Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care

INTRODUCTION: Infection is an important complication in cancer patients, which frequently leads to or prolongs hospitalization, and can also lead to acute organ dysfunction (severe sepsis) and eventually death. While cancer patients are known to be at higher risk for infection and subsequent complications, there is no national estimate of the magnitude of this problem. Our objective was to identify cancer patients with severe sepsis and to project these numbers to national levels. METHODS: Data for all 1999 hospitalizations from six states (Florida, Massachusetts, New Jersey, New York, Virginia, and Washington) were merged with US Census data, Centers for Disease Control vital statistics and National Cancer Institute, Surveillance, Epidemiology, and End Results initiative cancer prevalence data. Malignant neoplasms were identified by International Classification of Disease (ninth revision, clinical modification) (ICD-9-CM) codes (140–208), and infection and acute organ failure were identified from ICD-9-CM codes following Angus and colleagues. Cases were identified as a function of age and were projected to national levels. RESULTS: There were 606,176 cancer hospitalizations identified, with severe sepsis present in 29,795 (4.9%). Projecting national estimates for the US population, cancer patients account for 126,209 severe sepsis cases annually, or 16.4 cases per 1000 people with cancer per year. The inhospital mortality for cancer patients with severe sepsis was 37.8%. Compared with the overall population, cancer patients are much more likely to be hospitalized (relative risk, 2.77; 95% confidence interval, 2.77–2.78) and to be hospitalized with severe sepsis (relative risk, 3.96; 95% confidence interval, 3.94–3.99). Overall, severe sepsis is associated with 8.5% (46,729) of all cancer deaths at a cost of $3.4 billion per year. CONCLUSION: Severe sepsis is a common, deadly, and costly complication in cancer patients

Allergens in Paved Road Dust and Airborne Particles

Paved road dust present on the surface of streets in Southern California consists of a complex mixture of soil dust, deposited motor vehicle exhaust particles, tire dust, brake lining wear dust, plant fragments, and other biological materials. The research presented here shows that allergens from at least 20 different source materials are found in the paved road dust. These include pollens and pollen fragments, animal dander, and molds. When paved road dust is resuspended into the atmosphere by passing vehicle traffic, allergen concentrations in the air are increased above the levels that would prevail without the vehicle traffic. Using immunological assays that measure the proteins extracted from environmental samples that bind to IgE antibodies present in the blood serum of allergenic patients, it is possible to measure the allergen concentrations present in paved road dust and in airborne particle samples. Total protein contributions to monthly average airborne TSP and PM_(10) concentrations are found to be in the range from 1 to 5.8 μg m^(-3), potentially accounting for a significant fraction of the airborne particulate organic material that has not been identified to date by GC/MS techniques. Results show that up to 5−12% of the allergenicity of atmospheric total suspended particulate matter samples at Long Beach and Rubidoux, CA, is attributable to paved road dust emissions. In an industrial area of urban central Los Angeles where there is less proximity to vegetation and domestic activities, the paved road dust contribution to airborne allergen concentrations is lower, accounting for approximately 0.5% of the total allergenic activity of the atmospheric particle samples. In conclusion, paved road dust when entrained into the atmosphere by passing traffic is a source of allergen exposure for the general population and could be more important in areas with more abundant vegetation or with closer proximity of populations to major highways than is the case for the Southern California air monitoring sites studied here

A new vesicular compartment in Encephalitozoon cuniculi

Abstract The microsporidia are emerging human and veterinary pathogens known to infect every tissue type and organ system. Their infectious spore possesses a number of peculiar organelles, including the diagnostic polar tube. In a proteomics-driven effort to find novel components of this organelle in the human-pathogenic species Encephalitozoon cuniculi, we unexpectedly discovered a protein which localizes to punctate structures consistent with the appearance of relic mitochondria, or mitosomes. However, this novel protein did not colocalize with ferredoxin, a mitochondrial ironesulfur cluster protein which shows a similar localization pattern by light microscopy. The distribution pattern of this protein thus suggests either a novel vesicular compartment that is similar to mitosomes in size and distribution, the presence of subdomains or branching architecture within mitosomes, or heterogeneity in the protein composition of E. cuniculi mitosomes

