Impact of a Home Telehealth Program After a Hospitalized COPD Exacerbation: A Propensity Score Analysis

IntroductionCurrently there is lack of data regarding the impact of a home telehealth program on readmissions and mortality rate after a COPD exacerbation-related hospitalization.ObjectiveTo demonstrate if a tele-monitoring system after a COPD exacerbation admission could have a favorable effect in 1-year readmissions and mortality in a real-world setting.MethodsThis is an observational study where we compared an intervention group of COPD patients treated after hospitalization that conveyed a telehealth program with a followance period of 1 year with a control group of patients evaluated during one year before the intervention began. A propensity-score analyses was developed to control for confounders. The main clinical outcome was 1-year all-cause mortality or COPD-related readmission.ResultsThe analysis comprised 351 telemonitoring patients and 495 patients in the control group. The intervention resulted in less mortality or readmission after 12 months (35.2% vs. 45.2%; hazard ratio [HR] 0.71 [95% CI = 0.56–0.91]; p = 0.007). This benefit was maintained after the propensity score analysis (HR = 0.66 [95% CI = 0.51–0.84]). This benefit, which was seen from the first month of the study and during its whole duration, is maintained when mortality (HR = 0.54; 95% CI = [0.36–0.82]) or readmission (subdistribution hazard ratio [SHR] 0.66; 95% CI = [0.50–0.86]) are analyzed separately.ConclusionTelemonitoring after a severe COPD exacerbation is associated with less mortality or readmissions at 12 months in a real world clinical setting.     

A nationwide population cohort study: Irritable bowel syndrome is a risk factor of osteoporosis

BackgroundThe goal of the study is to determine the relationship between irritable bowel syndrome (IBS) and osteoporosis in Taiwan.Materials and methodsWe collected data from the National Health Insurance (NHI) program in Taiwan. The sample in this study consisted of 31,892 patients enrolled from 2000 to 2009 and diagnosed by the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). We divided the sample into 2 cohorts based on whether they had IBS, and formed subgroups based on age, sex, enrolment year, and enrolment month.ResultsAge and gender did not differ statistically among the 2 cohorts. Results show that IBS is more correlated with urbanization and the occupation of business. The IBS cohort had a higher incidence of osteoporosis than the non-IBS cohort (6.90 vs 4.15 per 1000 person-years; HR = 1.65, 955 CI = 1.54–1.77). Female patients aged 40–59 years had the highest risk of developing osteoporosis (HR = 4.42, 95% CI = 3.37–5.79 in the IBS cohort; HR = 4.41, 95% CI = 3.67–5.29 in the non-IBS cohort, respectively). In IBS patients less than 40 years of age, female patients had a significant 2.18-fold greater risk of developing osteoporosis than male patients (HR = 2.18, 95% CI = 1.09–4.38).ConclusionsIBS is a risk factor for osteoporosis in Taiwan.     

Le spasme coronaire lié à la dobutamine chez les patients avec des échocardiographies de stress faussement positives : prévalence et facteurs prédictifs

Background and objectiveDobutamine stress echocardiography (DSE) is being consistently used as an exercise-independent stress modality aimed at the detection of coronary artery disease (CAD) and the evaluation of myocardial ischemia. It may though occasionally induce coronary vasospasm. In this study, we aimed to evaluate the prevalence and predictors of dobutamine-related coronary spasm in patients without known CAD and false positive DSE (positive DSE but no significant coronary lesions on angiogram).MethodsThree thousand nine hundred and fifty-two patients referred to our echocardiography laboratory for DSE between January 2010 and May 2012 were prospectively investigated. Those with positive DSE underwent coronary angiograms with systematic methylergometrine intracoronary injection in case of absence of significant coronary stenosis or spontaneous occlusive coronary spasm. Patients with spontaneous occlusive coronary spasm or positive methylergometrine test but no significant stenoses were enrolled and compared with those with positive DSE but no coronary lesions nor spontaneous or induced spasm (“true” false positive DSE).ResultsTwenty-nine patients with DSE-related vasospasm (19.4% of positive DES without known CAD) were compared with 56 patients with no lesions and no spasm (“true” false positive DSE). They were more frequently smokers (72.4% vs 37.5%; P = 0.003); they had more frequently dyslipidemia (79.3% vs 43%; P = 0.001); they also had a larger ischemic area at peak DSE (3.4 segments vs 2.7 segments; P = 0.05). On multivariate analysis, dyslipidemia (HR = 10.7; 95% CI = [2.7–42.1]; P = 0.001) and active smoking (HR = 6.1; 95% CI = [1.7–21.1]; P = 0.004) were found to be independent predictors of spasm-related DSE rather than “true” false positive DSE.ConclusionDSE-related coronary spasm is present in a significant proportion of patients with erroneously labelled “false” positive DSE and should systematically be ruled out. Dyslipidemia and active smoking were independent predictors of spasm rather than “true” false positive DSE.     

