Linezolid versus vancomycin or teicoplanin for nosocomial pneumonia: meta-analysis of randomised controlled trials

Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of nosocomial pneumonia. Compared with glycopeptide antibiotics, linezolid achieves higher lung epithelial lining fluid concentrations, which may have an advantage in treating nosocomial pneumonia patients. The objective of this study was to evaluate the efficacy and safety of linezolid versus vancomycin or teicoplanin for the treatment of nosocomial pneumonia. Data were obtained from the Cochrane Central Register of Controlled Trials and the EMBASE and MEDLINE databases. Randomised controlled studies involving the use of linezolid versus vancomycin or teicoplanin in nosocomial pneumonia patients were included in the study. Twelve linezolid trials were included. There was no statistically significant difference between the two groups in the treatment of nosocomial pneumonia regarding the clinical cure rate [relative risk (RR)?=?1.08, 95 % confidence interval (CI)?=?1.00–1.17, p?=?0.06]. Linezolid was associated with better microbiological eradication rate in nosocomial pneumonia patients compared with glycopeptide antibiotics (RR?=?1.16, 95 % CI?=?1.03–1.31, p?=?0.01). There were no differences in the all-cause mortality (RR?=?0.95, 95 % CI?=?0.83–1.09, p?=?0.46) between the two groups. However, the risks of rash (RR?=?0.41, 95 % CI?=?0.24–0.71, p?=?0.001) and renal dysfunction (RR?=?0.41, 95 % CI?=?0.27–0.64, p?<?0.0001) were higher with glycopeptide antibiotics. Although linezolid was more effective in eradicating microbiology than glycopeptide antibiotics for nosocomial pneumonia patients, it did not demonstrate superiority in clinical cure. The incidences of renal dysfunction and rash are higher in the glycopeptide antibiotics group.     

Association of E-selectin Gene Polymorphism (S128R) with Ischemic Stroke and Stroke Subtypes

E-selectin is an important inflammatory cytokine involved in the pathogenesis of various diseases such as atherosclerosis and stroke. We investigated the association of E-selectin gene polymorphism (S128R) with ischemic stroke and its subtypes. We studied 610 patients with ischemic stroke and 610 age- and sex-matched healthy controls. The ischemic stroke was classified according to Trial of Org10172 in Acute Stroke Treatment (TOAST). E-selectin gene polymorphism (S128R) was determined by polymerase chain reaction–restriction fragment length polymorphism technique. We found statistically significant difference in the genotypic distribution between patients and controls (for AC vs. AA, χ ²?=?49.5; p?<?0.001, odds ratio?=?5.47(95 % CI, 3.25–9.21). A significant difference was observed in the frequency of C and A alleles in patients and controls (for C vs. A, χ ²?=?47.4; p?<?0.001, odds ratio?=?5.13 (95 % CI, 3.06–8.57). Multiple logistic regression analysis revealed that the most predictive risk factor for stroke was AC genotype (adjusted odds ratio?=?1.450 (95 % CI, 1.23–2.75) and p?=?0.001), hypertension, smoking, and diabetes (p?=?0.001 in each case). We also found a significant association of AC genotype with intracranial large artery atherosclerosis (p?<?0.01, odds ratio?=?9.37, (95 % CI, 5.31–16.5) and small artery occlusion (p?<?0.0001, odds ratio?=?9.81 (95 % CI, 4.94–19.4). Our results indicate that the individuals bearing AC genotype of E-selectin gene polymorphism (S128R) are more prone to stroke than AA genotype.     

