Clinical characteristics and risk factors for peripartum cardiomyopathy

Background

Peripartum cardiomyopathy (PPCM) is a potentially fatal form of heart failure and the recognition of its risk factors is important for prevention and treatment.

Objective

To explore the clinical characteristics and the risk factors for PPCM.

Methods

Echocardiographic was used to examine the left ventricular ejection fraction (LVEF). Blood level of troponin I (cTNI), high sensitive C-reaction protein (hs-CRP), NT-proBNP was measured. All PPCM occurred within weeks following delivery.

Results

Fifty-two PPCM patients and 52 normal delivery subjects (control group) were included in this study. Compared with the control group, PPCM patients were older, with a higher level of blood pressure, and a higher rate of suspected respiratory infection. The level of leucocytes, hs-CRP, cTNI and NT-proBNP in PPCM patients were higher than in the control. Multivariate logistic regression analysis showed that elevated plasma hs-CRP (OR =1.86, p<0.05), respiratory infection (OR = 2.87, p<0.01), and hypertension (OR =1.68, p < 0.05) were independent risk factors for PPCM. During the follow up of 21.6±5.4 d, one patient (1.9%) died probably of heart failure but other patients remained well.

Conclusion

Hypertension, respiratory infection, and elevated plasma hs-CRP seem to be associated with the pathogenesis of peripartum cardiomyopathy in this patient population.     

A retrospective cost analysis of angioplasty compared to bypass surgery for lower limb arterial disease in an Australian tertiary health service

Introduction

Percutaneous transluminal angioplasty (PTA) and surgical bypass (BYP) are treatment options for symptomatic peripheral arterial disease (PAD). PTA and BYP have different clinical outcomes and cost implications. This paper aims to compare hospital‐related costs of PTA and BYP for PAD of the lower limbs in an Australian health service.

Methods

A retrospective cost analysis using clinical and financial data from an urban, tertiary hospital was performed. Patient cohorts were matched to existing published studies and 3‐year findings were calculated. Outcomes measured were mean initial admission cost; mean bed stay; mean complication rate; mean cost of re‐intervention at 12 months and extrapolated mean cost at 3 years.

Results

The mean total admission costs for PTA compared to BYP were $8758 vs. $27,849 (P < 0.001). Patients undergoing BYP were admitted for 10.25 vs. 3.77 nights (P < 0.001). The complication rate was greater in the BYP group for infection only. Re‐intervention was required by 13% of the PTA group and 16% of the BYP group, at a mean cost of $11,798 and $14,728, respectively (P = 0.453). The extrapolated total mean cost at 3 years was higher in the BYP group for patients with both intermittent claudication ($26,764 vs. $11,402) and critical limb ischaemia ($27,719 vs. $12,655).

Conclusions

In this cohort, PTA is a favourable alternative to BYP for PAD of the lower limbs as it is less costly, does not result in a greater re‐intervention rate at 1 year and has been previously demonstrated to have comparable clinical outcomes. Given the limitations of this retrospective analysis, a prospective cost‐effectiveness analysis is recommended.

     

Dioeloyl phosphatidic acid induces morphological changes through an endogenous LPA receptor in C6 glioma cells

Previously, we suggested that dioleoyl phosphatidic acid (PA) and lysophosphatidic acid (LPA) increased [Ca(2+)](i) through endogenous LPA receptors coupled to pertussis toxin-sensitive G proteins in rat C6 glioma cells. In the present report, we investigated morphological changes and cytotoxicity induced by PA and LPA in C6 glioma cells. Isoproterenol treatment led to changes in the cell morphology of rat C6 glioma cells, which were reverted by the addition of PA and LPA. PA-and LPA-induced morphological reversions were inhibited by treatment with Ki16425, an LPA(1)/LPA(3) receptor antagonist. VPC32183, another LPA(1)/LPA(3) receptor antagonist with a different structure, only inhibited PA-induced morphological reversion but not LPA-induced reversion. However, the reversions were not inhibited by treatment with pertussis toxin, a specific inhibitor of G(i/o) proteins. In addition, cytotoxicity was only induced by LPA but not by PA in C6 glioma cells. Our results suggest that PA may act as a partial agonist at endogenous LPA receptors, which are sensitive to Ki16425 and coupled to PTX-insensitive G proteins, to evoke morphological changes in C6 glioma cells.     

广西HIV-1首次流行的分子流行病学分析

目的　广西自1996年4月起在静脉吸毒者和卖血者中发现HIV感染者,为了解其传染来源和判断其流行趋势,对广西流行的HIV进行分子流行病学分析。方法　选取HIV抗体阳性血清标本44份,分别采用多肽酶免疫法(PEIA)和经逆转录PCR扩增作cDNA序列分析,分别确定其HIV-1基因亚型并加以比较。结果　结果表明广西存在4种HIV-1M组基因亚型,即B’(泰国B亚型)、C、D、E亚型。在静脉吸毒人群和性混乱者中存在HIV-1E亚型流行和C亚型感染者;而在卖血者中发现HIV-1B’和D亚型感染。结论　HIV-1D亚型感染和E亚型流行已在国内出现,E亚型病毒已由东南亚传入流行并将在我国南部形成新的流行区域。提出血清学分型方法可作为HIV-1基因亚型分析的筛选技术推广应用。     

Avoidable readmission in Hong Kong - system, clinician, patient or social factor?

