Comparison of outcomes in emergency department patients with suspected cardiac chest pain: two-centre prospective observational study in Southern China

Background Hong Kong (HK) and Guangzhou (GZ) are cities in China with different healthcare systems. This study aimed to compare 30-day and 6-month mortality and characteristics of patients with suspected cardiac chest pain admitted to two emergency departments (ED) in HK and GZ. Methods A prospective observational study enrolled patients with suspected cardiac chest pain presenting to EDs in the Prince of Wales Hospital (PWH), HK and the Second Affiliated Hospital of Guangzhou Medical University (AHGZMU),GZ. The primary outcome was 30-day and 6-month mortality. Results In total, 996 patients were recruited, 407 cases from GZ and 589 cases from HK.The 30-day and 6-month mortality of chest patients were 3.7% and 4.7% in GZand 0.3% and 1.9% in HK, respectively. Serum creatinine level (Cr) was an independent factor for 30-day mortality whilst Cr and systolic blood pressure (SBP) were independent factors for 6-month mortality. In Cox regression analysis, unadjusted and adjusted hazard ratios for 30-day and 6-month mortality in GZ were significantly increased. Conclusion The 30-day and 6-month mortality of patients with suspected cardiac chest pain in Guangzhou were higher than in Hong Kong due to due to different baseline clinical characteristics of patients and different distributions of diagnoses, which were associated with different healthcare systems. Serum creatinine and SBP were independent factors for 30-day and 6-month mortality

An Interval-Censored Proportional Hazards Model

We fit a Cox proportional hazards (PH) model to interval-censored survival data by first subdividing each individual\u27s failure interval into non-overlapping sub-intervals. Using the set of all interval endpoints in the data set, those that fall into the individual\u27s interval are then used as the cut points for the sub-intervals. Each sub-interval has an accompanying weight calculated from a parametric Weibull model based on the current parameter estimates. A weighted PH model is then fit with multiple lines of observations corresponding to the sub-intervals for each individual, where the lower end of each sub-interval is used as the observed failure time with the accompanying weights incorporated. Right-censored observations are handled in the usual manner. We iterate between estimating the baseline Weibull distribution and fitting the weighted PH model until the regression parameters of interest converge. The regression parameter estimates are fixed as an offset when we update the estimates of the Weibull distribution and recalculate the weights. Our approach is similar to Satten et al.\u27s (1998) method for interval-censored survival analysis that used imputed failure times generated from a parametric model in a PH model. Simulation results demonstrate apparently unbiased parameter estimation for the correctly specified Weibull model and little to no bias for a mis-specified log-logistic model. Breast cosmetic deterioration data and ICU hyperlactemia data are analyzed

Hypothyroidism and the risk of lower extremity arterial disease

Background: Although an independent association between hypothyroidism and coronary artery disease has been demonstrated, few studies have examined the association between hypo-thyroidism and peripheral arterial disease. In the current study, we test the hypothesis that there is an independent association between hypothyroidism and lower extremity arterial disease. Methods: We retrospectively compared the prevalence of hypothyroidism in patients who had infra-inguinal arterial bypass surgery over a 6-year period with that of a control group of surgical patients who had pure cardiac valve surgery during the same time period. Both unadjusted and adjusted odds ratios were calculated to estimate the association between hypothyroidism and lower extremity arterial disease. Results: A total of 614 cases and 529 control subjects had surgery during the study period. When comparing all subjects, there was no association between hypothyroidism and lower extremity arterial disease (unadjusted odds ratio 0.88; 95% confidence intervals [CI]: 0.61-1.28). However, gender was found to be a significant effect modifier (P \u3c 0.001), and gender-stratified analyses were subsequently performed. In men, there was a positive independent association between hypothyroidism and lower extremity arterial disease (adjusted odds ratio 2.65; 95% CI: 1.19-5.89), whereas in women there was a negative independent association (adjusted odds ratio 0.22; 95% CI: 0.11-0.46). Conclusions: Gender is a significant effect modifier for the association between hypothyroidism and lower extremity arterial disease. The association is positive in men and negative in women. Future prospective studies that evaluate hypothyroidism as a risk factor for peripheral arterial disease should consider gender stratification in order to corroborate this finding. © 2010 Mazzeffi et al, publisher and licensee Dove Medical Press Ltd

