Depressive symptoms and chronic obstructive pulmonary disease: effect on mortality, hospital readmission, symptom burden, functional status, and quality of life

BACKGROUND: Depressive symptoms are common among patients with chronic obstructive pulmonary disease (COPD), but depression's impact on COPD outcomes has not been fully investigated. We evaluated the impact of comorbid depression on mortality, hospital readmission, smoking behavior, respiratory symptom burden, and physical and social functioning in patients with COPD. METHODS: In this prospective cohort study, 376 consecutive patients with COPD hospitalized for acute exacerbation were followed up for 1 year. The independent associations of baseline comorbid depression (designated as a Hospital Anxiety and Depression Scale score of > or =8) with mortality, hospital readmission, length of stay, persistent smoking, and quality of life (determined by responses to the St George Respiratory Questionnaire) were evaluated after adjusting for potential confounders. RESULTS: The prevalence of depression at admission was 44.4%. The median follow-up duration was 369 days, during which 57 patients (15.2%) died, and 202 (53.7%) were readmitted at least once. Multivariate analyses showed that depression was significantly associated with mortality (hazard ratio, 1.93; 95% confidence interval, 1.04-3.58), longer index stay (mean, 1.1 more days; P = .02) and total stay (mean, 3.0 more days; P = .047), persistent smoking at 6 months (odds ratio, 2.30; 95% confidence interval, 1.17-4.52), and 12% to 37% worse symptoms, activities, and impact subscale scores and total score on the St George Respiratory Questionnaire at the index hospitalization and 1 year later, even after controlling for chronicity and severity of COPD, comorbidities, and behavioral, psychosocial, and socioeconomic variables. CONCLUSIONS: Comorbid depressive symptoms in patients with COPD are associated with poorer survival, longer hospitalization stay, persistent smoking, increased symptom burden, and poorer physical and social functioning. Interventions that reduce depressive symptoms may potentially affect COPD outcomes.     

Open Gustilo 1 and 2 midshaft fractures of the radius and ulna in children: is there a role for cast immobilization after wound debridement?

INTRODUCTION: Open fractures of the forearm in children are one of the indications for open reduction and internal fixation. Fixation allows for soft tissue management and maintenance of reduction. This study compares the outcome of open Gustilo 1 and 2 midshaft forearm fractures treated with cast immobilization versus the outcome of those treated with internal fixation after wound debridement. METHODS: This is a retrospective study of the cases of 31 children treated in Kandang Kerbau Women's and Children's Hospital from 1998 to 2005. All had wound debridement, followed by cast immobilization in 15 patients and implant stabilization in 16 others, using plates and screws or intramedullary K-wires. The patients were assessed at final follow-up using the classification by Price. RESULTS: Both treatment groups had 100% excellent or good results. There was no significant difference in time to union. However, there was a higher incidence rate of delayed union and infection when treated with implant stabilization. The main complication associated with cast immobilization was loss of reduction (4 cases), of which 1 case required a second manipulation. DISCUSSION: Despite the trend toward implant stabilization of all open forearm fractures, this study shows that there is still a role for cast immobilization in its treatment of Gustilo 1 and 2 open forearm fractures as long as proper casting technique and close follow-up is achieved. However, internal fixation should be considered in cases where the fracture is noted intraoperatively to be unstable or if attempted reduction fails, bearing in mind the possible complications associated with internal fixation.     

Systematic review on quality control for drug management programs: Is quality reported in the literature?

Background  

Maintaining quality of care while managing limited healthcare resources is an ongoing challenge in healthcare. The objective of this study was to evaluate how the impact of drug management programs is reported in the literature and to identify potentially existing quality standards.     

The C-terminus of MinE from Neisseria gonorrhoeae acts as a topological specificity factor by modulating MinD activity in bacterial cell division

MinE regulates the proper placement of the cytokinetic FtsZ ring at midcell by inducing the pole-to-pole movement of MinCD complexes. While the N-terminus of MinE has been implicated in MinD binding, a clear functional role of the C-terminus has not been elucidated. We previously determined that MinE from Neisseria gonorrhoeae (Ng) was functional in Escherichia coli (Ec). Thus, using E. coli as a model organism, gonococcal MinE (MinE(Ng)) function was examined by generating amino acid substitutions of highly conserved MinE(Ng) residues and by testing the ability of the mutant proteins to interact with gonococcal MinD (MinD(Ng)), to induce a minicell phenotype upon overexpression, to initiate MinD(Ng) oscillation, and to stimulate MinD(Ng) ATPase activity. N-terminal MinE(Ng) mutants were unable to bind to MinD(Ng); thus, they did not induce a minicell phenotype, promote MinD(Ng) oscillation or stimulate MinD(Ng) ATPase activity. While C-terminal MinE(Ng) mutants exhibited reduced abilities to bind to MinD(Ng), we show that differences in MinD(Ng) binding to the C-terminus of MinE(Ng) alter the ability of MinE(Ng) to properly stimulate MinD(Ng) activity. We present four major findings from our studies of MinE(Ng): both the N- and C-termini of MinE(Ng) interact with MinD(Ng); interaction between MinD(Ng) and MinE(Ng) is required for the recruitment of MinD(Ng) to the coiled array; oscillation of MinD(Ng) does not require ATPase stimulation; and, the extent of MinD(Ng) ATPase stimulation depends on the binding strength between MinD(Ng) and the C-terminus of MinE(Ng.).     

Micromolding of shape-controlled, harvestable cell-laden hydrogels

Encapsulation of mammalian cells within hydrogels has great utility for a variety of applications ranging from tissue engineering to cell-based assays. In this work, we present a technique to encapsulate live cells in three-dimensional (3D) microscale hydrogels (microgels) of controlled shapes and sizes in the form of harvestable free standing units. Cells were suspended in methacrylated hyaluronic acid (MeHA) or poly(ethylene glycol) diacrylate (PEGDA) hydrogel precursor solution containing photoinitiator, micromolded using a hydrophilic poly(dimethylsiloxane) (PDMS) stamp, and crosslinked using ultraviolet (UV) radiation. By controlling the features on the PDMS stamp, the size and shape of the molded hydrogels were controlled. Cells within microgels were well distributed and remained viable. These shape-specific microgels could be easily retrieved, cultured and potentially assembled to generate structures with controlled spatial distribution of multiple cell types. Further development of this technique may lead to applications in 3D co-cultures for tissue/organ regeneration and cell-based assays in which it is important to mimic the architectural intricacies of physiological cell-cell interactions.     

Comparative study of torsional and bending properties for six models of nickel-titanium root canal instruments with different cross-sections

This study investigated the influence of cross-section profile on the mechanical behaviors of six commercial nickel-titanium (NiTi) root canal instruments using the finite element method. The nonlinear mechanical characteristics of the NiTi alloy were taken into account. The six root canal instruments studied were ProTaper, Hero642, Mtwo, ProFile, Quantec, and NiTiflex. Mathematical models for these instruments were constructed and their performances were analyzed under equal torque conditions. The ProTaper and Hero642 models achieved the lowest stress levels that made them the most torque-resistant while the NiTiflex model was the poorest. The maximum stress value and the stress distribution in a model were found strongly influenced by the cross-section profile. Factors affecting the stress distribution include the cross-sectional inertia, depth of the flute, area of the inner core, radial land, and peripheral surface ground. As the area of the inner core of the cross-section increased, the model was more torque-resistant.