcome of Extremely Premature Infants.

    Science.gov (United States)

    Zerach, Gadi; Elsayag, Adi; Shefer, Shahar; Gabis, Lidia

    2015-08-01

    In this study, we examined the relations between the severity of developmental outcomes of extremely low birth weight (ELBW) children and their mothers' stress and post-traumatic stress disorder (PTSD) symptoms, 4-16 years after birth. Israeli mothers (N = 78) of a cohort of extremely premature infants (24-27 weeks) born 4-16 years earlier were asked to report about the medical and developmental condition of their child and their current perceived stress and PTSD symptoms. Results show that mothers of ELBW children with normal development reported the lowest perceived stress compared with mothers of ELBW children with developmental difficulties. We also found that 25.6% of the mothers had the potential to suffer from PTSD following the birth of an ELBW child. Furthermore, the severity of prematurity developmental outcomes made a significant contribution to mothers' perceived stress. To sum, mothers of ELBW infants' perceived stress is related to their children's severity of prematurity developmental outcomes, 4-16 years after birth. Clinical implications of these findings are discussed.

  17. Short-Term Physical and Mental Health Outcomes for Combat Amputee and Nonamputee Extremity Injury Patients

    Science.gov (United States)

    2012-01-01

    16 5.8 Pulmonary embolism± 27 7.1 11 4.0 *Percentages for amputee group . extremity group (P , 0.05). †P , 0.08. PLS, phantom limb syndrome; ±, deep...consistent with previous research.9,11 Absolute rates of other complications ( phantom limb syndrome, osteomyelitis, and infections) were consistent...Amputees had significantly greater odds of certain mental health disorders including mood, sleep, pain , and postconcussion syndrome. However, ampu- tees

  18. Provider volume and outcomes for abdominal aortic aneurysm repair, carotid endarterectomy, and lower extremity revascularization procedures.

    LENUS (Irish Health Repository)

    Killeen, Shane D

    2012-02-03

    BACKGROUND: Intuitively, vascular procedures performed by high-volume vascular subspecialists working at high-volume institutions should be associated with improved patient outcome. Although a large number of studies assess the relationship between volume and outcome, a single contemporary compilation of such studies is lacking. METHODS: A review of the English language literature was performed incorporating searches of the Medline, EMBASE, and Cochrane collaboration databases for abdominal aortic aneurysm repair (elective and emergent), carotid endarterectomy, and arterial lower limb procedures for any volume outcome relationship. Studies were included if they involved a patient cohort from 1980 onwards, were community or population based, and assessed health outcomes (mortality and morbidity) as a dependent variable and volume as an independent variable. RESULTS: We identified 74 relevant studies, and 54 were included. All showed either an inverse relationship of variable magnitude between provider volume and mortality, or no volume-outcome effect. The reduction in the risk-adjusted mortality rate (RAMR) for high-volume providers was 3% to 11% for elective abdominal aortic aneurysm (AAA) repair, 2.5 to 5% for emergent AAA repair, 0.7% to 4.7% carotid endarterectomy, and 0.3% to 0.9% for lower limb arterial bypass procedures. Subspeciality training also conferred a considerable morbidity and mortality benefit for emergent AAA repair, carotid endarterectomy, and lower limb arterial procedures. CONCLUSION: High-volume providers have significantly better outcomes for vascular procedures both in the elective and emergent setting. Subspeciality training also has a considerable impact. These data provide further evidence for the specialization of vascular services, whereby vascular procedures should generally be preformed by high-volume, speciality trained providers.

  19. The Surgical Treatment and Outcome of Nonmetastatic Extremity Osteosarcoma with Pathological Fractures

    Directory of Open Access Journals (Sweden)

    Zhi-Ping Deng

    2015-01-01

    Conclusions: Our study suggests that surgically treated patients with pathologic fractures in osteosarcoma have adequate local control and do not have a poorer outcome compared to patients without a fracture. Though osteosarcoma with a pathologic fracture is not a contraindication for limb salvage, appropriate case selection is important when deciding local control options to ensure adequate oncologic clearance.

  20. The Military Extremity Trauma Amputation/Limb Salvage (METALS) study: outcomes of amputation versus limb salvage following major lower-extremity trauma.

    Science.gov (United States)

    Doukas, William C; Hayda, Roman A; Frisch, H Michael; Andersen, Romney C; Mazurek, Michael T; Ficke, James R; Keeling, John J; Pasquina, Paul F; Wain, Harold J; Carlini, Anthony R; MacKenzie, Ellen J

    2013-01-16

    The study was performed to examine the hypothesis that functional outcomes following major lower-extremity trauma sustained in the military would be similar between patients treated with amputation and those who underwent limb salvage. This is a retrospective cohort study of 324 service members deployed to Afghanistan or Iraq who sustained a lower-limb injury requiring either amputation or limb salvage involving revascularization, bone graft/bone transport, local/free flap coverage, repair of a major nerve injury, or a complete compartment injury/compartment syndrome. The Short Musculoskeletal Function Assessment (SMFA) questionnaire was used to measure overall function. Standard instruments were used to measure depression (the Center for Epidemiologic Studies Depression Scale), posttraumatic stress disorder (PTSD Checklist-military version), chronic pain (Chronic Pain Grade Scale), and engagement in sports and leisure activities (Paffenbarger Physical Activity Questionnaire). The outcomes of amputation and salvage were compared by using regression analysis with adjustment for age, time until the interview, military rank, upper-limb and bilateral injuries, social support, and intensity of combat experiences. Overall response rates were modest (59.2%) and significantly different between those who underwent amputation (64.5%) and those treated with limb salvage (55.4%) (p = 0.02). In all SMFA domains except arm/hand function, the patients scored significantly worse than population norms. Also, 38.3% screened positive for depressive symptoms and 17.9%, for posttraumatic stress disorder (PTSD). One-third (34.0%) were not working, on active duty, or in school. After adjustment for covariates, participants with an amputation had better scores in all SMFA domains compared with those whose limbs had been salvaged (p depressive symptoms, pain interfering with daily activities (pain interference), or work/school status. Major lower-limb trauma sustained in the military

  1. Glomerular Immune Deposits Are Predictive of Poor Long-Term Outcome in Patients with Adult Biopsy-Proven Minimal Change Disease: A Cohort Study in Korea.

    Directory of Open Access Journals (Sweden)

    Sung Woo Lee

    Full Text Available There has been little published information on risk factors for poor long-term outcome in adult biopsy-proven minimal change disease (MCD.Data from sixty-three adult, biopsy-proven primary MCD patients treated at a tertiary university hospital between 2003 and 2013 were analyzed. Baseline clinical and pathologic factors were assessed for the associations with composite outcome of creatinine doubling, end stage renal disease, or all-cause mortality.During a median (interquartile 5.0 (2.8-5.0 years, the composite outcome occurred in 11.1% (7/63 of patients. The rate of glomerular immune deposits was 23.8% (15/63. Patients with glomerular immune deposits showed a significantly lower urine protein creatinine ratio than those without deposits (P = 0.033. The rate of non-responders was significantly higher in patients with glomerular immune deposits than in those without deposits (P = 0.033. In patients with deposits, 26.7% (4/15 developed the composite outcome, while only 6.3% (3/48 developed the composite outcome among those without deposits (P = 0.049. In multivariate Cox proportional hazards regression analysis, the presence of glomerular immune deposits was the only factor associated with development of the composite outcome (hazard ratio: 2.310, 95% confidence interval: 1.031-98.579, P = 0.047.Glomerular immune deposits were associated with increased risk of a composite outcome in adult MCD patients. The higher rate of non-responders in patients with deposits might be related to the poor outcome. Future study is needed.

  2. Comparing outcomes in poorly-differentiated versus anaplastic thyroid cancers treated with radiation: A surveillance, epidemiology, and end results analysis

    Directory of Open Access Journals (Sweden)

    Shruthi Arora

    2014-01-01

    Conclusion: This is the first large population-based study evaluating PDTC and ATC outcomes in patients who received radiation treatment. Radioisotope use and timing of radiotherapy (postoperative vs. preoperative were associated with improved CSS in both histologies.

  3. Patient-based Outcomes and Quality of Life after Salvageable Wartime Extremity Vascular Injury

    Science.gov (United States)

    2014-01-01

    Quality of life evaluation. The SF-36 consists of 36 multiple -choice questions that seek to evaluate the overall quality of life of a patient in a...shunt use or nonuse, and associated primary amputation, were not predictive of unfavorable outcomes on multivariate analysis. Secondary amputees ...secondary amputees reported elevated Vitality scores (50.8 6 10.6 vs 46.5 6 11.3; P ¼ .046). Secondary ampu- tation was not associated with overall mental

  4. Clinical Outcome and Fusion Rates after the First 30 Extreme Lateral Interbody Fusions

    Directory of Open Access Journals (Sweden)

    Gregory M. Malham

    2012-01-01

    Full Text Available Introduction. The lateral transpsoas approach for lumbar interbody fusion (XLIF is gaining popularity. Studies examining a surgeon's early experience are rare. We aim to report treatment, complication, clinical, and radiographic outcomes in an early series of patients. Methods. Prospective data from the first thirty patients treated with XLIF by a single surgeon was reviewed. Outcome measures included pain, disability, and quality of life assessment. Radiographic assessment of fusion was performed by computed tomography. Results. Average follow-up was 11.5 months, operative time was 60 minutes per level and blood loss was 50 mL. Complications were observed: clinical subsidence, cage breakage upon insertion, new postoperative motor deficit and bowel injury. Approach side-effects were radiographic subsidence and anterior thigh sensory changes. Two patients required reoperation; microforaminotomy and pedicle screw fixation respectively. VAS back and leg pain decreased 63% and 56%, respectively. ODI improved 41.2% with 51.3% and 8.1% improvements in PCS and MCS. Complete fusion (last follow-up was observed in 85%. Conclusion. The XLIF approach provides superior treatment, clinical outcomes and fusion rates compared to conventional surgical approaches with lowered complication rates. Mentor supervision for early cases and strict adherence to the surgical technique including neuromonitoring is essential.

  5. The use of temporary vascular shunts in military extremity wounds: a preliminary outcome analysis with 2-year follow-up.

    Science.gov (United States)

    Borut, L T Jeffrey; Acosta, Capt José A; Tadlock, L C D R Matthew; Dye, Judy L; Galarneau, Michael; Elshire, Capt Donnel

    2010-07-01

    The use of temporary vascular shunts (TVS)s in the management of wartime extremity vascular injuries has received an increasing amount of attention. However, the overall impact of this adjunct remains incompletely defined. The objective of this study is to characterize outcomes of those patients who suffered wartime extremity vascular injuries managed with TVSs. This is a retrospective review of the Navy and Marine Corps Combat Trauma Registry examining peripheral vascular injuries treated during the military conflicts in the Middle East. Patient demographics, injury severity score, mechanism of injury, and vessels injured were recorded. Operative reports were reviewed for use of TVSs, type of definitive repair, the need for amputation, and survival. Eighty patients were included. Forty-six (57%) had TVSs placed and 34 (43%) underwent repair at initial presentation. The mean injury severity score for the TVS group and the non-TVS groups were 15.0 +/- 5.05 and 12.9 +/- 10.18, respectively, (p = 0.229). There were a total of 13 amputations, 6 (13%) in the TVS group and 7 (21%) in the non-TVS group (p = 0.38). There was no difference in amputation rates between either group. There were no recorded mortalities in either group. Median patient follow-up was 24.5 months (range, 3-48 months). This study demonstrates the importance and utility of TVSs in the management of wartime extremity vascular injury. When used to restore perfusion to an injured extremity, there seems to be no adverse effects or overall increase in limb loss rates and therefore a useful adjunct in the surgery for limb salvage.

  6. A retrospective study of risk factors for poor outcomes in methicillin-resistant staphylococcus aureus (MRSA infection in surgical patients

    Directory of Open Access Journals (Sweden)

    Middleton Scott D

    2011-05-01

    Full Text Available Abstract Background Since its isolation, Methicillin-resistant Staphlococcus aureus (MRSA has become a major cause of hospital acquired infection (HAI, adverse patient outcome and overall resource utilisation. It is endemic in Scotland and widespread in Western hospitals. MRSA has been the subject of widespread media interest- a manifestation of concerns about sterile surgical techniques and hospital cleanliness. This study aimed to investigate patient outcome of MRSA infections over the last decade at a major orthopaedic trauma centre. The objective was to establish the association of variables, such as patient age and inpatient residence, against patient outcome, in order to quantify significant relationships; facilitating the evaluation of management strategies with an aim to improving patient outcomes and targeting high-risk procedures. Methods This is a retrospective study of the rates and outcomes of MRSA infection in orthopaedic trauma at the Royal Infirmary of Edinburgh. Data was collated using SPSS 14.0 for Windows(R. Shapiro-Wilkes testing was performed to investigate the normality of continuous data sets (e.g: age. Data was analysed using both Chi-Squared and Fisher's exact tests (in cases of expected values under 5 Results This study found significant associations between adverse patient outcome (persistent deep infection, osteomyelitis, the necessity for revision surgery, amputation and mortality and the following patient variables: Length of inpatient stay, immuno-compromise, pre-admission residence in an institutional setting (such as a residential nursing home and the number of antibiotics used in patient care. Despite 63% of all infections sampled resulting from proximal femoral fractures, no association between patient outcome and site of infection or diagnosis was found. Somewhat surprisingly, the relationship between age and outcome of infection was not proved to be significant, contradicting previous studies suggesting a

  7. Abnormalities in orbitofrontal cortex gyrification and mental health outcomes in adolescents born extremely preterm and/or at an extremely low birth weight.

    Science.gov (United States)

    Ganella, Eleni P; Burnett, Alice; Cheong, Jeanie; Thompson, Deanne; Roberts, Gehan; Wood, Stephen; Lee, Katherine; Duff, Julianne; Anderson, Peter J; Pantelis, Christos; Doyle, Lex W; Bartholomeusz, Cali

    2015-03-01

    Extremely preterm (EP, orbitofrontal cortex (OFC) are determined during the third trimester, however little is known about OFC patterning in EP/ELBW cohorts, for whom this gestational period is disturbed. This study investigated whether the distribution of OFC pattern types and frequency of intermediate and/or posterior orbital sulci (IOS/POS) differed between EP/ELBW and control adolescents. This study also investigated whether OFC pattern type was associated with mental illness or executive function outcome in adolescence. Magnetic resonance images of 194 EP/ELBW and 147 full term (>37 completed weeks) and/or normal birth weight (> 2500 g) adolescents were acquired, from which the OFC pattern of each hemisphere was classified as Type I, II, or III. Compared with controls, more EP/ELBW adolescents possessed a Type II in the left hemisphere (P = 0.019). The EP/ELBW group had fewer IOS (P = 0.024) and more POS (P = 0.021) in the left hemisphere compared with controls. OFC pattern type was not associated with mental illness, however in terms of executive functioning, Type III in the left hemisphere was associated with better parent-reported metacognition scores overall (P = 0.008) and better self-reported behavioral regulation scores in the control group (P = 0.001) compared with Type I. We show, for the first time that EP/ELBW birth is associated with changes in orbitofrontal development, and that specific patterns of OFC folding are associated with executive function at age 18 years in both EP/ELBW and control subjects.

  8. Influence of Fever and Hospital-Acquired Infection on the Incidence of Delayed Neurological Deficit and Poor Outcome after Aneurysmal Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    G. Logan Douds

    2012-01-01

    Full Text Available Although fever and infection have been implicated in the causation of delayed neurological deficits (DND and poor outcome after aneurysmal subarachnoid hemorrhage (SAH, the relationship between these two often related events has not been extensively studied. We reviewed these events through of our retrospective database of patients with SAH. Multivariate logistic regression was used to determine independent predictors of DND and poor outcome. A total of 186 patients were analyzed. DND was noted in 76 patients (45%. Fever was recorded in 102 patients (55%; infection was noted in 87 patients (47%. A patient with one infection was more likely to experience DND compared to a patient with no infections (adjusted OR 3.73, 95% CI 1.62, 8.59. For those with more than two infections the likelihood of DND was even greater (adjusted OR 4.24, 95% CI 1.55, 11.56. Patients with 1-2 days of fever were less likely to have a favorable outcome when compared to their counterparts with no fever (adjusted OR 0.19, 95% CI 0.06, 0.62. This trend worsened as the number of days febrile increased. These data suggest that the presence of infection is associated with DND, but that fever may have a stronger independent association with overall outcome.

  9. Structural Pathways between Child Abuse, Poor Mental Health Outcomes and Male-Perpetrated Intimate Partner Violence (IPV.

    Directory of Open Access Journals (Sweden)

    Mercilene T Machisa

    Full Text Available Violent trauma exposures, including child abuse, are risk factors for PTSD and comorbid mental health disorders. Child abuse experiences of men exacerbate adult male-perpetrated intimate partner violence (IPV. The relationship between child abuse, poor mental health and IPV perpetration is complex but research among the general population is lacking. This study describes the relationship and pathways between history of child abuse exposure and male-perpetrated IPV while exploring the potentially mediating effect of poor mental health.We analysed data from a randomly selected, two-stage clustered, cross-sectional household survey conducted with 416 adult men in Gauteng Province of South Africa. We used multinomial regression modelling to identify associated factors and Structural Equation Modelling (SEM to test the primary hypothesis that poor mental health (defined as abusing alcohol or having PTSD or depressive symptoms mediates the relationship between child abuse and IPV perpetration.Eighty eight percent of men were physically abused, 55% were neglected, 63% were emotionally abused and 20% were sexually abused at least once in their childhood. Twenty four percent of men had PTSD symptoms, 24% had depressive symptoms and 36% binge drank. Fifty six percent of men physically abused and 31% sexually abused partners at least once in their lifetime. Twenty two percent of men had one episode and 40% had repeat episodes of IPV perpetration. PTSD symptomatology risk increased with severity of child trauma and other trauma. PTSD severity increased the risk for binge drinking. Child trauma, other trauma and PTSD symptomatology increased the severity of depressive symptoms. PTSD symptomatology was comorbid with alcohol abuse and depressive symptoms. Child trauma, having worked in the year before the survey, other trauma and PTSD increased the risk of repeat episodes of IPV perpetration. Highly equitable gender attitudes were protective against single and

  10. Structural Pathways between Child Abuse, Poor Mental Health Outcomes and Male-Perpetrated Intimate Partner Violence (IPV)

    Science.gov (United States)

    Machisa, Mercilene T.; Christofides, Nicola; Jewkes, Rachel

    2016-01-01

    Background Violent trauma exposures, including child abuse, are risk factors for PTSD and comorbid mental health disorders. Child abuse experiences of men exacerbate adult male-perpetrated intimate partner violence (IPV). The relationship between child abuse, poor mental health and IPV perpetration is complex but research among the general population is lacking. This study describes the relationship and pathways between history of child abuse exposure and male-perpetrated IPV while exploring the potentially mediating effect of poor mental health. Methods We analysed data from a randomly selected, two-stage clustered, cross-sectional household survey conducted with 416 adult men in Gauteng Province of South Africa. We used multinomial regression modelling to identify associated factors and Structural Equation Modelling (SEM) to test the primary hypothesis that poor mental health (defined as abusing alcohol or having PTSD or depressive symptoms) mediates the relationship between child abuse and IPV perpetration. Results Eighty eight percent of men were physically abused, 55% were neglected, 63% were emotionally abused and 20% were sexually abused at least once in their childhood. Twenty four percent of men had PTSD symptoms, 24% had depressive symptoms and 36% binge drank. Fifty six percent of men physically abused and 31% sexually abused partners at least once in their lifetime. Twenty two percent of men had one episode and 40% had repeat episodes of IPV perpetration. PTSD symptomatology risk increased with severity of child trauma and other trauma. PTSD severity increased the risk for binge drinking. Child trauma, other trauma and PTSD symptomatology increased the severity of depressive symptoms. PTSD symptomatology was comorbid with alcohol abuse and depressive symptoms. Child trauma, having worked in the year before the survey, other trauma and PTSD increased the risk of repeat episodes of IPV perpetration. Highly equitable gender attitudes were protective

  11. Understanding the importance of medical student clerkships in poor health outcome regions served by Area Health Education Centers (AHECs) in impoverished locations of Southern United States.

    Science.gov (United States)

    Patel, Ashruta

    2017-01-01

    Area Health Education Centers provide health professional students the opportunity to explore the benefits of practicing in a rural and underserved location. The status of health conditions in chronic disease patients residing in impoverished regions of the US provides the chance to understand the factors that are responsible for constant inadequate outcomes in underserved and rural communities. Many limiting barriers to positive health outcomes occur in disproportionate numbers in the Southern Black Belt. Students should consider participating in rural and underserved clerkships, and ultimately a career as a health care provider in a poor health outcome region. In addition, promising programs (e.g. telemedicine, community health workers) to help implement patient-centered evidence-based interventions can tackle current chronic disease issues commonly encountered by health professionals who work with diverse patient populations.

  12. Extremes of Interferon-Stimulated Gene Expression Associate with Worse Outcomes in the Acute Respiratory Distress Syndrome

    Science.gov (United States)

    Nick, Jerry A.; Caceres, Silvia M.; Kret, Jennifer E.; Poch, Katie R.; Strand, Matthew; Faino, Anna V.; Nichols, David P.; Saavedra, Milene T.; Taylor-Cousar, Jennifer L.; Geraci, Mark W.; Burnham, Ellen L.; Fessler, Michael B.; Suratt, Benjamin T.; Abraham, Edward; Moss, Marc; Malcolm, Kenneth C.

    2016-01-01

    Acute Respiratory Distress Syndrome (ARDS) severity may be influenced by heterogeneity of neutrophil activation. Interferon-stimulated genes (ISG) are a broad gene family induced by Type I interferons, often as a response to viral infections, which evokes extensive immunomodulation. We tested the hypothesis that over- or under-expression of immunomodulatory ISG by neutrophils is associated with worse clinical outcomes in patients with ARDS. Genome-wide transcriptional profiles of circulating neutrophils isolated from patients with sepsis-induced ARDS (n = 31) and healthy controls (n = 19) were used to characterize ISG expression. Hierarchical clustering of expression identified 3 distinct subject groups with Low, Mid and High ISG expression. ISG accounting for the greatest variability in expression were identified (MX1, IFIT1, and ISG15) and used to analyze a prospective cohort at the Colorado ARDS Network site. One hundred twenty ARDS patients from four urban hospitals were enrolled within 72 hours of initiation of mechanical ventilation. Circulating neutrophils were isolated from patients and expression of ISG determined by PCR. Samples were stratified by standard deviation from the mean into High (n = 21), Mid, (n = 82) or Low (n = 17) ISG expression. Clinical outcomes were compared between patients with High or Low ISG expression to those with Mid-range expression. At enrollment, there were no differences in age, gender, co-existing medical conditions, or type of physiologic injury between cohorts. After adjusting for age, race, gender and BMI, patients with either High or Low ISG expression had significantly worse clinical outcomes than those in the Mid for number of 28-day ventilator- and ICU-free days (P = 0.0006 and 0.0004), as well as 90-day mortality and 90-day home with unassisted breathing (P = 0.02 and 0.004). These findings suggest extremes of ISG expression by circulating neutrophils from ARDS patients recovered early in the syndrome are associated

  13. Pyruvate kinase M2 prevents apoptosis via modulating Bim stability and associates with poor outcome in hepatocellular carcinoma.

    Science.gov (United States)

    Hu, Wen; Lu, Shi-Xun; Li, Min; Zhang, Chao; Liu, Li-Li; Fu, Jia; Jin, Jie-Tian; Luo, Rong-Zhen; Zhang, Chris Zhiyi; Yun, Jing-Ping

    2015-03-30

    Pyruvate kinase M2 (PKM2) contributes to the Warburg effect, a hallmark of cancer. We showed that PKM2 levels were correlated with overall survival (hazard ration = 1.675, 95% confidence interval: 1.389-2.019, P Bim siRNA markedly abolished the PKM2-depletion-induced apoptosis. PKM2 depletion decreased the degradation of Bim. In clinical samples, PKM2 expression was reversely correlated with Bim expression. Combination of PKM2 and Bim levels had the best prognostic significance. We suggest that PKM2 serves as a promising biomarker for poor prognosis of patients with HCC and its knockdown induces HCC apoptosis by stabilizing Bim.

  14. The 5-minute Apgar score: survival and short-term outcomes in extremely low-birth-weight infants.

    Science.gov (United States)

    Phalen, Ann Gibbons; Kirkby, Sharon; Dysart, Kevin

    2012-01-01

    The Apgar score is a standardized tool for evaluating newborns in the delivery room. Despite its long history and widespread use, debate remains over its reliability of predicting neonatal outcomes, especially in extremely low-birth-weight premature infants. The aim of the study was to examine the relationship between the 5-minute Apgar score of extremely low-birth-weight infants, as it relates to survival and morbidities associated with prematurity and length of hospital stay. A retrospective query of the Alere neonatal database from 2001 to 2011 examined all infants less than 32 weeks' gestation and less than 1000-g birth weight. The 5-minute Apgar score was divided into 2 groups, score of 4 or greater or less than 4. The study compared results of the 5-minute Apgar score and associated morbidities in surviving infants. Statistical analyses included chi-square, Fisher exact test, t test, and multivariate regression. The sample consisted of 3898 infants with an 86.4% (n = 3366) survival rate. Controlling for gestational age and birth weight, surviving infants with a 5-minute Apgar score of less than 4 were more likely to demonstrate nonintact survival. Infants with a low 5-minute Apgar score have greater risk for mortality and morbidities associated with prematurity.

  15. Identification of a subset of perpheral T-cell lymphoma, not otherwise specified, characterized by FOXP3-positive regulatory T-cell phenotype, HTLV-1 negativity and poor outcome

    DEFF Research Database (Denmark)

    Pedersen, Martin Bjerregård; Hamilton-Dutoit, Stephen Jacques; Bendix, Knud

    2014-01-01

    Identification of a subset of perpheral T-cell lymphoma, not otherwise specified, characterized by FOXP3-positive regulatory T-cell phenotype, HTLV-1 negativity and poor outcome.......Identification of a subset of perpheral T-cell lymphoma, not otherwise specified, characterized by FOXP3-positive regulatory T-cell phenotype, HTLV-1 negativity and poor outcome....

  16. Long-term clinical outcomes of war-related bilateral lower extremities amputations.

    Science.gov (United States)

    Ebrahimzadeh, Mohammad Hosein; Moradi, Ali; Khorasani, Mohammad Reza; Hallaj-Moghaddam, Mohammad; Kachooei, Amir Reza

    2015-02-01

    In a cross-sectional study, 291 out of 500 veterans with war-related bilateral lower limb amputations from Iran-Iraq war (1980-1988) accepted to participate in our study. Information related to amputees and amputated limbs were gathered and a Persian version of the Medical Outcomes Study Short Form 36 (SF-36) was filled. To evaluate the effect of amputation level on health related quality of life, we classified patients to seven types according to the functional remainder of major joints (ankles, knees, hips). 97% of patients were male and the average age at the time of injury was 20 years. The major cause of war injury was shells in 50. 54% of amputees were involved in sport activities. The most common amputation level was transtibial (48%).The major stump complaint was muscle spasm. History of being hospitalized for a psychiatric disorder was reported in 5.6%. The average SF-36 score in type 2 to type 6 were 68, 60, 60, 56, and 62, respectively. Except Energy/Fatigue domain, all the other domains were different from normal population. There was not any significant statistical correlation between amputation type and any domain of the SF-36. Type 6 amputees showed an increase in physical health domains compared with former types.

  17. Nuclear HER4 mediates acquired resistance to trastuzumab and is associated with poor outcome in HER2 positive breast cancer.

