Painful skin lesions and squamous cell carcinoma predict overall mortality risk in organ transplant recipients:a cohort study

Item does not contain fulltextBACKGROUND: Organ transplant recipients (OTRs) have a highly increased risk of cutaneous squamous cell carcinomas (SCCs). Sensation of pain in cutaneous tumours is a powerful patient-reported warning signal for invasive SCCs in OTRs. OBJECTIVES: To investigate the impact of painful vs. painless skin lesions and SCC vs. other skin lesions on the overall mortality risk in OTRs. METHODS: We followed 410 OTRs from 10 different centres across Europe and North America between 2008 and 2015. These patients had been enrolled in an earlier study to define clinically meaningful patient-reported warning signals predicting the presence of SCC, and had been included if they had a lesion requiring histological diagnosis. Cumulative incidences of overall mortality were calculated using Kaplan-Meier survival analysis, and risk factors were analysed with Cox proportional hazard analysis. RESULTS: There was an increased overall mortality risk in OTRs who reported painful vs. painless skin lesions, with a hazard ratio (HR) of 1.6 [95% confidence interval (CI) 0.97-2.7], adjusted for age, sex and other relevant factors. There was also an increased overall mortality risk in OTRs diagnosed with SCC compared with other skin lesions, with an adjusted HR of 1.7 (95% CI 1.0-2.8). Mortality due to internal malignancies and systemic infections appeared to prevail in OTRs with SCC. CONCLUSIONS: We suggest that OTRs have an increased overall mortality risk if they develop painful skin lesions or are diagnosed with cutaneous SCC

The Central Limit Theorem for Random Dynamical Systems

We consider random dynamical systems with randomly chosen jumps. The choice of deterministic dynamical system and jumps depends on a position. The Central Limit Theorem for random dynamical systems is established

Nutrients balance in the diet of dairy cow

Obliczono bilans składników nawozowych w diecie krowy w celu opracowania zmian w strategii nawożenia w gospodarstwach ukierunkowanych na wyłączną produkcję mleka. Badania oparto na rzeczywistej technologii żywienia krów mlecznych w Zakładzie Doświadczalnym IMUZ w Falentach, w którym przeciętna wydajność mleka od krowy wynosiła 8 700 dm ³ · rok-1. Bilans obejmowałdietę krowy o wydajności 7 000, 8 000 i 10000dm ³ · rok-1. W rocznych odchodach od jednej krowy pozostawało z diety 115-180 kg N, 22-34 kg P, 103-131 kg K, 21-29 kg Mg, 44-63 kg Ca i 12-16 kg S. Te ilości fosforu i azotu pozostające w gospodarstwie mogą stanowić zagrożenie dla środowiska, a ilości potasu mogą powodować zwiększanie się jego zawartości w paszy z gospodarstwa, co może być niekorzystne dla zdrowotności krów. W intensywnych gospodarstwach ukierunkowanych na wyłączną produkcję mleka obserwuje się systematyczny nadmiar składników nawozowych. Gospodarstwa te wymagają innej strategii nawożenia i odpowiedniego doradztwa nawozowego.Nutrient balance has been calculated in the dairy cow diet in order to introduce changes in the fertilization strategy at the dairy farm. The investigations were based on the actual feeding technology used in the farm of Experimental Station at Falenty, where the average milking efficiency is 8 700 dm ³ · year–1. The diet of cows of milking efficiency 7 000, 8 000 and 10 000 dm³ · year-1 was considered. The amount of nutrients in animal wastes per one cow was in the range - 115-180 kg N, 22-34 kg P, 103-131 kg K, 21-29 kg Mg, 44-63 kg Ca and 12-16 kg S. These amounts of phosphorus or nitrogen may pose a risk to the environment, and the amount of potassium could increase its content in the farm fodder, that could be critical for animal health. A regular increase of nutrient surplus is observed in dairy farms. These farms need different fertilization strategy and appropriate fertilization advisory

Pain identifies squamous cell carcinoma in organ transplant recipients:The SCOPE-ITSCC PAIN study

Organ transplant recipients (OTR) are at high risk for cutaneous squamous cell carcinomas (SCC). We aimed to define clinically meaningful patient-reported warning signals predicting the presence of invasive SCC.Patient-reported signs and symptoms of 812 consecutively biopsied skin lesions from 410 OTR were determined by questionnaire and physical examination and related to the subsequent biopsy-proven diagnoses. Receiver-operating characteristic (ROC) curve analyses were used as a measure of distinction between the predictive values of patient-reported warning signals and the occurrence of SCC. Pain was an independent predictive patient-reported warning signal for a biopsy-proven invasive SCC. The odds ratio from the fully adjusted model predicting SCC was 4.4(95% confidence interval: 2.4–8.2). Higher scores on the visual analog scale (VAS) for pain were associated witha greater likelihood for the presence of SCC compared to none or mild pain. The for scores on the VAS from 1to 3, 4 to 6 and 7 to 10 were 4.9 (2.2–10.5), 2.3 (0.96–5.5)and 16.5 (3.6–75.8), respectively. Pain is the most powerful patient-reported warning signal for invasive cutaneous SCC in OTR. Empowerment of patients by education could accelerate diagnosis and treatment of cutaneous SCC