The Effect of Neutrophil-lymphocyte Ratio on 10-year Survival Outcomes Following Elective Open and EVAR Procedures

Objectives: The neutrophil-lymphocyte ratio (NLR) is a useful and inexpensive inflammatory marker associated with surgical outcomes. This study evaluates the effects of NLR on survival after elective endovascular (EVAR) and open aortic repair (OAR) of abdominal aortic aneurysm. Methods: We retrospectively reviewed patients from 1989 to 2019 who underwent elective OAR or EVAR at two separate academic centers. Baseline comorbidities were assessed. A receiver operating characteristic (ROC) curve was used to determine a cutoff point where NLR was associated with outcome. Kaplan-Meier survival analysis was used to compare survival through 10-year follow-up. Results: Overall, 437 patients (mean age, 72.0 6 10.1 years; 74.1% male) underwent 213 EVARs and 224 OARs. Median duration of follow-up was 4.55 years. The analysis of the ROC curve yielded an NLR of 3.94 with the highest specificity and sensitivity for 10-year survival. Baseline characteristics were similar between groups, except for an increased age in the group with NLR \u3e3.94 (73.5 vs 70.9 years; P ¼ .008) (Table). KaplanMeier analysis revealed that patients with NLR \u3e3.94 had decreased 10-year survival (37.2% vs 54.2%; P ¼ .0001) (Fig). By univariate analysis, NLR \u3e3.94 (P ¼ .0001), chronic obstructive pulmonary disease (P ¼ .006), and increased age (P ¼ .0001) were associated with increased mortality. On multivariable cox regression analysis, an NLR \u3e3.94 (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.19-2.40), increased age (OR, 1.05; 95% CI, 1.03-1.07), and chronic obstructive pulmonary disease (OR, 1.44; 95% CI, 1.01-2.07) were associated with increased risk of mortality. Between OAR and EVAR, no difference in late survival was noted (49.9% vs 43.5%; P ¼ .24). Conclusions: An NLR \u3e3.94 is associated with increased mortality over a 10-year follow-up period after open and endovascular aortic repair. Future studies to further understand the driving force between an elevated NLR and increased mortality are warranted

Modified bacterial reaction centers

Pigments of borohydride-treated reaction centers of Rhodobacter sphaeroides R 26 and Rhodopseudomonas viridis were analyzed by HPLC with polychromatic detection. In both species, pigment composition and contents were unchanged. Reaction centers from Rhodobacter sphaeroides R26 were prepared in which bacteriochlorophylls (BA,B) and bacteriopheophytins (HA,B) were exchanged with their potential borohydride products reduced at C-31. [3-Hydroxyethyl]-BChl a exchanges selectively into the BA,B pockets, and 31-OH-BPh a to the HA,B pockets. Stable reaction centers are obtained in both cases. A comparison of the absorption and circular dichroism spectra of reaction centers after exchange with 31-OH pigments, and of borohydride-modified reaction centers, reveal distinct differences. It is concluded that during borohydride reduction none of the pigments is chemically modified or extracted from the reaction centers

Addressing COVID-19 in the surgical ICU: Incidence of antibodies in healthcare personnel at a quaternary care center

Background: There is concern that frontline healthcare personnel (HCP) are at increased risk of exposure to COVID-19 compared to the general population. Multiple studies have demonstrated significant seroprevalence of COVID-19 antibodies in HCP. Increased seropositivity has been associated with reduced use of personal protective equipment (PPE) along with reported PPE shortages. This investigation aims to determine the seroprevalence of COVID-19 in frontline HCP working at a quaternary care center that was heavily impacted by the initial surge of COVID-19, while also identifying underlying factors associated with increased seropositivity. Methods & Materials: HCP who participated in the management of COVID-19 patients were recruited from April 27 to May 13 of 2020. Unidentifiable demographic data was collected, including a questionnaire to identify potential exposure, symptoms, medical comorbidities, and adherence to PPE usage on a scale of 1 to 5 (1 being always, 5 being never). Serological testing was performed using CMC-19D SARS-CoV-2 (COVID-19) Rapid Antibody Test manufactured by Audacia Bioscience. Seropositivity was captured by formation of a dark band at the G (IgG) and C (control) positions on the test device, while IgM alone was considered a false positive. Pearson chi-squared and Fisher exact tests were performed to analyze categorical variables. SPSS version 27.0 was used for statistical analysis (SPSS, Armonk, NY). Conclusion: Overall seropositivity of IgG antibodies was 10.6%. Non-ICU personnel showed higher seroprevalence compared to ICU personnel, this may be attributed to decreased reported adherence to strict PPE usage in non-ICU areas compared to ICU areas during patient contact. Compared to MICU, SICU personnel appeared to be less compliant with frequency of PPE use outside patient rooms. Adherence to PPE usage outside patient contact was a predictor of seropositivity, and non-ICU personnel had a tendency toward high seroprevalence.https://scholarlycommons.henryford.com/sarcd2021/1003/thumbnail.jp

