Antioxidant enzyme activities,lipid peroxidation,and total antioxidant status in children with Henoch–Schönlein purpura

The aim of this study was to assess the role of oxidative stress in the pathogenesis of Henoch–Schönlein purpura (HSP) vasculitis. The activities of catalase (CAT), arylesterase (ARYL), and paraoxonase (PON) as antioxidant enzymes and serum malondialdehyde (MDA) level as an indicator of lipid peroxidation, together with total antioxidant status (TAS), were measured in 29 children with HSP (mean age 9.3?±?2.7 years), both at the onset of the disease and at the remission period and in matched controls. Active-stage HSP had significantly higher MDA level (15.5?±?7.3 vs 7.8?±?3.9 nmol/l, respectively, P?P?P?=?0.042), ARYL (158?±?39 vs 212?±?52 U/l, P?P?=?0.002) activities compared with the control subjects. Although CAT (P?>?0.05) and PON (P?>?0.05) activities were found to be similar between active and remission stages of HSP, the active stage of the disease had significantly lower ARYL (P?=?0.011) and TAS (P?=?0.006) and higher MDA (P?r?=?0.433, P?=?0.019) and between CAT and C-reactive protein (r?=?0.386, P?=?0.035) in the active stage of HSP. No significant differences were detected in oxidant/antioxidant parameters between patients with or without renal, gastrointestinal, or joint involvement (P?>?0.05). Increased oxidative stress and lipid peroxidation may play important roles in the pathogenesis of HSP vasculitis. Antioxidant therapeutic interventions in long-lasting vasculitis and risk of atherosclerosis secondary to increased oxidant stress remain to be investigated.     

Diabetic foot in patients below 40 years of age

Data on diabetic foot ulcers (DFU) in young patients are scarce. We aimed to examine the risk factors, clinical presentation, wound characteristics, and outcome of DFU among young diabetic patients and to compare them with similar age diabetics without foot ulcer and those of older age diabetics with foot ulcers. A prospective cohort of 745 patients (834 ulcers) below 40 years of age, 7620 patients (9405 ulcers) ages 40 years and above, and 992 patients below 40 years diabetics without foot ulcers in a single multidisciplinary diabetes center were studied. Registered patients with foot ulcers in Jabir Abu Eliz Diabetes Centre (JADC) in Khartoum, Sudan from March 2001 to Dec 2011 were reviewed. Below 40 years of age constituted 8.9 % (n?=?7450) of all patients with DFU. Male-to-female ratio was 1.7:1. IDDM type was prevalent in 60.9 %. Thirty-six per cent of below 40 years had peripheral neuropathy compared to 61.6 % of older group (p?<?0.0002) and 8.7 % of below 40 without DFU (p?<?0.0002). ABI <0.9 was found in 38.7 % (n?=?288) in below 40 years with ulcers compared to 41.4 % in older patients (p?=?0.8989) and 36.3 % (n?=?360) of below 40 without DFU (p?=?0.3125). HbA1c >7 % was significantly more in diabetics below 40 years with foot ulcers compared to those without foot ulcers (83.5 vs. 75.1 %) (p?=?0.0002). In below 40 years of age, 80.1 % of ulcers healed compared to 70.6 % in older age group (p?>?0.0002). Major lower extremity amputation was performed in 4.8 % in below 40 years patients compared to 7.3 % in older group (0.0105). Young diabetics with foot ulcers had significantly longer duration of the disease, more foot deformities, and callus formation and more severe neuropathy than young diabetics without ulcers but had a lesser duration of diabetes than elderly diabetics with foot ulcers. HbA1c in young diabetics with foot ulcers was significantly higher than young diabetics without ulcers, and their foot ulcers healed better and with less major lower extremity amputation than elderly patients.     

