Evaluation of mortality trajectories in evolutionary biodemography

An important task in evolutionary biodemography is to determine the schedule of survival and reproduction as the outcome of natural selection acting on life histories. We do this by using a model in which the state of the organism is characterized by mass and accumulated damage, both of which are affected by activity and which affect the rate of mortality. Focusing on growth during the juvenile period, we determine the level of activity that maximizes reproductive value. Given this, we are able to project forward and determine the trajectory of mortality for an individual following the optimal life history, given the physiological and reproductive parameters. We show that there are two main classes of juvenile mortality trajectories: U-shaped (such as recently reported for prereproductive humans) and steadily declining and we are able to connect the shape of the mortality trajectory with the physiological and reproductive parameters characterizing the life history. Our work shows the importance of state in models of evolutionary biodemography and the power of modern computational methods to illuminate biological process.     

Incubation period and sources of exposure for cutaneous Mycobacterium marinum infection: case report and review of the literature.

The diagnosis of cutaneous Mycobacterium marinum infection is often delayed for months after presentation, perhaps because important clinical clues in the patient's history are frequently overlooked. Knowledge of the incubation period allows the clinician to target questions about the patient's history. Prompted by a case with a prolonged incubation period, we sought to determine more precisely the incubation period of M. marinum infection. The MEDLINE database for the period 1966-1996 was searched for information regarding incubation period and type of exposure preceding M. marinum infection. Ninety-nine articles were identified, describing 652 cases. Forty cases had known incubation periods (median, 21 days; range, 5-270 days). Thirty-five percent of cases had an incubation period > or =30 days. Of 193 infections with known exposures, 49% were aquarium-related, 27.4% were related to fish or shellfish injuries, and 8.8% were related to injuries associated with saltwater or brackish water. Because the incubation period for cutaneous M. marinum infection can be prolonged, patients with atypical cutaneous infections should be questioned about high-risk exposures that may have occurred up to 9 months before the onset of symptoms.     

Venous thrombosis and permanent cardiac pacing

Two patients with transvenous permanent pacemakers developed axillary-subclavian vein thrombosis along the course of the catheter long after the immediate postinsertion period. Both responded well to anticoagulation therapy. It is important to determine the frequency of venous thromboembolism related to pacemaker catheters.     

Hospital admissions due to adverse reactions to Chinese herbal medicines.

Chinese herbal medicines (CHM) are commonly used in Hong Kong. To determine the importance of adverse reactions to CHM as a cause of medical admissions in Hong Kong, all 1701 patients admitted to two general medical wards at the Prince of Wales Hospital over an eight-month period were prospectively studied. In only three patients (0.2%) was the admission attributed to the adverse effects of CHM. These were life-threatening in two cases ('dazao'-induced angio-neurotic oedema and liquorice-induced hypokalaemic periodic paralysis). Despite this low incidence of adverse reactions, in communities where CHM are commonly used, it is important that there is a continuing effort to collect new information on the safety of these compounds.     

Role of non-invasive imaging in the management of coronary artery disease: an assessment of likely change over the next 10 years. A report from the British Cardiovascular Society Working Group

Coronary angiography has been the gold standard for determining the severity, extent and prognosis of coronary atheromatous disease for the past 15-20 years. However, established non-invasive testing (such as myocardial perfusion scintigraphy and stress echocardiography) and newer imaging modalities (multi-detector x ray computed tomography and cardiovascular magnetic resonance) now need to be considered increasingly as a challenge to coronary angiography in contemporary practice. An important consideration is the degree to which appropriate use of such techniques impacts on the need for coronary angiography over the next 10-15 years. This review aims to determine the role of the various investigation techniques in the management of coronary artery disease and their resource implications, and should help determine future service provision, accepting that we are in a period of significant technological change.     

The effect of hemodynamic factors on cardiac performance following open heart surgery

Sixteen patients who had undergone open heart surgery were studied in order to determine the factors influencing cardiac performance in the postoperative period. Hemodynamic influences during and following cardiopulmonary bypass were found to be more important than the preoperative cardiac function. The flow rate used during cardiopulmonary bypass had a pronounced influence on the post-operative cardiac performance. A low flow can result in the development of vasoconstriction postoperative with an increased chance of low cardiac output. A high flow during bypass is recommended, and in the postoperative period vasoconstriction must be treated vigorously to forecome low cardiac output.     

