Relationship Between Depression and/or Anxiety and Hospital Readmission Among Women After Childbirth

ObjectiveTo examine the relationship between depression and/or anxiety and any psychiatric diagnosis and readmission after childbirth.DesignCross-sectional analysis of administrative data from patient discharge records.SettingUrban academic medical center in the northeastern United States.ParticipantsWomen admitted for childbirth (N = 17,905).MethodsDifferences among participants with and without depression and/or anxiety present on admission were compared using t tests and chi-square tests. Risk-adjusted logistic regression models were used to examine the effects of depression and/or anxiety and any psychiatric diagnosis on 7-, 30-, 60-, 90-, and 180-day readmissions after childbirth.ResultsSignificant differences were noted between participants with (n = 1,169) and without (n = 16,736) depression and/or anxiety. Participants with these diagnoses had a higher mean age and a longer mean length of stay during hospitalization for childbirth. A greater proportion of these participants were White, were single, had cesarean births, and were discharged with home health services. The presence of depression and/or anxiety was not significantly associated with readmission. The effect of having any psychiatric diagnosis was significantly associated with a greater risk of readmission at 7 (odds ratio [OR] = 1.51, p = .100), 30 (OR = 1.45, p = .030), 60 (OR = 1.45, p = .026), 90 (OR = 1.56, p = .004), and 180 days (OR =1.74, p < .001) following discharge after childbirth.ConclusionIn this sample, women with a psychiatric diagnosis, but not depression and/or anxiety alone, were at increased risk for readmission after childbirth.     

Two contemporaneous mitogenomes from terminal Pleistocene burials in eastern Beringia