HEPATITIS C VIRUS GENOTYPING IN CHRONIC HEPATITIS C PATIENTS

Chronic hepatitis C virus infection is a massive worldwide healthcare burden with estimated costs in the USA alone of over $5 billon per annum. The virus has a 9.5kb positive sense single-stranded RNA genome with striking heterogeneity between isolates, which has led to it being divided into 6 genotypes and more than 50 subtypes and many quasispecies that has been arisen due to the infidelity of the viral polymerase, which lacks of a proofreading function. The virus exists as a range of related but not identical species at the quasispecies. In each infected individual, HCV circulates as a quasispecies in which the population consists of a number of closely related but distinct genetic species. The distribution of the genotype might be influenced by the mode of transmission and racial group. The only current effective treatment is combination therapy with pegylated interferon plus ribavirin (peg-IFNα + RBV) for 24–48 weeks based for genotypes 1 and 4 is 48 weeks, whereas the treatment for genotypes 2 and 3 is completed in 24 weeks. It has proved effective in up to 50% of those infected with HCV genotype 1 and 4 and it varies with other genotypes. HCV genotype is consider to be a clinically important parameter for determining both; the potential response and the duration of treatment.

An exploratory randomized controlled trial evaluating text prompts in Lebanon to encourage health‐seeking behavior for hypertension

Aims of the study The current study evaluates the effectiveness of an opportunistic mobile screening on the percentage of people who are aware of whether they may be hypertensive (in an observational study) and the effectiveness of reminder prompts on the percentage of people who seek further medical attention (in a randomized controlled trial). Methods used to conduct the study The screening of 1227 participants (529 female) was conducted during the registration period of the 2018 Beirut International Marathon in Lebanon. Next, 266 participants whose screening indicated hypertension (64 Female) were randomly allocated to a treatment group or a control group in a 1:1 fashion. The treatment group received a reminder prompt to seek further medical attention for their potential hypertension and the control group did not. The overt nature of the text message meant that participants in the treatment group could not be blinded to their group allocation. The primary outcome is participants’ self‐reports of whether they sought further medical attention. Results of the study For the opportunistic screening, a 25% prevalence rate and a 24% awareness rate of hypertension was indicated. A McNemar analysis suggested that the screening increased participant awareness (X2 (N =1227)=72.16, p <0.001). For the randomized controlled trial, 219 participants provided follow‐up data via a phone call (82% retention). A Chi‐squared analysis suggested that the reminder prompt successfully encouraged more participants to seek further medical attention, 45.5% treatment group vs. 28.0% control group (X 2(1, N =219)=7.19, p =0.007, φ =0.18). Conclusions drawn and clinical implications Extra support in the form of a brief reminder message can increase the percentage of people who seek further medical attention after attending an opportunistic screening at a marathon event. The discussion reviews how the results align with previous research, strengths and limitations of the current study, and implications for future research and practice

Personality, cognition and hazardous drinking: support for the 2-Component Approach to Reinforcing Substances Model

