Socioeconomic characteristics, family structure and trajectories of children's psychosocial problems in a period of social transition

Data from the Czech part of the European Longitudinal Study of Pregnancy and Childhood offer a unique opportunity to examine a period of changing socioeconomic structure of the country. Our aim was to analyse the association between socioeconomic status, family structure and children’s psychosocial problems at the age of 7, 11, 15 and 18 years in 3,261 subjects and compare our results with findings from western settings. The Strengths and Difficulties Questionnaire (SDQ) and its five subscales were used to assess individual problem areas (emotional symptoms, peer problems, hyperactivity, conduct problems) and prosocial behaviour. Socioeconomic status was represented by maternal education and three forms of family structure were identified: nuclear family, new partner family and single parent family. The SDQ subscale score over time was modelled as a quadratic growth curve using a linear mixed-effects model. Maternal university education was associated with a faster decline in problems over time for all five SDQ subscales. Problems in children from nuclear families were found to be significantly lower than in children from single parent families for all SDQ subscales with the exception of peer problems. Compared to nuclear families, children from new partner families scored significantly higher in hyperactivity and conduct problems subscales. The nuclear family structure and higher maternal education have been identified as protective factors for children’s psychosocial problems, in agreement with findings from western settings. Adopting a longitudinal perspective was shown as essential for providing a more complex view of children’s psychosocial problems over time

Efficient description of many-body systems with Matrix Product Density Operators

Matrix Product States form the basis of powerful simulation methods for ground state problems in one dimension. Their power stems from the fact that they faithfully approximate states with a low amount of entanglement, the "area law". In this work, we establish the mixed state analogue of this result: We show that one-dimensional mixed states with a low amount of entanglement, quantified by the entanglement of purification, can be efficiently approximated by Matrix Product Density Operators (MPDOs). In combination with results establishing area laws for thermal states, this helps to put the use of MPDOs in the simulation of thermal states on a formal footing

The annual recurrence risk model for tailored surveillance strategy in patients with cervical cancer

Purpose: Current guidelines for surveillance strategy in cervical cancer are rigid, recommending the same strategy for all survivors. The aim of this study was to develop a robust model allowing for individualised surveillance based on a patient's risk profile. Methods: Data of 4343 early-stage patients with cervical cancer treated between 2007 and 2016 were obtained from the international SCCAN (Surveillance in Cervical Cancer) consortium. The Cox proportional hazards model predicting disease-free survival (DFS) was developed and internally validated. The risk score, derived from regression coefficients of the model, stratified the cohort into significantly distinctive risk groups. On its basis, the annual recurrence risk model (ARRM) was calculated. Results: Five variables were included in the prognostic model: maximal pathologic tumour diameter; tumour histotype; grade; number of positive pelvic lymph nodes; and lymphovascular space invasion. Five risk groups significantly differing in prognosis were identified with a five-year DFS of 97.5%, 94.7%, 85.2% and 63.3% in increasing risk groups, whereas a two-year DFS in the highest risk group equalled 15.4%. Based on the ARRM, the annual recurrence risk in the lowest risk group was below 1% since the beginning of follow-up and declined below 1% at years three, four and >5 in the medium-risk groups. In the whole cohort, 26% of recurrences appeared at the first year of the follow-up, 48% by year two and 78% by year five. Conclusion: The ARRM represents a potent tool for tailoring the surveillance strategy in early-stage patients with cervical cancer based on the patient's risk status and respective annual recurrence risk. It can easily be used in routine clinical settings internationally