    Science.gov (United States)

    Mohd Nafi, Siti Norasikin; Generali, Daniele; Kramer-Marek, Gabriela; Gijsen, Merel; Strina, Carla; Cappelletti, Mariarosa; Andreis, Daniele; Haider, Syed; Li, Ji-Liang; Bridges, Esther; Capala, Jacek; Ioannis, Roxanis; Harris, Adrian L; Kong, Anthony

    2014-08-15

    The role of HER4 in breast cancer is controversial and its role in relation to trastuzumab resistance remains unclear. We showed that trastuzumab treatment and its acquired resistance induced HER4 upregulation, cleavage and nuclear translocation. However, knockdown of HER4 by specific siRNAs increased trastuzumab sensitivity and reversed its resistance in HER2 positive breast cancer cells. Preventing HER4 cleavage by a γ-secretase inhibitor and inhibiting HER4 tyrosine kinase activity by neratinib decreased trastuzumab-induced HER4 nuclear translocation and enhanced trastuzumab response. There was also increased nuclear HER4 staining in the tumours from BT474 xenograft mice and human patients treated with trastuzumab. Furthermore, nuclear HER4 predicted poor clinical response to trastuzumab monotherapy in patients undergoing a window study and was shown to be an independent poor prognostic factor in HER2 positive breast cancer. Our data suggest that HER4 plays a key role in relation to trastuzumab resistance in HER2 positive breast cancer. Therefore, our study provides novel findings that HER4 activation, cleavage and nuclear translocation influence trastuzumab sensitivity and resistance in HER2 positive breast cancer. Nuclear HER4 could be a potential prognostic and predictive biomarker and understanding the role of HER4 may provide strategies to overcome trastuzumab resistance in HER2 positive breast cancer.

  18. Co-expression of parathyroid hormone related protein and TGF-beta in breast cancer predicts poor survival outcome.

    Science.gov (United States)

    Xu, Cheng; Wang, Zhengyuan; Cui, Rongrong; He, Hongyu; Lin, Xiaoyan; Sheng, Yuan; Zhang, Hongwei

    2015-11-23

    Better methods to predict prognosis can play a supplementary role in administering individualized treatment for breast cancer patients. Altered expressions of PTHrP and TGF-β have been observed in various types of human cancers. The objective of the current study was to evaluate the association of PTHrP and TGF-β level with the clinicopathological features of the breast cancer patients. Immunohistochemistry was used to examine PTHrP and TGF-β protein expression in 497 cases of early breast cancer, and Kaplan-Meier method and COX's Proportional Hazard Model were applied to the prognostic value of PTHrP and TGF-β expression. Both over-expressed TGF-β and PTHrP were correlated with the tumor in larger size, higher proportion of axillary lymph node metastasis and later clinical stage. Additionally, the tumors with a high TGF-β level developed poor differentiation, and only TGF-β expression was associated with disease-free survival (DFS) of the breast cancer patients. Followed up for a median of 48 months, it was found that only the patients with negative TGF-β expression had longer DFS (P PTHrP expression tended to show a higher rate of bone metastasis (67.6 % vs. 45.8 %, P = 0.019). In ER negative subgroup, those who developed PTHrP positive expression presented poor prognosis (P PTHrP expression were significantly associated with the high risk of metastases. As indicated by Cox's regression analysis, TGF-β expression and the high proportion of axillary lymph node metastasis served as significant independent predictors for breast cancer recurrence. TGF-β and PTHrP were confirmed to be involved in regulating the malignant progression in breast cancer, and PTHrP expression, to be associated with bone metastasis as a potential prognostic marker in ER negative breast cancer.

  19. Pyruvate Kinase M2 and Lactate Dehydrogenase A Are Overexpressed in Pancreatic Cancer and Correlate with Poor Outcome.

    Science.gov (United States)

    Mohammad, Goran Hamid; Olde Damink, S W M; Malago, Massimo; Dhar, Dipok Kumar; Pereira, Stephen P

    2016-01-01

    Pancreatic cancer has a 5-year survival rate of less than 4%. Despite advances in diagnostic technology, pancreatic cancer continues to be diagnosed at a late and incurable stage. Accurate biomarkers for early diagnosis and to predict treatment response are urgently needed. Since alteration of glucose metabolism is one of the hallmarks of cancer cells, we proposed that pyruvate kinase type M2 (M2PK) and lactate dehydrogenase A (LDHA) enzymes could represent novel diagnostic markers and potential therapeutic targets in pancreatic cancer. In 266 tissue sections from normal pancreas, pancreatic cystic neoplasms, pancreatic intraepithelial neoplasia (PanIN) and cancer, we evaluated the expression of PKM2, LDHA, Ki-67 and CD8+ by immunohistochemistry and correlated these markers with clinicopathological characteristics and patient survival. PKM2 and LDHA expression was also assessed by Western blot in 10 human pancreatic cancer cell lines. PKM2 expression increased progressively from cyst through PanIN to cancer, whereas LDHA was overexpressed throughout the carcinogenic process. All but one cell line showed high expression of both proteins. Patients with strong PKM2 and LDHA expression had significantly worse survival than those with weak PKM2 and/or LDHA expression (7.0 months vs. 27.9 months, respectively, p = 0.003, log rank test). The expression of both PKM2 and LDHA correlated directly with Ki-67 expression, and inversely with intratumoral CD8+ cell count. PKM2 was significantly overexpressed in poorly differentiated tumours and both PKM2 and LDHA were overexpressed in larger tumours. Multivariable analysis showed that combined expression of PKM2 and LDHA was an independent poor prognostic marker for survival. In conclusion, our results demonstrate a high expression pattern of two major glycolytic enzymes during pancreatic carcinogenesis, with increased expression in aggressive tumours and a significant adverse effect on survival.

  20. Pyruvate Kinase M2 and Lactate Dehydrogenase A Are Overexpressed in Pancreatic Cancer and Correlate with Poor Outcome.

    Directory of Open Access Journals (Sweden)

    Goran Hamid Mohammad

    Full Text Available Pancreatic cancer has a 5-year survival rate of less than 4%. Despite advances in diagnostic technology, pancreatic cancer continues to be diagnosed at a late and incurable stage. Accurate biomarkers for early diagnosis and to predict treatment response are urgently needed. Since alteration of glucose metabolism is one of the hallmarks of cancer cells, we proposed that pyruvate kinase type M2 (M2PK and lactate dehydrogenase A (LDHA enzymes could represent novel diagnostic markers and potential therapeutic targets in pancreatic cancer. In 266 tissue sections from normal pancreas, pancreatic cystic neoplasms, pancreatic intraepithelial neoplasia (PanIN and cancer, we evaluated the expression of PKM2, LDHA, Ki-67 and CD8+ by immunohistochemistry and correlated these markers with clinicopathological characteristics and patient survival. PKM2 and LDHA expression was also assessed by Western blot in 10 human pancreatic cancer cell lines. PKM2 expression increased progressively from cyst through PanIN to cancer, whereas LDHA was overexpressed throughout the carcinogenic process. All but one cell line showed high expression of both proteins. Patients with strong PKM2 and LDHA expression had significantly worse survival than those with weak PKM2 and/or LDHA expression (7.0 months vs. 27.9 months, respectively, p = 0.003, log rank test. The expression of both PKM2 and LDHA correlated directly with Ki-67 expression, and inversely with intratumoral CD8+ cell count. PKM2 was significantly overexpressed in poorly differentiated tumours and both PKM2 and LDHA were overexpressed in larger tumours. Multivariable analysis showed that combined expression of PKM2 and LDHA was an independent poor prognostic marker for survival. In conclusion, our results demonstrate a high expression pattern of two major glycolytic enzymes during pancreatic carcinogenesis, with increased expression in aggressive tumours and a significant adverse effect on survival.

  1. Association of Neurodevelopmental Outcomes and Neonatal Morbidities of Extremely Premature Infants With Differential Exposure to Antenatal Steroids

    Science.gov (United States)

    Chawla, Sanjay; Natarajan, Girija; Shankaran, Seetha; Pappas, Athina; Stoll, Barbara J.; Carlo, Waldemar A.; Saha, Shampa; Das, Abhik; Laptook, Abbot R.; Higgins, Rosemary D.

    2017-01-01

    IMPORTANCE Many premature infants are born without exposure to antenatal steroids (ANS) or with incomplete courses. This study evaluates the dose-dependent effect of ANS on rates of neonatal morbidities and early childhood neurodevelopmental outcomes of extremely premature infants. OBJECTIVE To compare rates of neonatal morbidities and 18- to 22-month neurodevelopmental outcomes of extremely premature infants exposed to no ANS or partial or complete courses of ANS. DESIGN, SETTING, AND PARTICIPANTS In this observational cohort study, participants were extremely premature infants (birth weight range, 401–1000 g; gestational age, 22–27 weeks) who were born at participating centers of the National Institute of Child Health and Human Development Neonatal Research Network between January 2006 and December 2011. Data were analyzed between October 2013 and May 2016. MAIN OUTCOMES AND MEASURES Rates of death or neurodevelopmental impairment at 18 to 22 months’ corrected age. Neurodevelopmental impairment was defined as the presence of any of the following: moderate to severe cerebral palsy, a cognitive score less than 85 on the Bayley Scales of Infant and Toddler Development III, blindness, or deafness. RESULTS There were 848 infants in the no ANS group, 1581 in the partial ANS group, and 3692 in the complete ANS group; the mean (SD) birth weights were 725 (169), 760 (173), and 753 (170) g, respectively, and the mean (SD) gestational ages were 24.5 (1.4), 24.9 (2), and 25.1 (1.1) weeks. Of 6121 eligible infants, 4284 (70.0%) survived to 18- to 22-month follow-up, and data were available for 3892 of 4284 infants (90.8%). Among the no, partial, and complete ANS groups, there were significant differences in the rates of mortality (43.1%, 29.6%, and 25.2%, respectively), severe intracranial hemorrhage among survivors (23.3%, 19.1%, and 11.7%), death or necrotizing enterocolitis (48.1%, 37.1%, and 32.5%), and death or bronchopulmonary dysplasia (74.9%, 68.9%, and 65

  2. Preoperative Angiographic Criteria for Predicting Free-Flap Transfer Outcomes in Patients With Lower-Extremity Peripheral Arterial Disease.

    Science.gov (United States)

    Park, Sang Woo; Kim, Junhyung; Choi, Jaehoon; Kim, Jun Sik; Lee, Jeong Hwan; Park, Young Sook

    2016-09-29

    Patients scheduled for microsurgical reconstruction of the lower leg often receive preoperative assessment of recipient vessels using angiography. However, no clear standard is available for evaluating angiographic results to predict free-flap survival outcomes. We developed angiographic criteria for predicting surgical outcome in patients with lower-extremity peripheral arterial disease based on abnormality of the anterior tibial and posterior tibial arteries. We applied the criteria to a small number of patients scheduled for microsurgical reconstruction of the lower leg. Angiographies with arterial abnormalities were classified into 3 groups: favorable free-flap survival, compromised free-flap survival, and postsurgical pedal ischemia. The study enrolled 50 patients between 2005 and 2013. In 42% of patients, arterial abnormalities were observed by angiography. Age >65 years was the strongest risk factor for development of lower-leg arterial abnormality (P free-flap survival and compromised free-flap survival groups, free-flap transfers were attempted in 7 patients but intraoperatively abandoned in 2 patients, with postoperative failure in 1 patient. In the postsurgical pedal ischemia group, free-flap transfers were attempted in 10 patients but intraoperatively abandoned in 6 patients, with postoperative failure in 3.

  3. Localization of nuclear cathepsin L and its association with disease progression and poor outcome in colorectal cancer.

    LENUS (Irish Health Repository)

    Sullivan, Shane

    2012-02-01

    Previous in vitro studies have identified a nuclear isoform of Cathepsin L. The aim of this study was to examine if nuclear Cathepsin L exists in vivo and examine its association with clinical, pathological and patient outcome data. Cellular localization (nuclear and cytoplasmic) and expression levels v of Cathespin L in 186 colorectal cancer cases using immunohistochemistry. The molecular weight and activity of nuclear and cytoplasmic Cathepsin L in vivo and in vitro were assessed by Western blotting and ELISA, respectively. Epithelial nuclear staining percentage (p = 0.04) and intensity (p = 0.006) increased with advancing tumor stage, whereas stromal cytoplasmic staining decreased (p = 0.02). Using multivariate statistical analysis, survival was inversely associated with staining intensity in the epithelial cytoplasm (p = 0.01) and stromal nuclei (p = 0.007). In different colorectal cell lines and in vivo tumors, pro- and active Cathepsin L isoforms were present in both the cytoplasm and nuclear samples, with pro-Cathepsin L at 50 kDa and active Cathepsin L at 25 kDa. Purified nuclear and cytoplasmic fractions from cell lines and tumors showed active Cathepsin L activity. The identification of nuclear Cathepsin L may play an important prognostic role in colorectal disease progression and patient outcome. Moreover, these findings suggest that altering active nuclear Cathepsin L may significantly influence disease progression.

  4. The Explosive Yields Produced by the First Generation of Core Collapse Supernovae and the Chemical Composition of Extremely Metal Poor Stars

    CERN Document Server

    Chieffi, A; Chieffi, Alessandro; Limongi, Marco

    2002-01-01

    We present a detailed comparison between an extended set of elemental abundances observed in some of the most metal poor stars presently known and the ejecta produced by a generation of primordial core collapse supernovae. We used five stars which form our initial database and define a "template" ultra metal poor star which is then compared to the theoretical predictions. Our main findings are as follows: a) the fit to [Si/Mg] and [Ca/Mg] of these very metal poor stars seems to favor the presence of a rather large C abundance at the end of the central He burning; in a classical scenario in which the border of the convective core is strictly determined by the Schwarzschild criterion, such a large C abundance would imply a rather low C12(alpha,gamma)O16 reaction rate; b) a low C abundance left by the central He burning would imply a low [Al/Mg] (<-1.2 dex) independently on the initial mass of the exploding star while a rather large C abundance would produce such a low [Al/Mg] only for the most massive stella...

  5. Transcranial regional cerebral oxygen desaturation predicts delayed cerebral ischaemia and poor outcomes after subarachnoid haemorrhage: a correlational study.

    Science.gov (United States)

    Yousef, Khalil M; Balzer, Jeffrey R; Crago, Elizabeth A; Poloyac, Samuel M; Sherwood, Paula R

    2014-12-01

    To examine the relationship between regional cerebral oxygen saturation (rSO2), delayed cerebral ischaemia (DCI), and outcomes after aneurysmal subarachnoid haemorrhage (aSAH). Subjects (n = 163) with aSAH, age 21-75 years, and Fisher grade >1 were included in the study. Continuous rSO2 monitoring was performed for 5-10 days after injury using near-infrared spectroscopy with sensors over the frontal/temporal cortex. rSO250 (OR 3.25, 95%CI 1.58-6.69), positive predictive value (PPV) = 70%. Subjects with rSO2 50 (OR 2.7, 95%CI 1.1-7.2), PPV = 70%. These results suggest that NIRS has the potential for detecting DCI after aSAH. This potential needs to be further explored in a larger prospective study. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Postoperative CMF Does Not Ameliorate Poor Outcomes in Women With Residual Invasive Breast Cancer After Neoadjuvant Epirubicin/Docetaxel Chemotherapy.

    Science.gov (United States)

    Promberger, Regina; Dubsky, Peter; Mittlböck, Martina; Ott, Johannes; Singer, Christian; Seemann, Rudolf; Exner, Ruth; Panhofer, Peter; Steger, Günther; Bergen, Elisabeth; Gnant, Michael; Jakesz, Raimund; Bago-Horvath, Zsuzsanna; Rudas, Margaretha; Bartsch, Rupert

    2015-12-01

    Neoadjuvant chemotherapy (NACT) is an accepted treatment approach in early-stage breast cancer. In contrast, the potential role of postneoadjuvant chemotherapy after taxane-containing NACT remains unclear. The aim of this study was to evaluate postneoadjuvant chemotherapy and further prognostic factors that predict outcome in women without pathologic complete remission (pCR). A total of 377 patients with breast cancer who received preoperative chemotherapy were included in this retrospective study. Patients without standard NACT (6 cycles of epirubicin with docetaxel) or primary metastatic breast cancer and locally advanced, inoperable cancer were excluded from further analysis (n = 186). This resulted in a study population of 191 women (30 [15.7%] with pCR; 161 [84.3%] without pCR). Major outcome parameters were event-free survival (EFS) and overall survival (OS). The following parameters were tested for their prognostic role: postneoadjuvant chemotherapy, patient age, breast cancer subtype (luminal/HER2-negative tumors, HER2-positive tumors, and triple-negative tumors), histological grade, pCR, residual lymph node invasion, and residual invasive tumor size. At a median follow-up of 54 months, 51 disease relapses (26.7%) and 21 deaths (11%) were observed. In a comparison of patients with pCR with those without, no significant differences in EFS or OS were observed. Postneoadjuvant chemotherapy was significantly associated with shorter OS in patients without pCR. In this population, which included a high percentage of patients with luminal cancers, pCR did not predict for improved OS. Postneoadjuvant chemotherapy showed no discernible benefit even in subgroups with aggressive tumor biology or significant remaining tumor burden. The use of such treatment should therefore be discouraged outside of clinical trials. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Poor outcomes and satisfaction in adolescent idiopathic scoliosis surgery: the relevance of the body mass index and self-image.

    Science.gov (United States)

    Pérez-Prieto, Daniel; Sánchez-Soler, Juan Francisco; Martínez-Llorens, Juana; Mojal, Sergi; Bagó, Joan; Cáceres, Enric; Ramírez, Manuel

    2015-02-01

    The purpose of this study was to evaluate patients with adolescent idiopathic scoliosis (AIS) to determine whether a low body mass index (BMI) influences surgery outcomes and satisfaction. There were 39 patients in this prospective 3-year cohort study. The BMI, Cobb angle, the Body Shape Questionnaire 14 (BSQ-14), the Scoliosis Research Society Questionnaire 22 (SRS-22) and eight satisfaction questions results were obtained. Having a BMI greater than or less than 18 kg/m(2) was used as a determiner to allocate patients to groups. As a low BMI is related to the presence of a disturbance in body perception, patients were also dichotomized by using the BSQ-14. All scales were worse in both slimmer patients and the group with a body perception disorder. The group with a BMI 18 kg/m(2) (p = 0.001). In terms of satisfaction, the percentage of patients that would undergo surgery again was 30.8 vs 69.2 % (p = 0.054). Patients with an alteration of physical perception obtained a total SRS-22 of 82.90 points versus 96.10 points in the control group (p < 0.001). No differences in terms of the Cobb correction (p = 0.29) or the percentage of correction (p = 0.841) were found in any case. The alteration of physical perception and a low BMI negatively affect the outcomes in AIS surgery, regardless of the curve magnitude and the percentage of correction. Considerable care should be taken in recommending surgical correction to these patients.

  8. Europe’s Tired, Poor, Huddled Masses: Self-Selection and Economic Outcomes in the Age of Mass Migration†

    Science.gov (United States)

    Abramitzky, Ran; Boustan, Leah Platt; Eriksson, Katherine

    2015-01-01

    During the age of mass migration (1850–1913), one of the largest migration episodes in history, the United States maintained a nearly open border, allowing the study of migrant decisions unhindered by entry restrictions. We estimate the return to migration while accounting for migrant selection by comparing Norway-to-US migrants with their brothers who stayed in Norway in the late nineteenth century. We also compare fathers of migrants and nonmigrants by wealth and occupation. We find that the return to migration was relatively low (70 percent) and that migrants from urban areas were negatively selected from the sending population. “Keep, ancient lands, your storied pomp!” cries she With silent lips. “Give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore. Send these, the homeless, tempest-tost to me, I lift my lamp beside the golden door!”——Emma Lazarus (1883)1 PMID:26594052

  9. Co-ordinated overexpression of SIRT1 and STAT3 is associated with poor survival outcome in gastric cancer patients.

    Science.gov (United States)

    Zhang, Shu; Huang, Shuling; Deng, Chao; Cao, Yu; Yang, Jun; Chen, Guangxia; Zhang, Bin; Duan, Chaoqin; Shi, Jiong; Kong, Bo; Friess, Helmut; Zhao, Nanyi; Huang, Chen; Huang, Xiaoli; Wang, Lei; Zou, Xiaoping

    2017-03-21

    In many gastric cancer patients, the disease is diagnosed in an advanced stage and therefore the mortality levels are high. Because there is a need to identify novel early diagnostic and prognostic biomarkers, we tested whether SIRT1 and STAT3 are good candidates. Towards this, we used patient tissues representing different stages of gastric cancer including gastric pre-cancerous lesions, early gastric cancer, and advanced gastric cancer, and probed SIRT1, STAT3 and phosphorylated STAT3 (pSTAT3) levels using immunohistochemistry. Our results revealed upregulated expression of SIRT1 in all stages of gastric cancer compared with noncancerous gastric mucosa, suggesting that high SIRT1 levels are likely involved in establishing gastric neoplasticity. However, STAT3 and pSTAT3 levels remained low until the gastric mucosa reached the tumor stage. Moreover, co-ordinated high expression of SIRT1 and STAT3 predicted poor overall survival for advanced gastric cancer patients. In addition, through analysis of gastric cancer patients from the TCGA dataset, we identified SIRT2 as an independent prognostic factor in gastric cancer patients. We postulate that SIRT1 and STAT3 are potential early diagnostic and prognostic markers of gastric cancer. Our study also shows that SIRT1 acts a gatekeeper during gastric tumorigenesis.

  10. Overexpression of MMP13 Is Associated with Clinical Outcomes and Poor Prognosis in Oral Squamous Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Vui King Vincent-Chong

    2014-01-01

    Full Text Available Matrix metalloproteinase 13 (MMP13 plays a central role in the MMP activation cascade that enables degradation of the extracellular matrix and basement membranes, and it is identified as a potential driver in oral carcinogenesis. Therefore, this study aims to determine the copy number, mRNA, and protein expression of MMP13 in oral squamous cell carcinoma (OSCC and to associate these expressions with clinicopathological parameters. Copy number, mRNA, and protein expression analysis of MMP13 were determined using real-time quantitative PCR and immunohistochemistry methods in OSCC samples. The correlations between MMP13 expressions and clinicopathological parameters were evaluated, and the significance of MMP13 as a prognostic factor was determined. Despite discrepancies between gene amplification and mRNA and protein overexpression rates, OSCC cases showed high amplification of MMP13 and overexpression of MMP13 at both mRNA and protein levels. High level of MMP13 protein expression showed a significant correlation with lymph node metastasis (P=0.011 and tumor staging (P=0.002. Multivariate Cox regression model analysis revealed that high level of mRNA and protein expression of MMP13 were significantly associated with poor prognosis (P<0.050. Taken together, these observations indicate that the MMP13 protein overexpression could be considered as a prognostic marker of OSCC.

  11. Discovering extremely compact and metal-poor, star-forming dwarf galaxies out to z ~ 0.9 in the VIMOS Ultra-Deep Survey

    CERN Document Server

    Amorín, Ricardo; Castellano, M; Grazian, A; Tasca, L A M; Fontana, A; Pentericci, L; Cassata, P; Garilli, B; Brun, V Le; Fèvre, O Le; Maccagni, D; Thomas, R; Vanzella, E; Zamorani, G; Zucca, E; Bardelli, S; Capak, P; Cassará, L; Cimatti, A; Cuby, J G; Cucciati, O; de la Torre, S; Durkalec, A; Giavalisco, M; Hathi, N P; Ilbert, O; Lemaux, B C; Moreau, C; Paltani, S; Ribeiro, B; Salvato, M; Schaerer, D; Scodeggio, M; Talia, M; Taniguchi, Y; Tresse, L; Vergani, D; Wang, P W; Charlot, S; Contini, T; Fotopoulou, S; López-Sanjuan, C; Mellier, Y; Scoville, N

    2014-01-01

    We report the discovery of 31 low-luminosity (-14.5 < M_{AB}(B) < -18.8), extreme emission line galaxies (EELGs) at 0.3 < z < 0.9 identified by their unusually high rest-frame equivalent widths (100 < EW[OIII] < 1700 A) as part of the VIMOS Ultra Deep Survey (VUDS). VIMOS optical spectra of unprecedented sensitivity ($I_{AB}$ ~ 25 mag) along with multiwavelength photometry and HST imaging are used to investigate spectrophotometric properties of this unique sample and explore, for the first time, the very low stellar mass end (M* < 10^8 M$_{\\odot}$) of the luminosity-metallicity (LZR) and mass-metallicity (MZR) relations at z < 1. Characterized by their extreme compactness (R50 < 1 kpc), low stellar mass and enhanced specific star formation rates (SFR/M* ~ 10^{-9} - 10^{-7} yr^{-1}), the VUDS EELGs are blue dwarf galaxies likely experiencing the first stages of a vigorous galaxy-wide starburst. Using T_e-sensitive direct and strong-line methods, we find that VUDS EELGs are low-metall...

  12. The association of fast food consumption with poor dietary outcomes and obesity among children: is it the fast food or the remainder of the diet?

    Science.gov (United States)

    Poti, Jennifer M; Duffey, Kiyah J; Popkin, Barry M

    2014-01-01

    Although fast food consumption has been linked to adverse health outcomes, the relative contribution of fast food itself compared with the rest of the diet to these associations remains unclear. Our objective was to compare the independent associations with overweight/obesity or dietary outcomes for fast food consumption compared with dietary pattern for the remainder of intake. This cross-sectional analysis studied 4466 US children aged 2-18 y from NHANES 2007-2010. Cluster analysis identified 2 dietary patterns for the non-fast food remainder of intake: Western (50.3%) and Prudent. Multivariable-adjusted linear and logistic regression models examined the association between fast food consumption and dietary pattern for the remainder of intake and estimated their independent associations with overweight/obesity and dietary outcomes. Half of US children consumed fast food: 39.5% low-consumers (≤30% of energy from fast food) and 10.5% high-consumers (>30% of energy). Consuming a Western dietary pattern for the remainder of intake was more likely among fast food low-consumers (OR: 1.51; 95% CI: 1.24, 1.85) and high-consumers (OR: 2.21; 95% CI: 1.60, 3.05) than among nonconsumers. The remainder of diet was independently associated with overweight/obesity (β: 5.9; 95% CI: 1.3, 10.5), whereas fast food consumption was not, and the remainder of diet had stronger associations with poor total intake than did fast food consumption. Outside the fast food restaurant, fast food consumers ate Western diets, which might have stronger associations with overweight/obesity and poor dietary outcomes than fast food consumption itself. Our findings support the need for prospective studies and randomized trials to confirm these hypotheses.