Relationship between circulating endothelial progenitor cells and insulin resistance in non-diabetic patients with ischemic chronic heart failure

AimThe objective of this study was to assess a relationship between insulin resistance (IR) and counts of CD45⁻CD34⁺, CD14⁺CD309⁺, and CD14⁺CD309⁺Tie2⁺ phenotyped circulating endothelial progenitor cells (EPCs) in patients with ischemic chronic heart failure (CHF).MethodsThe study involved 300 CHF patients (186 males) aged 48–62 years with angiografically proven coronary artery disease and/or previously defined myocardial infarction. Insulin resistance was assessed by the homeostasis model assessment for insulin resistance (HOMA-IR). EPC populations were phenotyped by flow cytofluorimetry.ResultsCirculating EPCs counts were statistically significantly lower in CHF patients with IR than in patients without IR. We found that the most valuable multivariable predictors of the depletion of the CD45⁺CD34⁺ EPCs were NT-pro-brain natriuretic peptide (BNP) (1.32; 95% CI = 1.19–2.77; P = 0.001), left ventricular ejection fraction (OR = 1.30; 95% CI = 1.09–1.60; P = 0.002), NYHA class (OR = 1.12; 95% CI = 1.02–1.19; P = 0.001). NT-pro-BNP (OR = 1.45; 95% CI = 1.15–2.90; P = 0.003), left ventricular ejection fraction (OR = 1.32; 95% CI = 1.11–1.65; P = 0.001) were found as powerful predictors for depletion in CD45⁻CD34⁺ EPCs. We also identified six independent variables with high predictive value for depletion of CD14⁺CD309⁺ EPCs: NT-pro-BNP (OR = 1.41; 95% CI = 1.15–2.90; P = 0.003), left ventricular ejection fraction (OR = 1.18; 95% CI = 1.10–1.76; P = 0.036), NYHA class (OR = 1.15; 95% CI = 1.07–1.22; P = 0.001), hs-C reactive protein (OR = 1.02; 95% CI = 1.01–1.05; P = 0.012). As independent multivariable predictors for depletion in CD14⁺CD309⁺Tie2⁺ EPCs were selected five variables: NT-pro-BNP (OR = 1.65; 95% CI = 1.44–4.70; P = 0.006), left ventricular ejection fraction (OR = 1.07; 95% CI = 1.02–1.12; P = 0.018), NYHA class (OR = 1.13; 95% CI = 1.06–1.21; P = 0.001), hs-C-reactive protein (OR = 1.08; 95% CI = 1.03–1.16; P = 0.002).ConclusionIR may be an additional factor contributing decreased circulating level of proangiogenic EPCs in non-diabetic CHF patients.     