Two rescue therapies in lamivudine-resistant patients with chronic hepatitis B in the central China: adefovir monotherapy and adefovir plus lamivudine

The emergence of mutations that confer drug resistance in patients with chronic hepatitis B (CHB) is increasing in China. We aimed to compare the cumulative efficacy and resistance of adefovir (ADV) monotherapy and ADV add-on lamivudine (LAM) (ADV+LAM) therapy in LAM-resistant patients. One-hundred adult CHB patients with LAM-resistance mutations were identified. Of these 100, 52 patients were treated with ADV monotherapy and 48 were treated with ADV+LAM combination therapy for at least 24 months. After 2-year treatment, the cumulative rates of serum alanine aminotransferase normalization were, respectively, 73.1 and 83.3 % in the ADV monotherapy and ADV+LAM therapy groups (P = 0.216). Additionally, 36 patients receiving ADV plus LAM had hepatitis B e antigen loss/seroconversion, as compared with 30 in patients (P = 0.068). More patients who received LAM plus ADV than those who received ADV alone had HBV DNA levels below 1,000 international unit/milliliters (83.3 vs. 50 %, P < 0.001). Viral breakthrough and genotypic mutations were detected in 19 (36.5 %) and 9 (18.8 %) patients in the ADV monotherapy and ADV+LAM therapy groups, respectively (P = 0.048). ADV+LAM combination therapy demonstrated faster and significantly greater suppression of HBV DNA compared with ADV therapy alone for patients with LAM-resistance mutations. ADV+LAM was superior to ADV monotherapy in achieving the initial viral breakthrough and genotypic mutations. ADV+LAM combination therapy was rational for most of LAM-resistant Chinese patients with chronic hepatitis B.     

The relevance of Tim-3 polymorphisms and F protein to the outcomes of HCV infection

Hepatitis C virus (HCV) is one of the major causes of liver inflammation. The aim of this study was to investigate the associations of T-cell immunoglobulin and mucin domain-3 (Tim-3) polymorphisms and the alternate reading frame protein (F protein) with the outcomes of HCV infection. Three single-nucleotide polymorphisms (SNPs; rs10053538, rs12186731, and rs13170556) of Tim-3 were genotyped in this study, which included 203 healthy controls, 558 hepatitis C anti-F-positive patients, and 163 hepatitis C anti-F-negative patients. The results revealed that the rs12186731 CT and rs13170556 TC and CC genotypes were significantly less frequent in the anti-F-positive patients [odds ratio (OR)?=?0.54, 95 % confidence interval (CI)?=?0.35–0.83, p?=?0.005; OR?=?0.26, 95 % CI?=?0.18–0.39, p?<?0.001; and OR?=?0.19, 95 % CI?=?0.10–0.35, p?<?0.001, respectively), and the rs13170556 TC genotype was more frequent in the chronic HCV (CHC) patients (OR?=?1.70, 95 % CI?=?1.20–2.40, p?=?0.002). The combined analysis of the rs12186731 CT and rs13170556 TC/CC genotypes revealed a locus-dosage protective effect in the anti-F-positive patients (OR?=?0.22, 95 % CI?=?0.14–0.33, p _trend?<?0.001). Stratified analyses revealed that the frequencies of the rs12186731 (CT?+?TT) genotypes were significantly lower in the older (OR?=?0.31, 95 % CI?=?0.15–0.65, p?=?0.002) and female (OR?=?0.30, 95 % CI?=?0.17–0.52, p?<?0.001) subgroups, and rs13170556 (TC?+?CC) genotypes exhibited the same effect in all subgroups (all p?<?0.001) in the anti-F antibody generations. Moreover, the rs13170556 (TC?+?CC) genotypes were significantly more frequent in the younger (OR?=?1.86, 95 % CI?=?1.18–2.94, p?=?0.007) and female (OR?=?2.38, 95 % CI?=?1.48–3.83, p?<?0.001) subgroups of CHC patients. These findings suggest that the rs12186731 CT and rs13170556 TC/CC genotypes of Tim-3 provide potential protective effects with the F protein in the outcomes of HCV infection and that these effects are related to sex and age.     