  13. The association of fast food consumption with poor dietary outcomes and obesity among children: is it the fast food or the remainder of the diet?123

    Science.gov (United States)

    Poti, Jennifer M; Duffey, Kiyah J

    2014-01-01

    Background: Although fast food consumption has been linked to adverse health outcomes, the relative contribution of fast food itself compared with the rest of the diet to these associations remains unclear. Objective: Our objective was to compare the independent associations with overweight/obesity or dietary outcomes for fast food consumption compared with dietary pattern for the remainder of intake. Design: This cross-sectional analysis studied 4466 US children aged 2–18 y from NHANES 2007–2010. Cluster analysis identified 2 dietary patterns for the non–fast food remainder of intake: Western (50.3%) and Prudent. Multivariable-adjusted linear and logistic regression models examined the association between fast food consumption and dietary pattern for the remainder of intake and estimated their independent associations with overweight/obesity and dietary outcomes. Results: Half of US children consumed fast food: 39.5% low-consumers (≤30% of energy from fast food) and 10.5% high-consumers (>30% of energy). Consuming a Western dietary pattern for the remainder of intake was more likely among fast food low-consumers (OR: 1.51; 95% CI: 1.24, 1.85) and high-consumers (OR: 2.21; 95% CI: 1.60, 3.05) than among nonconsumers. The remainder of diet was independently associated with overweight/obesity (β: 5.9; 95% CI: 1.3, 10.5), whereas fast food consumption was not, and the remainder of diet had stronger associations with poor total intake than did fast food consumption. Conclusions: Outside the fast food restaurant, fast food consumers ate Western diets, which might have stronger associations with overweight/obesity and poor dietary outcomes than fast food consumption itself. Our findings support the need for prospective studies and randomized trials to confirm these hypotheses. PMID:24153348

  14. Renal arterial resistive index is associated with severe histological changes and poor renal outcome during chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Bigé Naïke

    2012-10-01

    Full Text Available Abstract Background Chronic kidney disease (CKD is a growing public health problem and end stage renal disease (ESRD represents a large human and economic burden. It is important to identify patients at high risk of ESRD. In order to determine whether renal Doppler resistive index (RI may discriminate those patients, we analyzed whether RI was associated with identified prognosis factors of CKD, in particular histological findings, and with renal outcome. Methods RI was measured in the 48 hours before renal biopsy in 58 CKD patients. Clinical and biological data were collected prospectively at inclusion. Arteriosclerosis, interstitial fibrosis and glomerulosclerosis were quantitatively assessed on renal biopsy in a blinded fashion. MDRD eGFR at 18 months was collected for 35 (60% patients. Renal function decline was defined as a decrease in eGFR from baseline of at least 5 mL/min/ 1.73 m2/year or need for chronic renal replacement therapy. Pearson’s correlation, Mann–Whitney and Chi-square tests were used for analysis of quantitative and qualitative variables respectively. Kaplan Meier analysis was realized to determine renal survival according to RI value using the log-rank test. Multiple logistic regression was performed including variables with p Results Most patients had glomerulonephritis (82%. Median age was 46 years [21–87], eGFR 59 mL/min/ 1.73m2 [5–130], percentage of interstitial fibrosis 10% [0–90], glomerulosclerosis 13% [0–96] and RI 0.63 [0.31-1.00]. RI increased with age (r = 0.435, p = 0.0063, pulse pressure (r = 0.303, p = 0.022, renal atrophy (r = −0.275, p = 0.038 and renal dysfunction (r = −0.402, p = 0.0018. Patients with arterial intima/media ratio ≥ 1 (p = 0.032, interstitial fibrosis > 20% (p = 0.014 and renal function decline (p = 0.0023 had higher RI. Patients with baseline RI ≥ 0.65 had a poorer renal outcome than those with baseline RI Conclusions Our results suggest that RI ≥ 0.65 is associated

  15. Admission Heart Rate Predicts Poor Outcomes in Acute Intracerebral Hemorrhage: The Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial Studies.

    Science.gov (United States)

    Qiu, Miaoyan; Sato, Shoichiro; Zheng, Danni; Wang, Xia; Carcel, Cheryl; Hirakawa, Yoichiro; Sandset, Else C; Delcourt, Candice; Arima, Hisatomi; Wang, Jiguang; Chalmers, John; Anderson, Craig S

    2016-06-01

    Faster heart rate predicts higher mortality in coronary heart disease and acute ischemic stroke, but its prognostic significance in intracerebral hemorrhage remains uncertain. We aimed to determine the effect of admission heart rate on clinical and imaging outcomes in patients with intracerebral hemorrhage. A post hoc pooled analysis of the pilot and main phases of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT 1 and 2). Clinical outcomes were mortality and modified Rankin Scale score at 90 days; and imaging outcome was absolute growth in hematoma volume during the initial 24 hours. Patients were divided into 4 categories according to baseline heart rate (heart rate group as the reference. Of 3185 patients with available data, higher admission heart rate was associated with both mortality and worse modified Rankin Scale score: adjusted hazard ratio for heart rate (≥85 versus heart rate and absolute growth in hematoma volume (P-trend, 0.196). Higher admission heart rate is independently associated with death and poor functional outcome after acute intracerebral hemorrhage. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00226096 and NCT00716079. © 2016 American Heart Association, Inc.

  16. CS-31A NOVEL YAP-DRIVEN MIGRATION AND INVASION SIGNALING PATHWAY PREDICTS POOR OUTCOME IN GLIOBLASTOMA

    Science.gov (United States)

    Shah, Sagar R; Tippens, Nathaniel D; Park, Jinseok; Mohyeldin, Ahmed; Vela, Guillermo; Levchenko, Andre; Quinones-Hinojosa, Alfredo

    2014-01-01

    One of the hallmarks of tumor malignancy is the ability of cells to not only locally invade its surrounding parenchyma but also distally metastasize. Aggressive tumors such as glioblastoma (GBM) often display a collective sheet of migrating cells which may eventually disseminate and migrate in a single cell manner. By integrating extracellular cues and intracellular signaling, cell polarization and the persistence and speed of locomotion is tightly governed. Given the diverse inputs that may modulate this intricate cell migration pathway, it is of interest to identify critical modulators of this network. Yes-associated protein (YAP), a transcriptional regulator, has been suggested to potentiate migration, invasion, and metastasis; however, it is not known how or whether YAP expression and activity can regulate the molecular networks controlling cell migration and invasion, and whether this function of YAP may be consequential to the progression of aggressive cancers. We thus explored mechanisms of YAP-mediated migration and invasion in normal cells as well as cancer cells where YAP is hyperactive (p < 0.05). We found that YAP plays a pivotal role in regulation of this complex migratory and invasive behavior through a novel small Rho-GTPase-dependent signaling mechanism. As with GBM, metastatic cancers often evade detection because individual cells spread from the primary bulk tumor; thus, making complete resection and treatment virtually impossible. Congruent with our in vitro studies, our murine intracranial xenograft model argue the role of YAP in driving invasive tumor growth (p < 0.05). Moreover, we demonstrate that these YAP-driven cell dispersal mechanisms confer poor patient prognosis in the TCGA and REMBRANDT GBM databases (p < 0.05). Thus, our findings provide new insights into the biology of aggressive cancers with particular prognostic relevance of this YAP-driven pro-motility cascade in glioblastoma. In addition, our studies suggest these YAP

  17. Acute fibrinous and organising pneumonia following lung transplantation is associated with severe allograft dysfunction and poor outcome: a case series

    Directory of Open Access Journals (Sweden)

    Keith Meyer

    2015-01-01

    Full Text Available   Acute fibrinous and organising pneumonia (AFOP is a histopathologic variant of acute lung injury that has been associated with infection and inflammatory disorders and has been reported as a complication of lung transplantation. A retrospective chart review was performed for all patients transplanted at the University of Wisconsin Hospital and Clinics from January 1995 to December 2013 (n = 561. We identified 6 recipients whose clinical course was complicated by AFOP. All recipients were found to have AFOP on lung biopsy or at post-mortem examination, and 5 of the 6 patients suffered progressive allograft dysfunction that led to fatal outcome. Only 1 of the 6 patients stabilised with augmented immunosuppression and had subsequent improvement and stabilisation of allograft function. We could not clearly identify any specific cause of AFOP, such as drug toxicity or infection. Lung transplantation can be complicated by lung injury with an AFOP pattern on histopathologic examination of lung biopsy specimens. The presence of an AFOP pattern was associated with irreversible decline in lung function that was refractory to therapeutic interventions in 5 of our 6 cases and was associated with severe allograft dysfunction and death in these 5 individuals. AFOP should be considered as a potential diagnosis when lung transplant recipients develop progressive decline in lung function that is consistent with a clinical diagnosis of chronic lung allograft dysfunction.  

  18. Low Energy Population III Supernovae and the Origin of the Extremely Metal-Poor Star SMSS J031300.36-670839.3

    CERN Document Server

    Chen, Ke-Jung; Whalen, Daniel J; Moriya, Takashi J; Bromm, Volker; Woosley, Stan; Almgren, Ann

    2016-01-01

    Ancient, dim metal-poor stars may have formed in the ashes of the first supernovae. If their chemical abundances can be reconciled with the nucleosynthetic yields of specific Pop III explosions, they could reveal the properties of primordial stars. But simulations of such explosions must be multidimensional because dynamical instabilities can dredge material up from deep in the ejecta that would be predicted to fall back onto the compact remnant and be lost in one-dimensional models. We have performed two-dimensional numerical simulations of two low-energy Pop III supernovae, a 12.4 Msun explosion and a 60 Msun explosion, and find that they have elemental yields that are a good fit to those measured in the most iron-poor star discovered to date, SMSS J031300.36-670839.3 (J031300). Fallback onto the compact remnant in these weak explosions accounts for the lack of measurable iron in J031300 and its low iron-group abundances in general. The low energies of these dim events will prevent their detection in the ne...

  19. The obesity paradox, extreme obesity, and long-term outcomes in older adults with ST-segment elevation myocardial infarction: results from the NCDR.

    Science.gov (United States)

    Neeland, Ian J; Das, Sandeep R; Simon, DaJuanicia N; Diercks, Deborah B; Alexander, Karen P; Wang, Tracy Y; de Lemos, James A

    2017-07-01

    To investigate the obesity paradox and association of extreme obesity with long-term outcomes among older ST-segment elevation myocardial infarction (STEMI) patients. Nineteen thousand four hundred and ninety-nine patients ≥65 years with STEMI surviving to hospital discharge in NCDR ACTION Registry-GWTG linked to Centers for Medicare and Medicaid Services outcomes between 2007 and 2012 were stratified by body mass index (BMI) (kg/m2) into normal weight (18.5-24.9), overweight (25-29.9), class I (30-34.9), class II (35-39.9), and class III/extreme obese (≥40) categories. Multivariable-adjusted associations were evaluated between BMI categories and mortality by Cox proportional hazards models, and days alive and out of hospital (DAOH) by generalized estimating equations, within 3 years after discharge. Seventy percent of patients were overweight/obese and 3% extremely obese. Normal weight patients were older and more likely to smoke; while extremely obese patients were younger and more likely to be female and black, with lower socioeconomic status and more comorbidity (P ≤ 0.001). A U-shaped association was observed between BMI categories and mortality: patients with class I obesity were at lowest risk, while normal weight [hazard ratio (HR) 1.30, 95% confidence interval (CI) 1.15-1.47] and extremely obese patients (HR 1.33, 95% CI 1.02-1.74) had higher mortality. Normal weight [odds ratio (OR) 0.79, 95% CI 0.68-0.90] and extremely obese (OR 0.73, 95% CI 0.54-0.99) individuals also had lower odds of DAOH. Mild obesity is associated with lower long-term risk in older STEMI patients, while normal weight and extreme obesity are associated with worse outcomes. These findings highlight hazards faced by an increasing number of older individuals with normal weight or extreme obesity and cardiovascular disease.

  20. Marginal pulmonary function is associated with poor short- and long-term outcomes in lung cancer surgery

    Science.gov (United States)

    Ozeki, Naoki; Kawaguchi, Koji; Okasaka, Toshiki; Fukui, Takayuki; Fukumoto, Koichi; Nakamura, Shota; Hakiri, Shuhei; Yokoi, Kohei

    2017-01-01

    ABSTRACT We sought to determine the short- and long-term prognoses among ‘marginal-risk’ non-small cell lung cancer patients who have a predicted postoperative- (ppo) forced expiratory volume in the first second (FEV1) of 30–60% and/or a ppo-diffusing capacity of the lung for carbon monoxide (DLCO) of 30–60%. The present study included 73 ‘marginal-risk’ and 318 ‘normal-risk’ patients who underwent anatomical resection for clinical stage I lung cancer between 2008 and 2012. The rates of postoperative morbidity, prolonged hospital stay, and overall survival were assessed. Postoperative morbidity occurred in 35 (48%) ‘marginal-risk’ patients and 66 (21%) ‘normal-risk’ patients, and 17 (23%) ‘marginal-risk’ patients and 20 (6%) ‘normal-risk’ patients required a prolonged hospital stay. The three- and five-year survival rates were 79% and 64% in the ‘marginal-risk’ patients and 93% and 87% in the ‘normal-risk’ patients, respectively. A ‘marginal-risk’ status was a significant factor in the prediction of postoperative morbidity (odds ratio [OR] 2.97, p < 0.001), the rate of prolonged hospital stay (OR 3.83, p < 0.001), and overall survival (hazard ratio 2.07, p = 0.028). In conclusion, ‘Marginal-risk’ patients, who are assessed based on ppo-values, comprise a subgroup of patients with poorer short- and long-term postoperative outcomes.

  1. 极贫金属环境下超新星爆发的中子俘获元素核合成产量%Nucleosynthetic yield of neutron-capture elements from extremely metal-poor stars

    Institute of Scientific and Technical Information of China (English)

    马文娟; 单勇; 张波

    2011-01-01

    The extremely metal-poor stars ([Fe/H]< -2. 5)was formed in the early universe. Studies on the nucleosynthesis yield of the extremely metal-poor stars play a key role in the exploration of the formation of the solar system, the chemical evolution of galaxies and the fundamental issues in the nuclear astrophysics. In this paper, the neutron-capture element's nucleosynthesis yields of the extremely metal-poor stars are calculated on the basis of the observed correlations between the neutron-capture process elements Sr, Y, Ba and Si elements and the theoretical yields of Si.%极贫金属环境下超新星爆发([Fe/H]<-2.5)形成于星系演化的早期,研究极贫金属环境下超新星爆发的重元素丰度分布及核合成,对于探索星系形成及化学演化和核天体物理学中的基本问题都起着关键作用.分析了大量极贫金属环境下超新星爆发的元素丰度的观测数据,得出中子俘获元素Sr,Y和Ba与元素Si的相关性规律,计算了极贫金属环境下超新星爆发的元素Sr,Y和Ba的核合成产量.

  2. Effects of being uninsured or underinsured and living in extremely poor neighborhoods on colon cancer care and survival in California: historical cohort analysis, 1996—2011

    Directory of Open Access Journals (Sweden)

    Gorey Kevin M

    2012-10-01

    Full Text Available Abstract Background We examined the mediating effects of health insurance on poverty-colon cancer care and survival relationships and the moderating effects of poverty on health insurance-colon cancer care and survival relationships among women and men in California. Methods We analyzed registry data for 3,291 women and 3,009 men diagnosed with colon cancer between 1996 and 2000 and followed until 2011 on lymph node investigation, stage at diagnosis, surgery, chemotherapy, wait times and survival. We obtained socioeconomic data for individual residences from the 2000 census to categorize the following neighborhoods: high poverty (30% or more poor, middle poverty (5-29% poor and low poverty (less than 5% poor. Primary health insurers were Medicaid, Medicare, private or none. Results Evidence of mediation was observed for women, but not for men. For women, the apparent effect of poverty disappeared in the presence of payer, and the effects of all forms of health insurance seemed strengthened. All were advantaged on 6-year survival compared to the uninsured: Medicaid (RR = 1.83, Medicare (RR = 1.92 and private (RR = 1.83. Evidence of moderation was also only observed for women. The effects of all forms of health insurance were stronger for women in low poverty neighborhoods: Medicaid (RR = 2.90, Medicare (RR = 2.91 and private (RR = 2.60. For men, only main effects of poverty and payers were observed, the advantaging effect of private insurance being largest. Across colon cancer care processes, Medicare seemed most instrumental for women, private payers for men. Conclusions Health insurance substantially mediates the quality of colon cancer care and poverty seems to make the effects of being uninsured or underinsured even worse, especially among women in the United States. These findings are consistent with the theory that more facilitative social and economic capital is available in more affluent neighborhoods, where women

  3. The characteristics of short- and long-term surviving Shiba dogs with chronic enteropathies and the risk factors for poor outcome.

    Science.gov (United States)

    Okanishi, Hiroki; Sano, Tadashi; Yamaya, Yoshiki; Kagawa, Yumiko; Watari, Toshihiro

    2013-04-17

    The objectives of this study were to investigate the differences in the characteristics of short- and long-term surviving dogs, and the factors that predict poor outcome in Shiba dogs with chronic enteropathies (CE). A total of 25 Shiba dogs were included in this study, and classified as either short-term (≤6 months) survivors (Ss; n=16) or long-term (>6 months) survivors (Ls; n=9). The clinical and clinicopathological variables, histopathology, response to therapy, and outcomes were investigated between groups. Furthermore, these factors were tested for their ability to predict poor outcome. All CE dogs were diagnosed as having inflammatory bowel disease (IBD) with lymphocytic-plasmacytic enteritis (LPE). Age and canine inflammatory bowel disease activity index (CIBDAI) were significantly higher in the Ss group than in the Ls group (age: p = 0.035, CIBDAI: p = 0.018), as determined via univariate logistic regression analysis. According to receiver operator characteristic (ROC) curve analysis, the best predictors of poor outcome were age and CIBDAI, with the cutoffs determined as 7 years and 9 points, respectively. The majority of the cases (84%) responded to initial treatment; in particular, 75% of dogs in Ss group responded to therapy. The time to response (days) to the initial treatment in the Ss group (median 42.5 days, range: 20-91 days) was significantly shorter than that of the Ls group (median 285 days, range: 196-1026 days). Approximately half (55.5%) of the dogs in the Ls group died due to relapse of CE. This study suggested that there is a high risk of early mortality in Shiba dogs with CE, particularly if the dogs are older (>7 years) and have a high CIBDAI score (>9 points). There appears to be a possibility of early mortality even if the initial treatment was efficacious. Furthermore, Shiba dogs with CE that become less responsive to initial therapy in the short-term (approximately 3 months) are more likely to have an early mortality. Thus, it is

  4. Post-traumatic hypoxia is associated with prolonged cerebral cytokine production, higher serum biomarker levels, and poor outcome in patients with severe traumatic brain injury.

    Science.gov (United States)

    Yan, Edwin B; Satgunaseelan, Laveniya; Paul, Eldho; Bye, Nicole; Nguyen, Phuong; Agyapomaa, Doreen; Kossmann, Thomas; Rosenfeld, Jeffrey V; Morganti-Kossmann, Maria Cristina

    2014-04-01

    Secondary hypoxia is a known contributor to adverse outcomes in patients with traumatic brain injury (TBI). Based on the evidence that hypoxia and TBI in isolation induce neuroinflammation, we investigated whether TBI combined with hypoxia enhances cerebral cytokine production. We also explored whether increased concentrations of injury biomarkers discriminate between hypoxic (Hx) and normoxic (Nx) patients, correlate to worse outcome, and depend on blood-brain barrier (BBB) dysfunction. Forty-two TBI patients with Glasgow Coma Scale ≤8 were recruited. Cerebrospinal fluid (CSF) and serum were collected over 6 days. Patients were divided into Hx (n=22) and Nx (n=20) groups. Eight cytokines were measured in the CSF; albumin, S100, myelin basic protein (MBP) and neuronal specific enolase (NSE) were quantified in serum. CSF/serum albumin quotient was calculated for BBB function. Glasgow Outcome Scale Extended (GOSE) was assessed at 6 months post-TBI. Production of granulocye macrophage-colony stimulating factor (GM-CSF) was higher, and profiles of GM-CSF, interferon (IFN)-γ and, to a lesser extent, tumor necrosis factor (TNF), were prolonged in the CSF of Hx but not Nx patients at 4-5 days post-TBI. Interleukin (IL)-2, IL-4, IL-6, and IL-10 increased similarly in both Hx and Nx groups. S100, MBP, and NSE were significantly higher in Hx patients with unfavorable outcome. Among these three biomarkers, S100 showed the strongest correlations to GOSE after TBI-Hx. Elevated CSF/serum albumin quotients lasted for 5 days post-TBI and displayed similar profiles in Hx and Nx patients. We demonstrate for the first time that post-TBI hypoxia is associated with prolonged neuroinflammation, amplified extravasation of biomarkers, and poor outcome. S100 and MBP could be implemented to track the occurrence of post-TBI hypoxia, and prompt adequate treatment.

  5. Hunting for extremely metal-poor emission-line galaxies in the Sloan Digital Sky Survey: MMT and 3.5m APO observations

    CERN Document Server

    Izotov, Y I; Guseva, N G

    2012-01-01

    We present 6.5-meter MMT and 3.5m APO spectrophotometry of 69 H II regions in 42 low-metallicity emission-line galaxies, selected from the Data Release 7 of the Sloan Digital Sky Survey to have mostly [O III]4959/Hbeta < 1 and [N II]6583/Hbeta < 0.1. The electron temperature-sensitive emission line [O III] 4363 is detected in 53 H II regions allowing a direct abundance determination. The oxygen abundance in the remaining 16 H II regions is derived using a semi-empirical method. The oxygen abundance of the galaxies in our sample ranges from 12 + log O/H ~ 7.1 to ~ 7.9, with 14 H II regions in 7 galaxies with 12 +log O/H < 7.35. In 5 of the latter galaxies, the oxygen abundance is derived here for the first time. Including other known extremely metal-deficient emission-line galaxies from the literature, e.g. SBS 0335-052W, SBS 0335-052E and I Zw 18, we have compiled a sample of the 17 most metal-deficient (with 12 +log O/H < 7.35) emission-line galaxies known in the local universe. There appears to ...

  6. Extremely Metal-Poor Stars. VIII. High-Resolution, High-Signal-To-Noise Analysis of Five Stars with [Fe/H] < -3.5

    CERN Document Server

    Norris, J E; Beers, T C; Norris, John E.; Ryan, Sean G.; Beers, Timothy C.

    2001-01-01

    High-resolution, high-signal-to-noise ( = 85) spectra have been obtained for five stars -- CD-24:17504, CD-38:245, CS 22172-002, CS 22885-096, and CS 22949-037 -- having [Fe/H] < -3.5 according to previous lower S/N material. LTE model-atmosphere techniques are used to determine [Fe/H] and relative abundances, or their limits, for some 18 elements, and to constrain more tightly the early enrichment history of the Galaxy than is possible based on previous analyses. We compare our results with high-quality higher-abundance literature data for other metal-poor stars and with the canonical Galactic chemical enrichment results of Timmes et al. (1995) and obtain the following basic results: (1) Large supersolar values of [C/Fe] and [N/Fe], not predicted by the canonical models, exist at lowest abundance. For C at least, the result is difficult to attribute to internal mixing effects; (2) We confirm that there is {\\it no upward trend} in [$\\alpha$/Fe] as a function of [Fe/H], in contradistinction to some reports ...

  7. Evolution and nucleosynthesis of extremely metal-poor and metal-free low- and intermediate-mass stars II. s-process nucleosynthesis during the core He flash

    CERN Document Server

    Campbell, Simon W; Karakas, Amanda I

    2010-01-01

    Models of primordial and hyper-metal-poor stars with masses similar to the Sun experience an ingestion of protons into the hot core during the core helium flash phase at the end of their red giant branch evolution. This produces a concurrent secondary flash powered by hydrogen burning that gives rise to further nucleosynthesis in the core. We perform post-process nucleosynthesis calculations on a one-dimensional stellar evolution calculation of a star of 1 solar mass and metallicity [Fe/H] = -6.5 that suffers a proton ingestion episode. Our network includes 320 nuclear species and 2,366 reactions and treats mixing and burning simultaneously. The mixing and burning of protons into the hot convective core leads to the production of 13C, which then burns via the 13C(alpha,n)16O reaction releasing a large number of free neutrons. During the first two years of neutron production the neutron poison 14N abundance is low, allowing the prodigious production of heavy elements such as strontium, barium, and lead via slo...

  8. Non-LTE abundances of Mg and K in extremely metal-poor stars and the evolution of [O/Mg], [Na/Mg], [Al/Mg] and [K/Mg] in the Milky Way

    CERN Document Server

    Andrievsky, S M; Korotin, S A; Spite, F; Bonifacio, P; Cayrel, R; François, P; Hill, V

    2010-01-01

    LTE abundances of light elements in extremely metal-poor (EMP) stars have been previously derived from high quality spectra. New derivations, free from the NLTE effects, will better constrain the models of the Galactic chemical evolution and the yields of the very first supernovae. The NLTE profiles of the magnesium and potassium lines have been computed in a sample of 53 extremely metal-poor stars with a modified version of the program MULTI and adjusted to the observed lines in order to derive the abundances of these elements. The NLTE corrections for magnesium and potassium are in good agreement with the works found in the literature. The abundances are slightly changed, reaching a better precision: the scatter around the mean of the abundance ratios has decreased. Magnesium may be used with confidence as reference element. Together with previously determined NLTE abundances of sodium and aluminum, the new ratios are displayed, for comparison, along the theoretical trends proposed by some models of the che...

  9. Neurological deterioration in the acute phase of minor ischemic stroke is an independent predictor of poor outcomes at 1 year: results from the China National Stroke Registry (CNSR)

    Institute of Scientific and Technical Information of China (English)

    JU Yi; ZHAO Xing-quan; WANG Chun-xue; WANG Yi-long; LIU Gai-fen; WANG Yong-jun

    2013-01-01

    Background The risk of clinical deterioration still exists in the acute phase despite the fact that patients with minor stroke may display less severe symptoms.The impact of this clinical deterioration on long-term outcomes is unknown.We characterized the clinical features of neurological deterioration (ND) in the acute phase of minor ischemic stroke (MIS) and investigated its impact on mid-and long-term outcomes.Methods This was a multi-centered,prospective clinical study involving patients with MIS (the National Institutes of Health Stroke Scale,NIHSS <3) recruited from the China National Stroke Registry.Patients were included who had been hospitalized within 24 hours of stroke onset.Baseline characteristics,complication rates during hospitalization,etiology of stroke,as well as 3-,6-,and 12-month post-stroke outcomes were compared between patients with and without ND during the acute phase.Results A number of 368 (15.2%) out of 2424 patients included in the study exhibited ND in the acute phase.Compared to patients without ND,patients with ND had longer hospital stay,increased rate of baseline diabetes,and multiple complications.Multivariate Logistic regression indicated that ND in acute phase was an independent factor predictive of increased dependence (adjusted odds ratio =5.20,95% Cl,3.51-7.70,P <0.001) at 12-month post-stroke.Conclusions The risk of ND in the acute phase is high in patients with MIS.ND in the acute phase is an independent predictor for poor outcomes at 12 months post-stroke onset.

  10. Factors influencing feeding practices of extreme poor infants and young children in families of working mothers in Dhaka slums: A qualitative study

    Science.gov (United States)

    Maitrot, Mathilde Rose Louise

    2017-01-01

    Background Nutritional status differs between infants and young children living in slum and non-slum conditions—infants and young children living in City Corporation slums are likely to have worse nutritional status compared to those from non-slums. Furthermore, families in slums tend to engage female labor in cash-earning activities as a survival strategy; hence, a higher percentage of mothers stay at work. However, little is known about feeding practices for infants and young children in families with working mothers in slums. This study aims to understand the factors that determine feeding practices for infants and young children living in families with working mothers in Dhaka slums. Methods This study adopted a qualitative approach. Sixteen In-depth Interviews, five Key Informant Interviews, and Focused Group Discussions were conducted with family members, community leaders, and program staff. Method triangulation and thematic analyses were conducted. Results Feeding practices for infants and young children in families with working mothers are broadly determined by mothers’ occupation, basis civic facilities, and limited family buying capacity. Although mothers have good nutritional knowledge, they negotiate between work and feeding their infants and young children. Household composition, access to cooking facilities, and poverty level were also found to be significant determining factors. Conclusion The results suggest a trade-off between mothers’ work and childcare. The absence of alternative care support in homes and/or work places along with societal factors outweighs full benefits of project interventions. Improving alternative childcare support could reduce the burden of feeding practice experienced by working mothers and may improve nutritional outcomes. PMID:28207894

  11. HIGH D-DIMER LEVELS PREDICT A POOR OUTCOME IN PATIENTS WITH SEVERE TRAUMA, EVEN WITH HIGH FIBRINOGEN LEVELS ON ARRIVAL: A MULTICENTER RETROSPECTIVE STUDY.