The relationship between Helicobacter pylori and cancer risk

ObjectivesThis study investigated the correlation between Helicobacter pylori (HP) and cancer risk. We compared the age, sex, and comorbidity of cancer patients both infected and not infected by HP.MethodsIn this study, we compared a comparison cohort (N = 24,088) and an HP cohort (N = 6022), both taken from the NHI database. We performed a statistical analysis with the multivariable Cox proportional model to estimate the risk of developing cancer for a comparison and the HP cohort.ResultsOur results showed that the proportion of peptic ulcers in the HP cohort was nearly 4 times higher than that in the comparison cohort. The HP cohort was significantly associated with increased colorectal (HR = 1.73, 95% CI = 1.08–2.77), stomach (HR = 5.21, 95% CI = 2.46–11.05) and pancreatic (HR = 2.77, 95% CI = 1.04–7.39) cancer risks compared to the comparison cohort. In addition, the cancer risk in the HP cohort was considerably higher than that in the comparison cohort when hypertension was absent in both cohorts.ConclusionsIn this study, we proposed a method to investigate the correlation between HP infection and cancer risk. We found that HP infection is associated with the development of colorectal, stomach, and pancreatic cancers, and could thus be an independent carcinogenic risk factor.     

Long-term outcome after extensive intestinal resection for chronic radiation enteritis

IntroductionManagement of chronic radiation enteritis is often controversial, particularly due to the risk of short bowel syndrome.MethodsOne hundred and seven chronic radiation enteritis patients with short bowel syndrome were studied retrospectively between 1980 and 2009. Survival and home parenteral nutrition dependence rates were evaluated with univariate and multivariate analysis.ResultsThe survival probabilities were 93%, 67% and 44.5% at 1, 5 and 10 years, respectively. On multivariate analysis, survival was significantly decreased with residual neoplastic disease (HR = 0.21 [0.11–0.38], p < 0.001), an American Society of Anesthesiologists score >3 (HR = 0.38 [0.20–0.73], p = 0.004) and an age of chronic radiation enteritis diagnosis >60 years (HR = 0.45 [0.22–0.89], p = 0.02). The actuarial home parenteral nutrition dependence probabilities were 66%, 55% and 43% at 1, 2 and 3 years, respectively. On multivariate analysis, this dependence was significantly decreased when there was a residual small bowel length >100 cm (HR = 0.35 [0.18–0.68], p = 0.002), adaptive hyperphagia (HR = 0.39 [0.17–0.87], p = 0.02) and the absence of a definitive stoma (HR = 0.48 [0.27–0.84], p = 0.01).ConclusionThe survival of patients with diffuse chronic radiation enteritis after extensive intestinal resection was good and was mainly influenced by underlying comorbidities. Almost two-thirds of patients were able to be weaned off home parenteral nutrition.     

Influence of apolipoprotein E gene polymorphism on development of type 2 diabetes mellitus in Chinese Han population: A meta-analysis of 29 studies

ObjectivesPublished data regarding the association between apolipoprotein E (ApoE) gene polymorphism and type 2 diabetes mellitus (T2DM) risk in Chinese Han population were inconclusive. To derive a more precise estimation of the relationship between this variant and T2DM risk in Chinese Han population, we performed this meta-analysis.Design and methodsA computerized literature search was conducted to identify the relevant studies from PubMed, EMbase, Web of Science, CBMdisc, CNKI, and Google Scholar. Additionally, hand searching of the references of identified articles was performed. All the statistical tests were performed using Stata 11.0.ResultsA total of 29 articles with 4615 T2DM cases and 2867 controls were included in the present meta-analysis. The results showed evidence for significant association between ApoE gene polymorphism and T2DM risk (for ε2/ε3 vs. ε3/ε3: OR = 1.37, 95% CI = 1.12–1.68, P < 0.01; for ε3/ε4 vs. ε3/ε3: OR = 1.53, 95% CI = 1.23–1.91, P < 0.01; for ε4/ε4 vs. ε3/ε3: OR = 1.86, 95% CI = 1.22–2.84, P < 0.01; for ε2 allele vs. ε3 allele: OR = 1.28, 95% CI = 1.08–1.52, P = 0.01; for ε4 allele vs. ε3 allele: OR = 1.43, 95% CI = 1.22–1.68, P < 0.01). In addition, significant association was also found between ApoE gene polymorphism and diabetic nephropathy (DN) risk.ConclusionsThe results of this meta-analysis suggest that the ApoE ε2 and ε4 alleles may be associated with increased risks of T2DM and DN in Chinese Han population. Additional well-designed genome-wide association studies are required to confirm these results.     