Association of genetic variants in estrogen receptor α with HCV infection susceptibility and viral clearance in a high-risk Chinese population

The purpose of this study was to test the hypothesis that genetic variants of estrogen receptor α (ERα) are associated with the outcomes of hepatitis C virus (HCV) infection. We genotyped the seven single nucleotide polymorphisms (SNPs) (rs2077647, rs9340799, rs2234693, rs1801132, rs9322354, rs2228480 and rs3798577) of ERα and conducted a case-control study in a high-risk Chinese population, including 429 HCV spontaneous clearance cases, 880 persistent infection cases and 1,174 uninfected controls. The C allele of rs2234693 was significantly associated with increased susceptibility to HCV infection [dominant model: adjusted odds ratio (OR)?=?1.377, 95 % confidence interval (CI) =1.126–1.778], and the risk effect remained significant among the younger (≤55 years) and hemodialysis subjects (all P?<?0.007). The other three SNPs variant genotypes also showed significant correlation with elevated risk of HCV infection in different strata (rs2077647 in males; rs9340799 in blood donors; rs1801132 in younger subjects; all P?<?0.007). It was also discovered that carriage of rs2228480 A allele was more prone to develop persistent HCV infection (dominant model: adjusted OR?=?1.203, 95 % CI?=?1.154–1.552), and the risk effect was more evident in females and blood donors (all P?<?0.007). Haplotype analyses (rs2077647, rs9340799 and rs2234693) showed that, compared with the most frequent haplotype TAT, CAC played a risk effect in subgroups of younger (P?=?3.24?×?10^?3) and male (P?=?5.51?×?10^?4), whereas CAT expressed a protective effect in females (P?=?2.27?×?10^?4) for HCV infection susceptibility. We first report that these SNPs (rs2077647, rs9340799, rs2234693, rs1801132 and rs2228480) in ERα can influence the outcomes of HCV infection in a high-risk Chinese population.     

TNF-α-308 promoter G/A and PTPN22 (1858 C/T) genes polymorphisms in Egyptian patients with systemic lupus erythematosus

Tumor necrosis factor alpha (TNF-α) promoter gene polymorphism at position 308 and that of the protein tyrosine phosphatase nonreceptor type 22 (PTPN22) at position 1858 C/T have been inconsistently implicated as genetic risk factors for systemic lupus erythematosus (SLE) in some populations. We investigated the possible association of these polymorphisms with SLE susceptibility, and whether serum TNF-α level is related to different genotypes and disease activity in Egyptian SLE patients. TNF-α-308 G/A and PTPN22 C1858T polymorphisms were determined by PCR-restriction fragment length polymorphism analysis in 40 SLE patients and 40 unrelated healthy controls. Serum TNF-α level was measured by ELISA method. The median serum TNF-α was significantly higher in SLE patients than in controls (P?<?0.001). A significant positive correlation was detected between serum TNF-α and SLE activity index (r?=?0.723, P?<?0.001). There was no significant difference in TNF-α-308 G/A genotypes or allele frequency between SLE cases and controls (P?=?0.108 and P?=?0.133, respectively). Diabetes was the only clinical feature in SLE patients that showed significant higher frequency with GA genotype than with GG genotype (P?=?0.001). Risk estimation for the TNF-α-308 genotypes was of no significant (odds ratio?=?2.429; 95 % CI?=?0.8–7.2; P?=?0.108). Concerning PTPN22 1858 C/T, there was no significant difference in PTPN22 C/T genotypes or allele frequency between SLE cases and controls (P?=?0.152 and P?=?0.155, respectively). TNF-α-308 G/A and PTPN22 (1858 C/T) polymorphisms do not exhibit a significant influence on the susceptibility of SLE in Egyptian patients. However, serum TNF-α level could be a sensitive marker of SLE disease activity.     

Ribotype 027 Clostridium difficile infections with measurable stool toxin have increased lactoferrin and are associated with a higher mortality