Assessment of multimedia-supported intervention in Muslim diabetic patients treated with insulin

This study aimed to evaluate the effect on diabetic care of an educational DVD in Jawi, the primary spoken language of Muslims in the study area, and pharmacist intervention among Muslim patients with diabetes treated with insulin. Type 2 diabetes Muslim patients on insulin treatment and poor glycemic control (N?=?143) in one hospital in southern Thailand were recruited to participate in a 6-month-period pre- and post-intervention study. For the intervention, the pharmacist provided the patients with education using a DVD and then asked them to show how to use insulin injection. Afterward, the pharmacist would correct the techniques for patients individually. At 6 months after intervention, significant reductions in glycated hemoglobin (HbA_1c) (8.31?±?1.40 to 7.19?±?1.15 %, P?<?0.001), fasting blood glucose (FBG) (195.06?±?86.14 to 115.81?±?11.48 mg/dL, P?<?0.001), systolic blood pressure (130.62 to 126.57 mmHg, P?=?0.004), triglycerides (183.36?±?90.48 to 182.31?±?90.68 mg/dL, P?<?0.001), and total cholesterol (199.57?±?68.77 to 194.97?±?64.77 mg/dL, P?=?0.006) were detected in patients who received the intervention. Increased low-density lipoprotein cholesterol (LDL-C) level (P?=?0.028) but no significant change in high-density lipoprotein cholesterol (HDL-C) were found (P?=?0.900). Moreover, medication adherence, diabetes knowledge, and skill in using insulin injection improved at the end of the study (P?<?0.001). In conclusion, the combination of language-specific educational DVD and pharmacist intervention appears to improve the short-term outcomes of diabetes care in Muslim patients on correctional insulin therapy.     

Association between SNPs in <Emphasis Type="Italic">AdipoQ</Emphasis>, +45 T &gt; G and +276 G &gt; T,and adiponectin levels in the Korean Chinese population in Yanbian,China

This study investigated the association between single nucleotide polymorphisms (SNPs) in AdipoQ, +45 T?>?G and +276 G?>?T, and adiponectin levels in the Korean Chinese population in Yanbian, China. A total of 329 subjects were involved in this study, including 178 female and 151 male individuals. All of them are ethnic Koreans living in Yanbian, aged from 31 to 70, and 58 % of them were diagnosed with type 2 diabetes (T2D). Items tested and calculated include total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), body fat percentage (BF%), fasting plasma insulin (FPI), plasma adiponectin (PA), and homeostasis model assessment of insulin resistance (HOMA-IR). SNPs were screened with the method of SNaPshot. P?<?0.05 was defined as the statistically significant threshold. Results include the following: (1) PA levels in the T2D group are much lower than those in the normal group (P?<?0.001); (2) the distribution of genotypes of SNPs +45 T?>?G and +276 G?>?T was determined to be in Hardy-Weinberg equilibrium (P?>?0.05) and complete linkage disequilibrium (|D′|?=?1.0); (3) PA levels in females are much higher than those in males no matter which group they belong to (normal or T2D group) (P?=?0.004 and P?=?0.018); (4) PA levels are higher in the individuals with +45G as a dominant allele than those in individuals with homozygous genotype TT at locus +45 in the normal group (P?=?0.037); and (5) of SNPs +45 T?>?G and +276 G?>?T, no risk factor of genotype or allele was found (P?>?0.05). Three conclusions can be drawn: (1) PA levels are lower in T2D patients than in normal persons; (2) PA levels are higher in females than in males; (3) PA levels are higher for normal individuals with +45G allele than those with homozygous TT genotype at locus +45 in AdipoQ.     

Increased serum levels of adhesion molecules ICAM-1 and VCAM-1 in systemic sclerosis are not specific for pulmonary manifestations