The PACIFIQUE registry in post PCI patients: study protocol

This paper presents the protocol of the PACIFIQUE survey, carried out in the most important French interventional cardiology centres (>600 procedures/year) during a 2-week period in January 2004, in order to determine actual practices in terms of medical management at hospital discharge and 6-month follow-up in patients treated with coronary angioplasty.     

氧化三甲胺与慢性疾病关系的研究进展及测定方法概述

氧化三甲胺(TMAO)为肠道微生物代谢产物,是近年来被关注较多的缺血损伤标志物。随着对肠道菌群研究的不断深入,研究者发现TMAO与慢性疾病,尤其是心脑血管疾病、糖尿病、慢性肾脏病等的关系越来越密切。这些疾病通常潜伏期较长,临床症状不明显,病程常表现为不可逆,预后不良。因此,对这些慢性疾病早发现、早治疗尤为重要。本文简要总结了TMAO与上述慢性疾病的关系及现阶段测定TMAO的主要方法,以期为临床及早干预此类慢性疾病提供理论依据。     

Dosage effect on uropathogenic <Emphasis Type="Italic">Escherichia coli</Emphasis> anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study

Background  

Ingestion of cranberry (Vaccinium macrocarpon Ait.) has traditionally been utilized for prevention of urinary tract infections. The proanthocyanidins (PACs) in cranberry, in particular the A-type linkages have been implicated as important inhibitors of primarily P-fimbriated E. coli adhesion to uroepithelial cells. Additional experiments were required to investigate the persistence in urine samples over a broader time period, to determine the most effective dose per day and to determine if the urinary anti-adhesion effect following cranberry is detected within volunteers of different origins.     

Intrinsic near-24-h pacemaker period determines limits of circadian entrainment to a weak synchronizer in humans

Endogenous circadian clocks are robust regulators of physiology and behavior. Synchronization or entrainment of biological clocks to environmental time is adaptive and important for physiological homeostasis and for the proper timing of species-specific behaviors. We studied subjects in the laboratory for up to 55 days each to determine the ability to entrain the human clock to a weak circadian synchronizing stimulus [scheduled activity-rest cycle in very dim (approximately 1.5 lux in the angle of gaze) light-dark cycle] at three approximately 24-h periods: 23.5, 24.0, and 24.6 h. These studies allowed us to test two competing hypotheses as to whether the period of the human circadian pacemaker is near to or much longer than 24 h. We report here that imposition of a sleep-wake schedule with exposure to the equivalent of candle light during wakefulness and darkness during sleep is usually sufficient to maintain circadian entrainment to the 24-h day but not to a 23.5- or 24.6-h day. Our results demonstrate functionally that, in normally entrained sighted adults, the average intrinsic circadian period of the human biological clock is very close to 24 h. Either exposure to very dim light and/or the scheduled sleep-wake cycle itself can entrain this near-24-h intrinsic period of the human circadian pacemaker to the 24-h day.     

Bronchopulmonary infection due to Moraxella (Branhamella) catarrhalis at a specialist hospital in Saudi Arabia

Moraxella (Branhamella) catarrhalis is now considered as one of the most important causative organisms responsible for respiratory tract infection. Specimens of tracheal aspirates from inpatients at King Fahd specialist hospital, Buraidah, Saudi Arabia were collected over a period of 18 months to determine prospectively the frequency of Moraxella catarrhalis and its antimicrobial susceptibility. Moraxella catarrhalis was isolated in pure culture from 3.8% of the tracheal aspirates collected from patients with symptoms of acute respiratory tract infections. It was the third most important pathogen after Haemophilus influenzae and Streptococcus pneumoniae; 76% of the patients had an underlying chronic obstructive pulmonary disease (COPD). The significance of the findings is discussed.     

The knowledge, attitude and behavior related to the tuberculosis and approaches of tuberculosis therapy by the physicians providing first step service