We evaluated clinical and diagnostic indicators of severe C. difficile infection (CDI) and their association with poor clinical outcome. A total of 210 patients positive according to PCR (toxin B: tcdB) were included, with patients having a median age of 62 years and a Charlson co-morbidity index (CI) score of 5. Ninety-one percent (n?=?191) were positive by toxigenic culture and 61 % (n?=?129) had stool toxin. Toxin-positive patients had significantly higher fecal lactoferrin (mean 316 μg/g versus 106 μg/g stool; p?<?0.0001). Forty percent of patients (n?=?85) were infected with ribotype 027 and significantly more of these patients had measurable stool toxin (79 % vs. 50 %; p?<?0.0001). The mean fecal lactoferrin was significantly higher for toxin-positive 027 CDI compared with the 027 toxin-negative group (317 vs 60 μg/g; p?=?0.0014). Ribotype 027 CDI with stool toxin showed a higher all-cause, 100-day mortality compared with non-027 with stool toxin (36 % vs 18 %; p?=?0.017). Logistic regression univariate analysis for odds ratio (OR) and p values revealed that age (OR?=?1.1), intensive care unit treatment (OR?=?2.7), CI (OR?=?1.2), 027 CDI (OR?=?2.1), white blood cell count (OR?=?1.0), albumin level (OR?=?0.1), and stool toxin-positive 027 CDI (OR?=?2.5) were significantly associated with 100-day mortality (p?<?0.05). In conclusion, CDI PCR-positive patients with 027 infection and stool toxin have increased lactoferrin and are at an increased risk of death.     

Impact of multidrug resistance on Pseudomonas aeruginosa ventilator-associated pneumonia outcome: predictors of early and crude mortality

The prevalence of multidrug-resistant (MDR) Pseudomonas aeruginosa has increased over the past decade and a significant rise in these isolates in ventilator-associated pneumonia (VAP) has been observed. However, the impact of MDR on VAP outcome has not been analysed in depth. We investigated the risk factors for early and crude mortality in a retrospective study of microbiologically and clinically documented VAP. Ninety-one VAP episodes in 83 patients were included, 31 caused by susceptible P. aeruginosa and 60 by MDR strains, of which 42 (70 %) were extensively drug-resistant (XDR) P. aeruginosa. Thirteen episodes concomitantly presented P. aeruginosa bacteraemia, in seven of which the origin was the respiratory tract. Whereas susceptible P. aeruginosa episodes were more likely than MDR episodes to receive adequate empirical (68 % vs. 30 %; p?<?0.001) and definitive antimicrobial therapy (96 % vs. 50 %; p?<?0.001), susceptible P. aeruginosa VAP presented a trend towards early mortality (29 % vs. 15 %; p?=?0.06). A logistic regression model with early mortality as the dependent variable identified multiorgan dysfunction syndrome (MODS) [odds ratio (OR) 10.4; 95 % confidence interval (CI) 1.7–63.5; p?=?0.01] and inadequate antibiotic therapy (OR 4.27; 95 % CI 0.98–18.4; p?=?0.052) as independent risk factors for early mortality. A similar analysis identified MODS (OR 4.31; 95 % CI 1.14–16.2; p?=?0.03) as the only independent predictor of crude mortality. The severity of acute illness clinical presentation was the main predictor of mortality. Despite adequate antibiotic therapy, susceptible P. aeruginosa seems to cause major early mortality. Although adequate therapy is essential to treat VAP, the severity of acute illness is a more important factor than drug resistance.     

Relationship between transforming growth factor-β1 and type 2 diabetic nephropathy risk in Chinese population

Background

Diabetes mellitus (DM) is divided into four different etiological categories: type 1 DM (T1DM), type 2 DM (T2DM), other specific types, and gestational DM. One severe complication of T2DM is type 2 diabetic nephropathy (T2DN). The possible association of serum transforming growth factor-β1 (TGF-β1) levels and the TGF-β1 T869C gene polymorphism with patient susceptibility to T2DN in Chinese population is unclear at present. This study was conducted to assess these relationships in Chinese population by a meta-analysis.

Methods

Association reports were searched and pulled from the Cochrane Library, the China Biological Medicine Database (CBM), and PubMed on March 1, 2018, and eligible studies were selected and used for calculations. The results were expressed as weighted mean differences (MD) for continuous data. Odds ratios (OR) were used to express the results for dichotomous data. Additionally, 95% confidence intervals (CI) were calculated.