Personality and cognitive processes are both related to alcohol use and misuse. A recent model of hazardous drinking referred, the 2-CARS model, postulates two major pathways to hazardous drinking. One pathway primarily involves the association between Reward Drive and Positive Outcome Expectancies, the second involves the association between Rash Impulsiveness and Drinking Refusal Self-Efficacy. In previous tests of the model, Drinking Refusal Self-Efficacy was found to have the most proximal impact on drinking, being directly influenced by Rash Impulsiveness, and indirectly influenced by Reward Drive through Positive Outcome Expectancies. The aim of the current study was to test the 2-CARS model in a larger independent sample. Results found that individuals with a strong Reward Drive showed higher Positive Outcome Expectancies, while individuals high in Rash Impulsiveness were more likely to report reduced Drinking Refusal Self-Efficacy. The present results also showed a theoretically unexpected pathway with a direct association between Rash Impulsiveness and Positive Outcome Expectancies. However, overall the results support the view that a greater understanding of hazardous drinking can be achieved by investigating the relationship between these personality and cognitive variables. (C) 2013 Elsevier Ltd. All rights reserved

Race at the margins: A Critical Race Theory perspective on race equality in UK planning.

Despite evidence of the growing ethnic diversity of British cities and its impact on urban governance, the issue of racial equality in UK planning remains marginal, at best, to mainstream planning activity. This paper uses Critical Race Theory (CRT) to consider the reasons why the ‘race’ and planning agenda continues to stall. CRT, it is argued, offers a compelling account of why changes in practice over time have been patchy at best, and have sometimes gone into reverse

Up-regulation of multiple proteins and biological processes during maxillary expansion in rats

<p>Abstract</p> <p>Background</p> <p>Maxillary expansion (ME) is a common practice in orthodontics that aims to increase the constricted maxillary arch width. Relapse often occurs, however, and better treatment strategies are needed. In order to develop a more effective method, this study was designed to further examine the process of tissue remodeling during ME, to identify the changes in expression of several proteins of interest, and to clarify the molecular mechanism responsible for tissue remodeling.</p> <p>Methods</p> <p>Male Wistar rats were randomly divided into control and ME groups. The rats were euthanized at various intervals over 11 days, and the dissected palates were prepared for histological examination. The structure of the midpalatal sutures changed little during the first three days. Proteins from samples in the ground midpalatal tissues obtained on the third day were subjected to two-dimensional polyacrylamide gel electrophoresis (2-DE) and matrix assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) analysis. Validation of protein expression was performed by Western blot analyses.</p> <p>Results</p> <p>From day 5, chondrocytes in the inner layer of suture cartilage and osteoblasts at the end of the suture cartilage began to proliferate, and the skeletal matrix increased later adjacent to the cartilage in the ME group. Comparative proteomic analysis showed increases in 22 protein spots present in the ME group. The changes in three proteins closely related to osteogenesis (parathyroid hormone, osteoprotegerin and vimentin) were confirmed by Western blotting.</p> <p>Conclusion</p> <p>Many proteins are over-expressed during ME, and they may play an important role in the remodeling process.</p

Do airway metallic stents for benign lesions confer too costly a benefit?

<p>Abstract</p> <p>Background</p> <p>The use of self-expanding metallic stents (SEMAS) in the treatment benign airway obstruction is controversial.</p> <p>Methods</p> <p>To evaluate the safety and efficacy of SEMAS for this indication, we conducted a 10-year retrospective review at our tertiary medical centre.</p> <p>Results</p> <p>Using flexible bronchoscopy, 82 SEMAS (67% Ultraflex, 33% Wallstent) were placed in 35 patients with inoperable lesions, many with significant medical comorbidities (88%). 68% of stents were tracheal, and 83% of patients showed immediate symptomatic improvement. Reversible complications developed in 9% of patients within 24 hrs of stent placement. Late complications (>24 hrs) occurred in 77% of patients, of which 37% were clinically significant or required an interventional procedure. These were mainly due to stent migration (12.2%), fracture (19.5%), or obstructive granulomas (24.4%). The overall granuloma rate of 57% was higher at tracheal sites (59%) than bronchial ones (34%), but not significantly different between Ultraflex and Wallstents. Nevertheless, Wallstents were associated with higher rates of bleeding (5% vs. 30%, p = 0.005) and migration (7% vs. 26%, p = 0.026). Of 10 SEMAS removed using flexible bronchoscopy, only one was associated with incomplete removal of fractured stent wire. Median survival was 3.6 ± 2.7 years.</p> <p>Conclusion</p> <p>Ill patients with inoperable lesions may be considered for treatment with SEMAS.</p