    Science.gov (United States)

    Hayakawa, Mineji; Maekawa, Kunihiko; Kushimoto, Shigeki; Kato, Hiroshi; Sasaki, Junichi; Ogura, Hiroshi; Matauoka, Tetsuya; Uejima, Toshifumi; Morimura, Naoto; Ishikura, Hiroyasu; Hagiwara, Akiyoshi; Takeda, Munekazu; Kaneko, Naoyuki; Saitoh, Daizoh; Kudo, Daisuke; Kanemura, Takashi; Shibusawa, Takayuki; Furugori, Shintaro; Nakamura, Yoshihiko; Shiraishi, Atsushi; Murata, Kiyoshi; Mayama, Gou; Yaguchi, Arino; Kim, Shiei; Takasu, Osamu; Nishiyama, Kazutaka

    2016-03-01

    Elevated D-dimer level in trauma patients is associated with tissue damage severity and is an indicator of hyperfibrinolysis during the early phase of trauma. To investigate the interacting effects of fibrinogen and D-dimer levels on arrival at the emergency department for massive transfusion and mortality in severe trauma patients in a multicenter retrospective study. This study included 519 adult trauma patients with an injury severity score ≥16. Patients with ≥10 units of red cell concentrate transfusion and/or death during the first 24 h were classified as having a poor outcome. Receiver operating characteristic curve analysis for predicting poor outcome showed the optimal cut-off fibrinogen and D-dimer values to be 190 mg/dL and 38 mg/L, respectively. On the basis of these values, patients were divided into four groups: low D-dimer (high fibrinogen (>190 mg/dL), low D-dimer (low fibrinogen (≤190 mg/dL), high D-dimer (≥38 mg/L)/high fibrinogen (>190 mg/dL), and high D-dimer (≥38 mg/L)/low fibrinogen (≤190 mg/dL). The survival rate was lower in the high D-dimer/low fibrinogen group than in the other groups. Moreover, the survival rate was lower in the high D-dimer/high fibrinogen group than in the low D-dimer/high fibrinogen and low D-dimer/low fibrinogen groups. High D-dimer level on arrival is a strong predictor of early death or requirement for massive transfusion in severe trauma patients, even with high fibrinogen levels.

  12. Crescimento e desenvolvimento a longo prazo do prematuro extremo Growth and developmental outcomes of the extremely preterm infant

    Directory of Open Access Journals (Sweden)

    Ligia Maria Suppo de Souza Rugolo

    2005-03-01

    chronological age with respect of the degree of prematurity. There is special concern regarding the prognoses of small for gestational age preterm infants, and for those with bronchopulmonary dysplasia. Attention must be directed towards improving the nutrition of extremely low birth weight infants during their first years of life; these infants have high prevalence levels of failure to catch-up on growth, diseases and rehospitalizations during their first 2 years. They are frequently underweight and shorter than expected during early childhood, but delayed catch-up growth may occur between 8 and 14 years. Extremely low birth weight infants are at increased risk of neurological abnormalities and developmental delays during their first years of life. Educational, psychological, and behavioral problems are frequent during school years. Teenage and adult outcomes show that although some performance differences persist, social integration is not impaired. CONCLUSIONS: The growth and neurodevelopment of all ELBW infants must be carefully monitored after discharge, to ensure that children and their families receive adequate support and intervention to optimize prognoses.

  13. Overexpression of metastasis-associated in colon cancer 1 predicts a poor outcome of hepatitis B virus-related hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Jian-Hui Qu; Xiu-Juan Chang; Yin-Ying Lu; Wen-Lin Bai; Yan Chen; Lin Zhou; Zhen Zeng

    2012-01-01

    AIM:To investigate the intratumoral expression of metastasis-associated in colon cancer 1 (MACC1) and c-Met and determine their clinical values associated with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).METHODS:A retrospective study admitted three hundred fifty-four patients with HBV-related HCC.The expression and distribution of MACC1 and c-Met were assessed by quantitative real-time polymerase chain reaction and immunohistochemistry staining.Prognostic factors influencing survival,metastasis and recurrence were assessed.RESULTS:Intratumoral MACC1 level was found to be associated with HCC disease progression.Both median tumor-free survival (TFS) and overall survival (OS) were significantly shorter in the postoperative HCC patients with high intratumoral MACC1 expression,as compared to those with low intratumoral MACC1 levels (TFS:34 mo vs 48.0 mo,P < 0.001; OS:40 mo vs 48 mo,P < 0.01).Multivariable analysis indicated that high MACC1 expression or co-expression with c-Met were independent predictors for HCC clinic outcome (P < 0.001).CONCLUSION:High intratumoral MACC1 expression can be associated with enhanced tumor progression and poor outcome of HBV-related HCC.MACC1 may serve as a prognostic biomarker for postoperative HCC.

  14. Co-morbid depression is associated with poor work outcomes in persons with cardiovascular disease (CVD: A large, nationally representative survey in the Australian population

    Directory of Open Access Journals (Sweden)

    O'Neil Adrienne

    2012-01-01

    Full Text Available Abstract Background Co-morbid major depressive disorder (MDD and cardiovascular disease (CVD is associated with poor clinical and psychological outcomes. However, the full extent of the burden of, and interaction between, this co-morbidity on important vocational outcomes remains less clear, particularly at the population level. We examine the association of co-morbid MDD with work outcomes in persons with and without CVD. Methods This study utilised cross-sectional, population-based data from the 2007 Australian National Survey of Mental Health and Wellbeing (n = 8841 to compare work outcomes of individuals with diagnostically-defined MDD and CVD, MDD but not CVD, CVD but not MDD, with a reference group of "healthy" Australians. Workforce participation was defined as being in full- or part-time employment. Work functioning was measured using a WHO Disability Assessment Schedule item. Absenteeism was assessed using the 'days out of role' item. Results Of the four groups, those with co-morbid MDD and CVD were least likely to report workforce participation (adj OR:0.4, 95% CI: 0.3-0.6. Those with MDD only (adj OR:0.8, 95% CI:0.7-0.9 and CVD only (adj OR:0.8, 95% CI: 0.6-0.9 also reported significantly reduced odds of participation. Employed individuals with co-morbid MDD and CVD were 8 times as likely to experience impairments in work functioning (adj OR:8.1, 95% CI: 3.8- 17.3 compared with the reference group. MDD was associated with a four-fold increase in impaired functioning. Further, individuals with co-morbid MDD and CVD reported greatest likelihood of workplace absenteeism (adj. OR:3.0, 95% CI: 1.4-6.6. Simultaneous exposure to MDD and CVD conferred an even greater likelihood of poorer work functioning. Conclusions Co-morbid MDD and CVD is associated with significantly poorer work outcomes. Specifically, the effects of these conditions on work functioning are synergistic. The development of specialised treatment programs for those with co

  15. Analysis of Extreme Aesthetical Standpoint in Works About Poor People in New Century%新世纪小说底层写作中的单极化审美取向透析

    Institute of Scientific and Technical Information of China (English)

    祝嘉琳

    2011-01-01

    新世纪小说底层写作中存在着单极化审美取向:重物质、崇苦难、崇恶。这无法达到产生一种震撼人心的悲剧力量的审美目标;不符合现实主义美学思想;从文学的本质和价值来看,这样的写作无法产生一种超越的力量。%These works which write the lives of poor people always have extreme aesthetic standpoint.They always emphasize about materials,tragedy,evils,which can not obtain the powerful strength of tragedy,and are not in compliance with aesthetic view of realism,at the same time,from the view of literature essence,can not surpass our lives.

  16. High frequency of resistance, lack of clinical benefit, and poor outcomes in capreomycin treated South African patients with extensively drug-resistant tuberculosis.

    Directory of Open Access Journals (Sweden)

    Elize Pietersen

    Full Text Available There are limited data about the epidemiology and treatment-related outcomes associated with capreomycin resistance in patients with XDR-TB. Capreomycin achieves high serum concentrations relative to MIC but whether capreomycin has therapeutic benefit despite microbiological resistance remains unclear.We reviewed the susceptibility profiles and outcomes associated with capreomycin usage in patients diagnosed with XDR-TB between August 2002 and October 2012 in two provinces of South Africa. Patients whose isolates were genotypically tested for capreomycin resistance were included in the analysis.Of 178 XDR-TB patients 41% were HIV-infected. 87% (154/178 isolates contained a capreomycin resistance-conferring mutation [80% (143/178 rrs A1401G and 6% (11/178 were heteroresistant (containing both the rrs A1401G mutation and wild-type sequences]. Previous MDR-TB treatment, prior usage of kanamycin, or strain type was not associated with capreomycin resistance. 92% (163/178 of XDR-TB patients were empirically treated with capreomycin. Capreomycin resistance decreased the odds of sputum culture conversion. In capreomycin sensitive and resistant persons combined weight at diagnosis was the only independent predictor for survival (p=<0.001. By contrast, HIV status and use of co-amoxicillin/clavulanic acid were independent predictors of mortality (p=<0.05. Capreomycin usage was not associated with survival or culture conversion when the analysis was restricted to those whose isolates were resistant to capreomycin.In South Africa the frequency of capreomycin conferring mutations was extremely high in XDR-TB isolates. In those with capreomycin resistance there appeared to be no therapeutic benefit of using capreomycin. These data inform susceptibility testing and the design of treatment regimens for XDR-TB in TB endemic settings.

  17. The Outcomes of Salvage Surgery for Vascular Injury in The Extremities: A Special Consideration For Delayed Revascularization

    Directory of Open Access Journals (Sweden)

    Jagdish Krishnan

    2014-03-01

    Full Text Available A seven years retrospective study was performed in 45 consecutive vascular injuries in the extremities to investigate the pattern of injuries, managements and outcomes. Motor-vehicle accidents were the leading cause of injuries (80%, followed by industrial injuries (11.1% and iatrogenic injuries (4.4%. Popliteal and brachial artery injuries were commonly involved (20%. Fifteen (33.3% patients had fractures, dislocation or fracture dislocation around the knee joint and 6 (13.3% patients had soft tissue injuries without fracture. Traumatic arterial transection accounted for 34 (75.6% cases, followed by laceration in 7 (15.6% and 9 (6.7% contusions. Associated nerve injuries were seen in 8 (17.8 % patients using intra-operative findings as the gold standard, both conventional angiogram (CA and computerized tomography angiogram (CTA had 100% specificity and 100% sensitivity in determining the site of arterial injuries. The mean ischemic time was 25.31 hours (4 - 278 hours. Thirty-three (73.3 % patients were treated more than 6 hours after injury and 6 patients underwent revascularization after 24 hours; all had good collateral circulation without distal pulses or evidence of ischemic neurological deficit. The mean ischemic time in 39 patients who underwent revascularization within 24 hours was 13.2 hours. Delayed amputation was performed in 5 patients (11.1%. Of the 6 patients who underwent delayed revascularization, one patient had early amputation, one -had delayed amputation following infection and multiple flap procedures while the rest of the patients’ limbs survived. Joint stiffness was noted in 10 patients (22.2% involving the knee joint, elbow and shoulder in two patients each. Infection was also noted in 5 patients (11.1% with two of them were due to infected implants. Other complications encountered included nonunion (2 patients, 4.4%, delayed union (1 patient, 2.2%, limb length discrepancy (1 patient, 2.2%, hematoma (1 patient, 2.2% and

  18. [Successful outcome of a pregnancy with an extremely low fetal heart rate (34 bpm) due to isolated complete heart block--case report].

    Science.gov (United States)

    Hamela-Olkowska, Anita; Dangel, Joanna; Miszczak-Knecht, Maria

    2009-09-01

    Isolated complete congenital heart block (CHB) in the majority of cases is associated with the presence of autoantibodies to SSA (Ro) and SSB (La) antigens in the maternal serum. The prognosis is less favorable in fetuses with a ventricular rate bpm. We have reported a case of a fetus with an isolated non-autoimmune CHB with an extremely low ventricular rate (34bpm) in which the outcome was favorable. In the neonate the non-compaction of the myocardium was diagnosed.

  19. Enhanced cell migration and apoptosis resistance may underlie the association between high SERPINE1 expression and poor outcome in head and neck carcinoma patients

    Science.gov (United States)

    Téllez-Gabriel, Marta; León, Xavier; Virós, David; López, Montserrat; Gallardo, Alberto; Céspedes, Maria Virtudes; Casanova, Isolda; López-Pousa, Antonio; Mangues, Maria Antonia; Quer, Miquel; Barnadas, Agustí; Mangues, Ramón

    2015-01-01

    High SERPINE1 expression is a common event in head and neck squamous cell carcinoma (HNSCC); however, whether it plays a role in determining clinical outcome remains still unknown. We studied SERPINE1 as a prognostic marker in two HNSCC patient cohorts. In a retrospective study (n = 80), high expression of SERPINE1 was associated with poor progression-free (p = 0.022) and cancer-specific (p = 0.040) survival. In a prospective study (n = 190), high SERPINE1 expression was associated with poor local recurrence-free (p = 0.022), progression-free (p = 0.002) and cancer-specific (p = 0.006) survival. SERPINE1 expression was identified as an independent risk factor for progression-free survival in patients treated with chemo-radiotherapy or radiotherapy (p = 0.043). In both patient cohorts, high SERPINE1 expression increased the risk of metastasis spread (p = 0.045; p = 0.029). The association between SERPINE1 expression and survival was confirmed using the HNSCC cohort included in The Cancer Genome Atlas project (n = 507). Once again, patients showing high expression had a poorer survival (p < 0.001). SERPINE1 over-expression in HNSCC cells reduced cell proliferation and enhanced migration. It also protected cells from cisplatin-induced apoptosis, which was accompanied by PI3K/AKT pathway activation. Downregulation of SERPINE1 expression had the opposite effect. We propose SERPINE1 expression as a prognostic marker that could be used to stratify HNSCC patients according to their risk of recurrence. PMID:26359694

  20. Combined GnRH-agonist and human chorionic gonadotropin trigger improves ICSI cycle outcomes in patients with history of poor fertilization.

    Science.gov (United States)

    Elias, Rony T; Pereira, Nigel; Artusa, Lisa; Kelly, Amelia G; Pasternak, Monica; Lekovich, Jovana P; Palermo, Gianpiero D; Rosenwaks, Zev

    2017-06-01

    The purpose of this study was to investigate the utility of a combined GnRH-agonist (GnRH-a) and human chorionic gonadotropin (hCG) trigger in improving ICSI cycle outcomes in patients with poor fertilization history after standard hCG trigger in prior ICSI cycles. Retrospective cohort study. Patients with a fertilization rate of trigger were compared to those who underwent another ICSI cycle with a combined GnRH-a and hCG trigger. Oocyte maturity, fertilization, clinical pregnancy, and live birth rates were compared. A multiple linear regression model was used to explore the association between combined GnRH-a and hCG trigger (vs hCG trigger alone) and fertilization rate. A total of 427 patients with mean age of 37.3 ± 1.94 years and mean baseline fertilization rate of 17.9 ± 2.03% were included, of which 318 (74.5%) and 109 (25.5%) patients underwent a subsequent ICSI cycle with hCG and combined GnRH-a and hCG trigger, respectively. The baseline parameters of the male and female partner were similar. The mean fertilization rate in the combined trigger group was 16.4% (95% CI: 7.58-25.2%) higher than the hCG trigger group, even after adjustment for confounders. Patients in the combined trigger group had higher oocyte maturity (82.1 vs 69.8%), higher clinical pregnancy (27.5 vs 5.67%), and higher live birth rates (20.2 vs 3.46%) compared to the hCG trigger group. Combined GnRH-a and hCG trigger in ICSI cycles increase oocyte maturity, fertilization, clinical pregnancy, and live birth rates in patients with a history of poor fertilization after standard hCG trigger alone.

  1. Differential regulation of HIF-1α and HIF-2α in neuroblastoma: Estrogen-related receptor alpha (ERRα) regulates HIF2A transcription and correlates to poor outcome

    Energy Technology Data Exchange (ETDEWEB)

    Hamidian, Arash; Stedingk, Kristoffer von; Munksgaard Thorén, Matilda; Mohlin, Sofie; Påhlman, Sven, E-mail: sven.pahlman@med.lu.se

    2015-06-05

    Hypoxia-inducible factors (HIFs) are differentially regulated in tumor cells. While the current paradigm supports post-translational regulation of the HIF-α subunits, we recently showed that hypoxic HIF-2α is also transcriptionally regulated via insulin-like growth factor (IGF)-II in the childhood tumor neuroblastoma. Here, we demonstrate that transcriptional regulation of HIF-2α seems to be restricted to neural cell-derived tumors, while HIF-1α is canonically regulated at the post-translational level uniformly across different tumor forms. Enhanced expression of HIF2A mRNA at hypoxia is due to de novo transcription rather than increased mRNA stability, and chemical stabilization of the HIF-α proteins at oxygen-rich conditions unexpectedly leads to increased HIF2A transcription. The enhanced HIF2A levels do not seem to be dependent on active HIF-1. Using a transcriptome array approach, we identified members of the Peroxisome proliferator-activated receptor gamma coactivator (PGC)/Estrogen-related receptor (ERR) complex families as potential regulators of HIF2A. Knockdown or inhibition of one of the members, ERRα, leads to decreased expression of HIF2A, and high expression of the ERRα gene ESRRA correlates with poor overall and progression-free survival in a clinical neuroblastoma material consisting of 88 tumors. Thus, targeting of ERRα and pathways regulating transcriptional HIF-2α are promising therapeutic avenues in neuroblastoma. - Highlights: • Transcriptional control of HIF-2α is restricted to neural cell-derived tumors. • Enhanced transcription of HIF2A is not due to increased mRNA stability. • Chemical stabilization of the HIF-α subunits leads to increased HIF2A transcription. • ERRα regulates HIF2A mRNA expression in neuroblastoma. • High expression of ESRRA correlates to poor outcome in neuroblastoma.

  2. TP53 mutation does not confer a poor outcome in adult patients with acute lymphoblastic leukemia who are treated with frontline hyper-CVAD-based regimens.

    Science.gov (United States)

    Kanagal-Shamanna, Rashmi; Jain, Preetesh; Takahashi, Koichi; Short, Nicholas J; Tang, Guilin; Issa, Ghayas C; Ravandi, Farhad; Garcia-Manero, Guillermo; Yin, Cameron C; Luthra, Rajyalakshmi; Patel, Keyur P; Khoury, Joseph D; Montalban-Bravo, Guillermo; Sasaki, Koji; Kadia, Tapan M; Borthakur, Gautam; Konopleva, Marina; Jain, Nitin; Garris, Rebecca; Pierce, Sherry; Wierda, William; Estrov, Zeev; Cortes, Jorge; O'Brien, Susan; Kantarjian, Hagop M; Jabbour, Elias

    2017-10-01

    Tumor protein 53 (TP53) mutations are uncommon in adult patients with acute lymphoblastic leukemia (ALL) and predict a poor outcome. TP53 mutation analysis was performed in 164 newly diagnosed adult patients with ALL using a combination of targeted amplicon-based next-generation sequencing and Sanger sequencing. TP53 mutations were detected in 25 patients (15%), with a median allelic frequency of 42.2% (range, 5.6%-93.8%). The majority of mutations were single-nucleotide variants of missense type and involved the DNA-binding domain. TP53-mutated (TP53(mut) ) ALL was found to be significantly associated with older age, lower median white blood cell and platelet counts, lower frequency of Philadelphia chromosome and a higher frequency of low hypodiploid karyotype compared with ALL with wild-type TP53 (TP53(wt) ). To evaluate the prognostic effect of TP53 mutations, the authors selected 146 patients with B-cell immunophenotype ALL (24 with TP53(mut) and 122 with TP53(wt) ) who were uniformly treated with frontline hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD)-based regimens; >90% of these individuals also received a monoclonal antibody. Over a median follow-up duration of 15 months, there was no significant difference in the median overall survival, event-free survival, and duration of complete remission noted between patients with TP53(mut) ALL and those with TP53(wt) ALL. Hyper-CVAD-based regimens appear to negate the poor prognostic impact of TP53 mutations in patients with adult B-cell immunophenotype ALL. Cancer 2017;123:3717-24. © 2017 American Cancer Society. © 2017 American Cancer Society.

  3. Improved outcome in high-risk childhood acute lymphoblastic leukemia defined by prednisone-poor response treated with double Berlin-Frankfurt-Muenster protocol II.

    Science.gov (United States)

    Aricò, Maurizio; Valsecchi, Maria Grazia; Conter, Valentino; Rizzari, Carmelo; Pession, Andrea; Messina, Chiara; Barisone, Elena; Poggi, Vincenzo; De Rossi, Giulio; Locatelli, Franco; Micalizzi, Maria Concetta; Basso, Giuseppe; Masera, Giuseppe

    2002-07-15

    One hundred ninety-eight children and adolescents were entered in the Associazione Italiana di Ematologia ed Oncologia Pediatrica (AIEOP)-ALL95 study for high-risk acute lymphoblastic leukemia (ALL). Inclusion criteria were poor response to initial prednisone/intrathecal methotrexate (prednisone-poor response [PPR]), resistance to induction therapy, translocation t(9;22), infants with the t(4;11), or CD10(-) ALL. The event-free survival (EFS) rate at 4 years was 56.5% (SE, 3.9%) for the entire group. The overall EFS rate in the current study was significantly better (P =.002) than that obtained in a comparable group of patients treated in the early 1990s in the AIEOP-ALL91 study. In particular, patients with PPR had a 4-year EFS of 61.1% (SE, 4.4%) versus 42.8% (SE, 5.4%) in the ALL 91 study (P =.008). Among PPR patients, those who were PPR-only (60.1%)-that is, they achieved CR and were negative for t(9;22) and t(4;11) translocations-had the best outcomes with this intensive treatment, even when additional adverse features (hyperleukocytosis, T phenotype) were present (4-year EFS, 70.1%; SE, 4.7%). We attribute this improvement to the replacement of 6 alternating blocks of non-cross-resistant drugs with an 8-drug reinduction regimen (Berlin-Frankfurt-Muenster [BFM] protocol II), repeated twice, in the context of a standard BFM-type intensive chemotherapy for high-risk ALL. This modified therapy may lead to high cure rates for patients defined as at high risk for intrinsic resistance to corticosteroids only.

  4. Testosterone for Poor Ovarian Responders

    DEFF Research Database (Denmark)

    Polyzos, Nikolaos P; Davis, Susan R; Drakopoulos, Panagiotis

    2016-01-01

    ovarian stimulation with a duration varying from 5 to 21 days. Nevertheless, the key question to be asked is whether, based on ovarian physiology and testosterone pharmacokinetics, a short course of testosterone administration of more than 10 mg could be expected to have any beneficial effect...... on reproductive outcome. The rationale for asking this question lies in the existing scientific evidence derived from basic research and animal studies regarding the action of androgens during folliculogenesis, showing that their main effect in follicular development is defined during the earlier developmental...... stages. In addition, extreme testosterone excess is not only likely to induce adverse events but has also the potential to be ineffective and even detrimental. Thus, evidence from clinical studies is not enough to either "reopen" or "close" the "androgen chapter" in poor responders, mainly because...

  5. Association of cigarette smoking with Chinese ankylosing spondylitis patients in Taiwan: a poor disease outcome in systemic inflammation, functional ability, and physical mobility.

    Science.gov (United States)

    Chen, Chun-Hsiung; Chen, Hung-An; Lu, Chin-Li; Liao, Hsien-Tzung; Liu, Chin-Hsiu; Tsai, Chang-Youh; Chou, Chung-Tei

    2013-05-01

    We investigated the association between smoking and the disease activity, functional ability, physical mobility, and systemic inflammation in Chinese ankylosing spondylitis (AS) patients. Seventy five male Chinese AS patients in Taiwan were enrolled in the cross-sectional study. These patients fulfilled the 1984 modified New York criteria. Patients completed the questionnaires, containing the demographic data, disease activity, functional ability (BASFI), and patient's global assessment. Meanwhile, physical examinations were performed to determine the patient's physical mobility. Acute-phase reactants, erythrocyte sedimentation rate (ESR), and C-reactive protein levels were also measured in the AS patients. Smoking habits with smoking duration and smoking intensity (pack-years of smoking) were recorded. Among these physical mobility parameters, modified Schober's index (p expansion (p = 0.016), and occiput-to-wall distances (p = 0.003) were significantly impaired in smoking AS patients (n = 35) as compared to non-smoking (n = 40). Systemic inflammation parameter, ESR was significantly higher in smoking AS patients than non-smoking (p = 0.03). The odds ratio of advanced modified Schober's index, lateral lumbar flexion, fingertip-to-floor distance, chest expansion, and occiput-to-wall were significantly elevated in smoking AS patients as compared to non-smoking. Moreover, the smoking intensity correlated significantly with BASFI (r = 0.481, p = 0.005), cervical rotation (r = -0.401, p = 0.031), fingertip-to-floor distance (r = 0.485, p = 0.004), and occiput-to-wall distance (r = 0.473, p = 0.005) in the 35 smoking AS patients. The cigarette smokers in the Chinese AS patients have increased systemic inflammation and poor physical mobility. In addition, the higher smoking intensity in the AS smokers is associated with poor disease outcome, including functional ability and physical mobility. Thus, it is quite important for the physician to emphasize the association of

  6. Host genetic variants in the interleukin-6 promoter predict poor outcome in patients with estrogen receptor-positive, node-positive breast cancer.

    Science.gov (United States)

    DeMichele, Angela; Gray, Robert; Horn, Michelle; Chen, Jinbo; Aplenc, Richard; Vaughan, William P; Tallman, Martin S

    2009-05-15

    Interleukin-6 modulates immune response, estrogen production, and growth pathways in breast cancer. We evaluated the effect of several common, functional interleukin-6 promoter variants in node-positive breast cancer patients enrolled on a multicenter, cooperative group, adjuvant chemotherapy trial to determine whether these variants were associated with clinical outcome overall and by estrogen receptor tumor phenotype. Genomic DNA and clinical data were collected from a clinical trial of adjuvant anthracycline-based chemotherapy followed by randomization to high-dose cyclophosphamide/thiotepa or observation (Intergroup Trial 0121). Genotyping for -174G>C (rs1800795), -597G>A (rs1800797), and -572G>C (rs1800796) was done by site-specific PCR and PyroSequencing, whereas the -373A(n)T(n) repeat was directly sequenced. Log-rank tests and Cox modeling were used to compare outcomes by genotype/haplotype and other factors. Three hundred forty-six patients (64% of trial) had corresponding genotype/clinical data available and did not differ from overall trial participants. After adjustment, patients with estrogen receptor-positive tumors and genotypes 597 GG or 174 GG had significantly worse disease-free survival [hazard ratio (HR), 1.6; P = 0.02 and HR, 1.71; P = 0.007, respectively], whereas the 373 8A12T repeat appeared to be protective (HR, 0.62; P = 0.02). The presence of at least one copy of the haplotype ([-597G, -572G, -373[10A/11T], -174G]) was associated with worse disease-free survival (HR, 1.46; P = 0.04). Kaplan-Meier plots show that all patients in this group relapsed by 24 months from diagnosis. This poor-risk haplotype was quite common overall (estimated frequency, 0.20) and twice as frequent among Blacks (estimated frequency, 0.41).

  7. Psychological risk factors for poor outcome of spine surgery and spinal cord stimulator implant: a review of the literature and their assessment with the MMPI-2-RF.

    Science.gov (United States)

    Block, Andrew R; Ben-Porath, Yossef S; Marek, Ryan J

    2013-01-01

    Back pain is experienced by up to of 85% of the United States population. Most often it resolves with minimal to no medical treatment. For those whose pain endures, worsens, or becomes protracted, conservative care is typically first attempted. Individuals who continue to experience significant back pain are often considered for surgical procedures, the results of which are not uniformly positive. The consequences of failed surgical intervention can be quite devastating, and psychosocial factors have been found to predict poor outcome. The literature on psychosocial risk factors for failed back surgery is reviewed first, identifying psychological dysfunction in the domains of emotions, cognitions, behavior, and interpersonal processes as increasing the risk for failed back surgery. Empirical findings with the MMPI-2 Restructured Form (MMPI-2-RF) are presented next, including descriptive analyses with a sample of 1341 individuals assessed as part of a pre-surgical psychological screening. Correlations between MMPI-2-RF scale scores and measures of the primary risk factors identified in this review are reported for a smaller sample of 197 pre-surgical candidates. Interpretive implications of the MMPI-2-RF findings are discussed along with suggestions for further research in this area.