Background  

Studies that identify reasons for readmissions are gaining importance in the light of the changing demographics worldwide which has led to greater demand for hospital beds. It is essential to profile the prevalence of avoidable readmissions and understand its drivers so as to develop possible interventions for reducing readmissions that are preventable. The aim of this study is to identify the magnitude of avoidable readmissions, its contributing factors and costs in Hong Kong.     

中青年糖尿病患者胰岛素治疗存在的问题及护理干预

糖尿病易导致严重的急慢性并发症,已成为影响人们生活质量的一种常见疾病。胰岛素作为降糖激素,在控制糖尿病的发生、发展中有不可取代的作用。本文对中青年糖尿病患者在接受胰岛素治疗方面存在的问题及护理干预进行归纳。     

Lumbar fusion outcomes stratified by specific diagnostic indication

BACKGROUND: One of the primary difficulties in evaluating the effectiveness of lumbar fusion is that, with the exception of spondylolisthesis, specific diagnostic indications for surgery are poorly defined. Diagnostic specificity beyond the symptom of low back pain or the presence of lumbar degeneration needs to be delineated such that outcomes data can be effectively translated into clinical decision making or evidence-based guidelines. PURPOSE: The purpose of this study was to report on prospectively collected clinical outcome measures, stratified by diagnosis, among a series of patients with lumbar degenerative disease whose treatment included lumbar spine fusion. STUDY DESIGN: Demographics, diagnostic categorization, and clinical outcome measures were prospectively collected by six spine surgeons at a single tertiary spine center, as part of the surgeons' standard clinical practice. PATIENT SAMPLE: Four hundred and twenty-eight patients were enrolled in the study and complete 1- and 2-year Health-Related Quality of Life (HRQOL) data were available in 327 patients whose treatment included decompression and posterolateral lumbar fusion. OUTCOME MEASURES: The Oswestry Disability Index (ODI), Short Form-36 (SF-36), numeric rating scales for back pain and leg pain. METHODS: Preoperative diagnosis was classified, in the primary surgical cases, as disc pathology, spondylolisthesis, instability, stenosis, or scoliosis. In revision cases, the diagnosis was classified as nonunion, adjacent level degeneration, or postdiscectomy revision. Patient-reported outcomes at 1 and 2 years post-op were assessed based on diagnostic stratification. Statistical evaluation of clinical outcome was performed for both mean net change in outcome scores and the percentage of patients reaching a minimum clinically important difference (MCID) threshold for each outcome measure. RESULTS: Preoperative diagnosis was spondylolisthesis (n=80), scoliosis (n=17), disc pathology (n=33), instability (n=21), stenosis (n=46), postdiscectomy revision (n=67), adjacent level degeneration (n=40), or nonunion (n=23). Evaluation of 2-year post-op HRQOL measures by diagnostic subgroup revealed the most substantial improvement in ODI score for patients with spondylolisthesis (22.7 points) and scoliosis (21.2 points). Patients with the diagnosis of disc pathology (16.2 points), postdiscectomy revision (14.0 points), instability (12.7 points), stenosis (10.6 points), and adjacent level degeneration (9.5 points) demonstrated a progressively smaller magnitude of ODI improvement. The least ODI improvement at 2 years after surgery was seen in patients with nonunion of a prior fusion (5.5 points). The percentage of patients reaching MCID for ODI at 2 years post-op ranged from 71.0% in the spondylolisthesis subgroup to 34.8% in the nonunion subgroup. The greatest SF-36 physical component score improvement at 2-year follow-up was seen in patients with disc pathology (7.9 points) and spondylolisthesis (7.7 points), followed by scoliosis (6.6 points) and stenosis (6.5 points), instability (5.6 points), postdiscectomy revision (5.3 points) nonunion (3.1 points) and adjacent level degeneration (2.5 points). No significant changes from Year 1 to Year 2 were noted in any of the subgroups. For SF-36 physical component score, percentage of patients reaching MCID ranged from 63.6% in the disc pathology subgroup to 25% in the nonunion subgroup. CONCLUSIONS: This study supports the concept that added diagnostic specificity is a critical component in building an improved evidence base for lumbar fusion surgery. The magnitude of HRQOL improvement was not equal among diagnostic subgroups. The percentage of patients reaching an MCID level of improvement was also significantly influenced by diagnostic stratification. Without diagnostic specificity for entities beyond spondylolisthesis, the absence of well-defined study populations will continue to limit our ability to move toward evidence-based decision making.     

Advances and challenges in biosensor-based diagnosis of infectious diseases

Rapid diagnosis of infectious diseases and timely initiation of appropriate treatment are critical determinants that promote optimal clinical outcomes and general public health. Conventional in vitro diagnostics for infectious diseases are time-consuming and require centralized laboratories, experienced personnel and bulky equipment. Recent advances in biosensor technologies have potential to deliver point-of-care diagnostics that match or surpass conventional standards in regards to time, accuracy and cost. Broadly classified as either label-free or labeled, modern biosensors exploit micro- and nanofabrication technologies and diverse sensing strategies including optical, electrical and mechanical transducers. Despite clinical need, translation of biosensors from research laboratories to clinical applications has remained limited to a few notable examples, such as the glucose sensor. Challenges to be overcome include sample preparation, matrix effects and system integration. We review the advances of biosensors for infectious disease diagnostics and discuss the critical challenges that need to be overcome in order to implement integrated diagnostic biosensors in real world settings.