Results

Forty-eight reports for the relationship between serum TGF-β1 levels and the risk of T2DN and 13 studies on the association of the TGF-β1 T869C gene polymorphism with susceptibility to T2DN in Chinese population were retrieved from this study. Serum TGF-β1 levels in the T2DM group were higher than those in the normal control group (MD?=?17.30, 95% CI: 12.69–21.92, P?<?0.00001). The serum TGF-β1 level in the T2DN group was significantly higher than that in the normal control group (MD?=?70.03, 95% CI: 60.81–79.26, P?< 0.00001;). The serum TGF-β1 level in the T2DN group was significantly higher than that in the T2DM group (MD?=?56.18, 95% CI: 46.96–65.39, P?< 0.00001). Serum TGF-β1 levels in T2DM patients with microalbuminuria were increased when compared with those in T2DM patients with normoalbuminuria. Furthermore, serum TGF-β1 levels in T2DM patients with macroalbuminuria were increased when compared with those in T2DM patients with microalbuminuria. The TGF-β1 T allele, TT allele and CC genotype were associated with T2DN susceptibility in Chinese population (T: OR?=?0.74, 95% CI: 0.59–0.92, P?=?0.007; TT: OR?=?0.55, 95% CI: 0.31–0.96, P?=?0.04; CC: OR?=?1.38, 95% CI: 1.14–1.67, P?=?0.001).

Conclusions

High levels of TGF-β1 are associated with susceptibility to T2DM, T2DN and the progression of proteinuria in T2DN patients in Chinese population. Further, the TGF-β1 T allele, and TT genotype were protective factors against the onset of T2DN and CC genotype was a risk factor for the susceptibility of T2DN in Chinese populations.

     

Middle patellar tendon to posterior cruciate ligament (PT–PCL) and normalized PT–PCL: New magnetic resonance indices for tibial tubercle position in patients with patellar instability

Background

To demonstrate whether the distance between the middle point of the patellar tendon and posterior cruciate ligament (PT–PCL) calculated on a single axial MR image could be an alternative measure to tibial tubercle–PCL (TT–PCL) distance for TT lateralization without the need of imaging processing. To show that normalization of PT–PCL (nPT-PCL) against the maximum diameter of the tibial plateau may help to identify patients with patellar instability (PI).

Differences in successful treatment completion among pregnant and non-pregnant American women

The present study explores characteristics of successful substance abuse treatment completion of pregnant women through an analysis of retrospective outcomes data. Women without prior treatment admissions, aged 18–44, and not in methadone maintenance therapy were included (N?=?678,782). Chi-square tests analyzed significant differences; logistic regression provided predictive probabilities; odds ratios (OR) and risk differences with 95 % confidence intervals represent the effect sizes and clinically meaningful differences. Pregnant women were less likely to successfully complete treatment than non-pregnant women (χ ²?=?321.33, df?=?1, p?<?0.0001), though the difference was not clinically meaningful (risk difference?=?4.75, 95 % confidence interval (CI)?=?4.23–5.26). Aside from criminal justice agencies, “other community agencies” refer the greatest percentage of pregnant women to treatment (risk difference?=?6.37, 95 % CI?=?5.89–6.84). Pregnant women successfully complete treatment more than non-pregnant women in only non-intensive outpatient settings (χ ²?=?10,182.48, df?=?7, p?<?0.0001). Further attention to referral source and treatment setting for pregnant women may improve successful treatment completion by targeting needs of pregnant women. Referring to non-intensive outpatient and residential hospital treatment settings may help to ameliorate prenatal substance abuse treatment contingent on the primary problem substance.     

Longitudinal monitoring of liver fibrosis status by transient elastography in chronic hepatitis B patients during long-term entecavir treatment