Studies suggest elevated serum intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) levels may be markers of pulmonary arterial hypertension in systemic sclerosis (SSc-PAH). We sought to evaluate whether ICAM-1 and VCAM-1 levels are useful screening biomarkers for incident SSc-PAH. In this cross-sectional study, four groups were selected from the Australian Scleroderma Cohort Study: group 1 (n?=?15) had definite PAH; group 2 (n?=?19) had interstitial lung disease (ILD); group 3 (n?=?30) were SSc-controls; and group 4 (n?=?34) were healthy controls. Serum ICAM-1 and VCAM-1 levels were measured using the Millipore Milliplex MAP Human 2-Plex Panel. There were no differences in ICAM-1 levels in the PAH versus ILD group (263.0?±?85.4 vs 380.4?±?168.3 ng/mL, p?=?0.136), SSc-controls (263.0?±?85.4 vs 253.1?±?98.0 ng/mL, p?=?1.00), or healthy controls (263.0?±?85.4 vs 201.8?±?57.2 ng/mL, p?=?0.093). Similarly, there were no differences in VCAM-1 level in PAH versus ILD groups (1476.2?±?434.9 vs 1424.8?±?527.6 ng/mL, p?=?1.00) and SSc-controls (1476.2?±?434.9 vs 1409.5?±?341.1 ng/mL, p?=?1.00). SSc subjects had significantly higher levels of ICAM-1 (297.4?±?134.0 vs 201.8?±?57.2 ng/mL, p?<?0.0001) and VCAM-1 compared to healthy controls (1432.7?±?427.4 vs 1125.6?±?273.4 ng/mL, p?<?0.0001). Neither ICAM-1 nor VCAM-1 is a specific screening biomarker of SSc-PAH. Instead, increased levels of these adhesion molecules in SSc, irrespective of pulmonary complications, suggest that they may play a role in SSc pathogenesis.     

Mean platelet volume in Henoch-Sch?nlein purpura: relationship to gastrointestinal bleeding

Henoch-Schönlein purpura (HSP) is the most common systemic vasculitis in children. Gastrointestinal (GI) bleeding is one of the major complications affecting one third of the cases which may cause serious morbidity. Platelet volume directly correlates with the platelet function and activation. Small platelets have lower functional capabilities than larger ones. The aim of this retrospective study was to evaluate levels of mean platelet volume (MPV) in patients with HSP compared with healthy controls and to investigate the relationship between MPV and gastrointestinal bleeding. The study consisted of 43 HSP patients (male/female?=?25/18, mean age?=?6.2?±?2.6 years) and 27 age-matched healthy children (male/female?=?14/13, mean age?=?6.9?±?2 years) as control group. HSP patients had significantly lower MPV levels than healthy controls (7.5?±?0.8 vs. 7.9?±?0.5, p?=?0.027). Thirteen of 43 patients had gastrointestinal bleeding. MPV was significantly lower in patients with GI bleeding than patients without bleeding (7.0?±?0.8 vs. 7.7?±?0.6, p?=?0.01). Platelet counts, white blood cell counts, and C-reactive protein levels were significantly higher in patients with GI bleeding when compared to patients without GI bleeding (p?=?0.03, p?=?0.004, and p?=?0.03, respectively). This study suggests that low MPV may contribute to GI bleeding in HSP.     

Risk factors for surgical site infection following colorectal resection: a multi-institutional study

Introduction

Surgical site infection (SSI) is an infection occurring in an incisional wound within 30 days of surgery and significantly affects patients undergoing colorectal surgery. This study examined a multi-institutional dataset to determine risk factors for SSI following colorectal resection.

Methods

Data on 386 patients who underwent colorectal resection in three institutions were accrued. Patients were identified using a prospective SSI database and hospital records. Data are presented as median (interquartile range), and logistic regression analysis was used to identify risk factors.

Results

Patients (21.5 %) developed a postoperative SSI. The median time to the development of SSI was 7 days (5–10). Of all infections, 67.5 % were superficial, 22.9 % were deep and 9.6 % were organ space. In univariate analysis, an ASA grade of II (RR 0.6, CI 0.3–0.9, P?=?0.019), having an elective procedure (RR 0.4, CI 0.2–0.6, P?<?0.001), using a laparoscopic approach (RR 0.5, CI 0.3–0.9, P?=?0.019), having a daytime procedure (RR 0.3, CI 0.1–0.7, P?=?0.006) and having a clean/contaminated wound (RR 0.4, CI 0.2–0.7, P?=?0.001) were associated with reduced risk of SSI. In multivariate analysis, an ASA grade of IV (RR 3.9, CI 1.1–13.7, P?=?0.034), a procedure duration over 3 h (RR 4.3, CI 2.3–8.2, P?<?0.001) and undergoing a panproctocolectomy (RR 6.5, CI 1.0–40.9, P?=?0.044) were independent risk factors for SSI. Those who developed an SSI had a longer duration of inpatient stay (22 days [16–31] vs 15 days [10–26], P?<?0.001).