  8. Impact of dehydroepiandrosterone on clinical outcome in poor responders: A pilot study in women undergoing in vitro fertilization, using bologna criteria

    Directory of Open Access Journals (Sweden)

    Padma Rekha Jirge

    2014-01-01

    Full Text Available Objective: To evaluate the role of dehydroepiandrosterone (DHEA supplementation in women with poor ovarian response (POR undergoing in vitro fertilization (IVF. Design: Prospective case-control study. Setting: Private tertiary fertility clinic. MATERIALS AND Methods: 31 infertile women with POR diagnosed as per the Bologna criteria. Interventions: DHEA supplementation for 2 months and a subsequent IVF cycle, after two previous IVF cycles with POR. Main Outcome Measure(S: Dose and duration of gonadotropin therapy, oocyte yield, embryo number and quality, pregnancy and live birth rate. Results: No difference was seen in gonadotropin requirement before and after DHEA supplementation. There was a significant increase in total and metaphase II oocytes (5.9 ± 0.68 vs. 2.73 ± 0.24; 4.45 ± 0.47 vs. 2.09 ± 0.26, fertilization (3.65 ± 0.49 vs. 2.00 ± 0.27, Grade I embryos (1.52 ± 0.25 vs. 0.55 ± 0.18, pregnancy rate (30% vs. 9.1% and live birth rate (25% vs 0% in those who completed the cycle, following DHEA supplementation. Conclusions: Dehydroepiandrosterone supplementation results in an improvement in oocyte yield, embryo quality, and live birth rate in a group of women with POR having undergone at least two previous failures due to POR.

  9. Leptin stimulates migration and invasion and maintains cancer stem-like properties in ovarian cancer cells: an explanation for poor outcomes in obese women.

    Science.gov (United States)

    Kato, Sumie; Abarzua-Catalan, Lorena; Trigo, César; Delpiano, Ana; Sanhueza, Cristobal; García, Karen; Ibañez, Carolina; Hormazábal, Katherine; Diaz, Daniela; Brañes, Jorge; Castellón, Enrique; Bravo, Erasmo; Owen, Gareth; Cuello, Mauricio A

    2015-08-28

    The evidence linking obesity with ovarian cancer remains controversial. Leptin is expressed at higher levels in obese women and stimulates cell migration in other epithelial cancers. Here, we explored the clinical impact of overweight/obesity on patient prognosis and leptin's effects on the metastatic potential of ovarian cancer cells. We assessed clinical outcomes in 70 ovarian cancer patients (33 healthy weight and 37 overweight) that were validated with an external cohort from The Cancer Genome Atlas (TCGA) database. Progression-free and overall survival rates were significantly decreased in overweight patients. Similarly, a worse overall survival rate was found in TCGA patients expressing higher leptin/OB-Rb levels. We explored serum and ascites leptin levels and OB-Rb expression in our cohort. Serum and ascites leptin levels were higher in overweight patients experiencing worse survival. OB-Rb was more highly expressed in ascites and metastases than in primary tumors. Leptin exposure increased cancer cell migration/invasion through leptin-mediated activation of JAK/STAT3, PI3/AKT and RhoA/ROCK and promoted new lamellipodial, stress-fiber and focal adhesion formation. Leptin also contributed to the maintenance of stemness and the mesenchymal phenotype in ovarian cancer cells. Our findings demonstrate that leptin stimulated ovarian cancer cell migration and invasion, offering a potential explanation for the poor prognosis among obese women.

  10. Early Results with the Use of Heparin-bonded Stent Graft to Rescue Failed Angioplasty of Chronic Femoropopliteal Occlusive Lesions: TASC D Lesions Have a Poor Outcome

    Energy Technology Data Exchange (ETDEWEB)

    Kuhan, Ganesh, E-mail: gkuhan@nhs.net; Abisi, Said; Braithwaite, Bruce D.; MacSweeney, Shane T. R. [Nottingham University Hospitals, Vascular and Endovascular Unit, Queens Medical Centre (United Kingdom); Whitaker, Simon C.; Habib, Said B. [Nottingham University Hospitals, Department of Radiology, Queen' s Medical Centre (United Kingdom)

    2012-10-15

    Purpose: To evaluate early patency rate of the heparin-bonded stent grafts in atherosclerotic long femoropopliteal occlusive disease, and to identify factors that affect outcome. Methods: Heparin-bonded Viabahn stent grafts were placed in 33 limbs in 33 patients during 2009-2010. The stents were deployed to rescue failed conventional balloon angioplasty. Mean age was 69 (range 44-88) years, and 67 % (22 of 33) were men. Most procedures (21 of 33, 64 %) were performed for critical limb ischemia (33 % for rest pain, 30 % tissue loss). Kaplan-Meier plots and Cox regression analysis were used to identify significant risk factors. Results: The average length of lesions treated was 25 {+-} 10 cm, and they were predominantly TASC (Transatlantic Intersociety Consensus) D (n = 13) and C (n = 17) lesions. The median primary patency was 5.0 months (95 % confidence interval 1.22-8.77). The mean secondary patency was 8.6 months (95 % confidence interval 6.82-10.42). Subsequently, 4 patients underwent bypass surgery and 5 patients underwent major amputation. One patient died. There were 5 in-stent or edge-stent stenoses. Cox multivariate regression analysis identified TASC D lesions to be a significant risk factor for early occlusion (p = 0.035). Conclusion: TASC D lesions of femoropopliteal occlusions have poor patency rates with the use of heparin-bonded stent grafts after failed conventional angioplasty. Alternative options should be considered for these patients.

  11. Outcome measures for hand function naturally reveal three distinct domains in older adults: strength, coordinated upper extremity function, and sensorimotor processing

    Directory of Open Access Journals (Sweden)

    Emily L Lawrence

    2015-06-01

    Full Text Available Understanding the mapping between individual outcome measures and the latent functional domains of interest is critical to a quantitative evaluation and rehabilitation of hand function. We examined whether and how the associations among six hand-specific outcome measures reveal latent functional domains in elderly individuals. We asked 66 healthy older adult participants (38F, 28M, 66.1±11.6yrs, range: 45-88yrs and 33 older adults (65.8±9.7yrs, 44-81yrs, 51 hands diagnosed with osteoarthritis (OA of the carpometacarpal (CMC joint, to complete six functional assessments: hand strength (Grip, Key and Precision Pinch, Box and Block, Nine Hole Pegboard, and Strength-Dexterity tests. The first three principal components suffice to explain 86% of variance among the six outcome measures in healthy older adults, and 84% of variance in older adults with CMC OA. The composition of these dominant associations revealed three distinct latent functional domains: strength, coordinated upper extremity function, and sensorimotor processing. Furthermore, in participants with thumb CMC OA we found a blurring of the associations between the latent functional domains of strength and coordinated upper extremity function. This motivates future work to understand how the physiological effects of thumb CMC OA lead upper extremity coordination to become strongly associated with strength, while dynamic sensorimotor ability remains an independent functional domain.Thus, when assessing the level of hand function in our growing older adult populations, it is particularly important to acknowledge its multidimensional nature—and explicitly consider how each outcome measure maps to these three latent and fundamental domains of function. Moreover, this ability to distinguish among latent functional domains may facilitate the design of treatment modalities to target the rehabilitation of each of them.

  12. The 'Effects of Transfusion Thresholds on Neurocognitive Outcome of Extremely Low Birth-Weight Infants (ETTNO)' Study

    DEFF Research Database (Denmark)

    Reinholdt, Jes; Veiergang, Gitte

    2012-01-01

    Background: Infants with extremely low birth weight uniformly develop anemia of prematurity and frequently require red blood cell transfusions (RBCTs). Although RBCT is widely practiced, the indications remain controversial in the absence of conclusive data on the long-term effects of RBCT...

  13. Expression of PAM50 Genes in Lung Cancer: Evidence that Interactions between Hormone Receptors and HER2/HER3 Contribute to Poor Outcome

    Directory of Open Access Journals (Sweden)

    Jill M. Siegfried

    2015-11-01

    Full Text Available Non–small cell lung cancers (NSCLCs frequently express estrogen receptor (ER β, and estrogen signaling is active in many lung tumors. We investigated the ability of genes contained in the prediction analysis of microarray 50 (PAM50 breast cancer risk predictor gene signature to provide prognostic information in NSCLC. Supervised principal component analysis of mRNA expression data was used to evaluate the ability of the PAM50 panel to provide prognostic information in a stage I NSCLC cohort, in an all-stage NSCLC cohort, and in The Cancer Genome Atlas data. Immunohistochemistry was used to determine status of ERβ and other proteins in lung tumor tissue. Associations with prognosis were observed in the stage I cohort. Cross-validation identified seven genes that, when analyzed together, consistently showed survival associations. In pathway analysis, the seven-gene panel described one network containing the ER and progesterone receptor, as well as human epidermal growth factor receptor (HER2/HER3 and neuregulin-1. NSCLC cases also showed a significant association between ERβ and HER2 protein expression. Cases positive for HER2 expression were more likely to express HER3, and ERβ-positive cases were less likely to be both HER2 and HER3 negative. Prognostic ability of genes in the PAM50 panel was verified in an ERβ-positive cohort representing all NSCLC stages. In The Cancer Genome Atlas data sets, the PAM50 gene set was prognostic in both adenocarcinoma and squamous cell carcinoma, whereas the seven-gene panel was prognostic only in squamous cell carcinoma. Genes in the PAM50 panel, including those linking ER and HER2, identify lung cancer patients at risk for poor outcome, especially among ERβ-positive cases and squamous cell carcinoma.

  14. B3GNT3 Expression Is a Novel Marker Correlated with Pelvic Lymph Node Metastasis and Poor Clinical Outcome in Early-Stage Cervical Cancer

    Science.gov (United States)

    Niu, Chunhao; Song, Libing; Zhang, Yanna

    2015-01-01

    Background The β1,3-N-acetylglucosaminyltransferase-3 gene (B3GNT3) encodes a member of the B3GNT family that functions as the backbone structure of dimeric sialyl-Lewis A and is involved in L-selectin ligand biosynthesis, lymphocyte homing and lymphocyte trafficking. B3GNT3 has been implicated as an important element in the development of certain cancers. However, the characteristics of B3GNT3 in the development and progression of cancer remain largely unknown. Thus, our study aimed to investigate the expression pattern and the prognostic value of B3GNT3 in patients with early-stage cervical cancer. Methods The mRNA and protein levels of B3GNT3 expression were examined in eight cervical cancer cell lines and ten paired cervical cancer tumors, using real-time PCR and western blotting, respectively. Immunohistochemistry (IHC) was used to analyze B3GNT3 protein expression in paraffin-embedded tissues from 196 early-stage cervical cancer patients. Statistical analyses were applied to evaluate the association between B3GNT3 expression scores and clinical parameters, as well as patient survival. Results B3GNT3 expression was significantly upregulated in cervical cancer cell lines and lesions compared with normal cells and adjacent noncancerous cervical tissues. In the 196 cases of tested early-stage cervical cancer samples, the B3GNT3 protein level was positively correlated with high risk TYPES of human papillomavirus (HPV) infection (P = 0.026), FIGO stage (P cervical cancer patients. Conclusions Our study demonstrated that elevated B3GNT3 expression is associated with pelvic lymph node metastasis and poor outcome in early-stage cervical cancer patients. B3GNT3 may be a novel prognostic marker and therapeutic target for the treatment of cervical cancer. PMID:26709519

  15. DLL4 overexpression increases gastric cancer stem/progenitor cell self-renewal ability and correlates with poor clinical outcome via Notch-1 signaling pathway activation.

    Science.gov (United States)

    Miao, Zhi-Feng; Xu, Hao; Xu, Hui-Mian; Wang, Zhen-Ning; Zhao, Ting-Ting; Song, Yong-Xi; Xu, Ying-Ying

    2017-01-01

    Gastric cancer is one of the most common malignant diseases, and poses a serious threat to the quality of human life. Gastric cancer stem/progenitor cells (GCSPCs) have critical effects on tumor formation, affecting specific features of self-renewal and differentiation and playing a critical role in metastasis. The Notch-1 pathway is crucially important to GCSPCs and is regulated by DLL4. In this study, DLL4 and Nestin levels were measured in 383 gastric cancer tissue samples by immunohistochemistry, and the clinico-pathological features of patients assessed. After DLL4 silencing in selected gastric cancer cell lines, the expression of GCSPC markers and colony formation ability were analyzed and the self-renewal and differentiation capacities of the cells were evaluated. The relationship between DLL4 levels and Notch-1 signaling pathway effector amounts was assessed via Western blotting and immunofluorescence. Finally, the tumor formation ability of the gastric cancer cells was evaluated with different levels of DLL4 and multiple cell densities in vivo. Our results indicate that DLL4 expression is associated with TNM stage and cancer metastasis, with high amounts of DLL4 leading to poor outcome. DLL4 silencing inhibited the self-renewal ability of GCSPCs and increased their multidifferentiation capacity, resulting in reduced GCSPC ratios. DLL4 knockdown also blocked the Notch-1 pathway, weakening invasion ability and resistance to 5-FU chemotherapy. In vivo, DLL4 silencing inhibited the tumor formation ability of GCSPCs. In conclusion, DLL4 affects GCSPC stemness, altering their pathological behavior. DLL4 silencing inhibits GCSPC metastatic potential both in vitro and in vivo by impeding Notch-1 signaling pathway activation, indicating that DLL4 may be a new potential therapeutic target.

  16. The impact of cerebral microbleeds on intracerebral hemorrhage and poor functional outcome of acute ischemic stroke patients treated with intravenous thrombolysis: a systematic review and meta-analysis.

    Science.gov (United States)

    Wang, Shuang; Lv, Yan; Zheng, Xin; Qiu, Jing; Chen, Hui-Sheng

    2017-07-01

    It is still controversial whether pre-existing cerebral microbleeds (CMBs) increase the risks of intracranial hemorrhage (ICH) and poor functional outcome (PFO) in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). Therefore, we performed a systematic review and meta-analysis to determine the impact of CMBs on ICH and PFO of AIS patients with IVT. We searched PubMed, EMBASE and Web of Science from inception to August 3, 2016, with language restriction in English. We included studies that reported the relationship between CMBs and ICH or PFO after thrombolysis. Two retrospective and nine prospective studies met inclusion criteria (total 2702 patients). The overall prevalence of CMBs on pre-IVT MRI scans was 24.0%. Pre-existing CMBs on MRI scans were not significantly associated with a higher risk of early sICH (OR 1.74; 95% CI 0.91-3.33; I (2) = 44.5%). Subgroup analyses did not substantially influence these associations. The presence of CMBs was associated with the increased risk of 3-month PFO (OR 1.58; 95% CI 1.08-2.31; I (2) = 54.2%), PH (OR 2.14; 95% CI 1.34-3.42; I (2) = 11.0%) and any ICH (OR 1.42; 95% CI 1.04-1.95; I (2) = 0.0%), respectively. This meta-analysis showed that CMBs presence was not significantly associated with the increased risk of early sICH after IVT. However, the results also demonstrated that CMBs presence increased the risks of 3-month PFO, PH and any ICH after IVT. Due to a small number of included studies and methodological limitations, the results of this meta-analysis should be interpreted cautiously. CMBs presence should not be a contraindication to IVT for AIS patients based on the existing evidence.

  17. Outcomes of Botulinum Toxin Type A Injection Followed by Rehabilitation in Cases of Cerebral Palsy With Upper Extremity Involvement.

    Science.gov (United States)

    Karaca, Burcu; Ünlü, Ece; Köse, Gülşen; Gönen, Emel; Çakcı, Aytül

    2016-03-01

    We evaluated the efficiency of botulinum toxin type A injection followed by a rehabilitation program including individual therapy, group therapy, and occupational therapy in cases of cerebral palsy with upper extremity involvement. A total of 29 injections were performed on 25 patients, and the patients were placed on rehabilitation program. At 3-month and 6-month assessments, there was a significant improvement in lateral grip strength, 9 Hole Peg test, Upper Limb Physician's Rating Scale and pediatric functional independence measure total scores. There were significant decreases in active range of motion in elbow extension, supination, and wrist extension, and Modified Ashworth Scale in elbow flexion, elbow pronation, and wrist flexion at 6-week, 3-month, and 6-month assessments. Combination of group therapy with traditional therapy methods after injection is effective in cases of cerebral palsy with upper extremity involvement.

  18. On the properties of the interstellar medium in extremely metal-poor blue compact dwarf galaxies: GMOS-IFU spectroscopy and SDSS photometry of the double-knot galaxy HS 2236+1344

    CERN Document Server

    Lagos, P; Gomes, J M; Castelli, A V Smith; Vega, L R; .,

    2014-01-01

    The main goal of this study is to carry out a spatially resolved investigation of the warm interstellar medium (ISM) in the extremely metal-poor Blue Compact Dwarf (BCD) galaxy HS 2236+1344. Special emphasis is laid on the analysis of the spatial distribution of chemical abundances, emission-line ratios and kinematics of the ISM, and to the recent star-forming activity in this galaxy. This study is based on optical integral field unit spectroscopy data from Gemini Multi-Object Spectrograph at the Gemini North telescope and archival Sloan Digital Sky Survey images. The data were obtained in two different positions across the galaxy, obtaining a total 4 arcsec X 8 arcsec field which encompasses most of its ISM. Emission-line maps and broad-band images obtained in this study indicate that HS 2236+1344 hosts three Giant HII regions. Our data also reveal some faint curved features in the BCD periphery that might be due to tidal perturbations or expanding ionized-gas shells. The ISM velocity field shows systematic ...

  19. HuR cytoplasmic expression is associated with increased cyclin A expression and poor outcome with upper urinary tract urothelial carcinoma

    Directory of Open Access Journals (Sweden)

    Liang Peir-In

    2012-12-01

    Full Text Available Abstract Background HuR is an RNA-binding protein that post-transcriptionally modulates the expressions of various target genes implicated in carcinogenesis, such as CCNA2 encoding cyclin A. No prior study attempted to evaluate the significance of HuR expression in a large cohort with upper urinary tract urothelial carcinomas (UTUCs. Methods In total, 340 cases of primary localized UTUC without previous or concordant bladder carcinoma were selected. All of these patients received ureterectomy or radical nephroureterectomy with curative intents. Pathological slides were reviewed, and clinical findings were collected. Immunostaining for HuR and cyclin A was performed and evaluated by using H-score. The results of cytoplasmic HuR and nuclear cyclin A expressions were correlated with disease-specific survival (DSS, metastasis-free survival (MeFS, urinary bladder recurrence-free survival (UBRFS, and various clinicopathological factors. Results HuR cytoplasmic expression was significantly related to the pT status, lymph node metastasis, a higher histological grade, the pattern of invasion, vascular and perineurial invasion, and cyclin A expression (p = 0.005. Importantly, HuR cytoplasmic expression was strongly associated with a worse DSS (p p p = 0.0370 in the univariate analysis, and the first two results remained independently predictive of adverse outcomes (p = 0.038, relative risk [RR] = 1.996 for DSS; p = 0.027, RR = 1.880 for MeFS. Cyclin A nuclear expression was associated with a poor DSS (p = 0.0035 and MeFS (p = 0.0015 in the univariate analysis but was not prognosticatory in the multivariate analyses. High-risk patients (pT3 or pT4 with/without nodal metastasis with high HuR cytoplasmic expression had better DSS if adjuvant chemotherapy was performed (p = 0.015. Conclusions HuR cytoplasmic expression was correlated with adverse phenotypes and cyclin A overexpression and also independently predictive

  20. B3GNT3 Expression Is a Novel Marker Correlated with Pelvic Lymph Node Metastasis and Poor Clinical Outcome in Early-Stage Cervical Cancer.

    Directory of Open Access Journals (Sweden)

    Weijing Zhang

    demonstrated that elevated B3GNT3 expression is associated with pelvic lymph node metastasis and poor outcome in early-stage cervical cancer patients. B3GNT3 may be a novel prognostic marker and therapeutic target for the treatment of cervical cancer.

  1. Feasibility and outcomes of a classical Pilates program on lower extremity strength, posture, balance, gait, and quality of life in someone with impairments due to a stroke.

    Science.gov (United States)

    Shea, Sarah; Moriello, Gabriele

    2014-07-01

    Pilates is a method that can potentially be used for stroke rehabilitation to address impairments in gait, balance, strength, and posture. The purpose of this case report was to document the feasibility of using Pilates and to describe outcomes of a 9-month program on lower extremity strength, balance, posture, gait, and quality of life in an individual with stroke. The participant was taught Pilates exercises up to two times per week for nine months in addition to traditional rehabilitation in the United States. Outcomes were assessed using the Berg Balance Scale (BBS), Stroke Impact Scale (SIS), GAITRite System(®), 5 repetition sit-to-stand test (STST), and flexicurve. Improvements were found in balance, lower extremity strength, and quality of life. Posture and gait speed remained the same. While these changes cannot be specifically attributed to the intervention, Pilates may have added to his overall rehabilitation program and with some modifications was feasible to use in someone with a stroke. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Hospital Acquired Pneumonia is an Independent Predictor of Poor Global Outcome in Severe Traumatic Brain Injury up to 5 Years after Discharge

    Science.gov (United States)

    Kesinger, Matthew R.; Kumar, Raj G.; Wagner, Amy K.; Puyana, Juan C.; Peitzman, Andrew P.; Billiar, Timothy R.; Sperry, Jason L.

    2016-01-01

    Objectives Long-term outcomes following traumatic brain injury (TBI) correlate with initial head injury severity and other acute factors. Hospital-acquired pneumonia (HAP) is a common complication in TBI. Little information exists regarding the significance of infectious complications on long-term outcomes post-TBI. We sought to characterize risks associated with HAP on outcomes 5 years post-TBI. Methods Ddata from the merger of an institutional trauma registry and the TBI Model Systems outcome data. Individuals with severe head injuries (Abbreviated Injury Scale≥4), who survived to rehabilitation were analyzed. Primary outcome was Glasgow Outcome Scaled-Extended (GOSE) at 1, 2, and 5 years. GOSE was dichotomized into LOW (GOSEPneumonia TBI PMID:25757128

  3. Functional, psychosocial and professional outcomes in long-term survivors of lower-extremity osteosarcomas: amputation versus limb salvage.

    Science.gov (United States)

    Ottaviani, Giulia; Robert, Rhonda S; Huh, Winston W; Jaffe, Norman

    2009-01-01

    As the number of osteosarcoma survivors increases, the impact of quality of life and function needs to be addressed. Limb salvage is the preferred treatment when patients have treatment options; yet, the questionable long-term durability and complications of prostheses, combined with ambiguous function, leave some doubt regarding the best clinical and surgical options. Comparisons between limb salvage patients, amputees and controls also require further investigation. Amputation would leave the patients with a lifelong requirement for an external prosthetic leg associated with an overall limited walking distance. While artificial limbs are much more sophisticated than those used in the past, phantom limb sensations remain a substantial and unpredictable problem in the amputee. Complications such as stump overgrowth, bleeding, and infection, also require further elucidation. Limb salvage surgery using endoprosthesis, allografts or reconstruction is performed in approximately 85% of patients affected by osteosarcoma located in the middle and/or distal femur. One drawback in limb-salvage surgery in the long-term survivor is that endoprostheses have a limited life span with long-term prosthetic failure. The inherent high rate of reoperation remains a serious problem. Replacing a damaged, infected or severely worn-out arthroplastic joint or its intramedullary stem is difficult, especially in the long-stem cemented endoprostheses used in the 1980s. Limb lengthening procedures in patients who have not reached maturity must also be addressed. Periprosthetic infections, compared to other indications for joint reconstruction, were found to be more frequent in patients treated for neoplastic conditions and their outcome can be devastating, resulting in total loss of joint function, amputation, and systemic complications. Quality of life in terms of function, psychological outcome and endpoint achievements such as marriage and employment apparently do not differ significantly

  4. Molecular sources of residual cardiovascular risk, clinical signals, and innovative solutions: relationship with subclinical disease, undertreatment, and poor adherence: implications of new evidence upon optimizing cardiovascular patient outcomes

    Directory of Open Access Journals (Sweden)

    Kones R

    2013-10-01

    the conditional pleiotropic actions of HDL. Non-HDL cholesterol reflects the cholesterol in all atherogenic particles containing apolipoprotein B, and has outperformed LDL cholesterol as a lipid marker of cardiovascular risk and future mortality. In addition to including a measure of residual risk, the advantages of using non-HDL cholesterol as a primary lipid target are now compelling. Reinterpretation of data from the Treating to New Targets study suggests that better control of smoking, body weight, hypertension, and diabetes will help lower residual risk. Although much improved, control of risk factors other than LDL cholesterol currently remains inadequate due to shortfalls in compliance with guidelines and poor patient adherence. More efficient and greater use of proven simple therapies, such as aspirin, beta-blockers, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, combined with statin therapy, may be more fruitful in improving outcomes than using other complex therapies. Comprehensive, intensive, multimechanistic, global, and national programs using primordial, primary, and secondary prevention to lower the total level of cardiovascular risk are necessary.Keywords: cardiovascular prevention, low-density lipoprotein, high-density lipoprotein, statin drugs, metabolic syndrome, obesity, diabetes, niacin, AIM-HIGH study, cholesteryl ester transfer protein, endothelial progenitor cells, fibrate drugs

  5. Molecular sources of residual cardiovascular risk, clinical signals, and innovative solutions: relationship with subclinical disease, undertreatment, and poor adherence: implications of new evidence upon optimizing cardiovascular patient outcomes.

    Science.gov (United States)

    Kones, Richard

    2013-01-01

    atherogenic particles containing apolipoprotein B, and has outperformed LDL cholesterol as a lipid marker of cardiovascular risk and future mortality. In addition to including a measure of residual risk, the advantages of using non-HDL cholesterol as a primary lipid target are now compelling. Reinterpretation of data from the Treating to New Targets study suggests that better control of smoking, body weight, hypertension, and diabetes will help lower residual risk. Although much improved, control of risk factors other than LDL cholesterol currently remains inadequate due to shortfalls in compliance with guidelines and poor patient adherence. More efficient and greater use of proven simple therapies, such as aspirin, beta-blockers, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, combined with statin therapy, may be more fruitful in improving outcomes than using other complex therapies. Comprehensive, intensive, multimechanistic, global, and national programs using primordial, primary, and secondary prevention to lower the total level of cardiovascular risk are necessary.

  6. Molecular sources of residual cardiovascular risk, clinical signals, and innovative solutions: relationship with subclinical disease, undertreatment, and poor adherence: implications of new evidence upon optimizing cardiovascular patient outcomes

    Science.gov (United States)

    Kones, Richard

    2013-01-01

    atherogenic particles containing apolipoprotein B, and has outperformed LDL cholesterol as a lipid marker of cardiovascular risk and future mortality. In addition to including a measure of residual risk, the advantages of using non-HDL cholesterol as a primary lipid target are now compelling. Reinterpretation of data from the Treating to New Targets study suggests that better control of smoking, body weight, hypertension, and diabetes will help lower residual risk. Although much improved, control of risk factors other than LDL cholesterol currently remains inadequate due to shortfalls in compliance with guidelines and poor patient adherence. More efficient and greater use of proven simple therapies, such as aspirin, beta-blockers, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, combined with statin therapy, may be more fruitful in improving outcomes than using other complex therapies. Comprehensive, intensive, multimechanistic, global, and national programs using primordial, primary, and secondary prevention to lower the total level of cardiovascular risk are necessary. PMID:24174878

  7. Post-trauma ratings of pre-collision pain and psychological distress predict poor outcome following acute whiplash trauma: a 12-month follow-up study

    DEFF Research Database (Denmark)

    Carstensen, Tina B W; Frostholm, Lisbeth; Oernboel, Eva

    2008-01-01

    identified by multiple logistic regression analysis. Factors associated with affected work capacity at the 12-month follow-up were pre-collision unspecified pain condition (OR=2.4, p=0.002) and socio-demographic characteristics: female gender, low educational level, unemployment and blue collar worker...... with poor recovery and high accumulation of pre-collision psychological distress is associated with considerable neck pain at follow-up. However, no conclusions on causality can be drawn. Personal characteristics before the collision are important for recovery and attention to pre-collision characteristics...... may contribute to the prevention of poor recovery after acute whiplash trauma....