The correlation between improvement in longitudinal liver stiffness and fibrosis regression has not been properly evaluated during long-term antiviral therapy in chronic hepatitis B (CHB) patients. In this study, liver stiffness was serially performed by FibroScan^® every 26 weeks in a prospective cohort of CHB patients receiving entecavir. Results were compared with liver biopsies at baseline and week 78. A total of 120 treatment-naïve CHB patients were analyzed, in which 54 (45%) patients had fibrosis regression at 78 weeks of antiviral therapy. Liver stiffness measurement presented as a rapid-to-slow decline pattern and decreased more significantly in patients with fibrosis regression than those without improvement in fibrosis at week 78 (? 46.4 vs. ? 28.6%, P?<?0.001). Multivariate analysis revealed that percentage decline of 52-week and 78-week liver stiffness from baseline was independent predictive factors for fibrosis regression (OR?=?46.6, P?<?0.001; OR?=?17.8, P?=?0.002, respectively). Moreover, percentage decline of 78-week liver stiffness was moderately predictive of fibrosis regression (AUROC?=?0.694, P?<?0.001), while the optimal cutoff values were different between non-cirrhosis and cirrhosis patients (38 vs. 45%). Fibrosis regression could be predicted with a high positive predictive value (96%) in non-cirrhosis patients and could be excluded with a high negative predictive value (94%) in cirrhosis patients. In conclusion, serial liver stiffness measurement could be applied for longitudinal monitoring of fibrosis status in CHB patients. Continuous decline of liver stiffness after effective antiviral treatment could partially reflect fibrosis regression at an optimal cutoff value.     

Therapeutic drug monitoring and receiver operating characteristic curve prediction may reduce the development of linezolid-associated thrombocytopenia in critically ill patients

To investigate the risk factors associated with the development of thrombocytopenia, and define the thresholds of efficacy and safety in critically ill patients who received linezolid therapy. A retrospective study was performed in critically ill patients treated with linezolid. Risk factors associated with thrombocytopenia were identified via medical records and trough levels (C_min) measured during linezolid treatment. By establishing a logistic model, the risks were predicted by the receiver operating characteristic (ROC) curve and the thresholds of efficacy and safety were identified in the patients. Logistic analysis showed that, weight (OR?=?0.906; 95 % CI, 0.839–0.978; P?=?0.011), baseline platelet count (OR?=?0.989; 95 % CI, 0.977–1.000; P?=?0.049), C_min (OR?=?1.545; 95 % CI, 1.203–1.983; P?=?0.001), and APACHE II score (OR?=?1.130; 95 % CI, 1.003–1.273; P?=?0.044) were significant factors for linezolid-associated thrombocytopenia. The area under the ROC curve of the combined predictor was larger based on the above factors. When the Youden index was the maximum, the best optimal cut-off point was 205.6 on the ROC curve; when C_min?≥?2 mg/L, the probability of bacterial eradication was more than 80 %; when C_min?≥?6.3 mg/L, the probability of thrombocytopenia was more than 50 %. In clinical practice, when the calculating results of the combined predictor ≤205.6, the risk of the development of thrombocytopenia may be higher. Furthermore, maintenance of C_min between 2 and 6.3 mg/L over time may be helpful in retaining appropriate efficacy and reducing the associated thrombocytopenia.     

Efficacy of adefovir add‐on lamivudine rescue therapy compared with switching to entecavir monotherapy in patients with lamivudine‐resistant chronic hepatitis B

No study has reported on the comparative effect of adefovir (ADV) add‐on lamivudine (LAM) versus switching to entecavir (ETV) in LAM‐resistant patients with chronic hepatitis B. From October 2007 to September 2008, 92 consecutive LAM‐resistant patients were enrolled (47 LAM + ADV and 45 ETV 1 mg). All patients were followed for at least 12 months. The parameters assessed included normalization of ALT, HBeAg seroconversion, undetectable HBV DNA, reduction of HBV DNA, and predictors of virologic response. In the LAM + ADV and ETV groups, the baseline DNA levels were 7.61 (5.19–9.49) and 7.10 (5.43–9.74) log₁₀ copies/ml, respectively. At month 12, a virologic response occurred in 18/47 (38.3%) and 11/45 (24.4%; P = 0.182) patients; ALT normalization, in 39/41 (95.1%) and 36/40 (90.0%; P = 0.432); HBeAg seroconversion, in 5.1% and 2.4% (P = 0.606); and virologic breakthrough, in 2.1% and 11.1% (P = 0.107), respectively. The mean reduction from the baseline HBV DNA level was greater in the LAM + ADV group at month 12 (3.80 ± 1.12 vs. 2.72 ± 1.32 log₁₀ copies/ml; P < 0.001). In the multivariate analysis, the independent parameters related to a virologic response at month 12 were baseline ALT (OR = 1.003, 95% CI = 1.000–1.006, P = 0.026) and baseline HBV DNA (OR = 0.495, 95% CI = 0.298–0.823, P = 0.007). Compared with switching to ETV monotherapy, ADV add‐on LAM therapy was more effective at reducing the viral load in patients with LAM resistance, and the baseline HBV DNA and ALT levels were independent predictors of the virologic response. However, ADV add‐on therapy had limitations in patients with a higher baseline HBV DNA in LAM rescue therapy. J. Med. Virol. 82:1835–1842, 2010. © 2010 Wiley‐Liss, Inc.     