Conclusions

Patients who develop an SSI have a longer duration of inpatient stay. Independent risk factors for SSI following colorectal resection include being ASA grade IV, having a procedure duration over 3 h, and undergoing a panproctocolectomy.

     

Increased Sputum IL-17A Level in Non-asthmatic Eosinophilic Bronchitis

Background

Non-asthmatic eosinophilic bronchitis (NAEB) is one common cause of chronic cough which is characterized as airway eosinophilic inflammation like asthma but lack of airway hyper-responsiveness. Previous studies showed that Th2-pathway plays a role in NAEB, but the role of non-Th2 pathway in mechanism of NAEB remains unknown. Recently, IL-17A, a Th17-pathway cytokine, has been demonstrated to be involved in asthma development. However, the relationship between Th17-pathway and NAEB is unknown.

Methods

We aim to assess the airway level of IL-17A in the subjects with NAEB. Relationships between the IL-17A level and airway function in NAEB or asthma are also observed. We measured IL-17A concentrations in the sputum supernatant from 12 subjects with EB, 16 subjects with asthma [9 eosinophilic asthmatic (EA) and 7 non-eosinophilic asthmatic (NEA) according to the sputum eosinophil ≥?3%], and 9 healthy control subjects.

Results

Increasing IL-17A level was found in NAEB group (29.65?±?8.13 pg/ml), EA group (32.45?±?3.22 pg/ml), and NEA group (29.62?±?6.91 pg/ml) compared with the healthy control group (17.05?±?10.30 pg/ml) (P?<?0.05, P?<?0.01, P?<?0.05, respectively). The sputum IL-17A level was correlated with FENO (r?=?0.44, P?<?0.01), FEV1/FVC% (r?=???0.38, P?<?0.05), MMEF%pred (r?=???0.34, P?<?0.05), and sputum neutrophil% (r?=?0.33, P?<?0.05) in total.

Conclusion

Th17-pathway may play a role not only in asthmatics, but also in subjects with NAEB, as reflected by increasing IL-17A concentrations in sputum supernatant.

     

Factors associated with the location of local rectal cancer recurrence and predictors of survival

Purpose

The location of locally recurrent rectal cancer (LRRC) may influence survival. This study examines factors affecting the location of LRRC, the effect of LRRC location on survival, and predictive factors for survival in patients with LRRC.

Methods

Patients undergoing initial proctectomy and subsequent management of LRRC at the Cleveland Clinic (1980–2011) were included. Data regarding index surgery, LRRC, and survival were obtained from a prospectively maintained database.

Results

One hundred and fifty-seven patients were identified with a mean follow-up 59.8?±?50.1 months and time to LRRC of 31.7?±?30.1 months. Sixty patients underwent surgery with curative intent. Anastomotic leak and retrieving less than 12 lymph nodes at index proctectomy were associated with posterior (P?=?0.019) and lateral (P?=?0.036) recurrences, respectively. Having an axial relative to an anterior, posterior, or lateral recurrence was associated with improved overall survival (P?=?0.001). On multivariable analysis, undergoing primarily palliative treatment (OR, 5.2; 95 % confidence interval (CI), 3.2–8.4; P?<?0.001), age at LRRC >60 years (OR, 1.9; 95 % CI, 1.3–2.7, P?<?0.001), advanced primary tumour stage (OR, 1.5; 95 % CI, 1.1–2.1; P?=?0.021), and anastomotic leak at index surgery (OR, 1.8; 95 % CI, 1.2–2.7; P?=?0.008) were associated with reduced LRRC 5-year survival.

Conclusions

The current study suggests that features of the primary tumour and technical factors at the time of index proctectomy influence both the location of LRRC and survival.