National Kriging Exposure Estimation: Liao et al. Respond

Szpiro et al. suggest that our findings Liao et al. (2006) do not adequately support using national-scale, log-normal ordinary kriging to estimate daily mean concentrations of PM10 (particulate matter with aerodynamic diameter ≤ 10 µm) at unmonitored locations in the contiguous United States. They posit that the absence of the cross-validation SE prevents evaluating the validity of kriging estimation, as we implemented in this context, and the comparability of both regionalversus national-scale kriging and manually modified versus semiautomated, defaultcalculated semivariograms

Inactivation of HIV-1 in breast milk by treatment with the alkyl sulfate microbicide sodium dodecyl sulfate (SDS)

BACKGROUND: Reducing transmission of HIV-1 through breast milk is needed to help decrease the burden of pediatric HIV/AIDS in society. We have previously reported that alkyl sulfates (i.e., sodium dodecyl sulfate, SDS) are microbicidal against HIV-1 at low concentrations, are biodegradable, have little/no toxicity and are inexpensive. Therefore, they may be used for treatment of HIV-1 infected breast milk. In this report, human milk was artificially infected by adding to it HIV-1 (cell-free or cell-associated) and treated with ≤1% SDS (≤10 mg/ml). Microbicidal treatment was at 37°C or room temperature for 10 min. SDS removal was performed with a commercially available resin. Infectivity of HIV-1 and HIV-1 load in breast milk were determined after treatment. RESULTS: SDS (≥0.1%) was virucidal against cell-free and cell-associated HIV-1 in breast milk. SDS could be substantially removed from breast milk, without recovery of viral infectivity. Viral load in artificially infected milk was reduced to undetectable levels after treatment with 0.1% SDS. SDS was virucidal against HIV-1 in human milk and could be removed from breast milk if necessary. Milk was not infectious after SDS removal. CONCLUSION: The proposed treatment concentrations are within reported safe limits for ingestion of SDS by children of 1 g/kg/day. Therefore, use of alkyl sulfate microbicides, such as SDS, to treat HIV1-infected breast milk may be a novel alternative to help prevent/reduce transmission of HIV-1 through breastfeeding

Estimating agreement coefficients from sample survey data

We present a generalized estimating equations approach for estimating the concordance correlation coefficient and the kappa coefficient from sample survey data. The estimates and their accompanying standard error need to correctly account for the sampling design. Weighted measures of the concordance correlation coefficient and the kappa coefficient, along with the variance of these measures accounting for the sampling design, are presented. We use the Taylor series linearization method and the jackknife procedure for estimating the standard errors of the resulting parameter estimates. Body measurement and oral health data from the Third National Health and Nutrition Examination Survey are used to illustrate this methodology.Keywords: Generalized estimating equations, Sample weighting, Concordance correlation coefficient, Stratification, Taylor series linearization, Kappa coefficient, Jackknife estimator, ClusteringKeywords: Generalized estimating equations, Sample weighting, Concordance correlation coefficient, Stratification, Taylor series linearization, Kappa coefficient, Jackknife estimator, Clusterin

Analysis of urgent/emergent conversions from monitored anesthesia care to general anesthesia with airway instrumentation