Facteurs prédictifs d’amputation après angioplastie de l’artère iliaque chez les patients avec artériopathie sévère

IntroductionDespite the success of angioplasty of the iliac artery, this technique remains associated with significant amputation rates. The purpose of this study was to identify predictive factors for lower limb amputation after iliac angioplasty in patients with critical ischemia.MethodsWe reported a retrospective study including patients who successfully underwent angioplasty of the iliac artery between 2014 and 2018. The primary endpoint was limb salvage at 1 month. The variables were studied in univariate and multivariate analysis.ResultsOur study included 86 patients. The median age was 57 ± 10 and the sex ratio was 4.7. Cardiovascular risk factors were represented by smoking in 14 cases (16.3%), diabetes in 25 cases (29.1%), arterial hypertension in 2 cases (2.3%) and dyslipidemia in 2 cases (2.3%). Seventy patients (81.3%) were classified as stage 4 according to the Leriche and Fontaine classification and 16 patients (18.7%) were classified as stage 3. The lesions were stenosing in 48 cases (55.8%) and occlusive in 38 cases (44.2%). These lesions were classified according to the TASC classification “Trans-Atlantic-Society-Consensus” in TASC A-B in 61 cases (70.9%) and TASC C-D in 35 cases (29.1%). Distal arteritis was found in 8 cases (9.3%). Balloon angioplasty was performed in 36 cases (41.8%) and angioplasty stenting in 50 cases (58.2%). At 1 month, the amputation rate was 9.3%. Univariate analysis showed that diabetes and smoking were the most important factors associated with amputation (respectively P = 0.007, OR = 9.31, 95% CI = [1.73–50.07] and P = 0.022; OR = 6.8; 95% CI = [1.46 to 31.61]). Multivariate analysis showed that diabetes and distal arteritis were the predictive factors for amputation (respectively P = 0.034, OR = 21.06, 95% CI = [1.25 to 354.46] and P = 0.008, OR = 11,61, 95% CI = [1.88 to 71.69]).ConclusionDiabetes and distal arteritis are the predictive factors for lower limb amputation after iliac angioplasty.     

Metabolic syndrome and cardiovascular risk prediction in peripheral arterial disease

Background and aimsMetabolic syndrome (MetS) was reported to be associated with increased cardiovascular risk in various settings, however its prognostic impact in peripheral arterial disease (PAD) is scanty.Methods and resultsWe prospectively studied 173 patients with intermittent claudication and ankle/brachial index (ABI) <0.90, in whom MetS was defined using the criteria of both the revised version of the Adults Treatment Panel III (rATP III) and the International Diabetes Federation (IDF). Of these patients, 52.6% met the rATP III and 54.9% the IDF criteria for MetS. During a median follow-up of 31 months, 54 cardiovascular events occurred. Kaplan–Meier curves showed a greater incidence of ischemic events in patients with MetS than in those without. However, adjusted Cox analyses revealed that only IDF-MetS was independently associated with increased cardiovascular risk (HR = 1.91, 95% CI 1.03–3.51, p = 0.038). Kaplan–Meier curves for the four groups of patients delineated according to the bootstrapped ABI cut-off value (0.73) and the presence or absence of IDF-MetS revealed that the syndrome improved the predictive power of ABI alone. Actually, among patients with an ABI ≤ 0.73, those with IDF-MetS had a higher cardiovascular risk than those without the syndrome (HR = 2.55, 95% CI 1.22–5.12, p = 0.012). This was confirmed by c-statistic, which was 0.56 for ABI alone and increased to 0.65 (p = 0.046) when IDF-Mets was added to the pressure index.ConclusionIn PAD, IDF-MetS, but not rATP III-MetS, is associated with an increased risk of cardiovascular events. Furthermore, IDF-MetS adds to the prognostic value of ABI, currently the most powerful prognostic indicator in PAD.     