     

Comorbidities,repeated hospitalizations,and age ≥ 80 years as indicators of anemia development in the older population

Anemia represents a common condition among the elderly; however, its prevalence and causes are not well known. This retrospective analysis was performed on 981 patients aged ≥?60 in Poland over 2013–2014. The prevalence of anemia was 17.2% and increased with age. The predominant causes of anemia were the following: anemia of chronic disease (33.1%), unexplained anemia (28.4%), deficiency anemia (22.5%, including iron deficiency 13%), and chemo-/radiotherapy-induced anemia (8.9%). In the multivariate logistic regression model, factors increasing the risk of anemia were the following: age?≥?80 years (OR 2.29; 95%CI 1.19–4.42; P?=?0.013), the number of comorbidities (two diseases OR 2.85; 95%CI 1.12–7.30; P?=?0.029, three diseases OR 6.28; 95%CI 2.22–17.76; P?=?0.001, four diseases OR 4.64; 95%CI 1.27–17.01; P?=?0.021), and hospitalizations (OR 1.34; 95%CI 1.13–1.58; P?=?0.001). After a 2-year follow-up, the cumulative survival among patients without anemia in relation to the group with anemia was 90.76 vs. 78.08% (P?<?0.001). In the multivariate model, anemia (HR 3.33, 95%CI 1.43–7.74, P?=?0.005), heart failure (HR 2.94, 95%CI 1.33–6.50, P?=?0.008), and cancer (HR 3.31, 95%CI 1.47–7.49, P?<?0.004) were all significantly correlated with mortality. In patients ≥?60 years, the incidence of anemia increases with age, number of comorbidities, and frequency of hospitalizations and has an adverse impact on survival.     

Role of <Emphasis Type="Italic">PPARG</Emphasis> (Pro12Ala) in Malaysian type 2 diabetes mellitus patients

Diabetes is one of the major lifestyle disorders in the world. Asian countries, including Malaysia, contribute with more than 60 % of the world’s diabetic population. The single nucleotide polymorphisms (SNPs) of the peroxisome proliferator-activated receptor gamma (PPARG) have been identified as one of the key regulators of glucose and lipid metabolism that controls the protein synthesis in multiple metabolic, biochemical, and molecular pathways. The aim of this study was to investigate the possible role of PPARG (Pro12Ala) gene polymorphism as a genetic risk factor for type 2 diabetes mellitus (T2DM) patients in Malaysian population. A total of 241 subjects between the age of 35 and 85 years were recruited in this study. Out of the total 241 subjects, 120 were T2DM patients and 121 were healthy individuals. SNP of PPARG (Pro12Ala) was determined by polymerase chain reaction (PCR) and restriction fragment length polymorphisms (RFLPs). The frequencies of wild homozygote (WH), heterozygote (H), and mutant homozygote (MH) among the T2DM patients were (n?=?73) 60.8 %, (n?=?39) 32.5 %, and (n?=?3) 2.5 % compared to (n?=?57) 47 %, (n?=?46) 38 %, and (n?=?16) 13.2 % among the healthy subjects. The mean of Hba1C (%) among normal and diabetic patients with genotypes were different (5.36?±?0.54 vs 7.58?±?1.76), p?<?0.005. SNP of PPARG (Pro12Ala) gene could be a genetic risk factor for insulin resistance and T2DM among Malaysian population.     

Pneumothorax in Patients with Pulmonary Langerhans Cell Histiocytosis

Introduction

Pneumothorax often develops in pulmonary Langerhans cell histiocytosis (PLCH), but some patients take a long time to be correctly diagnosed.

Objectives

This study assessed the frequency of pneumothorax in PLCH and analysed the role of chest computed tomography (CT) in the prompt diagnosis.

Patients and material

Of the 90 patients with PLCH seen from 2000 to 2015, 29 (32%) had pneumothorax as the initial finding. In this group, 18 (62%) patients were diagnosed within 1 month, whereas the diagnosis was delayed for 4–120 months in 11 (38%) patients.

Results

Patients who had pneumothorax as the initial sign of PLCH tended to be younger (mean age 27.7?±?7.92 vs. 39.9?±?13.21 years; P?=?0.0001), male (69% vs. 43%; P?=?0.028), smoked less (mean pack/years 8.4?±?6.85 vs. 19?±?17.16; P?=?0.003), and had a significantly lower mean FVC (77.96?±?19.62 vs. 89.47?±?21.86% pred.; P?=?0.015) and FEV₁ (68.6?±?19.93 vs. 79.4?±?21.48% pred.; P?=?0.03 than patients who had no pneumothorax. Recurrent pneumothorax was diagnosed more frequently in the group with a delayed diagnosis (82% vs. 39%; P?=?0.02). CT was performed in all of the patients who were diagnosed promptly, but in none of the patients with a delayed diagnosis.