Measurements of cancer extent in a conservatively treated prostate cancer biopsy cohort

The optimal method for measuring cancer extent in prostate biopsy specimens is unknown. Seven hundred forty-four patients diagnosed between 1990 and 1996 with prostate cancer and managed conservatively were identified. The clinical end point was death from prostate cancer. The extent of cancer was measured in terms of number of cancer cores (NCC), percentage of cores with cancer (PCC), total length of cancer (LCC) and percentage length of cancer in the cores (PLC). These were correlated with prostate cancer mortality, in univariate and multivariate analysis including Gleason score and prostate-specific antigen (PSA). All extent of cancer variables were significant predictors of prostate cancer death on univariate analysis: NCC, hazard ration (HR)?=?1.15, 95% confidence interval (CI)?=?1.04–1.28, P?=?0.011; PPC, HR?=?1.01, 95% CI?=?1.01–1.02, P?<?0.0001; LCC, HR?=?1.02, 95% CI?=?1.01–1.03, P?=?0.002; PLC, HR?=?1.01, 95% CI?=?1.01–1.02, P?=?0.0001. In multivariate analysis including Gleason score and baseline PSA, PCC and PLC were both independently significant P?=?0.004 and P?=?0.012, respectively, and added further information to that provided by PSA and Gleason score, whereas NNC and LCC were no longer significant (P?=?0.5 and P?=?0.3 respectively). In a final model, including both extent of cancer variables, PCC was the stronger, adding more value than PLC (χ ² (1df)?=?7.8, P?=?0.005, χ ² (1df)?=?0.5, P?=?0.48 respectively). Measurements of disease burden in needle biopsy specimens are significant predictors of prostate-cancer-related death. The percentage of positive cores appeared the strongest predictor and was stronger than percentage length of cancer in the cores.     

Molecular epidemiology of Theileria equi in horses and their association with possible tick vectors in the state of Rio de Janeiro, Brazil

The aim of this study was to detect Theileria equi (Laveran 1901) DNA in horses and ticks using real-time PCR and to list the factors associated with infection in animals located in the Seropedica and Petropolis municipalities of the state of Rio de Janeiro. We tested blood samples from 314 horses and samples from 300 ticks, including 191 Amblyomma cajennense, 104 Dermacentor nitens, and 5 Ixodida larvae. Factors inherent to the horse, the ownership, and animal management were obtained from an epidemiological questionnaire and were evaluated in association with the presence of T. equi DNA in the animals. Among the horses in the study, 81 % (n?=?253/314) presented T. equi DNA, and the animals of the Seropedica municipality had the highest infection frequency (91 %, n?=?128/141, p?<?0.001). The factors that had significantly different infection frequencies by chi-squared or Fisher’s exact tests (p?<?0.2) were included in a logistic regression model using the R programming package. Work and walking activity (odds ratio [OR]?=?5.7, CI?=?2.3–14.4), reproductive activity (OR?=?3.8, CI?=?1.3–11.5), and tick infestation (OR?=?2.6, CI?=?1.1–6.2) were factors that favored the presence of T. equi DNA in the animals (p?<?0.05). Among the tick samples, A. cajennense and D. nitens were the identified species. The presence of T. equi DNA was observed in 9.9 % (n?=?19/191) of the A. cajennense samples and 3.8 % (n?=?4/104) of the D. nitens samples. A multivariate analysis revealed that the presence of A. cajennense on the animals (OR?=?4.1, CI?=?1.8–9.1) was associated with the presence of T. equi DNA in the horses. In the studied municipalities, activities related to work, walking, and reproduction and the presence of ticks on the horses, particularly an intense infestation of A. cajennense, are factors that lead to infection with T. equi in the horses.     