E23K variant in KCNJ11 gene is associated with susceptibility to type 2 diabetes in the Mauritanian population

AimsMany genetic association studies reported the contribution of KCNJ11 gene to type 2 diabetes susceptibility in different populations. We aimed to evaluate the association between E23K variant of KCNJ11 and type 2 diabetes in the Mauritanian population.Materials and methodsWe performed a case-control association study including 135 type 2 diabetes Mauritanian patients and 135 controls. Genotyping for the E23K variant was performed using a TaqMan allelic discrimination assay.ResultsWe found significant association between KCNJ11 E23K variant and type 2 diabetes (Global model, OR = 2.08, 95% CI = 1.09–3.97, p = 0.026). In the Moor ethnic group, E23K was also associated with type 2 diabetes in the general model (OR = 2.08, 95% CI = 1.09–3.97, p = 0.026) and under the dominant model (OR = 2.49, 95% CI = 1.12–5.55, p = 0.026). In the Mauritanians of African descent, KK genotype was not found. Besides, E23K variant was not associated with type 2 diabetes (OR = 0.69, 95% CI = 0.04–11.32, p = 0.793).ConclusionsOur results revealed the risk of type 2 diabetes conferred by KCNJ11 E23K gene variant in the Mauritanian population.     

Association of serum soluble Fas concentrations and mortality of septic patients

IntroductionScarce data on Fas, one of the main receptors that activates the apoptosis extrinsic pathway, in septic patients exists. Higher blood soluble Fas (sFas) concentrations in non-survivor septic patients compared with survivors have been found in small studies; however, the association of blood sFas concentrations with mortality controlling for sepsis severity has not been stablished due to this small sample size in those studies. Thus, our main objective study was to determine whether an association between blood sFas concentrations and sepsis mortality controlling for sepsis severity exists.MethodsWe included septic patients in this observational and prospective study carried out in three Spanish Intensive Care Units. We obtained serum samples at sepsis diagnosis sepsis for sFas levels determination.ResultsThirty-day non-surviving patients (n = 85) compared to surviving patients (n = 151) had higher serum sFas levels (p < 0.001). We found in multiple logistic regression analysis an association of serum sFas levels with mortality controlling for age and SOFA (OR = 1.004; 95% CI = 1.002–1.006; p < 0.001), and for age and APACHE-II (OR = 1.004; 95% CI = 1.002–1.006; p < 0.001). Serum sFas levels showed and area under the curve for mortality prediction of 71% (95% CI = 65–71%; p < 0.001). Kaplan–Meier analysis showed higher mortality rate in patients with serum sFas levels > 83.5 ng/mL (Hazard ratio = 3.2; 95% CI = 2.1–5.0; p < 0.001).ConclusionsThat an association between blood sFas concentrations and sepsis mortality controlling for sepsis severity exists was our main new finding study.     

FTO gene variant and risk of hypertension: A meta-analysis of 57,464 hypertensive cases and 41,256 controls

ObjectivesRecent studies have suggested that fat mass and obesity-associated gene (FTO) may predispose individuals to develop hypertension. However, the results have been inconsistent. We performed a meta-analysis to investigate the relationship of FTO gene variant with risk of hypertension and influence of body mass index (BMI) on this risk.Materials/methodsA systematic literature search in PubMed, Embase and ISI web of science databases was performed to identify eligible published literatures. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.ResultsA total of seven studies comprising 57,464 hypertensive cases and 41,256 controls met the inclusion criteria and were included in the meta-analysis. The FTO gene variant(s) showed significant association with the risk of hypertension (OR = 1.16, 95% CI = 1.07–1.25, P < 0.001) which disappeared on adjustment for BMI (OR = 1.04, 95% CI = 0.98–1.10, P = 0.162). In addition, stratified analysis demonstrated a significant association of the FTO variant with the risk of hypertension in obese subjects (OR = 1.10, 95% CI = 1.01–1.19, P = 0.032) but not in non-obese individuals (OR = 1.00, 95% CI = 0.97–1.03, P = 0.832). Subgroup analysis based on ethnicity showed significant association between FTO variant and hypertension in both European (OR = 1.07, 95% CI = 1.01–1.14, P = 0.028) and Asian populations (OR = 1.37, 95% CI = 1.23–1.53, P < 0.001). However, the association remained significant only in Asians (OR = 1.17, 95% CI = 1.01–1.35, P = 0.035) but not in the Europeans (OR = 1.02, 95% CI = 0.97–1.07, P = 0.390) on adjustment for BMI.ConclusionsThe present meta-analysis confirms that FTO genotype mediates obesity-related hypertension.     