Conclusions

Patients who had pneumothorax as the initial sign of PLCH were younger, more frequently men, and had greater respiratory impairment than those who had no pneumothorax. CT in patients with pneumothorax led to a correct diagnosis of this disease.

     

Expression of circulating Semaphorin3A and its association with inflammation and bone destruction in rheumatoid arthritis

To determine the expression of Semaphorin3A (Sema3A) in rheumatoid arthritis (RA) patients, and analyze the correlation between serum Sema3A and the pathogenesis of RA. The concentration of serum Sema3A and its mRNA expression level were detected in RA patients. The association of serum Sema3A level with clinical and laboratory features of RA were analyzed. Serum Sema3A of 130 RA patients (15.89?±?8.58 ng/ml) was significantly higher than that of 150 HC (6.96?±?2.62 ng/ml) and 215 patients with other rheumatic diseases (P?<?0.05). Consistent with the serum level, the Sema3A mRNA level was also higher in RA patients’ PBMC than that in HC (1.8-fold increase, P?<?0.01). The serum level of Sema3A was correlated with platelet counts (r?=?0.229), ESR (r?=?0.172), RF (r?=?0.230), IgM (r?=?0.254) and Sharp score (r?=?0.254), and bone mineral density (BMD) of lumbar spine (r?=?0.263). Serum Sema3A was also fundamentally higher in AKA-, APF-, anti-CCP-positive groups compared with negative groups (P?<?0.05). The ROC curve showed that the optimum diagnostic cutoff value for Sema3A was 10.881 ng/ml. RF level and antibodies (anti-CCP, APF, AKA, and GPI) positive rates were significantly higher in Sema3A positive group. Sharp score was also higher, although without significance. The expression of Sema3A is significantly elevated in RA patients. The level of serum Sema3A is positively correlated with inflammatory factors (including ESR, IgM, and RF) and is associated with auto-antibody production and bone destruction.     

CTLA-4 +49A/G gene polymorphism and type 1 diabetes mellitus in the Chinese population: a meta-analysis of 2238 subjects

Previous studies reported that cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) +49A/G gene polymorphism is correlated with type 1 diabetes mellitus (T1DM) risk. However, their results remain disputable. This study aims to discuss the relationship between CTLA-4 +49A/G gene polymorphism and T1DM in a Chinese population. The current meta-analysis involved 2238 participants from seven individual studies. The pooled odds ratio (OR) and its corresponding 95 % confidence interval (95 % CI) were assessed by the random- or fixed-effects model. A significant relationship between CTLA-4 +49A/G gene polymorphism and T1DM was detected under allelic (OR: 1.84, 95 % CI: 1.62–2.10, P?<?0.00001), dominant (OR: 1.152, 95 % CI: 1.062–1.249, P?=?0.001), recessive (OR: 1.631, 95 % CI: 1.443–1.844, P?<?0.00001), and additive (OR: 1.292, 95 % CI: 1.224–1.363, P?<?0.00001) genetic models. A significant relationship exists between CTLA-4 +49A/G gene polymorphism and increased T1DM risk in the Chinese population. Individuals having the G allele of CTLA-4 +49A/G gene polymorphism have a higher risk for T1DM in the Chinese population.     

Self-expandable metallic stent as a bridge to elective surgery versus emergency surgery for acute malignant colorectal obstruction

Backgroud

The efficacy and safety of self-expandable metallic stents (SEMSs) as a bridge for patients with acute malignant colorectal obstructions (AMCOs) are still controversial. We conducted this study to evaluate the outcomes of patients with AMCOs treated by different strategies.

Methods

From January 2010 to March 2014, a total of 171 patients with AMCOs from Zhongshan Hospital were retrospectively enrolled in this study. One hundred twenty patients successfully received stent placement followed by one-stage laparoscopic or open resection in the stent group, and 51 patients received emergency operations in the emergency group.