  8. How extreme are extremes?

    Science.gov (United States)

    Cucchi, Marco; Petitta, Marcello; Calmanti, Sandro

    2016-04-01

    High temperatures have an impact on the energy balance of any living organism and on the operational capabilities of critical infrastructures. Heat-wave indicators have been mainly developed with the aim of capturing the potential impacts on specific sectors (agriculture, health, wildfires, transport, power generation and distribution). However, the ability to capture the occurrence of extreme temperature events is an essential property of a multi-hazard extreme climate indicator. Aim of this study is to develop a standardized heat-wave indicator, that can be combined with other indices in order to describe multiple hazards in a single indicator. The proposed approach can be used in order to have a quantified indicator of the strenght of a certain extreme. As a matter of fact, extremes are usually distributed in exponential or exponential-exponential functions and it is difficult to quickly asses how strong was an extreme events considering only its magnitude. The proposed approach simplify the quantitative and qualitative communication of extreme magnitude

  9. Functional outcomes in self-care, mobility, communication, and learning in extremely low-birth weight infants.

    Science.gov (United States)

    Msall, M E; Tremont, M R

    2000-06-01

    Gaps have existed in specifying degrees of severity of cerebral palsy assessment of self-care and communicative competencies, and specifying age-appropriate preschool educational and behavioral competencies. Imbedded in the concept of measuring functional status is the interaction between health and neurologic impairments, developmental challenges and competencies, family resources and disadvantages, and the child's current status. In reviewing historic outcomes of severe ROP over the past 40 years, it was noted that severe ROP caused blindness in 2% to 11% of survivors. There was a constant observation that approximately 50% of severe ROP survivors with blindness had multiple functional and developmental challenges beyond blindness alone. Similarly, in reviewing outcomes of cerebral palsy, it is imperative to describe the severity of cerebral palsy and functional consequences in motor, selfcare, communication, and learning. The reason to measure the functional status of children with neurodevelopmental impairments before first grade is that the degrees of severity of these disorders can be specified before attending school with peers. Subtler aspects of neurodevelopmental impairments need to assess impact on literacy, information learning, written language, social competencies with peers, and recreational and community participation. In this way, we can understand the vulnerabilities and resiliences of children and families of VLBW and ELBW status. This is a critical step in understanding long-term quality of life and independent living issues. In addition, our efforts can address those factors and pathways whereby multiple disabilities and multiple functional limitations cluster. Our biomedical intervention can prioritize strategies that lessen severe multiple disabilities and simultaneously support families, when despite our best efforts functional challenges are life long.

  10. The association of fast food consumption with poor dietary outcomes and obesity among children: is it the fast food or the remainder of the diet?123

    OpenAIRE

    Poti, Jennifer M.; Duffey, Kiyah J.; Popkin, Barry M

    2013-01-01

    Background: Although fast food consumption has been linked to adverse health outcomes, the relative contribution of fast food itself compared with the rest of the diet to these associations remains unclear.

  11. Poor versus rich children with epilepsy have the same clinical course and remission rates but a less favorable social outcome: A population-based study with 25 years of follow-up.

    Science.gov (United States)

    Camfield, Carol; Camfield, Peter; Smith, Bruce

    2016-11-01

    To explore the influence of several estimates of family socioeconomic status on the long-term clinical course and social outcomes of children with epilepsy. The Nova Scotia childhood epilepsy cohort is population based and includes all children in this Canadian province who developed epilepsy between 1977 and 1985. Eligible patients had ≥10 years of follow-up. Children with childhood absence epilepsy were excluded. Total family income at seizure onset was assessed at seizure onset and classified as "poor" (first quintile), "adequate" (second to third quintiles), and "well-off" (fourth to fifth quintiles). We also assessed parental education and home ownership. Social outcome was assessed in those with normal intelligence who were ≥18 years of age at the end of follow-up using a semistructured interview that explored eight adverse effects. Of 584 patients, 421 (72%) were included. Average follow-up was 26 ± 5.6 years. Overall 137 families (33%) had "poor" income, 159 (38%) had "adequate income," and 125 (30%) were "well-off." Terminal remission of epilepsy occurred in 65% of the poor, 61% of the adequate, and 61% of the well-off (p = ns). Intractable epilepsy, status epilepticus, number of antiepileptic drugs (AEDs) used, and the number of generalized tonic-clonic or focal with secondary generalization seizures through the clinical course was the same in all groups. Home ownership did not predict remission. Neither paternal nor maternal education was associated with remission. Poor children had significantly more adverse social outcomes including failure to graduate from high school, unemployment, personal poverty, inadvertent pregnancy, and psychiatric diagnoses. In Nova Scotia with universal health care, coming from a poor or more affluent family does not seem to affect the clinical course or long-term seizure outcome of childhood epilepsy. Unfortunately children from poor families are less likely to have a good social outcome. Wiley Periodicals, Inc

  12. Reduced Hospital Mortality With Surgical Ligation of Patent Ductus Arteriosus in Premature, Extremely Low Birth Weight Infants: A Propensity Score-matched Outcome Study.

    Science.gov (United States)

    Tashiro, Jun; Perez, Eduardo A; Sola, Juan E

    2016-03-01

    To evaluate outcomes after surgical ligation (SL) of patent ductus arteriosus (PDA) in premature, extremely low birth weight (ELBW) infants. Optimal management of PDA in this specialized population remains undefined. Currently, surgical therapy is largely reserved for infants failing medical management. To date, a large-scale, risk-matched population-based study has not been performed to evaluate differences in mortality and resource utilization. Data on identified premature (Propensity score-matched analysis of 1620 SL versus 1584 non-SL found reduced mortality (15% vs 26%) and more routine disposition (48% vs 41%) for SL (P Propensity score-matched analysis demonstrates reduced mortality in premature/ELBW infants with SL for PDA. NEC and sepsis are predictors of mortality and resource utilization.

  13. Poor initial graft function after orthotopic liver transplantation : can it be predicted and does it affect outcome? An analysis of 125 adult primary transplantations

    NARCIS (Netherlands)

    Maring, JK; Klompmaker, IJ; Zwaveling, JH; Kranenburg, K; TenVergert, EM; Slooff, MJH

    1997-01-01

    Donor liver shortage is a persistent problem in liver transplantation. A more liberal donor acceptance policy may be a possible solution. However, this might put recipients at risk for initial poor function or even non-function of the graft. Therefore risk factors for initial graft dysfunction shoul

  14. Home-based Exercise on Functional Outcome of the Donor Lower Extremity in Oral Cancer Patients after Fibula Flap Harvest

    Directory of Open Access Journals (Sweden)

    Ting-Yuan Liu

    2013-04-01

    Full Text Available Background: After harvesting the fibula flap, pain, sensory disturbance, weakness of donor leg, reduced walking endurance, ankle instability, and lower walking speed had been reported. The aim of this study was to quantitatively assess functional outcome of regular home-based exercise on donor ankle strength, endurance, and walking ability after free fibula flap for mandibular reconstruction. Methods: Fourteen patients were recruited. Objective isokinetic testing and a 6-min walk test (6MWT were used to evaluate ankle strength/endurance and walking ability, respectively. Results: There was a significant increase in the peak torque of ankle dorsiflexion/foot inversion of the healthy leg and ankle dorsiflexion/foot eversion of the donor leg after exercise (p < 0.05. After home-based exercise, there was reduced asymmetry in the peak torques of ankle dorsiflexion and foot eversion and the total work of foot eversion between the donor and healthy legs. In 6MWT, no significant difference was found between the walking distances before and after exercise. Conclusion: Regular home-based exercise could improve the strength of ankle dorsiflexion and foot eversion of the donor leg, and get more symmetric ankle motor function between the donor and healthy legs.

  15. High Blood Pressure Increases the Risk of Poor Outcome at Discharge and 12-month Follow-up in Patients with Symptomatic Intracranial Large Artery Stenosis and Occlusions: Subgroup analysis of the CICAS Study.

    Science.gov (United States)

    Yu, Dan-Dan; Pu, Yue-Hua; Pan, Yue-Song; Zou, Xin-Ying; Soo, Yannie; Leung, Thomas; Liu, Li-Ping; Wang, David Z; Wong, Ka-Sing; Wang, Yi-Long; Wang, Yong-Jun

    2015-06-01

    The purpose of this study was to discuss the relationship between blood pressure and prognosis of patients with symptomatic intracranial arterial stenosis. Data on 2426 patients with symptomatic intracranial large artery stenosis and occlusion who participated in the Chinese Intracranial Atherosclerosis (CICAS) study were analyzed. According to the JNC 7 criteria, blood pressure of all patients was classified into one of the four subgroups: normal, prehypertension, hypertension stage I, and hypertension stage II. Poor outcomes were defined as death and functional dependency (mRS 3-5) at discharge or at 1 year. For patients with intracranial stenosis of 70% to 99%, the rate of poor outcome at discharge was 19.3%, 23.5%, 26.8%, and 39.8% (P = 0.001) for each blood pressure subgroup. For patients with intracranial large artery occlusion, the rates were 17.6%, 22.1%, 29.5%, and 49.8%, respectively (P blood pressure subgroup and 11.6%, 21.5%, 23.9%, 35.1% (P risk of poor outcome at discharge and 12-month follow-up. © 2015 The Authors. CNS Neuroscience & Therapeutics Published by John Wiley & Sons Ltd.

  16. Effect of American College of Surgeons Trauma Center Designation on Outcomes: Measurable Benefit at the Extremes of Age and Injury.

    Science.gov (United States)

    Grossman, Michael D; Yelon, Jay A; Szydiak, Lisa

    2017-08-01

    American College of Surgeons (ACS) verification is believed to provide benefits for trauma patients, but is associated with direct costs. We performed a 1-year retrospective review of the National Trauma Data Bank (NTDB) for 2012. Patients were separated into 3 age groups; Pediatric (PEDS), 0 to 14 years; adult, 15 to 65 years; and elderly (ELD), older than 65 years. We analyzed 2 injury severity cohorts, Injury Severity Score (ISS) 9 to 74 (ALL) and ISS 25 to 74 (MAJ). Multiple logistic regression to determine significance of ACS verification on mortality and major complications, controlling for age, ISS, shock, Glasgow Coma Scale, sex, age, comorbidities, and mechanism. Patients were excluded with an ISS <8 or equal to 75, dead on arrival, emergency department transfers, and burns. There were 392,997 patients: 262,644 in ACS centers and 130,353 in non-ACS centers. Distribution was: PEDS 3.8%, adults 64.5%, ELD 31.7%. For ALL adults, no differences were observed for primary outcome in ACS vs non-ACS centers (p = 0.128 and 0.061, for mortality and complications, respectively). For ALL PEDS and ELD, complications were more likely in non-ACS centers: (p = 0.003, odds ratio [OR] 2.61 [95% CI 1.36 to 5.0], and p < 0.0001, OR 3.17 [95% CI 2.21 to 4.56]). For MAJ trauma, death was more likely in adults in ACS vs non-ACS centers (p = 0.013, OR 0.82 [95% CI 0.71 to 0.96]). Complications for MAJ trauma were more likely in all age groups in non-ACS centers (adult: p = 0.028, OR 1.48 [95% CI 1.04 to 2.1]; ELD: p < 0.0001, OR 2.49 [95% CI 1.7 to 3.7]; PEDS: p < 0.0001, OR 4.29 [95% CI 2.13 to 8.69]). Length of stay was increased for all patients with complications (p < 0.0001). Measurable benefits in complications were observed in all age groups with MAJ trauma and in PEDS and ELD for ALL injury severity in ACS vs non-ACS trauma centers. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Excellent Patient Care Processes in Poor Hospitals? Why Hospital-Level and Patient-Level Care Quality-Outcome Relationships Can Differ.

    Science.gov (United States)

    Finney, John W; Humphreys, Keith; Kivlahan, Daniel R; Harris, Alex H S

    2016-04-01

    Studies finding weak or nonexistent relationships between hospital performance on providing recommended care and hospital-level clinical outcomes raise questions about the value and validity of process of care performance measures. Such findings may cause clinicians to question the effectiveness of the care process presumably captured by the performance measure. However, one cannot infer from hospital-level results whether patients who received the specified care had comparable, worse or superior outcomes relative to patients not receiving that care. To make such an inference has been labeled the "ecological fallacy," an error that is well known among epidemiologists and sociologists, but less so among health care researchers and policy makers. We discuss such inappropriate inferences in the health care performance measurement field and illustrate how and why process measure-outcome relationships can differ at the patient and hospital levels. We also offer recommendations for appropriate multilevel analyses to evaluate process measure-outcome relationships at the patient and hospital levels and for a more effective role for performance measure bodies and research funding organizations in encouraging such multilevel analyses.

  18. Investigation of isoniazid and ethionamide cross-resistance by whole genome sequencing and association with poor treatment outcomes of multidrug-resistant tuberculosis patients in South Africa

    Directory of Open Access Journals (Sweden)

    L Malinga

    2016-01-01

    Conclusion: Baseline ETH molecular resistance before second-line treatment is a concern. Unfavorable treatment outcomes of patients with ethA, ethR, and inhA mutations highlight the importance of genotypic testing before initiation of treatment containing ETH. The clinical significance of whole genome analysis for early detection of mutations predictive of treatment failure needs further investigation.

  19. Poor nutritional status is associated with other geriatric domain impairments and adverse postoperative outcomes in onco-geriatric surgical patients - A multicentre cohort study

    NARCIS (Netherlands)

    Huisman, M G; Veronese, G; Audisio, R A; Ugolini, G; Montroni, I; de Bock, G H; van Leeuwen, B L

    BACKGROUND: Nutritional status (NS), though frequently affected in onco-geriatric patients, is no standard part of a geriatric assessment. The aim of this study was to analyse the association between a preoperatively impaired NS and geriatric domain impairments and adverse postoperative outcomes in

  20. Poor pregnancy outcome in women with type 1 diabetes is predicted by elevated HbA1c and spikes of high glucose values in the third trimester

    DEFF Research Database (Denmark)

    Damm, Peter; Mersebach, Henriette; Råstam, Jacob

    2014-01-01

    late-pregnancy outcomes included: composite endpoint including pre-eclampsia, preterm delivery and perinatal death (n=78); preterm delivery (n=63); and excessive fetal growth (n=88). RESULTS: 18 patients experienced a malformed/lost fetus in early pregnancy - none preceded by severe hypoglycaemia...

  1. Cognitive-Behavioral Therapy for Obsessive–Compulsive Disorder with and without Autism Spectrum Disorder: Gray Matter Differences Associated with Poor Outcome

    Science.gov (United States)

    Tsuchiyagaito, Aki; Hirano, Yoshiyuki; Asano, Kenichi; Oshima, Fumiyo; Nagaoka, Sawako; Takebayashi, Yoshitake; Matsumoto, Koji; Masuda, Yoshitada; Iyo, Masaomi; Shimizu, Eiji; Nakagawa, Akiko

    2017-01-01

    Cognitive behavioral therapy (CBT) is an effective treatment for obsessive–compulsive disorder (OCD) and is also applicable to patients with both OCD and autism spectrum disorder (ASD). However, previous studies have reported that CBT for patients with both OCD and ASD might be less effective than for patients with OCD alone. In addition, there is no evidence as to why autistic traits might be risk factors. Therefore, we investigated whether comorbidity between ASD and OCD may significantly affect treatment outcome and discovered predictors of CBT outcomes using structural magnetic resonance imaging (MRI) data. A total of 39 patients, who were diagnosed with OCD, were enrolled in this study. Of these, except for 2 dropout cases, 15 patients were diagnosed with ASD, and 22 patients were diagnosed with OCD without ASD. Both groups took CBT for 11–20 sessions. First, to examine the effectiveness of CBT for OCD patients with and without ASD, we compared CBT outcomes between the two groups. Second, to investigate how the structural abnormality profile of the brain at pretreatment influenced CBT outcomes, we performed a structural MRI comparison focusing on the gray matter volume of the whole brain in both patients with only OCD, and those with both OCD and ASD. In order to discover neurostructural predictors of CBT outcomes besides autistic traits, we divided our samples again into two groups of those who did and those who did not remit after CBT, and repeated the analysis taking autistic traits into account. The results showed that OCD patients with ASD responded significantly less well to CBT. The OCD patients with ASD had much less gray matter volume in the left occipital lobe than OCD patients without ASD. The non-remission group had a significantly smaller volume of gray matter in the left dorsolateral prefrontal cortex (DLPFC) compared with the remission group, after having partialed out autistic traits. These results indicate that the abnormalities in DLPFC

  2. Outcome of conservative treatment and subsequent assisted reproductive technology for patients with early-stage endometrial adenocarcinoma and poor fertility potential

    Institute of Scientific and Technical Information of China (English)

    TONG Xiao-mei; ZHU Hai-yan; LIN Xiao-na; JIANG Ling-ying; XU Wei-hai; LIU Liu; ZHANG Song-ying

    2012-01-01

    Conservative treatment with high doses of progestin is an alternative to standard hysterectomy for young patients with early-stage endometrial adenocarcinoma who desire to preserve their fertility.Here we report a patient with well-differentiated early-stage endometrial adenocarcinoma and poor fertility potential who failed to become pregnant in two in vitro fertilization-embryo transfer cycles and suffered a relapse after conservative treatment.This case illustrates that assessment of fertility potential is critical at the time of initial evaluation and conservative treatment planning for patients with endometrial adenocarcinoma.Chin Med J 2012; 125(19):3578-3580

  3. Reverse Mismatch Pattern in Cardiac 18F-FDG Viability PET/CT Is Not Associated With Poor Outcome of Revascularization

    DEFF Research Database (Denmark)

    Hansen, Allan Kjeldsen; Gejl, Michael; Bouchelouche, Kirsten;

    2016-01-01

    myocardium; however, only in 12 of 91 patients was the RM considered significant (percentage RM in the left ventricle, 42.5 ± 12.9 [reverse patients] vs 14.1 ± 8.6 [scar and hibernation patients]; P ... is common among HF patients (~15%) and is inversely correlated to insulin sensitivity. It is not, however, associated with increased cardiac morbidity and mortality and does not predict a worse outcome after revascularization....

  4. A systematic review of functional outcome and quality of life following reconstruction of maxillofacial defects using vascularized free fibula flaps and dental rehabilitation reveals poor data quality.

    Science.gov (United States)

    Wijbenga, Johan G; Schepers, Rutger H; Werker, Paul M N; Witjes, Max J H; Dijkstra, Pieter U

    2016-08-01

    Reconstruction and oral rehabilitation of segmental maxillofacial defects resulting from ablative surgery is commonly achieved by osteocutaneous vascularized free fibula (VFFF) transplantation combined with implant-supported dental prostheses. We systematically reviewed the literature regarding impact of oral rehabilitation with or without dental implants on functional outcome and quality of life (Qol) following reconstruction of such segmental maxillofacial defects with VFFF. This systematic review was performed according to the PRISMA guidelines. A literature search was conducted using the databases of Cochrane, MEDLINE and EMBASE. Relevant search terms for maxilla or mandible, reconstruction with VFFF, and oral rehabilitation were used. Two reviewers independently assessed the publications using eligibility and research quality criteria (MINORS). In total, 554 unique publications were found. After scrutinization, 2 prospective studies and 8 retrospective case-series without comparison were left for ultimate analysis. Quality ranged from 44% to 88% of the maximum score. Overall survival rate of the VFFF was 99% and the survival rate of dental implants was 95%. Speech intelligibility and overall aesthetic outcome were 'good' to 'excellent'. No statistically significant changes in QoL were found. Methods to measure functional outcome varied strongly, making pooling impossible. Oral rehabilitation with implant-supported dental prostheses after reconstruction of segmental maxillofacial defects with VFFF results in good to excellent speech intelligibility and aesthetics. Results are probably positively biased by the retrospective nature of the studies. In future prospective research, functional outcome measures should be addressed using standardized questionnaires and validated objective tests with adequate follow-up. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. Poor People's Income to Be Increased

    Institute of Scientific and Technical Information of China (English)

    Wen Duoduo

    2005-01-01

    @@ During the period of the 11 th FiveYear Program, Chinese govern ment will be inclined to take policies to realize a balanced economic growth, equalized opportunities and social justice so as to avoid that the poor people become extremely poor and the gap between poor and wealthy become larger, according to the analysts.

  6. Poor People's Income to Be Increased

    Institute of Scientific and Technical Information of China (English)

    Wen; Duoduo

    2005-01-01

      During the period of the 11 th FiveYear Program, Chinese govern ment will be inclined to take policies to realize a balanced economic growth, equalized opportunities and social justice so as to avoid that the poor people become extremely poor and the gap between poor and wealthy become larger, according to the analysts.……

  7. Strengthening health human resources and improving clinical outcomes through an integrated guideline and educational outreach in resource-poor settings: a cluster-randomized trial

    Directory of Open Access Journals (Sweden)

    Burciul Barry

    2010-12-01

    Full Text Available Abstract Background In low-income countries, only about a third of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS patients eligible for anti-retroviral treatment currently receive it. Providing decentralized treatment close to where patients live is crucial to a faster scale up, however, a key obstacle is limited health system capacity due to a shortage of trained health-care workers and challenges of integrating HIV/AIDS care with other primary care services (e.g. tuberculosis, malaria, respiratory conditions. This study will test an adapted primary care health care worker training and guideline intervention, Practical Approach to Lung Health and HIV/AIDS Malawi (PALM PLUS, on staff retention and satisfaction, and quality of patient care. Methods/Design A cluster-randomized trial design is being used to compare usual care with a standardized clinical guideline and training intervention, PALM PLUS. The intervention targets middle-cadre health care workers (nurses, clinical officers, medical assistants in 30 rural primary care health centres in a single district in Malawi. PALM PLUS is an integrated, symptom-based and user-friendly guideline consistent with Malawian national treatment protocols. Training is standardized and based on an educational outreach approach. Trainers will be front-line peer healthcare workers trained to provide outreach training and support to their fellow front-line healthcare workers during focused (1-2 hours, intermittent, interactive sessions on-site in health centers. Primary outcomes are health care worker retention and satisfaction. Secondary outcomes are clinical outcomes measured at the health centre level for HIV/AIDS, tuberculosis, prevention-of-mother-to-child-transmission of HIV and other primary care conditions. Effect sizes and 95% confidence intervals for outcomes will be presented. Assessment of outcomes will occur at 1 year post- implementation. Discussion The PALM PLUS trial

  8. Predictors of poor outcomes after significant chest trauma in multiply injured patients: a retrospective analysis from the German Trauma Registry (Trauma Register DGU®)

    Science.gov (United States)

    2014-01-01

    Background Blunt thoracic trauma is one of the critical injury mechanisms in multiply injured trauma victims. Although these patients present a plethora of potential structural damages to vital organs, it remains debated which injuries actually influence outcome and thereby should be addressed initially. Hence, the aim of this study was to identify the influence of critical structural damages on mortality. Methods All patients in the database of the TraumaRegister DGU® (TR-DGU) from 2002–2011 with AIS Chest ≥ 2, blunt trauma, age of 16 or older and an ISS ≥ 16 were analyzed. Outcome parameters were in-hospital mortality as well as ventilation time in patients surviving the initial 14 days after trauma. Results 22613 Patients were included (mean ISS 30.5 ± 12.6; 74.7% male; Mean Age 46.1 ± 197 years; mortality 17.5%; mean duration of ventilation 7.3 ± 11.5; mean ICU stay 11.7 ± 14.1 days). Only a limited number of specific injuries had a significant impact on survival. Major thoracic vessel injuries (AIS ≥5), bilateral lung contusion, bilateral flail chest, structural heart injury (AIS ≥3) significantly influence mortality in study patients. Several extrathoracic factors (age, blood transfusion, systolic blood pressure and extrathoracic severe injuries) were also predictive of increased mortality. Most injuries of the thoracic wall had no or only a moderate effect on the duration of ventilation. Injuries to the lung (laceration, contusion or pneumothoraces) had a moderate prolonging effect. Cardiac injuries and severe injuries to the thoracic vessels induced a substantially prolonged ventilation interval. Conclusions We demonstrate quantitatively the influence of specific structural damages of the chest on critical outcome parameters. While most injuries of the chest wall have no or only limited impact in the study collective, injuries to the lung overall show adverse outcome. Injuries to the heart or thoracic vessels have a

  9. V-akt murine thymoma viral oncogene homolog 3 (AKT3) contributes to poor disease outcome in humans and mice with pneumococcal meningitis.

    Science.gov (United States)

    Valls Serón, Mercedes; Ferwerda, Bart; Engelen-Lee, JooYeon; Geldhoff, Madelijn; Jaspers, Valery; Zwinderman, Aeilko H; Tanck, Michael W; Baas, Frank; van der Ende, Arie; Brouwer, Matthijs C; van de Beek, Diederik

    2016-05-18

    Pneumococcal meningitis is the most common and severe form of bacterial meningitis. Fatality rates are substantial, and long-term sequelae develop in about half of survivors. Here, we have performed a prospective nationwide genetic association study using the Human Exome BeadChip and identified gene variants in encoding dynactin 4 (DCTN4), retinoic acid early transcript 1E (RAET1E), and V-akt murine thymoma viral oncogene homolog 3 (AKT3) to be associated with unfavourable outcome in patients with pneumococcal meningitis. No clinical replication cohort is available, so we validated the role of one of these targets, AKT3, in a pneumococcal meningitis mouse model. Akt3 deficient mice had worse survival and increased histopathology scores for parenchymal damage (infiltration) and vascular infiltration (large meningeal artery inflammation) but similar bacterial loads, cytokine responses, compared to wild-type mice. We found no differences in cerebrospinal fluid cytokine levels between patients with risk or non-risk alleles. Patients with the risk genotype (rs10157763, AA) presented with low scores on the Glasgow Coma Scale and high rate of epileptic seizures. Thus, our results show that AKT3 influences outcome of pneumococcal meningitis.

  10. Sex differences in utilization and outcomes of catheter-directed thrombolysis in patients with proximal lower extremity deep venous thrombosis - Insights from the Nationwide Inpatient Sample.

    Science.gov (United States)

    Lakhter, Vladimir; Zack, Chad J; Brailovsky, Yevgeniy; Chatterjee, Saurav; Aggarwal, Vikas; Rao, Koneti A; Crabbe, Deborah; Zhao, Huaqing; Choi, Eric; Kolluri, Raghu; Bashir, Riyaz

    2017-04-01

    Catheter-directed thrombolysis (CDT) is being increasingly used for the treatment of proximal lower extremity (LE) deep venous thrombosis (DVT). However, sex differences in utilization and safety outcomes of CDT in these patients are unknown. The Nationwide Inpatient Sample (NIS) database was used to identify all patients with a principal discharge diagnosis of proximal LE or caval DVT who underwent CDT between January 2005 and December 2011 in the United States. We evaluated the comparative safety outcomes of CDT among a propensity-matched group of 1731 men versus 1731 women. Among 108,243 patients with proximal LE or caval DVT, 4826 patients (4.5%) underwent CDT. Overall, women underwent CDT less often compared to men (4.1% vs 4.9%, p<0.01, respectively). The rates of CDT increased between 2005 and 2011 for both women (2.1% to 5.9%, p<0.01) and men (2.5% to 7.5%, p<0.01). There was no significant difference in in-hospital mortality (1.2% vs 1.3%, p=0.76). Women were noted to have higher rates of blood transfusions (11.7% vs 8.8%, p<0.01), but lower rates of intracranial hemorrhage (0.5% vs 1.2%, p=0.03) and gastrointestinal bleeding (0.9% vs 2.2%, p<0.01) compared with men. Women were more likely to undergo inferior vena cava filter placement (37.0% vs 32.1%, p<0.01). In this large nationwide cohort, women with proximal DVT were less likely to receive CDT compared to men. Although mortality rates were similar, women were noted to have higher blood transfusion rates while men had more episodes of intracranial and gastrointestinal bleeding.