Alcohol dose in septal ablation for hypertrophic obstructive cardiomyopathy

Background: The aim of this study was to evaluate short- and long-term outcomes related to dose of alcohol administered during alcohol septal ablation (ASA) in patients with hypertrophic obstructive cardiomyopathy (HOCM). Current guidelines recommend using 1–3 mL of alcohol administered in the target septal perforator artery, but this recommendation is based more on practical experience of interventionalists rather than on systematic evidence. Methods: We included 1448 patients and used propensity score to match patients who received a low-dose (1.0–1.9 mL) versus a high-dose (2.0–3.8 mL) of alcohol during ASA. Results: The matched cohort analysis comprised 770 patients (n = 385 in both groups). There was a similar occurrence of 30-day post-procedural adverse events (13% vs. 12%; p = 0.59), and similar all-cause mortality rates (0.8% vs. 0.5%; p = 1) in the low-dose group and the high-dose group, respectively. In the long-term follow-up (5.4 ± 4.5 years), a total of 110 (14%) patients died representing 2.58 deaths and 2.64 deaths per 100 patient-years in the low dose and the high dose group (logrank, p = 0.92), respectively. There were no significant differences in the long-term dyspnea and left ventricular outflow gradient between the two groups. Patients treated with a low-dose of alcohol underwent more subsequent septal reduction procedures (logrank, p = 0.04). Conclusions: Matched HOCM patients undergoing ASA with a low-dose (1.0–1.9 mL) or a high-dose (2.0–3.8 mL) of alcohol had similar short- and long-term outcomes. A higher rate of repeated septal reduction procedures was observed in the group treated with a low-dose of alcohol. © 2021 The Author

Alcohol dose in septal ablation for hypertrophic obstructive cardiomyopathy

Background: The aim of this study was to evaluate short- and long-term outcomes related to dose of alcohol administered during alcohol septal ablation (ASA) in patients with hypertrophic obstructive cardiomyopathy (HOCM). Current guidelines recommend using 1–3 mL of alcohol administered in the target septal perforator artery, but this recommendation is based more on practical experience of interventionalists rather than on systematic evidence. Methods: We included 1448 patients and used propensity score to match patients who received a low-dose (1.0–1.9 mL) versus a high-dose (2.0–3.8 mL) of alcohol during ASA. Results: The matched cohort analysis comprised 770 patients (n = 385 in both groups). There was a similar occurrence of 30-day post-procedural adverse events (13% vs. 12%; p = 0.59), and similar all-cause mortality rates (0.8% vs. 0.5%; p = 1) in the low-dose group and the high-dose group, respectively. In the long-term follow-up (5.4 ± 4.5 years), a total of 110 (14%) patients died representing 2.58 deaths and 2.64 deaths per 100 patient-years in the low dose and the high dose group (logrank, p = 0.92), respectively. There were no significant differences in the long-term dyspnea and left ventricular outflow gradient between the two groups. Patients treated with a low-dose of alcohol underwent more subsequent septal reduction procedures (logrank, p = 0.04). Conclusions: Matched HOCM patients undergoing ASA with a low-dose (1.0–1.9 mL) or a high-dose (2.0–3.8 mL) of alcohol had similar short- and long-term outcomes. A higher rate of repeated septal reduction procedures was observed in the group treated with a low-dose of alcohol

ACE gene insertion/deletion polymorphism has a mild influence on the acute development of left ventricular dysfunction in patients with ST elevation myocardial infarction treated with primary PCI

<p>Abstract</p> <p>Background</p> <p>We evaluated the associations among angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism, ACE activity and post-myocardial infarction (MI) left ventricular dysfunction and acute heart failure (AHF) early after presentation with MI with ST-segment elevation (STEMI).</p> <p>Methods</p> <p>A total of 556 patients with STEMI treated by primary PCI (421 patients without AHF and 135 patients with AHF) were the study population. The activity of BNP, NT-ProBNP and ACE were measured at hospital admission and 24 h after MI onset. Left ventricular angiography was done before PCI; echocardiography was undertaken between the third and fifth day after MI.</p> <p>Results</p> <p>In comparison with the II genotypes group, the DD/ID group had a higher level of ACE activity upon hospital admission (p < 0.001). We found a significantly higher level of ACE activity in patients with moderate LV dysfunction (EF 40-54%) in comparison both with patients with preserved LV function (EF ≥55%) and with patients with severe LV dysfunction (p = 0.028). A non-significant trend towards a higher incidence of mild AHF (22.1% vs. 16.02%, p = 0,093), a significantly higher value of end-systolic volume (ESV/BSA) (30.0 ± 12.3 vs. 28.5 ± 13.0; p < 0.05) and lower EF (50.2 ± 11.1 vs. 52.7 ± 11.7; p < 0.05) in the DD/ID genotypes group was noted. Even after multiple adjustments according to multivariate models, the EF for the DD/ID group remained significantly lower (p = 0,033). The DD/ID genotypes were associated with a significantly higher risk of EF <45% (OR 2.04 [95% CI 1.28; 3.25]).</p> <p>Conclusions</p> <p>These results suggest that the I/D polymorphism of ACE is associated with the development of LV dysfunction in the acute phase after STEMI. We demonstrated for the first time an association of the low ACE activity with the severe LV dysfunction, although patients with moderate LV dysfunction had higher level ACE activity than patients with preserved LV function.</p