Results

The operation duration and postoperative hospital stay were significantly shorter in the stent group (114.51?±?28.65 vs. 160.39?±?58.94 min, P?<?0.001; 8.00?±?3.97 vs. 12.59?±?9.07 days, P?=?0.001). The stent group also had significantly reduced intraoperative blood loss and the incidence of postoperative complications compared with the emergency group (61.00?±?43.70 vs. 121.18?±?85.90 ml, P?<?0.001; 16.7 vs. 37.3 %, P?=?0.003). Kaplan–Meier survival curves showed that the median survival time in the stent group was significantly longer than that in the emergency group (53 vs. 41 months, P?=?0.034). In subgroup analysis of stent group, the stent laparoscopy group had significantly decreased postoperative complications (P?=?0.025), and similar long-term survival (P?=?0.81).

Conclusions

Stent placement as a bridge to surgery is a safe and feasible procedure and provides significant advantages in terms of short-term outcomes and favorable prognoses for patients with AMCOs. Laparoscopic surgery could be considered as an optimal treatment after stent placement.

     

Effect of glycemic state on postprandial hyperlipidemia and hyperinsulinemia in patients with coronary artery disease

Both postprandial hyperlipidemia and hyperinsulinemia have been thought to play an important role in the development of atherosclerosis, and to be a potent risk factor for cardiovascular event. To examine effects of glycemic state on postprandial hyperlipidemia and hyperinsulinemia in patients with coronary artery disease (CAD), a total of 112 consecutive male patients with angiographically confirmed CAD were loaded with a high-fat and high-glucose test meal. CAD patients were divided into three groups as “non-diabetic”, “prediabetic”, and “diabetic” CAD groups. The serum triglyceride (TG) and remnant-like particle cholesterol (RLP-C) levels at the 6th hour in diabetic CAD group showed significantly higher than non-diabetic CAD group, and the incremental area under the curves (iAUCs) of these levels in diabetic CAD group were significantly greater than non-diabetic CAD group (TG, P = 0.0194; RLP-C, P = 0.0219). There were no significant differences in the iAUCs of TG or RLP-C between prediabetic and non-diabetic CAD group. The AUCs of plasma insulin levels or insulin resistance index (IRI): (AUCs of insulin) × (AUCs of glucose) as the insulin resistance marker were greater in diabetic CAD group than non-diabetic CAD group (insulin, P = 0.0373; IRI, P = 0.0228). The AUCs of serum TG or RLP-C levels showed a correlation with the AUCs of plasma insulin (AUC-TG, r = 0.5437, P < 0.0001; AUC-RLP-C, r = 0.6847, P < 0.0001), and they correlated well with the insulin resistance index (AUC-TG, r = 0.7724, P < 0.0001; AUC-RLP-C, r = 0.7645, P < 0.0001). We found that the insulin resistance showed a close relationship with postprandial hyperlipidemia in CAD patients. Diabetic, but not prediabetic state, may be a risk for postprandial impaired lipid metabolism in CAD patients.     

Evaluation of work disability in Japanese patients with rheumatoid arthritis: from the TOMORROW study

To evaluate work disability and associated factors in patients with rheumatoid arthritis (RA) who participated in the TOMORROW study, a 10-year cohort study in Japan. Subjects in this cross-sectional analysis comprised 191 RA patients and 191 age- and sex-matched non-RA individuals. Work-related outcomes were measured using the Work Productivity and Activity Impairment questionnaire by employment status (full-time worker (FTW), employed ≥ 35 h/week; part-time worker (PTW), < 35 h/week; home worker (HW), non-employed). In addition, we assessed the EuroQol-5 Dimensions (EQ-5D) and Health Assessment Questionnaire (HAQ) to evaluate quality of life and activities of daily living. No significant differences were evident between groups in percentages of participants in each employment status (p =?0.11), percentages of absenteeism (FTW, p?=?1.00; PTW, p?=?0.29), presenteeism (FTW, p?=?0.23; PTW, p?=?0.54), overall work impairment (FTW, p?=?0.23; PTW, p?=?0.73), or percentage of activity impairment (AI) (FTW, p?=?0.62; PTW, p?=?0.60). In the HW group, percentage of AI was higher in RA patients than that in non-RA patients (p?<?0.01). Among RA patients, HW showed lower EQ-5D and higher HAQ than FTW or PTW (p?<?0.001 each). Higher disease activity was observed in HW than FTW (p <?0.01). In terms of the effect of biological disease-modifying anti-rheumatic drugs, no significant differences in work-related outcomes, health status, or daily activity were evident between users and non-users. No significant differences in employment status or work impairment were seen between RA and non-RA groups among paid workers. HW with RA showed more impaired daily activity and higher disease activity compared to working RA patients. Trial registration: University Hospital Medical Information Network Clinical Trials Registry: UMIN000003876. Registered 1 Jun 2010.     