  11. Functional PstI/RsaI polymorphism in CYP2E1 is associated with the development, progression and poor outcome of gastric cancer.

    Directory of Open Access Journals (Sweden)

    Jin Feng

    Full Text Available BACKGROUND: Cytochrome P450 2E1 (CYP2E1, an ethanol-inducible enzyme, has been shown to metabolically activate various carcinogens, which is critical for the development and progression of cancers. It has demonstrated that CYP2E1 polymorphisms alter the transcriptional activity of the gene. However, studies on the association between CYP2E1 polymorphisms (PstI/RsaI or DraI and gastric cancer have reported conflicting results. Thus, the aim of the present study was to investigate whether CYP2E1 polymorphisms is associated with the development and progression of gastric cancer and its prognosis in Chinese patients. METHODS: A case-control study was conducted in which CYP2E1 PstI/RsaI and DraI polymorphisms were analyzed in 510 Chinese patients with gastric cancer and 510 age- and sex- matched healthy controls by PCR-RFLP. Odds ratios were estimated by multivariate logistic regression, and the lifetime was calculated by Kaplan-Meier survival curves. In addition, a meta-analysis was also conducted to verify the findings. RESULTS: For CYP2E1 PstI/RsaI polymorphism, C2C2 homozygotes (OR = 2.15; CI: 1.18-3.94 and C2 carriers (OR = 1.48; CI: 1.13-1.96 were associated with an increased risk of gastric cancer when compared with C1C1 homozygotes. Both C1C2 and C2C2 genotypes were associated with advanced stage, but not the grade of gastric cancer. Moreover, C2C2 genotype was identified as an independent marker of poor overall survival for gastric cancer. However, there was not any significant association between CYP2E1 DraI polymorphism and the risk of gastric cancer. In the meta-analysis, pooled data from 13 studies confirmed that the CYP2E1 PstI/RsaI polymorphism was associated with a significantly increased risk of gastric cancer. CONCLUSION: CYP2E1 PstI/RsaI polymorphism is associated with increased risk of development, progression and poor prognosis of gastric cancer in Chinese patients. Pooled data from 13 studies, mainly in Asian countries, are in

  12. Reactive Oxygen Species Modulator 1 (Romo1) Predicts Poor Outcomes in Advanced Non-small Cell Lung Cancer Patients Treated with Platinum-Based Chemotherapy.

    Science.gov (United States)

    Lee, Seung Hyeun; Choi, Sue In; Lee, Ji Sung; Kim, Chul Hwan; Jung, Won Jai; Lee, Eun Joo; Min, Kyung Hoon; Hur, Gyu Young; Lee, Seung Heon; Lee, Sung Yong; Kim, Je Hyeong; Lee, Sang Yeub; Shin, Chol; Shim, Jae Jeong; Kang, Kyung Ho; In, Kwang Ho

    2017-01-01

    Reactive oxygen species modulator 1 (Romo1) is a key mediator of intracellular reactive oxygen species production. However, examination of the clinical usefulness of Romo1 in cancers has been limited. We evaluated the association of Romo1 expression with clinical outcomes in advanced non-small cell lung cancer (NSCLC) patients treated with platinum-based chemotherapy. Romo1 expression in tumor tissue was examined by immunohistochemistry and evaluated by histological score. Survival analyses were performed according to Romo1 expression and the association between Romo1 expression and clinical parameters was evaluated. A total of 88 tumor specimens were analyzed. Significantly shorter median progression-free survival (PFS) was observed in the high Romo1 group compared with the low Romo1 group (4.5 months vs. 9.8 months, p in advanced NSCLC patients treated with platinum-based chemotherapy. Romo1 could be a potential adverse predictive marker in this setting.

  13. Pain sensitisation and the risk of poor outcome following physiotherapy for patients with moderate to severe knee osteoarthritis: protocol for a prospective cohort study

    Science.gov (United States)

    O'Leary, Helen; Smart, Keith M; Moloney, Niamh A; Blake, Catherine; Doody, Catherine M

    2015-01-01

    Introduction Pain is the dominant symptom of knee osteoarthritis (OA), and recent evidence suggests factors outside of local joint pathology, such as pain sensitisation, can contribute significantly to the pain experience. It is unknown how pain sensitisation influences outcomes from commonly employed interventions such as physiotherapy. The aims of this study are, first, to provide a comprehensive description of the somatosensory characteristics of people with pain associated with knee OA. Second, we will investigate if indicators of pain sensitisation in patients with knee osteoarthritis are predictive of non-response to physiotherapy. Methods and analysis This is a multicentre prospective cohort study with 140 participants. Eligible patients with moderate to severe symptomatic knee osteoarthritis will be identified at outpatient orthopaedic and rheumatology clinics. A baseline assessment will provide a comprehensive description of the somatosensory characteristics of each participant by means of clinical examination, quantitative sensory testing, and validated questionnaires measuring pain and functional capacity. Participants will then undergo physiotherapy treatment. The primary outcome will be non-response to physiotherapy on completion of the physiotherapy treatment programme as defined by the Osteoarthritis Research Society International treatment responder criteria. A principal component analysis will identify measures related to pain sensitisation to include in the predictive model. Regression analyses will explore the relationship between responder status and pain sensitisation while accounting for confounders. Ethics and dissemination This study has been approved by St James’ Hospital/AMNCH Research Ethics Committee and by the St Vincent's Healthcare Group Ethics and Medical Research Committee. The results will be presented at international conferences and published in a peer review journal. Trial registration number NCT02310945. PMID:26059523

  14. Differential regulation of HIF-1α and HIF-2α in neuroblastoma: Estrogen-related receptor alpha (ERRα) regulates HIF2A transcription and correlates to poor outcome.

    Science.gov (United States)

    Hamidian, Arash; von Stedingk, Kristoffer; Munksgaard Thorén, Matilda; Mohlin, Sofie; Påhlman, Sven

    2015-06-01

    Hypoxia-inducible factors (HIFs) are differentially regulated in tumor cells. While the current paradigm supports post-translational regulation of the HIF-α subunits, we recently showed that hypoxic HIF-2α is also transcriptionally regulated via insulin-like growth factor (IGF)-II in the childhood tumor neuroblastoma. Here, we demonstrate that transcriptional regulation of HIF-2α seems to be restricted to neural cell-derived tumors, while HIF-1α is canonically regulated at the post-translational level uniformly across different tumor forms. Enhanced expression of HIF2A mRNA at hypoxia is due to de novo transcription rather than increased mRNA stability, and chemical stabilization of the HIF-α proteins at oxygen-rich conditions unexpectedly leads to increased HIF2A transcription. The enhanced HIF2A levels do not seem to be dependent on active HIF-1. Using a transcriptome array approach, we identified members of the Peroxisome proliferator-activated receptor gamma coactivator (PGC)/Estrogen-related receptor (ERR) complex families as potential regulators of HIF2A. Knockdown or inhibition of one of the members, ERRα, leads to decreased expression of HIF2A, and high expression of the ERRα gene ESRRA correlates with poor overall and progression-free survival in a clinical neuroblastoma material consisting of 88 tumors. Thus, targeting of ERRα and pathways regulating transcriptional HIF-2α are promising therapeutic avenues in neuroblastoma.

  15. High ERCC1 expression predicts cisplatin-based chemotherapy resistance and poor outcome in unresectable squamous cell carcinoma of head and neck in a betel-chewing area

    Directory of Open Access Journals (Sweden)

    Chien Chih-Yen

    2011-03-01

    Full Text Available Abstract Background This study was to evaluate the effect of excision repair cross-complementation group 1(ERCC1 expression on response to cisplatin-based induction chemotherapy (IC followed by concurrent chemoradiation (CCRT in locally advanced unresectable head and neck squamous cell carcinoma (HNSCC patients. Methods Fifty-seven patients with locally advanced unresectable HNSCC who received cisplatin-based IC followed by CCRT from January 1, 2006 through January 1, 2008. Eligibility criteria included presence of biopsy-proven HNSCC without a prior history of chemotherapy or radiotherapy. Immunohistochemistry was used to assess ERCC1 expression in pretreatment biopsy specimens from paraffin blocks. Clinical parameters, including smoking, alcohol consumption and betel nuts chewing, were obtained from the medical records. Results The 12-month progression-free survival (PFS and 2-year overall survival (OS rates of fifty-seven patients were 61.1% and 61.0%, respectively. Among these patients, thirty-one patients had low ERCC1 expression and forty-one patients responded to IC followed by CCRT. Univariate analyses showed that patients with low expression of ERCC1 had a significantly higher 12-month PFS rates (73.3% vs. 42.3%, p Conclusions Our study suggest that a high expression of ERCC1 predict a poor response and survival to cisplatin-based IC followed by CCRT in patients with locally advanced unresectable HNSCC in betel nut chewing area.

  16. Overview of extremity arterial trauma in Jordan.

    Science.gov (United States)

    Heis, H A; Bani-Hani, K E; Elheis, M A

    2008-12-01

    The objectives of this study were to review etiologies of trauma, associated injuries, diagnosis, management, and outcomes of patients with vascular injuries in the extremities and relate factors in their treatment to the outcome of the injured extremity. Data were collected retrospectively on 73 patients diagnosed to have upper and lower limbs arterial injuries at King Abdullah University Hospital, Jordan, between 2001 and 2006. Factors evaluated included demographic data, location of vessels injured, mechanism of injury, associated injuries, treatment, and outcome. Patients were predominantly males (54 patients). Isolated vascular trauma was present in 36 patients, while in the remaining 37 patients vascular trauma was aggravated by concomitant injuries. The most common etiology of vascular injuries in the upper and lower extremities was a penetrating injury found in 38 patients (52%). The vessels most commonly involved were the femoral and brachial arteries. Various associated injuries were identified mainly orthopedic in 21 patients (29%) and nerve injuries in 18 patients (25%). Autogenous vein graft interposition was mostly performed in 32 patients (44%). Permanent disability was seen in 8 patients (11%), limb amputation was performed in 5 patients (7%). Five patients died due to associated intraabdominal, thoracic, and head injuries giving a mortality rate of 7%. Delay in surgery, blunt trauma and extensive soft tissue defect in combined orthopedic and vascular injuries were associated with increased risk of amputation, while associated nerve injuries and bone injuries with extensive soft tissue damage are risk factors of poor quality outcome.

  17. PREDICTION OF FETAL DISTRESS AND POOR OUTCOME OF PREGNANCY BEYOND 40 WEEKS USING DOPPLER ULTRASOUND COMPARED WITH FETAL HEART RATE MONITORING WITH NST

    Directory of Open Access Journals (Sweden)

    Supriya

    2015-06-01

    Full Text Available OBJECTIVES: Postdate pregnancy is the most common indication for Antepartum . F etal heart rate testing because of its increased perinatal morbidity and perinatal mortality. Complications are stillbirth , meconium aspiration , asphyxia , and the dysmaturity syndrome , is increased in post - term pregnancies. The most recent ACOG review of the subject of "post - term" pregnancy cites estimates of 3 - 14 % of all pregna n cies . MATERIALS AND METHODS: 55 patients with pregnancy beyond 40 weeks attending antenatal out - patient department of the Rajiv Gandhi medical college in the period between October 2014 to March 2015 were included. In present study , patients were monitored with twice weekly NST and once a week Doppler. In those with either NST nonreactive or Doppler abnormal , induction was done. Cases with normal results were monitored till 42 weeks when routine induction was done . RESULTS: A reactive non stress test in prolonged pregnancy has good negative predictive value – i.e. adverse outcomes are unlikely to occur in the setting of a reactive non - stress test – but that the positive predictive values are low . W eekly measurement of Doppler waveforms from umbilical artery (PI p=0.02 for Apgar <7 at 5 min , p=0.02 NICU admissions , p=0.003 for meconium staining of amniotic fluid and S/d ratio p=0.02 for Apgar <7 at 5 min , p=0.04 for NICU admission and biweekly NST(p=0.005 for Apgar <7 at 5 min , p=0.0219 for NICU admission , p=0.0039 for meconium staining of amniotic fluid appears to be reliable method of establishing fetal health in pregnancy beyond 40 weeks. CONCLUSION: The most sensitive tests to assess the risks to the fetus of prolonged pregnancy app ear to be combinations of fetal heart rate monitoring with NST combined with umbilical PI and S/D ratio. Reactive NST is reassuring and indicates fetal wellbeing, but non - reactive NST alone cannot be taken as an indicator of fetal jeopardy. Although individual randomized trials

  18. Loss of secreted frizzled-related protein 4 correlates with an aggressive phenotype and predicts poor outcome in ovarian cancer patients.

    Directory of Open Access Journals (Sweden)

    Francis Jacob

    Full Text Available BACKGROUND: Activation of the Wnt signaling pathway is implicated in aberrant cellular proliferation in various cancers. In 40% of endometrioid ovarian cancers, constitutive activation of the pathway is due to oncogenic mutations in β-catenin or other inactivating mutations in key negative regulators. Secreted frizzled-related protein 4 (SFRP4 has been proposed to have inhibitory activity through binding and sequestering Wnt ligands. METHODOLOGY/PRINCIPAL FINDINGS: We performed RT-qPCR and Western-blotting in primary cultures and ovarian cell lines for SFRP4 and its key downstream regulators activated β-catenin, β-catenin and GSK3β. SFRP4 was then examined by immunohistochemistry in a cohort of 721 patients and due to its proposed secretory function, in plasma, presenting the first ELISA for SFRP4. SFRP4 was most highly expressed in tubal epithelium and decreased with malignant transformation, both on RNA and on protein level, where it was even more profound in the membrane fraction (p<0.0001. SFRP4 was expressed on the protein level in all histotypes of ovarian cancer but was decreased from borderline tumors to cancers and with loss of cellular differentiation. Loss of membrane expression was an independent predictor of poor survival in ovarian cancer patients (p = 0.02 unadjusted; p = 0.089 adjusted, which increased the risk of a patient to die from this disease by the factor 1.8. CONCLUSIONS/SIGNIFICANCE: Our results support a role for SFRP4 as a tumor suppressor gene in ovarian cancers via inhibition of the Wnt signaling pathway. This has not only predictive implications but could also facilitate a therapeutic role using epigenetic targets.

  19. Loss of Secreted Frizzled-Related Protein 4 Correlates with an Aggressive Phenotype and Predicts Poor Outcome in Ovarian Cancer Patients

    Science.gov (United States)

    Nixdorf, Sheri; Ford, Caroline E.; Olivier, Jake; Caduff, Rosmarie; Scurry, James P.; Guertler, Rea; Hornung, Daniela; Mueller, Renato; Fink, Daniel A.; Hacker, Neville F.; Heinzelmann-Schwarz, Viola A.

    2012-01-01

    Background Activation of the Wnt signaling pathway is implicated in aberrant cellular proliferation in various cancers. In 40% of endometrioid ovarian cancers, constitutive activation of the pathway is due to oncogenic mutations in β-catenin or other inactivating mutations in key negative regulators. Secreted frizzled-related protein 4 (SFRP4) has been proposed to have inhibitory activity through binding and sequestering Wnt ligands. Methodology/Principal Findings We performed RT-qPCR and Western-blotting in primary cultures and ovarian cell lines for SFRP4 and its key downstream regulators activated β-catenin, β-catenin and GSK3β. SFRP4 was then examined by immunohistochemistry in a cohort of 721 patients and due to its proposed secretory function, in plasma, presenting the first ELISA for SFRP4. SFRP4 was most highly expressed in tubal epithelium and decreased with malignant transformation, both on RNA and on protein level, where it was even more profound in the membrane fraction (p<0.0001). SFRP4 was expressed on the protein level in all histotypes of ovarian cancer but was decreased from borderline tumors to cancers and with loss of cellular differentiation. Loss of membrane expression was an independent predictor of poor survival in ovarian cancer patients (p = 0.02 unadjusted; p = 0.089 adjusted), which increased the risk of a patient to die from this disease by the factor 1.8. Conclusions/Significance Our results support a role for SFRP4 as a tumor suppressor gene in ovarian cancers via inhibition of the Wnt signaling pathway. This has not only predictive implications but could also facilitate a therapeutic role using epigenetic targets. PMID:22363760

  20. Pre-treatment double- or triple-positive tumor markers are predictive of a poor outcome for patients undergoing radiofrequency ablation for hepatocellular carcinoma.

    Science.gov (United States)

    Nitta, Hidetoshi; Nakagawa, Shigeki; Kaida, Takayoshi; Arima, Kota; Higashi, Takaaki; Taki, Katsunobu; Okabe, Hirohisa; Hayashi, Hiromitsu; Hashimoto, Daisuke; Chikamoto, Akira; Ishiko, Takatoshi; Beppu, Toru; Baba, Hideo

    2017-03-01

    We evaluated the therapeutic effect of radiofrequency ablation (RFA) on hepatocellular carcinoma (HCC) according to the number of positive tumor markers. The subjects of this study were 160 patients who underwent percutaneous and surgical RFA for HCC. Patients were divided into negative (n = 51), single- (n = 69), double- (n = 31), and triple-positive (n = 9) tumor marker groups according to the pre-treatment expression of these markers. We looked for any relationships among clinical parameters, outcomes, and tumor markers. The 3-year recurrence-free and overall survival rates of the negative, single-, double-, and triple-positive groups were 30, 19, 16, and 11 % (P = 0.02), and 94, 88, 67, and 37 % (P tumor marker profile was independently associated with local recurrence [hazard ratio (HR) 5.48, 95 % confidence interval (CI) 2.44-12.33, P tumor markers.

  1. CD63 and GLUT-1 Overexpression Could Predict a Poor Clinical Outcome in GIST: A Study of 54 Cases with Follow-Up.

    Science.gov (United States)

    Lewitowicz, Piotr; Matykiewicz, Jarosław; Koziel, Dorota; Chrapek, Magdalena; Horecka-Lewitowicz, Agata; Gluszek, Stanislaw

    2016-01-01

    Background and Goals. In light of current knowledge, it seems that alternations underlying GISTs are well explained, although all that is enhanced by various aspects on a daily basis. More recently, attention has been pointed towards exosomes as important particles able to modify healthy and also diseased tissues including cancer. The goal of the present study was an analysis of CD9, CD63, and GLUT-1 as a marker of hypoxia status within 54 cases of GIST and evaluation of their predictive value. Methods. 54 cases of patients suffering from GIST were enrolled into the study, predominantly in the gastric location. All operated cases had no Imatinib and other chemotherapies up to the day of operation. Expression of targeted proteins was performed by immunohistochemistry and, after that, the results with tabulated clinical data were compared by Kaplan-Meier method and multivariate Cox proportional hazard model of statistical analysis. Results. Our results presented a marked dependence of worsening clinical outcome with high expression CD63 (p = 0.008) as well as with GLUT-1 (p = 0.014). We noted a strict correlation of GLUT-1 expression with CD63 expression (p = 0.03), which could confirm the thesis about the contribution of exosomes in intratumoural hypoxia status. The collected material did not confirm CD9 contribution. Conclusions. As presented here, CD63 and GLUT-1 have a prognostic value in GIST cases. The results confirm the other studies in this scope and can be used in future as an additional prognostic factor.

  2. Poor adjustment to college life mediates the relationship between drinking motives and alcohol consequences: a look at college adjustment, drinking motives, and drinking outcomes.

    Science.gov (United States)

    LaBrie, Joseph W; Ehret, Phillip J; Hummer, Justin F; Prenovost, Katherine

    2012-04-01

    The current study examined whether the relationship between drinking motives and alcohol-related outcomes was mediated by college adjustment. Participants (N=253) completed an online survey that assessed drinking motives, degree of both positive and negative college adjustment, typical weekly drinking, and past month negative alcohol-related consequences. Structural equation modeling examined negative alcohol consequences as a function of college adjustment, drinking motives, and weekly drinking behavior in college students. Negative college adjustment mediated the relationship between coping drinking motives and drinking consequences. Positive college adjustment was not related to alcohol consumption or consequences. Positive reinforcement drinking motives (i.e. social and enhancement) not only directly predicted consequences, but were partially mediated by weekly drinking and degree of negative college adjustment. Gender specific models revealed that males exhibited more variability in drinking and their positive reinforcement drinking motives were more strongly associated with weekly drinking. Uniquely for females, coping motives were directly and indirectly (via negative adjustment) related to consequences. These findings suggest that interventions which seek to decrease alcohol-related risk may wish to incorporate discussions about strategies for decreasing stress and increasing other factors associated with better college adjustment.

  3. Efficacy of Preoperative Color Doppler Sonography of Lower Extremity Veins on Postoperative Outcomes in Candidates of Saphenectomy: A Randomized Clinical Trial

    Science.gov (United States)

    Zarepur, Rouhollah; Kargar, Saeed; Hadadzadeh, Mehdi; Hatamizadeh, Nooshin; Zarepur, Ehsan; Forouzannia, Seyed Khalil; Faraji, Reza; Sarebanhassanabadi, Mohammadtaghi

    2016-01-01

    Background Doppler sonography is a type of sonography used for imaging the blood flow in the vessels and heart. This technique uses ultrasound waves with high frequency. In some patient candidates for venous graft, the identification of the suitable vein is not possible with clinical examination. Objective This study compared the effects of preoperative color Doppler sonography of lower extremity veins on the postoperative outcomes of saphenectomy. Methods This randomized clinical trial was conducted on 100 candidates of an off-pump coronary artery bypass graft (CABG) hospitalized in Afshar Hospital in Yazd in 2015. Patients were divided into two groups: 50 patients in the study group and 50 patients in the control group. Patients in the study group underwent color Doppler sonography of lower extremity veins using the Medison 8000 Live device. Patients in the control group were assessed preoperatively by routine venous examination without undergoing color Doppler sonography. The prepping and draping methods and also the preoperative antibiotics were the same for both groups. The patients were assessed for wound infection, edema, hematoma, and DVT 2 days, 1 week, and 1 month after surgery. Data were analyzed by SPSS version 16 using t-test, Chi-square, and Fisher’s exact test. Results The length of incision for saphenectomy was 29.20 ± 3.71 cm in the Doppler group and 28.98 ± 3.72 cm in the non-Doppler group with no significant difference between the two groups (p=0.768). The two groups were not significantly different with respect to age, gender, diabetes, hypertension, hyperlipidemia, smoking, and history of peripheral vessels disease, postoperative infection, postoperative organ edema, postoperative hematoma, and postoperative DVT. Conclusion Preoperative color Doppler sonography of the saphenous vein before saphenectomy has no effect on reducing the postoperative complications, and saphenectomy on the basis of intraoperative examination of the vein course by

  4. Inadequate prenatal care utilization and risks of infant mortality and poor birth outcome: a retrospective analysis of 28,729,765 U.S. deliveries over 8 years.

    Science.gov (United States)

    Partridge, Sarah; Balayla, Jacques; Holcroft, Christina A; Abenhaim, Haim A

    2012-11-01

    To evaluate the association between adequacy of prenatal care utilization and risk of fetal and neonatal mortality and adverse outcomes. We conducted a population-based cohort study using the Center for Disease Control and Prevention's Linked Birth-Infant Death and Fetal Death data on all deliveries in the United States between 1995 and 2002. Inclusion criteria were singleton births ≥22 weeks of gestation with no known congenital malformation. Inadequate prenatal care was defined according to the Adequacy of Prenatal Care Utilization Index, and its effect on fetal and neonatal death was estimated using unconditional logistic regression analysis adjusting for maternal age, race, education, and other confounding variables. During our 8-year study period, 32,206,417 births occurred, 28,729,765 (89.2%) of which met inclusion criteria. Inadequate prenatal care utilization occurred in 11.2% of expectant mothers, more commonly among women ≤20 years, black non-Hispanic and Hispanic women, and those without high school education. Relative to adequate care, inadequate care was associated with increased risk of prematurity 3.75 (3.73 to 3.77), stillbirth 1.94 (1.89 to 1.99), early neonatal dearth 2.03 (1.97 to 2.09), late neonatal death 1.67 (1.59 to 1.76), and infant death 1.79 (1.76 to 1.82). Risk of prematurity, stillbirth, early and late neonatal death, and infant death increased linearly with decreasing care. Given the population effect of this association, public health initiatives should target program expansion to ensure timely and adequate access, particularly for women ≤20 years, Black non-Hispanic and Hispanic women, and those without high school education. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  5. CD63 and GLUT-1 Overexpression Could Predict a Poor Clinical Outcome in GIST: A Study of 54 Cases with Follow-Up

    Directory of Open Access Journals (Sweden)

    Piotr Lewitowicz

    2016-01-01

    Full Text Available Background and Goals. In light of current knowledge, it seems that alternations underlying GISTs are well explained, although all that is enhanced by various aspects on a daily basis. More recently, attention has been pointed towards exosomes as important particles able to modify healthy and also diseased tissues including cancer. The goal of the present study was an analysis of CD9, CD63, and GLUT-1 as a marker of hypoxia status within 54 cases of GIST and evaluation of their predictive value. Methods. 54 cases of patients suffering from GIST were enrolled into the study, predominantly in the gastric location. All operated cases had no Imatinib and other chemotherapies up to the day of operation. Expression of targeted proteins was performed by immunohistochemistry and, after that, the results with tabulated clinical data were compared by Kaplan-Meier method and multivariate Cox proportional hazard model of statistical analysis. Results. Our results presented a marked dependence of worsening clinical outcome with high expression CD63 (p=0.008 as well as with GLUT-1 (p=0.014. We noted a strict correlation of GLUT-1 expression with CD63 expression (p=0.03, which could confirm the thesis about the contribution of exosomes in intratumoural hypoxia status. The collected material did not confirm CD9 contribution. Conclusions. As presented here, CD63 and GLUT-1 have a prognostic value in GIST cases. The results confirm the other studies in this scope and can be used in future as an additional prognostic factor.

  6. Decreased CD8+CD28+/CD8+CD28- T cell ratio can sensitively predict poor outcome for patients with complicated Crohn disease.

    Science.gov (United States)

    Dai, Shi-Xue; Gu, Hong-Xiang; Lin, Qian-Yi; Wu, Yan-Kun; Wang, Xiao-Yan; Huang, Shao-Zhuo; Xing, Tiao-Si; Chen, Min-Hua; Zhang, Qing-Fang; Zheng, Zhong-Wen; Sha, Wei-Hong

    2017-06-01

    Crohn disease (CD) with complications such as penetrating, stricturing, and perianal disease is called complicated CD. The aim of this study is to test the efficiency with which the CD8CD28/CD8CD28 cell balance can predict a subsequent active stage in patients with newly diagnosed complicated CD.Seventeen patients with complicated CD and 48 CD patients with no complications were enrolled. Blood CD8 T cells were tested from all of the 65 newly diagnosed CD patients upon enrollment. The potential risk factors were compared between the 2 groups. A 30-week follow-up was performed, and the efficiency of the CD8 cell balance at predicting active CD was analyzed using receiver-operating characteristic curves. The cumulative remission lasting rates (CRLRs) were analyzed using the Kaplan-Meier method.Compared with the control CD group, patients with complicated CD were predominantly male and younger in age; they also had lower body mass indices (BMIs), higher Crohn disease activity indices (CDAIs), higher immunosuppressant and steroid prescription rates, and significantly higher surgical rates. The CD8CD28/CD8CD28 balance was associated with BMI, CDAI, steroids, and surgery. The CD8CD28/CD8CD28 ratios were significantly lower at week 0 and on the 6th, 22nd, and 30th week during follow-up with a shorter lasting time of remission for the complicated CD patients. The CD8CD28/CD8CD28 ratio could accurately predict the active stage for the patients with complicated CD, and the highest sensitivity (89.2%) and specificity (85.3%) were found when the ratio was 1.03. Treatment with steroids and surgery, along with a significantly lower CD8CD28/CD8CD28 ratio and lower CRLRs, was closely related to a worse outcome for the patients with complicated CD.Patients requiring steroids and surgery experience more severe disease activity and thus a disequilibrated immunological balance, which could be the main reason for a decreased CD8CD28/CD8CD28 ratio. This ratio can sensitively predict the

  7. Patients with diffuse large B-cell lymphoma of germinal center origin with BCL2 translocations have poor outcome, irrespective of MYC status: a report from an International DLBCL rituximab-CHOP Consortium Program Study.