Allergens in Paved Road Dust and Airborne Particles

Paved road dust present on the surface of streets in Southern California consists of a complex mixture of soil dust, deposited motor vehicle exhaust particles, tire dust, brake lining wear dust, plant fragments, and other biological materials. The research presented here shows that allergens from at least 20 different source materials are found in the paved road dust. These include pollens and pollen fragments, animal dander, and molds. When paved road dust is resuspended into the atmosphere by passing vehicle traffic, allergen concentrations in the air are increased above the levels that would prevail without the vehicle traffic. Using immunological assays that measure the proteins extracted from environmental samples that bind to IgE antibodies present in the blood serum of allergenic patients, it is possible to measure the allergen concentrations present in paved road dust and in airborne particle samples. Total protein contributions to monthly average airborne TSP and PM_(10) concentrations are found to be in the range from 1 to 5.8 μg m^(-3), potentially accounting for a significant fraction of the airborne particulate organic material that has not been identified to date by GC/MS techniques. Results show that up to 5−12% of the allergenicity of atmospheric total suspended particulate matter samples at Long Beach and Rubidoux, CA, is attributable to paved road dust emissions. In an industrial area of urban central Los Angeles where there is less proximity to vegetation and domestic activities, the paved road dust contribution to airborne allergen concentrations is lower, accounting for approximately 0.5% of the total allergenic activity of the atmospheric particle samples. In conclusion, paved road dust when entrained into the atmosphere by passing traffic is a source of allergen exposure for the general population and could be more important in areas with more abundant vegetation or with closer proximity of populations to major highways than is the case for the Southern California air monitoring sites studied here

Expression of SMARCD1 interacts with age in association with asthma control on inhaled corticosteroid therapy.

BackgroundGlobal gene expression levels are known to be highly dependent upon gross demographic features including age, yet identification of age-related genomic indicators has yet to be comprehensively undertaken in a disease and treatment-specific context.MethodsWe used gene expression data from CD4+ lymphocytes in the Asthma BioRepository for Integrative Genomic Exploration (Asthma BRIDGE), an open-access collection of subjects participating in genetic studies of asthma with available gene expression data. Replication population participants were Puerto Rico islanders recruited as part of the ongoing Genes environments & Admixture in Latino Americans (GALA II), who provided nasal brushings for transcript sequencing. The main outcome measure was chronic asthma control as derived by questionnaires. Genomic associations were performed using regression of chronic asthma control score on gene expression with age in years as a covariate, including a multiplicative interaction term for gene expression times age.ResultsThe SMARCD1 gene (SWI/SNF-related matrix-associated actin-dependent regulator of chromatin subfamily D member 1) interacted with age to influence chronic asthma control on inhaled corticosteroids, with a doubling of expression leading to an increase of 1.3 units of chronic asthma control per year (95% CI [0.86, 1.74], p = 6 × 10- 9), suggesting worsening asthma control with increasing age. This result replicated in GALA II (p = 3.8 × 10- 8). Cellular assays confirmed the role of SMARCD1 in glucocorticoid response in airway epithelial cells.ConclusionFocusing on age-dependent factors may help identify novel indicators of asthma medication response. Age appears to modulate the effect of SMARCD1 on asthma control with inhaled corticosteroids

Trends in caesarean section and instrumental deliveries in relation to Body Mass Index: a clinical survey during 1978 - 2001

<p>Abstract</p> <p>Background</p> <p>During the last 20 years the rate of CS has increased in Sweden as it has in many other countries. The proportion of pregnant women suffering from a high BMI has also increased rapidly during the same time period. It would therefore be of interest to study both how and if these two observations are related to each other. The aim was therefore to study trends in mode of caesarean section (CS) and instrumental deliveries among women in three BMI groups over a time span of almost 25 years with special focus on the observed body weight of pregnant women.</p> <p>Method</p> <p>The design is a retrospective cohort study using medical records of consecutively delivered women at two delivery wards in South East Sweden during the years 1978, 1986, 1992, 1997 and 2001.</p> <p>Results</p> <p>No significant time-trends were found for CS and instrumental delivery within each BMI-group for the time period studied. The proportion of women with BMI ≥ 25 delivered by means of CS or instrumental delivery increased quite dramatically from 1978 to 2001 (χ²test for trend; p < 0.001 for both CS and instrumental deliveries). The mean birth weight in relation to BMI and year of study among women delivered by means of CS decreased, a trend that was most evident between 1997 and 2001 (F-test; p = 0.005, p = 0.004, and p = 0.003 for BMI < 20, 20-24.9, and ≥ 25, respectively).</p> <p>Conclusion</p> <p>Overweight and obese pregnant women constitute a rapidly growing proportion of the total number of CS and instrumental deliveries. Planning and allocation of health resources must be adjusted to this fact and its implications.</p