Colonization with multidrug-resistant bacteria increases the risk of complications and a fatal outcome after allogeneic hematopoietic cell transplantation

Composition of the gut microbiota seems to influence early complications of allogeneic hematopoietic cell transplantation (HCT) such as bacterial infections and acute graft-versus-host disease (GVHD). In this study, we assessed the impact of colonization with multidrug-resistant bacteria (MDRB) prior to HCT and the use of antibiotics against anaerobic bacteria on the outcomes of HCT. We retrospectively analyzed the data of 120 patients who underwent HCT for hematologic disorders between 2012 and 2014. Fifty-one (42.5%) patients were colonized with MDRB and 39 (32.5%) had infections caused by MDRB. Prior colonization was significantly correlated with MDRB infections (P?<?0.001), especially bacteremia (P?=?0.038). A higher incidence of MDRB infections was observed in patients with acute (P?=?0.014) or chronic (P?=?0.002) GVHD and in patients aged >?40 years (P?=?0.002). Colonization had a negative impact on overall survival (OS) after HCT (64 vs. 47% at 24 months; P?=?0.034) and infection-associated mortality (P?<?0.001). Use of metronidazole was correlated with an increased incidence of acute GVHD (P?<?0.001) and lower OS (P?=?0.002). Patients colonized with MDRB are more susceptible to life-threatening infections. Colonization with virulent flora is the most probable source of neutropenic infection; therefore, information about prior positive colonization should be crucial for the selection of empiric antibiotic therapy. The use of metronidazole, affecting the biodiversity of the intestinal microbiome, seems to have a significant impact on OS and acute GVHD.     

Oral supplementation of Lanthanum Zirconate nanoparticles moderately affected behavior but drastically disturbed leukocyte count,serum cholesterol levels and antioxidant parameters from vital organs of albino mice in a gender specific manner

Lanthanum Zirconate nanoparticles (NPs) are used in blades of gas turbine engines to thermally insulate them and to protect them against hot and corrosive gas streams. However, the information regarding their biocompatibility is limited. The present study was aimed to report the effect of Lanthanum Zirconate NPs on selected aspects of behavior, serum biochemistry, complete blood count and antioxidant parameters from vital organs of albino mice in a gender specific manner. Albino mice, seven weeks old, were orally treated with 75 mg/ml solvent/Kg body weight of Lanthanum Zirconate nanoparticles for consecutive 22 days. Saline treated control groups were maintained in parallel. It was observed that rearing frequency was significantly decreased (P =?0.01) in NPs treated male mice. Complete blood count analysis indicated that NPs treated female mice had significantly reduced white blood cells (P =?0.05) and lymphocytes count (P =?0.03). NPs treated male had significantly reduced serum cholesterol levels (P =?0.05) than control group. It was observed that Superoxide dismutase concentrations in liver (P?=?0.025) and kidney (P?=?0.008), Malondialdehyde concentrations in liver (P =?0.044) of female and Malondialdehyde concentrations in kidney (P <?0.001) and brain (P <?0.001) and catalase concentrations in liver (P =?0.05) of NPs treated male mice were significantly higher than their respective control groups.. In conclusion, we are reporting that oral supplementation with 75 mg/ml solvent/Kg body weight of Lanthanum Zirconate nanoparticles can affect the behavior, leukocyte count, serum cholesterol and antioxidant metabolites from vital organs of albino mice in a gender specific manner.