Clinical characteristics and outcomes of community-onset acute pyelonephritis caused by Escherichia coli in elderly patients

PurposeTo evaluate clinical characteristics and outcomes of community-onset acute pyelonephritis (APN) caused by Escherichia coli in elderly patients.Patients/methodsCases of adult patients with community-onset APN caused by E. coli were collected from 10 referral centres in Korea from November 2006 to August 2007. Demographic, clinical and microbiological data were analysed.ResultsDiabetes mellitus (38% vs 23%, P = 0.036), chills (83% vs 66%, P = 0.015), gastrointestinal symptoms (55% vs 34%, P = 0.008), altered mental status on admission (21% vs 9%, P = 0.032), acute renal failure (17% vs 3%, P = 0.004) and concomitant bacteraemia (34% vs 17%, P = 0.015) were more frequently observed in patients aged ≥ 65 years compared with those aged < 65 years. The overall intergroup mortality rates did not differ. However, diabetes mellitus (OR = 3.54, 95% CI = 1.40–9.00, P = 0.008) and age of ≥ 65 years (OR = 2.34, 95% CI = 1.05–5.19, P = 0.037) were significantly related to a longer duration of hospital stay (≥ 5 days).ConclusionElderly patients with APN have a higher frequency of atypical manifestations, such as gastrointestinal symptoms, altered mental status and longer durations of hospital stays. Age was independently associated with longer duration of hospital stays among patients with APN. Careful diagnosis and appropriate treatment are crucial in the management of elderly patients with APN.     

Fragilidad y pronóstico de los pacientes mayores con insuficiencia cardiaca

Introduction and objectivesHeart failure (HF) is prevalent in advanced ages. Our objective was to assess the impact of frailty on 1-year mortality in older patients with ambulatory HF.MethodsOur data come from the FRAGIC study (Spanish acronym for “Study of the impact of frailty and other geriatric syndromes on the clinical management and prognosis of elderly outpatients with heart failure”), a multicenter prospective registry conducted in 16 Spanish hospitals including outpatients ≥ 75 years with HF followed up by cardiology services in Spain.ResultsWe included 499 patients with a mean age of 81.4 ± 4.3 years, of whom 193 (38%) were women. A total of 268 (54%) had left ventricular ejection fraction < 40%, and 84.6% was in NYHA II functional class. The FRAIL scale identified 244 (49%) pre-frail and 111 (22%) frail patients. Frail patients were significantly older, were more frequently female (both, P < .001), and had higher comorbidity according to the Charlson index (P = .017) and a higher prevalence of geriatric syndromes (P < .001). During a median follow-up of 371 [361-387] days, 58 patients (11.6%) died. On multivariate analysis (Cox regression model), frailty detected with the FRAIL scale was marginally associated with mortality (HR = 2.35; 95%CI, 0.96-5.71; P = .059), while frailty identified by the visual mobility scale was an independent predictor of mortality (HR = 2.26; 95%CI, 1.16-4.38; P = .015); this association was maintained after adjustment for confounding variables (HR = 2.13; 95%CI, 1.08-4.20; P = .02).ConclusionsIn elderly outpatients with HF, frailty is independently associated with mortality at 1 year of follow-up. It is essential to identify frailty as part of the comprehensive approach to elderly patients with HF.     