Background Monitored Anesthesia Care (MAC) is an anesthetic service involving the titration of sedatives/analgesics to achieve varying levels of sedation while avoiding general anesthesia (GA) and airway instrumentation. The goal of our study was to determine the overall incidence of conversion from MAC to general anesthesia with airway instrumentation and elucidate reasons and risk factors for conversion. Methods In this retrospective observational study, all non-obstetric adult patients who received MAC from July 2002 to July 2015 at Mount Sinai Hospital were electronically screened for inclusion via a clinical database. Patient, procedure, anesthetic, and practitioner data were all collected and analyzed to generate descriptive analyses. Subsequent univariate and multivariate analyses were used to identify specific risk factors associated with conversion to GA. Results Overall, 0.50% (1097/219,061) of MAC cases were converted to GA. Approximately half of conversions were due to the patient’s “intolerance” of MAC (with or without failed regional anesthesia), while the other half were due to physiologic derangements. Body mass index, male sex, American Society of Anesthesiologists Physical Status Classification, anesthesia team composition, and surgical specialty were all associated with risk of conversion to GA. Conclusions This is one of the first and largest retrospective studies aimed at identifying reasons and risk factors associated with the conversion of MAC to GA. These findings may be used to help better anticipate or prevent these events

Retraction notice to “A feasibility study of the combination of intranasal insulin with dulaglutide for cognition in older adults with metabolic syndrome at high dementia risk- Study rationale and design” [Mech. Ageing Dev. 213 (2023) 111825] (Mechanisms of Ageing and Development (2023) 213, (S0047637423000519), (10.1016/j.mad.2023.111825))

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/policies/article-withdrawal). “This article has been retracted at the request of the authors and Editor-in-Chief. The authors brought to the Editor-in-Chief\u27s attention that they encountered an issue during the ongoing preparations for their research study involving the formulation of the placebo for Dulaglutide. The manuscript described the design and methods of a double-blind placebo controlled clinical trial examining the combined effects of twice daily intranasal insulin and once weekly an injection of dulaglutide. At the time of publication, the authors were awaiting a placebo syringe for dulaglutide to be shipped to them. Regrettably, the syringe the authors received was not in line with their initial order and did not match their specifications. Despite enormous efforts to find an alternative supplier for syringes for the placebo of Dulaglutide, they were unable to identify a suitable provider. Consequently, they made the decision to transition to an alternative GLP1 receptor agonist medication drug named Semaglutide. Semaglutide is administered orally, marking the only change in their study design and rationale, with the core objectives remaining unchanged. All other components of the study rationale, design and methods, including the four study arms, the length of the study, the number of face-to-face assessments, and all outcome measures remained unchanged. Changes relate to the potential adverse events from Semaglutide. The authors confirmed that the funding organization supporting their research reviewed and approved of this change. Following this change, the authors have submitted an amended version of the article, which was subject to standard peer review, and has been accepted by Mechanisms of Ageing and Development. It has been published online and is available via https://www.sciencedirect.com/science/article/pii/S0047637423001240 and the DOI: https://doi.org/10.1016/j.mad.2023.111898. The authors apologize for any inconvenience”

A feasibility study of the combination of intranasal insulin with dulaglutide for cognition in older adults with metabolic syndrome at high dementia risk – Study rationale and design

Introduction: We present the rationale and design of a double-blind placebo-controlled feasibility trial combining intranasal insulin (INI) with dulaglutide, a GLP-1 receptor agonist, to improve cognition in older adults with metabolic syndrome (MetS) and mild cognitive impairment (MCI). Since both INI and dulaglutide have beneficial effects on the cerebrovascular disease (CVD), we anticipate that improved CVD will underlie the hypothesized cognitive benefits. Methods: This 12-months trial will include 80 older adults aged \u3e 60 with MetS and MCI, randomized to 4 groups: INI/dulaglutide injection, intranasal placebo/dulaglutide injection, INI/placebo injection, and intranasal placebo/placebo injection. Feasibility of combining INI with dulaglutide will be tested by examining the ease of use of INI (20IU, twice/day) with dulaglutide (1.5 mg/week), adherence, and safety profile are the efficacy of combination therapy on global cognition and neurobiological markers: cerebral blood flow, cerebral glucose utilization, white matter hyperintensities, Alzheimer\u27s related blood biomarkers and expression of insulin signaling proteins measured in brain-derived exosomes. Efficacy will be assessed for the intent-to-treat sample. Discussion: This feasibility study is anticipated to provide the basis for a multi-center large-scale randomized clinical trial of the cognitive benefits of the combination of INI with dulaglutide in individuals enriched for CVD and at high dementia risk