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

Treatment Patterns, Effectiveness, and Safety of Originator Insulin Glargine versus Insulin Glargine-yfgn within the Veterans Health Administration

We described insulin glargine (originator) and insulin glargine-yfgn (biosimilar) treatment patterns, assessed effectiveness and safety outcomes, and identified reasons for switching back to the originator product from the biosimilar. This retrospective study included 328,463 Veterans 18 years of age and older who received one or more outpatient prescriptions for insulin glargine and/or insulin glargine-yfgn between 1 June 2021 and 31 December 2022. Patients were assigned to subgroups based on the initial prescription during the study period, prevalent versus incident use for originator insulin glargine, and prior versus no prior use of the originator before the biosimilar (i.e., prevalent originator non-switcher (n = 189,734), originator switch to biosimilar (n = 81,010), incident originator non-switcher (n = 49,401), and incident biosimilar (n = 8318)). There were no differences in the outcome of mean HbA1c (7.9% for all subgroups). There were also no differences in the unadjusted rates of hospitalization and/or emergency room visits for hyper- and hypoglycemia between the prevalent originator non-switcher and originator switched to biosimilar subgroups (p = 0.09 and 0.38, respectively) or the incident originator non-switcher and incident biosimilar subgroups (p = 0.054 and 0.61, respectively). Finally, none of the HbA1c or hyperglycemia outcomes adjusted for baseline characteristics were statistically different. Adjusted analyses for rates of hospitalization and/or emergency room visits for hypoglycemia could not be performed due to the low number of events. Overall, patients who received insulin glargine-yfgn had similar effectiveness and safety outcomes as patients who received the originator