Pleistocene residential sites with multiple contemporaneous human burials are extremely rare in the Americas. We report mitochondrial genomic variation in the first multiple mitochondrial genomes from a single prehistoric population: two infant burials (USR1 and USR2) from a common interment at the Upward Sun River Site in central Alaska dating to ∼11,500 cal B.P. Using a targeted capture method and next-generation sequencing, we determined that the USR1 infant possessed variants that define mitochondrial lineage C1b, whereas the USR2 genome falls at the root of lineage B2, allowing us to refine younger coalescence age estimates for these two clades. C1b and B2 are rare to absent in modern populations of northern North America. Documentation of these lineages at this location in the Late Pleistocene provides evidence for the extent of mitochondrial diversity in early Beringian populations, which supports the expectations of the Beringian Standstill Model.The colonization of the Western Hemisphere has been of interest to scholars since 1590, when Jose de Acosta postulated a northeast Asian origin of the indigenous populations of the Americas (1). Both the archaeological (2, 3) and genetic (4–10) records consistently indicate a primary entry point from Asia to the Americas via the Bering Land Bridge, sometime during the Late Pleistocene. However, there are unfortunate lacunae in both records. The archaeological record indicates a relatively late (<14–16 kya), rapid colonization event following the Last Glacial Maximum. This temporal scale supports the clear northeastward geographical expansion of late Upper Paleolithic (Diuktai) populations from southern and central Siberia to Beringia after 16 kya (5). However, archaeological evidence is accumulating that shows people had penetrated parts of North and South America before 13,250 cal B.P., the earliest date associated with Clovis, the first widespread cultural tradition in North America (2–5, 11).The genetic record is equally problematic. Continental scale analyses of genetic variation rely heavily on Central and South American population data, as well as data from Arctic populations (6–9, 12, 13). Few data exist for North American populations south of the Arctic. Recent surveys of contemporary genetic variation in the Americas are consistent with a period of population isolation during which the distinctive composition of Native American genomes differentiated from ancestral Asian genomes, followed by a rapid colonization; this scenario has been deemed the “Beringian Standstill Model” (6, 7, 10). How early the Native American gene pool diverged remains uncertain, but estimates of up to 30 kya have been postulated (5, 6, 10, 12, 14, 15). Most geneticists argue for at least a several thousand-year period of isolation and genetic differentiation in Beringia before a southward dispersal, despite the absence of supporting archaeological evidence (2, 4, 5, 10). Recently, Raghavan et al. (15), using genome-wide low-coverage data, suggested the dates of this isolation began no earlier than 23 kya and lasted no longer than 8,000 y (15).Ancient DNA (aDNA) samples from early inhabitants of the Americas would be important for linking the modern genetic and archaeological records (16), but few exist. The Mal’ta child from South Central Siberia indicates an early origin (>24 kya) of some signal of Native American ancestry (9), but although a few Pleistocene-aged remains have been recovered in central North America (below the Laurentide Ice Sheet) or along the Northwest Coast, no similarly aged Beringian human remains have previously been available for genetic comparison. Very few Late Pleistocene (>10,000 cal B.P.) individuals have yielded mitochondrial genetic (mtDNA) data, although we highlight the seven sites with ancient human remains dating to >8,000-y-old that have been characterized for mtDNA lineages: Hoyo Negro, Mexico (17); Anzick, MT (18); Kennewick, WA (19); On-Your-Knees Cave, AK; Wizard’s Beach, NV; Hourglass Cave, CO; and, indirectly through coprolite analysis, Paisley Cave, OR (the last four are reviewed in ref. 20) (Fig. 1).Open in a separate windowFig. 1.Geographic map of reported Native American populations with >40% C1 or B2 haplogroup frequencies, as well as locations of archaeological sites discussed. The locations of the Upward Sun River site, as well as the seven previously reported archaeological sites dated at >8,000 y B.P. with successfully genotyped human mitochondrial DNA lineages, are listed on the map (with reported haplotypes). Reported populations of ≥20 individuals with ≥40% C1 (yellow) or B2 (blue) are shown. Populations and frequencies specific to this figure (referenced by numbers 1–50) are available in the SI Materials and Methods.In 2011 Potter et al. (21) reported on the discovery of a cremated 3-y-old child from a residential feature at Upward Sun River (USR) in eastern Beringia dating to 11,500 cal B.P. Additional excavation at this deeply stratified and well-dated site (22) recently yielded two additional infant burials (Fig. 1) (USR1 and USR2) (23). A series of radiocarbon ages securely date the three individuals between 11,600 and 11,270 cal B.P. (23). Based on dental and osteological aging methods, USR1 represents a late preterm fetus, and USR2 likely died within the first 6 wk of life (23). The proximity of these three burials, their context within the same feature, and radiocarbon analyses presented in Potter et al. (23) strongly suggest that all three burials represent nearly contemporaneous events, and that the three individuals were members of a single population.We attempted to extract and sequence the mitochondrial genomes from these three Late Pleistocene burials. From burnt bone fragments of the cremated infant and well-preserved samples of the petrous portion of the parietal bone, DNA was extracted using a silica-based method and attempts were made to Sanger sequence three overlapping fragments of the mitochondrial hypervariable region 1 (HVR1). From USR1 and USR2, all three HVR1 fragments were successfully amplified, and from the cremated infant only one fragment amplified, albeit inconsistently. DNA samples and applicable blank controls from USR1 and USR2 were converted to Ion Torrent Ion Plus Fragment libraries with laboratory-unique barcodes. We targeted the mitochondrial genomes by hybridization capture (24) and sequenced the libraries on two P1 chips with an Ion Proton System (Life Technologies). This is one of the first examples of the Ion Torrent technology applied to aDNA.     

四肢关节专用低场强MRI评估对膝关节损伤的诊断价值

目的：分析四肢关节专用低场强MRI诊断膝关节损伤的临床应用价值。 方法：于2004-12/2005-10解放军总医院全军骨科研究所收治经手术、关节镜检查或临床证实的膝关节损伤患者40例（43个膝关节）。应用Atorscan0.2T永磁型四肢关节专用低场强磁共振机,对膝关节损伤的MRI表现进行分析。 结果：四肢关节专用低场强MRI对半月板、前交叉韧带、骨挫伤等均可作出正确诊断。 结论：四肢关节专用低场强MRI对膝关节损伤的综合诊断具有重要意义,是膝关节损伤较理想的一种非创伤性检查方法。     

Blood transfusion exposure does not influence survival in patients with carcinoma of the breast

There is abundant evidence of immune modulation induced by exposure to blood transfusions. Some studies have demonstrated a detrimental effect of transfusion on the recurrence of malignant disease and survival. We retrospectively studied the impact of blood transfusion exposure on 229 patients with breast cancer who were seen from July 1973 to September 1980, had at least 5 years' follow-up and had been randomized by therapy at the time of diagnosis. The patients were divided into four groups according to transfusion history: Group 1 (111 patients), no transfusion; Group 2 (34 patients), first transfusion after mastectomy; Group 3 (41 patients), first transfusion at mastectomy; and Group 4 (43 patients), first transfusion before mastectomy. All transfused patients received red cells or whole blood or both. At the time of analysis, 124 (54%) of the patients had died. Only Group 2 was statistically associated with decreased survival; recurrence of disease was 85 percent in this group, compared with 53 percent to 61 percent in the other three groups (p = 0.006, log-rank test). In general, Group 2 patients received transfusions because of recurrent disease. We conclude that transfusions before or at mastectomy are not associated with increased recurrence or reduced survival in patients with breast cancer.     

