Determinants for the use of ambulation AIDS in a geriatric rehabilitation care unit: a retrospective study

ObjectivesThis study aimed at assessing the profile of ambulation aid users among patients admitted for geriatric rehabilitation care.DesignRetrospective chart review.SettingGeriatric Rehabilitation Department of the Hôpital Albert Chenevier, Créteil, France.ParticipantsThe sample comprised 206 records of patients aged 65 or older with no previous use of assistive device before admission and length of stay longer than 7 days.MeasurementsAmbulation levels were classified as independent ambulators (IA, reference category), ambulation aid users (AA), or nonambulatory patients (NA). we explored age, gender, purpose of initial admission, comorbidities, and past medical history as factors potentially associated with ambulation levels, using multinomial logistic regression.ResultsThe study population (mean age 84 years [6.1 standard deviation], 68.5 % women) comprised 110 IA (53.4% of the overall population), 72 AA (34.9%), and 24 NA (11.6%). Factors independently associated with AA use were the following: older age (odds ratio = 1.17; [95% confidence interval 1.09–1.25]), previous history of lower limb surgery (2.15; [1.0–4.73]), and admission for hip surgery (8.14; [2.60–25.53]). Factors independently associated with NA were the following: older age (1.12 [1.02–1.23]) and low Mini-Mental State Exam score (0.77 [0.70–0.85]). A borderline association was observed for visual impairment (3.36 [0.93–12.95]). Cardiac disease, respiratory disease, falls, and dementia were not associated with ambulation aid use.ConclusionsHistory of lower-limb surgery, particularly recent hip surgery, and old age are the primary predictive factors of ambulation aid use in a geriatric rehabilitation hospital.     

Generating fuzzy rules for constructing interpretable classifier of diabetes disease

Diabetes is a type of disease in which the body fails to regulate the amount of glucose necessary for the body. It does not allow the body to produce or properly use insulin. Diabetes has widespread fallout, with a large people affected by it in world. In this paper; we demonstrate that a fuzzy c-means-neuro-fuzzy rule-based classifier of diabetes disease with an acceptable interpretability is obtained. The accuracy of the classifier is measured by the number of correctly recognized diabetes record while its complexity is measured by the number of fuzzy rules extracted. Experimental results show that the proposed fuzzy classifier can achieve a good tradeoff between the accuracy and interpretability. Also the basic structure of the fuzzy rules which were automatically extracted from the UCI Machine learning database shows strong similarities to the rules applied by human experts. Results are compared to other approaches in the literature. The proposed approach gives more compact, interpretable and accurate classifier.     

Process optimization and scale-up for production of rabies vaccine live adenovirus vector (AdRG1.3)

Rabies virus is an important causative agent of disease resulting in an acute infection of the nervous system and death. Although curable if treated in a timely manner, rabies remains a serious public health issue in developing countries, and the indigenous threat of rabies continues in developed countries because of wildlife reservoirs. Control of rabies in wildlife is still an important challenge for governmental authorities.There are a number of rabies vaccines commercially available for control of wildlife rabies infection. However, the vaccines currently distributed to wildlife do not effectively immunize all at-risk species, particularly skunks. A replication competent recombinant adenovirus expressing rabies glycoprotein (AdRG1.3) has shown the most promising results in laboratory trials. The adenovirus vectored vaccine is manufactured using HEK 293 cells.This study describes the successful scale-up of AdRG1.3 adenovirus production from 1 to 500 L and the manufacturing of large quantities of bulk material required for field trials to demonstrate efficacy of this new candidate vaccine. The production process was streamlined by eliminating a medium replacement step prior to infection and the culture titer was increased by over 2 fold through optimization of cell culture medium. These improvements produced a more robust and cost-effective process that facilitates industrialization and commercialization. Over 17,000 L of AdRG1.3 adenovirus cultures were manufactured to support extensive field trials. AdRG1.3 adenovirus is formulated and packaged into baits by Artemis Technologies Inc. using proprietary technology. Field trials of AdRG1.3 rabies vaccine baits have been conducted in several Canadian provinces including Ontario, Quebec and New Brunswick. The results from field trials over the period 2006-2009 demonstrated superiority of the new vaccine over other licensed vaccines in immunizing wild animals that were previously difficult to vaccinate.     

Spontaneous rupture and hemorrhage of hepatic focal nodular hyperplasia in lobus caudatus

In general, focal nodular hyperplasia lesions of the liver have a benign natural course; the majority of cases remain asymptomatic and complications are rare. We report a case of spontaneous rupture and hemorrhage of focal nodular hyperplasia, which is extremely rare in the literature. A 35-year-old woman was admitted with severe upper abdominal pain and unstable hemodynamic status. No major abdominal trauma was noted. Radiology findings suggested a diffuse hemoperitoneum. Emergent surgical exploration showed a hemoperitoneum due to the rupture of a hepatic mass lesion in segment I. Suture of the rupture was undertaken with success. After this lifesaving emergent surgery, further investigations, including ultrasound, contrast-enhanced computed tomography, and magnetic resonance imaging, were undertaken, and a 5.7 × 9.8 × 6.4-cm focal nodular hyperplasia lesion was identified in segment I. Two weeks after the first surgical hemostasis, surgical removal of segment I, including the mass, was performed. The postoperative course was uneventful. Pathological evaluation confirmed the nature of focal nodular hyperplasia. The patient remains asymptomatic without evidence of recurrence 3 years and 6 months after surgery. To our knowledge, this is the firstcase of spontaneous rupture and hemorrhage of focal nodular hyperplasia that needed two consecutive surgical operations.     