Before a performed education of tuberculosis for physicians who give first step treatment in our city center, a questionnaire was applied to the participants to evaluate the knowledge, attitude, behavior and approach to the treatment. The 66 practicing physician having an employment period of 64.88 +/- 39.42 months were coming from tuberculosis eradication dispensers at the rate of 3%, and from heath center at the rate 97%. The percentage of facing with tuberculosis patients in physicians, exclude who work in tuberculosis eradication dispensers, per year was median 7.30 +/- 9.77 (0-50). 21.2%, of the physicians determine that disease could be spread by only with respiratory tract, 77.3% of them consider that other than respiratory tract and 59.1% of them deemed that the most important factor is living in the same place with a tuberculosis patient and 75.8% of them determine that for a certain diagnosis the sputum examination is enough. 80.3% of the participants said that in our country conditions PPD must be done for the diagnosis. When the most important 4 tuberculosis drugs are asked only 16.7% of the physicians include morphozinamide as a first choice tuberculosis therapy. 48.5% of the physicians deemed that the therapy duration must be at least 6 months. 74.2% of them determine that follow up the disease must be made by sputum plus another examination, 93.9% of them indicated that the tuberculosis patients must be reported to tuberculosis eradication dispensers. When the hepatotoxicity is occurred, only 27.3% of the physicians could interfere the necessary implementation. 74.2% of them determine that the most important problem in control of tuberculosis is about diagnosis, therapy and follow up. When the directly observed treatment short course (DOTS) strategy is asked 16.7% of them gave correct answer. 34.9% of the first step physicians think that tuberculosis eradication dispensers is the primary responsible center in the control of tuberculosis but 53% of them think that tuberculosis eradication dispensers is inadequate in this subject. In conclusion, the first step practice physicians who work in Elazi? city center have insufficient knowledge and it is needed periodically postgraduate education.     

Mortality related to diagnostic cardiac catherization

Background. The mortality of diagnostic catheterization is very low but still exists. Large series have documented left main disease as the most important anatomical risk factor but have not clarified the mechanism. Objectives. (1) To determine the mortality of diagnostic catheterization in a single high volume centre over a 9 year period and assess any change during this period. (2) To compare this experience with that of larger multicentre surveys (3) To identify the clinical and anatomical risk factors. (4) To investigate the mechanism of the event (5) To develope quidelines for prevention. Methods. Cardiac catheterization records were reviewed over a 9 year period and patients dying during or within 24 hours were identified. The clinical and anatomical profile of the patients who died were compared with the overall group to search for independent risk factors. The angiograms of the deaths were reviewed for a mechanism. Results. There were 30 deaths in 42,345 procedures (0.071%). There was no change in the incidence over the 9 years. Left main coronary disease was an overwhelming risk factor (incidence 0.7%, p<.002 compared to all other subgroups) and no other anatomical subgroup including triple vessel disease was at greater risk than the overall group. Dissection of the left main coronary artery by the diagnostic catheter was the mechanism of death in 20 cases (67%). Conclusions. Left main disease and catheter induced trauma are the most important risk factor for and mechanism of death during diagnostic catheterization and may account for the unchanging incidence. Technical guidelines are described which may reduce this risk.     

Lactocrine programming of female reproductive tract development: environmental connections to the reproductive continuum

For eutherian mammals a continuum of maternal support insures that development of progeny follows an optimal program. Beginning in utero, such support extends into the early neonatal period when bioactive factors are communicated from mother to offspring in colostrum/milk. Defined as lactocrine signaling, communication of milk-borne bioactive factors from mother to offspring as a consequence of nursing is important for development of somatic tissues, including the female reproductive tract (FRT). Data for the domestic pig indicate that lactocrine signaling contributes to the maternal continuum of factors that define the developmental program and determine the developmental trajectory of FRT tissues during early neonatal life. Both naturally occurring and manmade factors of environmental origin can be communicated to neonates in milk and affect development with lasting consequences. Here, evidence for lactocrine programming of FRT development and the potential for environmental endocrine disruption of this process are reviewed.     

Perforation of esophagus after endoscopic variceal sclerotherapy

To determine the true incidence of endoscopic variceal sclerotherapy (EVS) -related esophageal perforation, a retrospective analysis of 900 EVS procedures using sodium tetradecyl sulfate performed on 170 patients during a five-year period (1980–1985) was carried out. Autopsy data of all patients who received EVS and who died (32 patients, 100%) during this period were available to confirm the diagnosis of perforation. Esophageal perforation was confirmed in 5 (2.9%) and was seen in patients with advanced alcoholic liver disease. Importantly, most patients did not manifest features of an esophageal leak, but presented instead as a deterioration in condition and died after a mean (±sd) 14±5.2 days. Analysis of the clinical and EVS data reveals that the risk of developing perforation is high when EVS is performed during active bleeding. The extravariceal location of sclerosant and microabscesses may be important predisposing factors. In our experience largedose injection, deep ulceration, and balloon tamponade are less likely predisposing factors of this complication.     