Patient-reported outcome after rheumatoid arthritis-related surgery in the lower extremities: A report from the Swedish National Register of Rheuma Surgery (RAKIR)

Background and purpose Although decreasing with the development of effective pharmacological regimes, joint surgery has improved the function and quality of life of patients with rheumatoid arthritis (RA). Few studies have assessed patient-reported outcomes after RA surgery to the lower extremities. Here we report patient-relevant outcome after RA-related surgery based on the first data from the Swedish National Register of Rheuma Surgery (RAKIR). Patients and methods 258 RA patients (212 women) who had joint surgery performed at the Department of Orthopaedics, Spenshult Hospital between September 2007 and June 2009 were included. Mean age at surgery was 64 (20-86) years. The patients completed the SF-36 and HAQ questionnaires preoperatively and 6 months postoperatively, and 165 patients completed them after 12 months. Results Improvement was seen as early as at 6 months. At 12 months, 165 patients (141 women)-including hip (n = 15), knee (n = 27), foot (n = 102), and ankle (n = 21) patients-reported statistically significant improvements from preoperatively to 12 months postoperatively in HAQ (mean change: -0.11) and SF-36 subscales physical function (11), role physical (12), bodily pain (13), social functioning (6.4), and role emotional (9.4). Hip and knee patients reported the greatest improvements. Interpretation Orthopedic RA-related surgery of the lower extremities has a strong effect on pain and physical function. Improvement is evident as early as 6 months postoperatively and remains after 12 months

The Personalized Acne Treatment Tool - Recommendations to facilitate a patient-centered approach to acne management from the Personalizing Acne: Consensus of Experts

BACKGROUND: Acne, a commonly treated skin disease, requires patient-centered management due to its varying presentations, chronicity, and impact on health-related quality of life. Despite this, evidence-based clinical guidelines focus primarily on clinical severity of facial acne, omitting important patient- and disease-related factors, including ongoing management. OBJECTIVES: To generate recommendations to support patient-centered acne management, which incorporate priority and prognostic factors beyond conventional clinical severity, traditionally defined by grading the appearance and extent of visible lesions. METHODS: The Personalizing Acne: Consensus of Experts consisted of 17 dermatologists who used a modified Delphi approach to reach consensus on statements regarding patient- and treatment-related factors pertaining to patient-centered acne management. Consensus was defined as ≥75% voting agree or strongly agree. RESULTS: Recommendations based on factors such as acne sequelae, location of acne, high burden of disease, and individual patient features were generated and incorporated into the Personalized Acne Treatment Tool. LIMITATIONS: Recommendations are based on expert opinion, which may differ from patients\u27 perspectives. Regional variations in healthcare systems may not be represented. CONCLUSIONS: The Personalizing Acne: Consensus of Experts panel provided practical recommendations to facilitate individualized management of acne, based on patient features, which can be implemented to improve treatment outcomes, adherence, and patient satisfaction

Homozygous microdeletion of exon 5 in ZNF277 in a girl with specific language impairment

Peer reviewedPublisher PD

T-cell receptor early signalling complex activation in response to interferon-α receptor stimulation

Signalling through the IFNαR (interferon-α receptor) and TCR (T-cell receptor) in Jurkat T lymphocytes results in distinct immune responses. Despite this both receptors elicit ERK (extracellular-signal-regulated kinase)/MAPK (mitogen-activated protein kinase) phosphorylation. Vav and Slp76 are shown to be required for IFNα (interferon-α)-stimulated ERK activity. These form a subset of proteins which behave identically on stimulation of both receptors. TCR deletion abrogates IFNαR-stimulated MAPK activity, whereas the canonical JAK/STAT (Janus kinase/signal transducer and activator of transcription) pathway is unaffected. Thus recruitment of the intact TCR ESC (early signalling complex) is necessary for this downstream MAPK response. Despite using a common ESC, stimulation of the IFNαR does not produce the transcriptional response associated with TCR. Up-regulation of the MAPK pathway by IFNαR might be important to ensure that the cell responds to only one stimulant