Factors affecting outcomes of individualised treatment for drug resistant tuberculosis in an endemic region

BackgroundIndividualised treatment regimens for drug resistant tuberculosis have improved outcomes. This retrospective observational study examined potential factors that affect individualised treatment in an endemic region, and highlighted predictors of a successful outcome.MethodsWe examined records of proven MDR, pre-XDR and XDR TB patients diagnosed and started on treatment between 2010 and 2014, and collected the following data for each patient: age, gender, comorbidities, past history of TB, diagnosis, site of disease, drug susceptibility testing (DST) results, treatment, adverse reactions to anti-tubercular drugs, treatment changes and outcomes, which were recorded as positive, negative or neutral. Tests of association were carried out between factors and outcomes, following which multiple logistic regression analysis was done to determine the predictors of a positive outcome such as patient cured after completion of treatment at 18 months or longer.ResultsFifty-nine patients completed treatment at our centre. The median age was 26 years (range 8–65 years). There were 31 (52.5%) female patients. Forty-four (74.6%) were successfully treated over a median treatment period of 23 months (range 18–30 months). Successful outcomes were associated with age less than 45 years (P = 0.01, OR = 6.67, 95% CI = 1.73–23.47), resistance to fewer than five drugs (P = 0.001, OR = 9.51, 95% CI = 2.50–38.18) and susceptibility to Group 4 drugs (P = 0.04, OR = 4.71, 95% CI = 1.03–16.83).ConclusionsAge and drug susceptibility were important predictors of treatment outcome.     

Diarrhoea is not the only symptom that needs to be treated in patients with microscopic colitis

BackgroundMany patients with microscopic colitis (MC) also suffer from symptoms of irritable bowel syndrome (IBS), but the only treatment given is corticosteroids for the diarrhoea. The aim of this study was to examine how social factors, life style factors and drug treatment affect symptoms and well-being in patients suffering from MC.MethodsWomen, over the age of 73 years, with biopsy-verified MC, at any Departments of Gastroenterology, Skåne, between 2002 and 2010 were invited. The questionnaires Gastrointestinal Symptom Rating Scale (GSRS) and Psychological General Well-being Index (PGWB) were sent by mail, along with questions about social and life style factors, and medical history.ResultsOf 240 invited, 158 patients (66%) were included (median age 63 years, range 27–73 years). Only 26% had never smoked. Smoking and concomitant IBS were associated with both impaired gastrointestinal symptoms (OR = 3.96, 95% CI = 1.47–10.66 and OR = 4.40, 95% CI = 2.09–9.26, respectively) and impaired psychological well-being (OR = 2.77, 95% CI = 1.04–7.34 and OR = 3.82, 95% CI = 1.83–7.99, respectively). Treatment with proton pump inhibitors (PPI) was associated with increased gastrointestinal symptoms (OR = 3.44, 95% CI = 1.45–8.16). Age, social factors, and corticosteroids had no effect on symptoms or well-being. Smoking was the only risk factor associated with IBS (OR = 2.68, 95% CI = 1.115–6.26).ConclusionSmoking and IBS are associated with impaired gastrointestinal symptoms and psychological well-being in MC patients. PPI is associated with impaired gastrointestinal symptoms.     

Resultado del tratamiento percutáneo de la reestenosis de stents farmacoactivos: ¿depende de si el stent tenía o no recubrimiento polimérico?

Introduction and objectivesOutcomes of patients undergoing percutaneous intervention for drug-eluting stent (DES) restenosis are poorer than those in patients with bare-metal stent restenosis. It is unknown if this is related to the presence of polymer coating. We sought to compare outcomes after interventions for in-stent restenosis (ISR) of polymer-free DES vs durable polymer DES.MethodsPatients enrolled in the ISAR-TEST 5 randomized trial who underwent repeat percutaneous intervention for ISR during follow-up were included. Angiographic outcomes at 6 to 8 months and clinical outcomes at 2 years were analyzed and compared between 2 groups according to whether the restenosed stent was a polymer-free or a durable polymer DES. Multivariate analysis was used to adjust for differences between groups.ResultsA total of 326 patients with ISR were included: 220 with ISR in polymer-free DES and 106 with ISR in durable polymer DES. Angiographic follow-up was available for 83.4% of patients. No difference was observed in recurrent binary restenosis between the 2 groups (31.7% vs 27.0%; P = .38; P_adjusted = .29). At 2 years, the composite of death, myocardial infarction, or repeat target lesion revascularization were similar between the 2 groups (35.7% vs 34.0%; HR = 1.04, 95%CI, 0.70-1.55; P = .83; P_adjusted = .79). The rate of repeat target lesion revascularization was also similar in the 2 groups (29.8% vs 31.5%; HR = 0.91, 95%CI, 0.60-1.39; P = .68; P_adjusted = .62).ConclusionsIn patients undergoing reintervention for DES-ISR, we found no evidence of differences in outcomes according to whether the restenosed stent was a polymer-free or durable polymer DES.     