The Risk Factors of Avascular Necrosis in Patients with Systemic Lupus Erythematosus: a Meta-analysis

The aim of this study was to determine the risk factors for avascular necrosis (AVN) in patients with systemic lupus erythematosus (SLE). Four electronic databases (PubMed, EMBASE, Ovid, and Science Direct) were searched for. The search was performed to identify the articles as to SLE with AVN before September 2013. The clinical and laboratory data were extracted, and a meta-analysis was performed to identify the risk factors for AVN in patients with SLE. Publication bias was assessed with funnel plot and Egger’s test. A total of 995 papers were found from the four databases; 16 studies were finally included. Pooled analysis showed the following result. The result showed that arthritis (odds ratio (OR)?=?2.448, 95 % confidence interval (CI)?=?1.617–3.707), cushingoid (OR?=?3.890, 95 % CI?=?1.591–9.510), gastrointestinal involvement (OR?=?2.054, 95 % CI?=?1.283–3.290), hypertension (OR?=?1.482, 95 % CI?=?1.093–2.008), oral ulcers (OR?=?1.877, 95 % CI?=?1.182–2.979), pleuritis (OR?=?2.302, 95 % CI?=?1.325–4.001), renal disease (OR?=?1.475, 95 % CI?=?1.124–1.936), and vasculitis (OR?=?2.591, 95 % CI?=?1.358–4.944) were relevant with AVN in SLE patients. Cytotoxic drug (OR?=?1.834, 95 % CI?=?1.065–3.156, P?=?0.029), the total cumulative dose (Standard Mean Difference (SMD) = 1.104, 95 % CI = 0.118–2.090, P = 0.028), maximum daily dose (SMD = 0.484, 95 % CI = 0.288–0.678, P < 0.001), and mean daily dose (SMD?=?1.305, 95 % CI?=?0.061–2.549, P?=?0.040) were significantly higher in AVN group. There were no significantly laboratory features that appeared in this pooled analysis. We conclude that arthritic, cushingoid, gastrointestinal involvement, hypertension, oral ulcers, pleuritis, renal disease, vasculitis, cytotoxic drug, and steroid treatment may contribute to AVN in SLE patients.     

The correlation between <Emphasis Type="Italic">Toxoplasma gondii</Emphasis> infection and prenatal depression in pregnant women

Previous studies have demonstrated that latent toxoplasmosis is associated with neuropsychiatric disorders. We evaluated the correlation between Toxoplasma gondii infection and prenatal depression. In this case–control study, we enrolled 116 depressed pregnant women and 244 healthy controls. The Edinburgh Postpartum Depression Scale (EPDS) was used to evaluate the depression symptom severity in study participants. All participants were screened for the anti-Toxoplasma IgG by enzyme-linked immunosorbent assay. Seroprevalence of T. gondii did not significantly differ between the depressed pregnant women and healthy controls (OR?=?1.4; 95 % CI?=?0.9–2.19; P?=?0.142). T. gondii IgG titer was significantly higher in depressed women (18.6?±?10.9 IUs) than those in the control group (13.6?±?8.1 IUs) (z?= ?5.36, P?<?0.001). The T. gondii–positive depressed women showed a positive correlation of T. gondii IgG titer with the EPDS scores (r?=?0.52; P?<?0.01). The mean EPDS score was also significantly higher in the T. gondii–positive depressed women (20.7?±?2.7) compared with the controls (18.36?±?2.7) (P?<?0.001). The results obtained from the current study revealed that T. gondii infection might affect susceptibility to depression and severity of depressive symptoms in pregnant women, particularly in those patients who have high antibody titers. Further study is required to fully elucidate the characteristics and mechanisms of this association.     

The role of meniscal tears and meniscectomy in the mechanical stability of the anterior cruciate ligament deficient knee

Background

The role of an intact meniscus in providing mechanical stability to the knee of anterior cruciate ligament (ACL) deficient and ACL reconstructed patients has not been well studied.