Influence of dose, gender, and cigarette smoking on clozapine plasma concentrations

Michaela Mayerova,1&ndash;3 Libor Ustohal,1&ndash;3 Jiri Jarkovsky,4 Jan Pivnicka,1,5 Tomas Kasparek,1,2 Eva Ceskova1,3 1Faculty of Medicine, Masaryk University, Brno, Czech Republic; 2Department of Psychiatry, University Hospital Brno, Brno, Czech Republic; 3CEITEC &ndash; Central European Institute of Technology, Masaryk University, Brno, Czech Republic; 4Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic; 5Institute of Forensic Medicine, St. Anne&rsquo;s University Hospital, Masaryk University, Brno, Czech Republic Introduction: Therapeutic drug monitoring (TDM) of clozapine is a very useful method for verifying both the correct intake and the interindividual variability of its metabolism, thereby avoiding the risk of toxicity. The purposes of this paper were to discover how many patients using clozapine in common clinical practice have clozapine plasma concentration (PC) levels in the proposed reference range and to identify factors that influence clozapine PC levels. Methods: Our study included 100 inpatients (diagnosed with schizophrenia or schizoaffective disorder) taking standard doses of clozapine (100&ndash;700 mg/day). Clozapine concentration was measured by high-performance liquid chromatography. Correlations between doses and PC levels and the influence of smoking and gender on clozapine PC levels were calculated. Results: A large number of the patients (67%) had PC levels outside the proposed reference range. The clozapine PC levels were influenced by dose, gender, and cigarette smoking. Conclusion: The correlations between dose, gender, and cigarette smoking and clozapine PC levels highlighted by our study overlap other research. It was surprising to find such a large number of patients with clozapine PC levels outside the therapeutic range. This result suggests the importance of clozapine TDM due to misunderstood inter- and/or intraindividual variability or misestimated partial therapeutic compliance. Keywords: therapeutic drug monitoring, plasma levels, interindividual variability, schizophrenia, schizoaffective disorde

Influence of dose, gender, and cigarette smoking on clozapine plasma concentrations [Corrigendum]

Mayerova M, Ustohal L, Jarkovsky J, et al. Neuropsychiatr&nbsp;Dis Treat. 2018;14:1535&ndash;1543. On page 1539, &ldquo;Clozapine doses and clozapine PCs&rdquo; section,&nbsp;second paragraph, line 2, the following sentence was&nbsp;incorrect: &ldquo;The clozapine PC levels of 67% of patients were&nbsp;outside the proposed reference range (proposed reference&nbsp;range 350&ndash;600 ng/mL);28 the levels of 43% were above&nbsp;and 24% of patients had levels below the proposed reference&nbsp;range.&rdquo;&nbsp;The correct sentence is: &ldquo;The clozapine PC levels of approximately67% of patients were outside the proposed reference&nbsp;range (proposed reference range 350&ndash;600 ng/mL);7 42% of&nbsp;patients had levels below and 25% of patients had levels&nbsp;above the proposed reference range.&rdquo;On page 1541, &ldquo;Discussion&rdquo; section, first paragraph, line 2, the&nbsp;following sentence was incorrect: &ldquo;In contrast to the study by&nbsp;Couchman, in which more PC levels were below the proposed&nbsp;reference range (42.5% under and 28.4% above), in our study&nbsp;more PC levels were above (43% above and 24% under).&rdquo;The correct sentence is: &ldquo;In agreement with the study by&nbsp;Couchman, in which more PC levels were below the proposed&nbsp;reference range (42.5% below and 28.4% above), our&nbsp;study also found more PC levels below (42% below and&nbsp;25% above).&rdquo; Read the original articl