OCTN1 variant L503F is associated with familial and sporadic inflammatory bowel disease

PurposeA two-allele haplotype of TC (OCTN1 rs1050152 and OCTN2 -207G→C) is associated with Crohn's disease (CD). The association has been replicated in different populations, but also failed in some studies. The present study is to replicate the association of OCTN1 rs1050152 and examine another variant rs272879 with familial and sporadic inflammatory bowel disease (IBD) in a cohort from central Pennsylvania, USA.MethodsThe study samples (n = 465) included 212 inflammatory bowel disease patients (CD = 115, UC = 97), including 103 familial (CD = 55, UC = 46) and 111 sporadic (CD = 60, UC = 51) IBD, 139 non-IBD family members from a familial IBD registry, and 114 unrelated healthy controls. A total of 12 OCTN1 variants within exonic sequences were examined. Two nonsynonymous SNPs, rs1050152 (L503F) and rs272879 (L395V) were genotyped by a PCR-based RFLP/cRFLP method and statistically analyzed. These samples with an additional 141 unrelated healthy samples were also genotyped for rs1050152 using the SNPlex? Genotyping System.ResultsThe OCTN1 rs1050152 is associated with CD (OR = 1.745, 95% CI = 1.019–2.990, χ² = 4.129, p = 0.042) and with IBD (OR = 1.68, 95% CI = 1.052–2.676, χ² = 4.732, p = 0.030); while the variant rs272879 is not associated with IBD, CD or ulcerative colitis (UC). The distribution of the rs1050152 variant showed a high level of the T allele in male UC (OR = 2.585, 95% CI = 1.139–5.869, p = 0.023) and IBD (OR = 2.039, 95% CI = 1.024–4.059, p = 0.042) patients, and in female CD patients (OR = 2.329, 95% CI = 1.038–5.226, ρ value = 0.039).ConclusionThe present results replicated the association of the OCTN1 rs1050152 (L503F) variant with CD and IBD overall. A weak gender-specific effect of rs1050152 (L503F) on male UC and female CD was observed.     

Circulating Bcl-2 concentrations and septic patient mortality

IntroductionThere are not data on blood B-cell lymphoma 2 (Bcl-2) concentrations (one of the antiapoptotic molecules of the Bcl-2 family in the intrinsic apoptosis pathway) in septic patients. Therefore, this study was carried with the aims to explore whether blood Bcl-2 concentrations at diagnosis of sepsis are different in survivor and non-survivor septic patients, are associated with mortality, and are useful for the mortality prediction.MethodsIntensive Care Units from 3 Spanish hospitals participated in this observational and prospective study with septic patients and serum Bcl-2 concentrations at diagnosis of sepsis were determined. Mortality at 30 days was as outcome variable.ResultsWe found that 30-day non-surviving patients (n = 81) showed lower serum Bcl-2 levels (p = 0.003) than surviving patients (n = 140). We found that serum concentrations of Bcl-2 < 4.4 ng/mL were associated with mortality (OR = 3.228; 95% CI = 1.406–7.415; p = 0.006) in the multiple logistic regression analysis, and that showed an area under the curve for mortality prediction of 62% (95% CI = 55–68%; p = 0.003).ConclusionsIn our study appears novel findings such as higher blood Bcl-2 concentrations in survivor than in non-survivor septic patients, the association between low blood Bcl-2 concentrations and mortality of septic patients, and the ability of blood Bcl-2 concentrations for the prediction of septic patient mortality.