Postneurosurgical Nosocomial Bacterial Brain Abscess in Adults

Abstract Background: Bacterial brain abscess after a neurosurgical procedure has become an important occurrence in the hospital setting. However, no information about the frequency, clinical relevance, and the outcome has been reported. Patients and Methods: Over a period of 19 years (1986– 2004), a total of 31 patients were retrospectively identified as having brain abscesses after neurosurgical procedures and were enrolled in this study. Results: Those included in this study accounted for 0.17% (31/18600) of all neurosurgical procedures in the same period. There was an increased percentage of adult postneurological nosocomial brain abscess compared to all adult bacterial brain abscesses in recent years. The majority of cases were due to Gram-negative bacilli and polymicrobial infections, including both Gram-negative bacilli and Staphylococcus species. Furthermore, the appearance of multi-antibiotic resistant strains was also noted during the study period. The overall fatality rate was 16%. Conclusion: Post-neurosurgical states have become important predisposing factor for bacterial brain abscess. In patients that undergo neurosurgical procedures and develop smoldering fever, progressively disturbed consciousness, headache, and new onset focal neurologic signs, immediate neuro-imaging studies should be undertaken to determine whether bacterial brain abscess is present. Although mortality may be related to the primary brain pathology, early diagnosis and timely use of appropriate antibiotics based on antimicrobial susceptibility testing are also essential for survival.     

The Co-Relation of Alcoholics Anonymous Participation to Alcohol and Other Drug (AOD) Treatment Outcomes

A sample of 301 clients from a large substance abuse treatment facility was surveyed utilizing a pretest/posttest design. Participants completed measures both prior to participating in outpatient treatment and then approximately 7 months after discharge. Twelve-step participation was measured, along with effects of the individual 12 steps, to determine any contribution to treatment outcomes, including spirituality, health, mental health, and alcohol and other drug (AOD) outcomes. Analyses were conducted to determine if participation changed over the study period and whether it impacted outcomes after treatment. Results indicated that participation and the effects of the individual steps were not statistically significant in relation to many treatment outcomes. However, these factors were important in the development of client spirituality.     

Correlations among time and frequency domain measures of heart period variability two weeks after acute myocardial infarction.

Seven hundred fifteen participants from a multicenter natural history study of acute myocardial infarction were studied (1) to determine the correlations among time and frequency domain measures of heart period variability, (2) to determine the correlations between the measures of heart period variability and previously established post-infarction risk predictors, and (3) to determine the predictive value of time domain measures of heart period variability for death during follow-up after acute myocardial infarction. Twenty-four hour electrocardiographic recordings obtained 11 +/- 3 days after acute myocardial infarction were analyzed and 11 measures of heart period variability were computed. Each of 4 bands in the heart period power spectrum had 1 or 2 corresponding variables in the time domain that correlated with it so strongly (r greater than or equal to 0.90) that the variables were essentially equivalent: ultra low frequency power with SDNN* and SDANN index,* very low frequency power and low-frequency power with SDNN index,* and high-frequency power with r-MSSD* and pNN50.* As expected from theoretical considerations, SDNN and the square root of total power were almost perfectly correlated. Correlations between the time and frequency domain measures of heart period variability and previously identified postinfarction risk predictors, e.g., left ventricular ejection fraction and ventricular arrhythmias, are remarkably weak. Time domain measures of heart period variability, especially those that measure ultra low or low-frequency power, are strongly and independently associated with death during follow-up. * Defined in Table II.     

Hepatitis B: modern end points of treatment and the specter of viral resistance

The goal of antiviral treatment of chronic hepatitis B is to prevent the complications of cirrhosis, hepatic decompensation, HCC, and death. Because these clinical outcomes may take a long period of time to develop, it is important to use intermediate or surrogate end points to evaluate the efficacy and response to antiviral treatment, and to determine whether treatment can be safely stopped, especially given concern for the development of antiviral resistance with NUC therapy. Although normalization of ALT and suppression of HBV DNA viral replication are associated with favorable outcomes, the durability of their response is low, and these end points are insufficient markers for stopping treatment. HBeAg seroconversion is currently used to discontinue NUC treatment in patients with HBeAg-positive chronic hepatitis B, whereas the stopping rule for HBeAg-negative disease relies on HBsAg loss. However, HBsAg loss occurs very infrequently and is not a practical end point for clinical use, although quantitative HBsAg levels may be useful in identifying patients who could achieve a sustained virologic response to treatment.