    Science.gov (United States)

    Visco, Carlo; Tzankov, Alexander; Xu-Monette, Zijun Y; Miranda, Roberto N; Tai, Yu Chuan; Li, Yan; Liu, Wei-min; d'Amore, Emanuele S G; Li, Yong; Montes-Moreno, Santiago; Dybkær, Karen; Chiu, April; Orazi, Attilio; Zu, Youli; Bhagat, Govind; Wang, Huan-You; Dunphy, Cherie H; His, Eric D; Zhao, X Frank; Choi, William W L; Zhao, Xiaoying; van Krieken, J Han; Huang, Qin; Ai, Weiyun; O'Neill, Stacey; Ponzoni, Maurilio; Ferreri, Andres J M; Kahl, Brad S; Winter, Jane N; Go, Ronald S; Dirnhofer, Stephan; Piris, Miguel A; Møller, Michael B; Wu, Lin; Medeiros, L Jeffrey; Young, Ken H

    2013-02-01

    Diffuse large B-cell lymphoma can be classified by gene expression profiling into germinal center and activated B-cell subtypes with different prognoses after rituximab-CHOP. The importance of previously recognized prognostic markers, such as Bcl-2 protein expression and BCL2 gene abnormalities, has been questioned in the new therapeutic era. We analyzed Bcl-2 protein expression, and BCL2 and MYC gene abnormalities by interphase fluorescence in situ hybridization in 327 patients with de novo disease treated with rituximab-CHOP. Isolated BCL2 and MYC rearrangements were not predictive of outcome in our patients as a whole, but only in those with the germinal center subtype of lymphoma. The prognostic relevance of isolated MYC rearrangements was weaker than that of BCL2 isolated translocations, but was probably limited by the rarity of the rearrangements. Seven of eight patients with double hit lymphoma had the germinal center subtype with poor outcome. The germinal center subtype patients with isolated BCL2 translocations had significantly worse outcome than the patients without BCL2 rearrangements (P=0.0002), and their outcome was similar to that of patients with the activated B-cell subtype (P=0.30), but not as bad as the outcome of patients with double hit lymphoma (Pgerminal center subtype lymphoma, but multivariate analysis showed that this was dependent on BCL2 translocations. The gene expression profiling of patients with BCL2 rearrangements was unique, showing activation of pathways that were silent in the negative counterpart. BCL2 translocated germinal center subtype patients have worse prognosis after rituximab-CHOP, irrespective of MYC status, but the presence of combined gene breaks significantly overcomes the prognostic relevance of isolated lesions.

  8. An array CGH based genomic instability index (G2I is predictive of clinical outcome in breast cancer and reveals a subset of tumors without lymph node involvement but with poor prognosis

    Directory of Open Access Journals (Sweden)

    Bonnet Françoise

    2012-11-01

    Full Text Available Abstract Background Despite entering complete remission after primary treatment, a substantial proportion of patients with early stage breast cancer will develop metastases. Prediction of such an outcome remains challenging despite the clinical use of several prognostic parameters. Several reports indicate that genomic instability, as reflected in specific chromosomal aneuploidies and variations in DNA content, influences clinical outcome but no precise definition of this parameter has yet been clearly established. Methods To explore the prognostic value of genomic alterations present in primary tumors, we performed a comparative genomic hybridization study on BAC arrays with a panel of breast carcinomas from 45 patients with metastatic relapse and 95 others, matched for age and axillary node involvement, without any recurrence after at least 11 years of follow-up. Array-CGH data was used to establish a two-parameter index representative of the global level of aneusomy by chromosomal arm, and of the number of breakpoints throughout the genome. Results Application of appropriate thresholds allowed us to distinguish three classes of tumors highly associated with metastatic relapse. This index used with the same thresholds on a published set of tumors confirms its prognostic significance with a hazard ratio of 3.24 [95CI: 1.76-5.96] p = 6.7x10-5 for the bad prognostic group with respect to the intermediate group. The high prognostic value of this genomic index is related to its ability to individualize a specific group of breast cancers, mainly luminal type and axillary node negative, showing very high genetic instability and poor outcome. Indirect transcriptomic validation was obtained on independent data sets. Conclusion Accurate evaluation of genetic instability in breast cancers by a genomic instability index (G2I helps individualizing specific tumors with previously unexpected very poor prognosis.

  9. Extreme Heat

    Science.gov (United States)

    ... Landslides & Debris Flow Nuclear Blast Nuclear Power Plants Power Outages Pandemic Radiological Dispersion Device Severe Weather Snowstorms & Extreme ... Landslides & Debris Flow Nuclear Blast Nuclear Power Plants Power Outages Pandemic Radiological Dispersion Device Severe Weather Snowstorms & Extreme ...

  10. Impact of Glycoprotein IIb/IIIa Inhibitors Use on Outcomes After Lower Extremity Endovascular Interventions From Nationwide Inpatient Sample (2006-2011).

    Science.gov (United States)

    Echeverria, Angela; Krajcer, Zvonimir

    2016-10-01

    Anticoagulant and antiplatelet medications are necessary in peripheral endovascular intervention, but a standardized approach has not yet been established. Glycoprotein IIb/IIIa inhibitor use in endovascular lower extremity interventions decreased overall amputation rates. Glycoprotein IIb/IIIa inhibitor use in endovascular lower extremity interventions increased postprocedural bleeding and complications requiring intervention.

  11. Long-term outcomes following lower extremity press-fit bone-anchored prosthesis surgery: a 5-year longitudinal study protocol

    NARCIS (Netherlands)

    Leijendekkers, R.A.; Staal, J.B.; Hinte, G. van; Frolke, J.P.M.; Meent, H. van de; Atsma, F.; Nijhuis-Van der Sanden, M.W.G.; Hoogeboom, T.J.

    2016-01-01

    BACKGROUND: Patients with lower extremity amputation frequently suffer from socket-related problems. This seriously limits prosthesis use, level of activity and health-related quality of life (HRQoL). An additional problem in patients with lower extremity amputation are asymmetries in gait kinematic

  12. Mandelbrot's Extremism

    NARCIS (Netherlands)

    Beirlant, J.; Schoutens, W.; Segers, J.J.J.

    2004-01-01

    In the sixties Mandelbrot already showed that extreme price swings are more likely than some of us think or incorporate in our models.A modern toolbox for analyzing such rare events can be found in the field of extreme value theory.At the core of extreme value theory lies the modelling of maxima

  13. DDX3 loss by p53 inactivation promotes tumor malignancy via the MDM2/Slug/E-cadherin pathway and poor patient outcome in non-small-cell lung cancer.

    Science.gov (United States)

    Wu, D-W; Lee, M-C; Wang, J; Chen, C-Y; Cheng, Y-W; Lee, H

    2014-03-20

    P53 inactivation by p53 mutation and E6 oncoprotein has a crucial role in human carcinogenesis. DDX3 has been shown to be a target of p53. In this study, we hypothesized that DDX3 loss by p53 inactivation may promote tumor malignancy and poor patients' outcome. Mechanically, DDX3 loss by p53 knockdown and E6 overexpression was observed in A549 lung cancer cells. Conversely, DDX3 expression was markedly elevated by wild-type (WT) p53 ectopic expression in p53-null H1299 cells, E6-knockdown TL-1 lung cancer and SiHa cervical cancer cells. Interestingly, DDX3 loss promotes soft-agar growth and invasive capability; however, both capabilities were suppressed by DDX3 overexpression. We next expected that DDX3 loss might result in Slug-suppressed E-cadherin expression via decreased MDM2-mediated Slug degradation. As expected, MDM2 transcription is suppressed by DDX3 loss via decreased SP1 binding activity to the MDM2 promoter. Consequently, Slug expression was elevated by the reduction of MDM2 because of DDX3 loss, and E-cadherin expression was suppressed by Slug. Consistent observations in the correlation of DDX3 loss with MDM2, Slug and E-cadherin were seen in lung tumors from lung cancer patients. In addition, patients with low-DDX3 tumors had poorer survival and relapse than patients with high-DDX3 tumors. In conclusion, we suggest that DDX3 loss by p53 inactivation via MDM2/Slug/E-cadherin pathway promotes tumor malignancy and poor patient outcome.

  14. Laparoscopic surgery for colorectal cancer is safe and has survival outcomes similar to those of open surgery in elderly patients with a poor performance status: subanalysis of a large multicenter case-control study in Japan.

    Science.gov (United States)

    Niitsu, Hiroaki; Hinoi, Takao; Kawaguchi, Yasuo; Ohdan, Hideki; Hasegawa, Hirotoshi; Suzuka, Ichio; Fukunaga, Yosuke; Yamaguchi, Takashi; Endo, Shungo; Tagami, Soichi; Idani, Hitoshi; Ichihara, Takao; Watanabe, Kazuteru; Watanabe, Masahiko

    2016-01-01

    It remains controversial whether open or laparoscopic surgery should be indicated for elderly patients with colorectal cancer and a poor performance status. In those patients aged 80 years or older with Eastern Cooperative Oncology Group performance status score of 2 or greater who received elective surgery for stage 0 to stage III colorectal adenocarcinoma and had no concomitant malignancies and who were enrolled in a multicenter case-control study entitled "Retrospective study of laparoscopic colorectal surgery for elderly patients" that was conducted in Japan between 2003 and 2007, background characteristics and short-term and long-term outcomes for open surgery and laparoscopic surgery were compared. Of the 398 patients included, 295 underwent open surgery and 103 underwent laparoscopic surgery. There were no significant differences in the baseline characteristics between open surgery and laparoscopic surgery patients, except for previous abdominal surgery and TNM stage. The median operation duration was shorter with open surgery (open surgery, 153 min; laparoscopic surgery, 202 min; P cancer patients with a poor performance status is safe and not inferior to open surgery in terms of overall survival.

  15. The development and validation of a novel outcome measure to quantify mobility in the dysvascular lower extremity amputee: the amputee single item mobility measure

    Science.gov (United States)

    Norvell, Daniel C; Williams, Rhonda M; Turner, Aaron P; Czerniecki, Joseph M

    2016-01-01

    Objective: This study describes the development and psychometric evaluation of a novel patient-reported single-item mobility measure. Design: Prospective cohort study. Setting: Four Veteran’s Administration Medical Centers. Subjects: Individuals undergoing their first major unilateral lower extremity amputation; 198 met inclusion criteria; of these, 113 (57%) enrolled. Interventions: None. Main measures: The Amputee Single Item Mobility Measure, a single item measure with scores ranging from 0 to 6, was developed by an expert panel, and concurrently administered with the Locomotor Capabilities Index-5 (LCI-5) and other outcome measures at six weeks, four months, and 12 months post-amputation. Criterion and construct validity, responsiveness, and floor/ceiling effects were evaluated. Responsiveness was assessed using the standardized response mean. Results: The overall mean 12-month Amputee Single Item Mobility Measure score was 3.39 ±1.4. Scores for transmetatarsal, transtibial, and transfemoral amputees were 4.2 (±1.3), 3.2 (±1.5), and 2.9 (±1.1), respectively. Amputee Single Item Mobility Measure scores demonstrated “large” and statistically significant correlations with the LCI-5 scores at six weeks (r = 0.72), four months (r = 0.81), and 12 months (r = 0.86). At four months and 12 months, the correlation between Amputee Single Item Mobility Measure scores and hours of prosthetic use were r = 0.69 and r = 0.66, respectively, and between Amputee Single Item Mobility Measure scores and Trinity Amputation and Prosthesis Experience Scales functional restriction scores were r = 0.45 and r = 0.67, respectively. Amputee Single Item Mobility Measure scores increased significantly from six weeks to 12 months post-amputation. Minimal floor/ceiling effects were demonstrated. Conclusions: In the unilateral dysvascular amputee, the Amputee Single Item Mobility Measure has strong criterion and construct validity, excellent

  16. Esthesioneuroblastoma With Poor Outcome Despite Extensive Treatment.

    Science.gov (United States)

    Niyaz, Leyla; Gunduz, Kaan; Meco, Cem; Kankaya, Duygu

    2015-10-01

    Esthesioneuroblastoma is a rare malignant tumor of neuroectodermal origin. It usually presents with nonspecific symptoms, such as nasal obstruction, epistaxis, and pain, but has an aggressive course if the treatment is delayed. The authors report a case of esthesioneuroblastoma in a 47-year-old woman, treated with extensive surgical resection, radiotherapy, and chemotherapy. Despite intensive treatment, the patient developed a local recurrence with systemic metastasis and succumbed 4 months later.

  17. Mildly raised tricuspid regurgitant velocity 2.5-3.0 m/s in pregnant women with sickle cell disease is not associated with poor obstetric outcome - An observational cross-sectional study.

    Science.gov (United States)

    Soh, May C; Sankaran, Srividhya; Chung, Natali Ya; Nelson-Piercy, Catherine; Howard, Jo; Robinson, Sue E; Oteng-Ntim, Eugene

    2016-12-01

    Pulmonary hypertension is associated with 36% mortality in pregnancy, and 6-10% of patients with sickle cell disease have pulmonary hypertension. Tricuspid regurgitant velocity ≥2.5 m/s on echocardiography is a well validated means of screening for pulmonary hypertension in the non-pregnant population. This is a pilot study to determine if this is a useful non-invasive screening test for pulmonary hypertension in pregnancy, and whether raised tricuspid regurgitant velocity ≥2.5 m/s was associated with poor outcomes. This is a cross-sectional study over a five-year period in a tertiary referral centre with a specialised multidisciplinary clinic for pregnant women with sickle cell disease. Women with sickle cell disease, no prior pulmonary hypertension and singleton pregnancies who had echocardiography with a measurable tricuspid regurgitant velocity in pregnancy were included. There were 34 pregnancies, of which eight had tricuspid regurgitant velocity ≥2.5 m/s. There were no significant differences in their characteristics, sickle cell-related complications or medical co-morbidities. The women with tricuspid regurgitant velocity ≥2.5 m/s had similar obstetric and perinatal outcomes as those with a tricuspid regurgitant velocity <2.5 m/s.

  18. DNMT3A R882 Mutation with FLT3-ITD Positivity Is an Extremely Poor Prognostic Factor in Patients with Normal-Karyotype Acute Myeloid Leukemia after Allogeneic Hematopoietic Cell Transplantation.

    Science.gov (United States)

    Ahn, Jae-Sook; Kim, Hyeoung-Joon; Kim, Yeo-Kyeoung; Lee, Seun-Shin; Jung, Sung-Hoon; Yang, Deok-Hwan; Lee, Je-Jung; Kim, Nan Young; Choi, Seung Hyun; Jung, Chul Won; Jang, Jun-Ho; Kim, Hee Je; Moon, Joon Ho; Sohn, Sang Kyun; Won, Jong-Ho; Kim, Sung-Hyun; Kim, Dennis Dong Hwan

    2016-01-01

    The prognostic relevance of epigenetic modifying genes (DNMT3A, TET2, and IDH1/2) in patients with acute myeloid leukemia (AML) has been investigated extensively. However, the prognostic implications of these mutations after allogeneic hematopoietic cell transplantation (HCT) have not been evaluated comprehensively in patients with normal-karyotype (NK)-AML. A total of 115 patients who received allogeneic HCT for NK-AML were retrospectively evaluated for the FLT3-ITD, NPM1, CEBPA, DNMT3A, TET2, IDH1/2, WT1, NRAS, ASXL2, FAT1, DNAH11, and GATA2 mutations in diagnostic samples and analyzed for long-term outcomes after allogeneic HCT. The prevalence rates for the mutations were as follows: FLT3-ITD positivity (FLT3-ITD(pos)) (32.2%), NPM1 mutation (43.5%), CEBPA mutation (double) (24.6%), DNMT3A mutation (DNMT3A(mut)) (31.3%), DNMT3A R882(mut) (18.3%), TET2 mutation (8.7%), and IDH1/2 mutation (16.5%). The 5-year overall survival (OS) and event-free survival (EFS) rates were 57.3% and 58.1%, respectively. A multivariate analysis revealed that FLT3-ITD(pos) (hazard ratio, [HR], 2.23; P = .006) and DNMT3A R882(mut) (HR, 2.74; P = .002) were unfavorable prognostic factors for OS. In addition, both mutations were significant risk factors for EFS and relapse. People with DNMT3A R882(mut) accompanied by FLT3-ITD(pos) had worse OS and EFS, and higher relapse rates than those with the other mutations, which were confirmed in a propensity score 1:2 matching analysis. These results suggest that DNMT3A R882(mut), particularly when accompanied by FLT3-ITD(pos), is a significant prognostic factor for inferior transplantation survival outcome by increasing relapse risk, even after allogeneic HCT.

  19. Genitourinary injuries and extremity amputation in Operations Enduring Freedom and Iraqi Freedom: Early findings from the Trauma Outcomes and Urogenital Health (TOUGH) project.

    Science.gov (United States)

    Nnamani, Nina S; Janak, Judson C; Hudak, Steven J; Rivera, Jessica C; Lewis, Eluned A; Soderdahl, Douglas W; Orman, Jean A

    2016-11-01

    In Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF), genitourinary (GU) wounds have occurred in unprecedented numbers. Severe concomitant injuries, including extremity amputations, are common. The epidemiology of GU injury and extremity amputation in OEF/OIF has not been described. The Department of Defense Trauma Registry was queried from October 2001 through August 2013 to identify all surviving US male service members with GU injuries sustained in OEF/OIF. Genitourinary injury was defined as sustaining one or more injuries to any organ or structure within the genitourinary and/or reproductive system(s) based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Injury severity was quantified based on Abbreviated Injury Scale scores and overall Injury Severity Scores. The incidence, nature, and severity of GU injuries and extremity amputations are described. Of the 1,367 service members with GU injury included in this analysis, 433 (31.7%) had one or more extremity amputations. Most GU injuries were to the external genitalia [scrotum (55.6%), testes (33.0%), penis (31.0%), and urethra (9.1%)] vs. the kidneys (21.1%). Those with amputation(s) had greater GU injury severity (Abbreviated Injury Scale score ≥ 3) than those without amputations (50.1% vs. 30.5%, respectively; p < 0.0001). Approximately 3.4% of male service members with GU injury had an upper extremity amputation only, 8.9% had both lower and upper extremity amputation(s), and 19.4% had lower extremity amputation(s) only. Of the 387 patients with GU injury and lower extremity amputations, 87 (22.5%) had amputations below the knee and 300 (77.5%) had amputation(s) at/above the knee. In OEF/OIF, concomitant GU injury and extremity amputation are common and have serious implications for health and quality of life. This wounding pattern presents new challenges to the military medical and research and development communities to prevent, mitigate

  20. Abnormalities of the upper extremities on fetal magnetic resonance imaging.

    Science.gov (United States)

    Nemec, S F; Kasprian, G; Brugger, P C; Bettelheim, D; Amann, G; Nemec, U; Rotmensch, S; Graham, J M; Rimoin, D L; Lachman, R S; Prayer, D

    2011-11-01

    In view of the increasing use of fetal magnetic resonance imaging (MRI) as an adjunct to prenatal ultrasonography, we sought to demonstrate the visualization of upper extremity abnormalities and associated defects on MRI, with regard to fetal outcomes and compared with ultrasound imaging. This retrospective study included 29 fetuses with upper extremity abnormalities visualized with fetal MRI following suspicious ultrasound findings and confirmed by postnatal assessment or autopsy. On a 1.5-Tesla unit, dedicated sequences were applied to image the extremities. Central nervous system (CNS) and extra-CNS anomalies were assessed to define extremity abnormalities as isolated or as complex, with associated defects. Fetal outcome was identified from medical records. MRI and ultrasound findings, when available, were compared. Isolated upper extremity abnormalities were found in three (10.3%) fetuses. In 26 (89.7%) fetuses complex abnormalities, including postural extremity disorders (21/26) and structural extremity abnormalities (15/26), were demonstrated. Associated defects involved: face (15/26); musculoskeletal system (14/26); thorax and cardio/pulmonary system (12/26); lower extremities (12/26); brain and skull (10/26); and abdomen (8/26). Of the 29 cases, 18 (62.1%) pregnancies were delivered and 11 (37.9%) were terminated. MRI and US findings were compared in 27/29 cases: the diagnosis was concordant in 14 (51.9%) of these cases, and additional findings were made on MRI in 13/27 (48.1%) cases. Visualization of upper extremity abnormalities on fetal MRI enables differentiation between isolated defects and complex ones, which may be related to poor fetal prognosis. MRI generally confirms the ultrasound diagnosis, and may provide additional findings in certain cases. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

  1. 采用中国道个新辅助化疗方案治疗四肢成骨肉瘤的回顾性分析%Neoadjuvant chemotherapy for osteosarcoma of the extremity: Outcome of the Chinese 1st protocol in a single institute

    Institute of Scientific and Technical Information of China (English)

    Sujia Wu; Xin Shi; Guangxin Zhou; Meng Lu; Chengjun Li; Weiwen Wang; Jianning Zhao

    2009-01-01

    Objective: The aim of this study was to determine stand protocol for patients with extremity osteosarcoma by case following up after neoadjuvant chemotherapy and limb salvage operation. Methods: Between January 2000 and Janu-ary 2007, 121 patients with extremity osteosarcoma were eligible for this analysis. After being graded according to Ennek-ing classification, all patients were preoperative chemotherapy (methotrexate, cisplatin, doxorubicin, and ifosfamide. Some patients with lib tumors received extra interventional embolism). And postoperatively, the same protocols were employed, but poor responders (tumor necrosis < 95%) received more treatment cycles than good responders and took some new medicine in place of the former one. Most of patients underwent limb salvage operation (99/121), and the Musculoskeletal Tumor So-ciety Score (MSTS) was used to evaluate the recovery of their limb functions. Results: The followed up last for average 37.3 months (range: 16-101 months). Most patients (76/121) survived, and the overall survival (OS) was 62.8%. Forty-seven of the 121 patients underwent osteoarticular allografts, among which 12 cases of disunion between the host bone and graft bone, 4 cases of allograft absorption and 3 local recurrences appeared. The mean MSTS score was 22.6±4.13, with an excel-lent limb function in 17 patients, good in 19 patients, fair in 6 patients and poor in 7 patients. The overall excellent and good function outcome was obtained in 76.6% of the patients. Fifty-two of 121 patients underwent custom-made or modular tumor endoprosthesis replacememt, among which 1 case of aseptic loosening, 1 case of peri-prosthesis infection and 4 local recur-rences appeared. The mean MSTS was 24.32:1:3.85, with an excellent limb function in 28 patients, good in 16 patients, fair in 5 patients and poor in 3 patients. The overall excellent and good function outcome was obtained in 84.6% of the patients. Conclusion: Neoadjuvant chemotherapy and limb salvage

  2. Extreme cosmos

    CERN Document Server

    Gaensler, Bryan

    2011-01-01

    The universe is all about extremes. Space has a temperature 270°C below freezing. Stars die in catastrophic supernova explosions a billion times brighter than the Sun. A black hole can generate 10 million trillion volts of electricity. And hypergiants are stars 2 billion kilometres across, larger than the orbit of Jupiter. Extreme Cosmos provides a stunning new view of the way the Universe works, seen through the lens of extremes: the fastest, hottest, heaviest, brightest, oldest, densest and even the loudest. This is an astronomy book that not only offers amazing facts and figures but also re

  3. 全面惊厥性癫痫持续状态预后不良的相关因素分析%Analysis of associated factors for poor outcome of GCSE

    Institute of Scientific and Technical Information of China (English)

    陈卫碧; 宿英英; 高冉; 田飞; 张运周; 张艳

    2013-01-01

    目的 分析全面惊厥性癫痫持续状态(generalized convulsive status epilepticus,GCSE)预后不良的相关因素,为改善预后提供指导.方法 将66例GCSE患者根据疗效分为难治性癫痫持续状态(refractory status epilepticus,RSE)和非难治性癫痫持续状态(non-refractory status epilepticus,NRSE),比较两组预后并分析预后不良的相关因素.结果 RSE组的病因(急性症状性)、长时程发作、脑炎、并发低血压或呼吸抑制5项指标均高于NRSE组,病因(癫痫相关)低于NRSE组.多因素logis-tic回归分析提示脑炎及长时程发作是RSE的独立危险因素,校正的OR (95% CI)分别为39.37(6.577~235.671)、11.628(1.92~70.419).多因素logistic回归分析还发现呼吸抑制为短期预后不良的独立危险因素,校正的OR (95% CI)为16(3.713~68.955).病因(急性症状性)与脑炎分别是远期恢复至发病前与遗留癫痫的独立影响因素,校正的OR (95% CI)分别为0.127(0.027~0.604)、7.7(1.661~35.692).结论 脑炎及长时程发作是RSE的独立危险因素;呼吸抑制与短期预后不良(死亡或昏迷)独立相关;病因(急性症状性)与脑炎分别是恢复至发病前与遗留癫痫的独立危险因素.%Objective To evaluate clinical data associated with poor outcome of generalized convulsive status epilepticus (GCSE).Methods Sixty-six patients with GCSE were divided into refractory status epilepticus (RSE) group and non-refractory status epilepticus (NRSE) group.Prognosis was compared between both groups and clinical data associated with poor outcome were also analyzed.Results The difference between both groups was statistically significant in etiology (acute symptomatic),prolonged GCSE duration,etiology (encephalitis and epilepsy related) as well as concurrent hypotension and respiratory depression.By further multi-factor logistic regression,encephalitis and prolonged GCSE duration were independently associated with RSE (OR =39.37,95% CI

  4. Is location of burns related to outcome? A comparison between burns on extremities and burns on head and/or trunk in patients with low to intermediate TBSA in a burn center in The Netherlands.

    Science.gov (United States)

    Menger, Tirsa; Krijnen, Pieta; Tuinebreijer, Willem E; Breederveld, Roelf S

    2014-01-01

    In the literature no study was found about the effect of location of burns on outcome. The objective of this retrospective study was to investigate the effect of location on outcome parameters of 371 patients, admitted to our burn center from January 2009 to December 2011. The patients were included in the study if more than 80% of the burn(s) was localized either on the extremities or on the head and/or trunk. Two groups of TBSA were elaborated, low: 0 to 5% and intermediate: 5 to 15%. Two-hundred ninety-two patients (78.7%) had a low TBSA (patients died. The patients with an intermediate TBSA were on average 8.0 days longer admitted compared with the patients with a low TBSA adjusted for age and depth (95% confidence interval: 6.5-9.4). The patients with burns on the head and/or trunk were more often admitted to the intensive care unit, mostly as a result of suspected inhalation injury (6.2 vs 0.9%; P = .008). More complications were seen in the intermediate TBSA group. In this study no difference in outcome was found between burns on the head and/or trunk or on extremities. The patients with burns on the head and/or trunk group are more frequently admitted to intensive care.

  5. Factors associated with poor short-term outcomes following positional maneuvers in patients with benign paroxysmal positional vertigo%良性阵发性位置性眩晕复位短期疗效不佳的分析

    Institute of Scientific and Technical Information of China (English)

    熊彬彬; 赵晓明; 刘劲; 林春梅; 伍慧卿; 梁勇

    2016-01-01

    Objective To investigate factors that may be associated with poor short-term outcomes following position-al maneuvers in patients with BPPV. Methods From Jan, 2014 to Jun, 2015, 39 patients experiencing poor short-term out-comes following multiple positional maneuvers within two weeks were inquired and their clinical data were analyzed retro-spectively. Results The rate of poor outcomes among all treated patients in the period was 9.8% (39/3