Systematic, genome-wide identification of host genes affecting replication of a positive-strand RNA virus

Positive-strand RNA viruses are the largest virus class and include many pathogens such as hepatitis C virus and the severe acute respiratory syndrome coronavirus (SARS). Brome mosaic virus (BMV) is a representative positive-strand RNA virus whose RNA replication, gene expression, and encapsidation have been reproduced in the yeast Saccharomyces cerevisiae. By using traditional yeast genetics, host genes have been identified that function in controlling BMV translation, selecting BMV RNAs as replication templates, activating the replication complex, maintaining a lipid composition required for membrane-associated RNA replication, and other steps. To more globally and systematically identify such host factors, we used engineered BMV derivatives to assay viral RNA replication in each strain of an ordered, genome-wide set of yeast single-gene deletion mutants. Each deletion strain was transformed to express BMV replicase proteins and a BMV RNA replication template with the capsid gene replaced by a luciferase reporter. Luciferase expression, which is dependent on viral RNA replication and RNA-dependent mRNA synthesis, was measured in intact yeast cells. Approximately 4500 yeast deletion strains ( approximately 80% of yeast genes) were screened in duplicate and selected strains analyzed further. This functional genomics approach revealed nearly 100 genes whose absence inhibited or stimulated BMV RNA replication and/or gene expression by 3- to >25-fold. Several of these genes were shown previously to function in BMV replication, validating the approach. Newly identified genes include some in RNA, protein, or membrane modification pathways and genes of unknown function. The results further illuminate virus and cell pathways. Further refinement of virus screening likely will reveal contributions from additional host genes.     

The role of clips in preventing migration of fully covered metallic esophageal stents: a pilot comparative study

Background

Migration is the most common complication of the fully covered metallic self-expanding esophageal stent (SEMS). This study aimed to determine the potential preventive effect of proximal fixation on the mucosa by clips for patients treated with fully covered SEMS.

Methods

In this study, 44 patients (25 males, 57%) were treated with fully covered SEMS including 22 patients with esophageal stricture (4 malignant obstructions, 6 anastomotic strictures, and 12 peptic strictures) and 22 patients with fistulas or perforations (10 anastomotic leaks, 4 perforations, and 8 postbariatric surgery fistulas). The Hanarostent (n?=?25), Bonastent (n?=?5), Niti-S (n?=?12), and HV-stent (n?=?2) with diameters of 18 to 22?mm and lengths of 80 to 170?mm were used. Two to four clips (mean, 2.35?±?0.75 clips) were used consecutively in 23 patients to fix the upper flared end of the stent with the esophageal mucosal layer. Stent migration and its consequences were collected in the follow-up assessment with statistical analysis to compare the patients with and without clip placement.

Results

No complication with clip placement was observed, and the retrieval of the stent was not unsettled by the persistence of at least one clip (12 cases). Stent migration was noted in 15 patients (34%) but in only in 3 of the 23 patients with clips (13%). The number of patients treated to prevent one stent migration was 2.23. The predictive positive value of nonmigration after placement of the clip was 87%. In the multivariate analysis, the fixation with clips was the unique independent factor for the prevention of stent migration (odds ratio, 2.3; 95% confidence interval, 0.10?C0.01; p?=?0.03).

Conclusions

Anchoring of the upper flare of the fully covered SEMS with the endoscopic clip is feasible and significantly reduces stent migration.     

Identification of AP80978, a Novel Small-Molecule Inhibitor of Hepatitis C Virus Replication That Targets NS4B

A small-molecule inhibitor of hepatitis C virus (HCV) designated AP89652 was identified by screening a compound library with an HCV genotype 1b subgenomic replicon assay. AP89652 contains two chiral centers, and testing of two syn enantiomers revealed that activity in the replicon assay resided with only one, AP80978, whose 50% effective concentration (EC₅₀) (the concentration at which a 50% reduction in Renilla luciferase levels was observed relative to an untreated control) was 630 nM. AP80978 was inhibitory against HCV genotypes 1a and 1b but not genotype 2a. In a replicon clearance assay, the potency and clearance rate of AP80978 were similar to those of telaprevir (VX950) and cyclosporine (CsA). AP80978 was nontoxic when tested against a panel of human cell lines, and inhibitory activity was HCV specific in that there was limited activity against negative-strand viruses, an alphavirus, and flaviviruses. By selection of resistant replicons and assessment of activity in genotype 1b/2a intergenotypic replicons, the viral protein target of this compound was identified as NS4B. NS4B F98V/L substitutions were confirmed by site-directed mutagenesis as AP80978 resistance-associated mutations. When tested against HCV produced in cell culture, the compound was significantly more potent than other HCV inhibitors, including VX950, CsA, and 2′-C-methyladenosine (2′C-meA). In addition, AP80977, the enantiomer that was inactive in the replicon assay, had activity against the virus, although it was lower than the activity of AP80978. These results suggest that AP80978 has the potential to be optimized into an effective antiviral drug and is a useful tool to further study the role of NS4B in HCV replication.