人脂肪干细胞复合脱细胞软骨基质支架在生物反应器中构建组织工程软骨

目的:观察人脂肪干细胞复合脱细胞软骨基质支架在生物反应器中初步构建组织工程软骨的可行性。方法:实验于2005-04/2006-05在解放军总医院骨科研究所完成。脂肪组织和关节软骨均来自膝关节置换术中切除的组织,并经患者知情同意。关节软骨冻干后经粉碎机粉碎,过筛,选取25～38μm大小的软骨微粒。在样品中先加入2.5g/L胰蛋白酶,37℃消化24h,再加入1%Triton X-100震荡72h。将软骨微粒和蒸馏水按1∶3的比例混合后滴加在模板中,置入冷冻干燥机冻干后行紫外线交联。紫外线照射8h完成。最后经25kGy 60Co辐照灭菌完成支架制备。取膝关节置换术中切除的髌下脂肪垫,酶消法获得脂肪干细胞,扩增后复合于脱细胞软骨基质制成圆柱状三维支架上(细胞密度5×1010L-1),置于生物反应器中进行诱导培养,同时设静态培养组作为对照,3周后观测大体形态和组织学形态变化,同时进行组织化学(包括番红花O,阿利新蓝染色)和Ⅱ型胶原免疫组织化学分析。结果:生物反应器组诱导培养3周苏木精-伊红染色显示支架结构消失,只有中心区域残存少量支架结构;静态培养组支架结构尚存在,有少量基质分泌。番红花O染色显示生物反应器组细胞外有大量蛋白聚糖沉积,阿利新蓝染色表明有软骨特异性蛋白多糖的聚集;而静态培养组只有部分区域染色且淡于生物反应器组。Ⅰ型胶原免疫组化的结果显示,在生物反应器组细胞能够合成大量软骨细胞特异性胶原成分,而静态培养组呈弱阳性。结论:生物反应器培养明显促进了脂肪干细胞的增殖与软骨分化,是体外构建组织工程软骨的良好方法。     

The EMPOWER Study: Randomized, Prospective, Double-Blind, Multicenter Trial of Vagal Blockade to Induce Weight Loss in Morbid Obesity

Background

Intermittent, reversible intraabdominal vagal blockade (VBLOC? Therapy) demonstrated clinically important weight loss in feasibility trials. EMPOWER, a randomized, double-blind, prospective, controlled trial was conducted in USA and Australia.

Methods

Five hundred three subjects were enrolled at 15 centers. After informed consent, 294 subjects were implanted with the vagal blocking system and randomized to the treated (n?=?192) or control (n?=?102) group. Main outcome measures were percent excess weight loss (percent EWL) at 12?months and serious adverse events. Subjects controlled duration of therapy using an external power source; therapy involved a programmed algorithm of electrical energy delivered to the subdiaphragmatic vagal nerves to inhibit afferent/efferent vagal transmission. Devices in both groups performed regular, low-energy safety checks. Data are mean ± SEM.

Results

Study subjects consisted of 90?% females, body mass index of 41?±?1?kg/m², and age of 46?±?1?years. Device-related complications occurred in 3?% of subjects. There was no mortality. 12-month percent EWL was 17?±?2?% for the treated and 16?±?2?% for the control group. Weight loss was related linearly to hours of device use; treated and controls with ??12?h/day use achieved 30?±?4 and 22?±?8?% EWL, respectively.

Conclusions

VBLOC? therapy to treat morbid obesity was safe, but weight loss was not greater in treated compared to controls; clinically important weight loss, however, was related to hours of device use. Post-study analysis suggested that the system electrical safety checks (low charge delivered via the system for electrical impedance, safety, and diagnostic checks) may have contributed to weight loss in the control group.