Prognostic impact of hyperglycemia at onset of methicillin-sensitive Staphylococcus aureus bacteraemia

Previous reports have associated hyperglycemia to poor outcome among aged and comorbid Staphylococcus aureus bacteraemia (SAB) patients. However, the prognostic impact of hyperglycemia in SAB irrespective of age and underlying conditions including a diagnosis of diabetes has received little attention. The objective here was to evaluate the prognostic relevance of hyperglycemia at onset of methicillin-sensitive SAB (MS-SAB). It was a retrospective study of MS-SAB patients. Blood glucose was measured within 24 h of positive blood cultures. The patient cohort was analyzed en bloc and by categorization according to age, underlying conditions and a diagnosis of diabetes. Altogether 161 patients were identified. High initial blood glucose levels were observed among diabetics (p <0.001), patients with deep infections (p <0.05) and poor outcome at 28- or 90-days (p <0.05). Receiver operating characteristics presented the glucose cut-off level of 7.2 mmol/L as a significant predictor of mortality with an area under the curve of 0.63 (95% CI 0.52-0.75, p <0.05). Blood glucose ae7.2 mmol/L connected to higher 28- (9 vs. 20%, p <0.05) and 90-day (14 vs. 29%, p <0.01) mortality. In Cox proportional hazard regression the blood glucose cut-off value of 7.2 mmol/L significantly predicted 90-day mortality (HR, 2.12; 95% CI, 1.01-4.46; p <0.05). Among young and healthy non-diabetics the negative prognostic impact of high glucose was further accentuated (HR 7.46, p <0.05). High glucose levels had no prognostic impact among diabetics. Hyperglycemia at SAB onset may associate to poor outcome. The negative prognostic impact is accentuated among young and healthy non-diabetics.Peer reviewe

An efficient algorithm for learning to rank from preference graphs

In this paper, we introduce a framework for regularized least-squares (RLS) type of ranking cost functions and we propose three such cost functions. Further, we propose a kernel-based preference learning algorithm, which we call RankRLS, for minimizing these functions. It is shown that RankRLS has many computational advantages compared to the ranking algorithms that are based on minimizing other types of costs, such as the hinge cost. In particular, we present efficient algorithms for training, parameter selection, multiple output learning, cross-validation, and large-scale learning. Circumstances under which these computational benefits make RankRLS preferable to RankSVM are considered. We evaluate RankRLS on four different types of ranking tasks using RankSVM and the standard RLS regression as the baselines. RankRLS outperforms the standard RLS regression and its performance is very similar to that of RankSVM, while RankRLS has several computational benefits over RankSVM

A New Mechanism for Generating a Single Transverse Spin Asymmetry

We propose a new mechanism for generating a single transverse spin asymmetry (STSA) in polarized proton-proton and proton-nucleus collisions in the high-energy scattering approximation. In this framework the STSA originates from the q->q G splitting in the projectile (proton) light-cone wave function followed by a perturbative (C-odd) odderon interaction, together with a C-even interaction, between the projectile and the target. We show that some aspects of the obtained expression for the STSA of the produced quarks are in qualitative agreement with experiment: STSA decreases with decreasing projectile x_F and is a non-monotonic function of the transverse momentum k_T. In our framework the STSA peaks at k_T near the saturation scale Q_s. Our mechanism predicts that the quark STSA in proton-nucleus collisions should be much smaller than in proton-proton collisions. We also observe that in our formalism the STSA for prompt photons is zero.Comment: 28 pages, 17 figues; v2: minor corrections, a subsection, discussion and references added; v3: minor corrections and a new figure added; v4: minor corrections; v5: minor corrections in figure

Predictive Value of C-Reactive Protein (CRP) in Identifying Fatal Outcome and Deep Infections in Staphylococcus aureus Bacteremia

IntroductionClear cut-off levels could aid clinicians in identifying patients with a risk of fatal outcomes or complications such as deep infection foci in Staphylococcus aureus bacteremia (SAB). Cutoff levels for widely used clinical follow-up parameters including serum C-reactive protein (CRP) levels and white blood cell counts (WBC) have not been previously studied.Methods430 adult SAB patients in Finland took part in prospective multicentre study in which their CRP levels and WBC counts were measured on the day of the positive blood culture, every other day during the first week, twice a week during hospitalization and at 30 days. Receiver operating characteristic (ROC) analysis was used to evaluate the prognostic value of CRP and WBC on the day of the positive blood culture and at days 4, 7, and 14 in predicting mortality and the presence of deep infections at 30 days. Adjusted hazard ratios (HR) for CRP level and WBC count cut-off values for mortality were calculated by the Cox regression analysis and adjusted odds ratios (OR) for cut-off values to predict the presence of deep infection by the binary logistic regression analysis.ResultsThe succumbing patients could be distinguished from the survivors, starting on day 4 after the positive blood culture, by higher CRP levels. Cut-off values of CRP for day 30 mortality in adjusted analysis, that significantly predicted fatal outcome were at day 4 CRP > 103 mg/L with sensitivity of 77%, specificity of 55%, and HR of 3.5 (95% CI, 1.2-10.3; p = 0.024), at day 14 CRP > 61 mg/L with a sensitivity of 82%, specificity of 80% and HR of 3.6 (95% CI, 1.1-10.3; p 8.6 x 10(9)/L was prognostic with sensitivity of 77%, specificity of 78% and HR of 8.2 (95% CI, 2.9-23.1; p 108 mg/L with sensitivity of 77%, specificity of 60%, and HR of 2.6 (95% CI, 1.3-4.9; p = 0.005) and at day 14 CRP > 22 mg/L with sensitivity of 59%, specificity of 68%, and HR of 3.9 (95% CI, 1.6-9.5; p = 0.003). The lack of decline of CRP in 14 days or during the second week were neither prognostic nor markers of deep infection focus.ConclusionsCRP levels have potential for the early identification of SAB patients with a greater risk for death and deep infections

Treatment of keloid scars with intralesional triamcinolone and 5-fluorouracil injections - a randomized controlled trial

Keloids have high recurrence rates. Current first-line therapy is triamcinolone (TAC) injection, but it has been suggested that approximately 50% of keloids are steroid resistant. We compared the efficacy of intralesional 5-fluorouracil (5-FU) and triamcinalone injections in a double-blind randomized controlled trial. Forty-three patients with 50 keloid scars were treated with either intralesional TAC or 5-FU-injections over 6 months. There was no statistically significant difference in the remission rate at 6 months between the 5-FU and TAC groups (46% vs 60%, respectively). Local adverse effects were higher in the TAC group compared to the 5-FU group. Occurrence of skin atrophy in TAC group was 44% and in the 5-FU group 8% (p <0.05). Also the occurrence of telangiectasia in the TAC group was 50% and in the 5-FU 21% (p <0.05). Vascularity of the keloids, assessed by spectral imaging and immunohistochemical staining for blood vessels, after treatment decreased in the TAC group, but not in the 5-FU group (p <0.05). Fibroblast proliferation evaluated by Ki-67 staining significantly decreased in the TAC group (p <0.05) but increased in the 5-FU group (p <0.05). TAC and 5-FU injections did not differ in their clinical effectivity in this randomized study, but 5-FU injections lead to increased proliferation rate and did not affect vascular density in histological assessment. Due to the greater number of adverse effects observed after TAC treatment, 5-FU injections may be preferable for cosmetically sensitive skin areas. (C) 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.Peer reviewe

The experience of long-term opiate maintenance treatment and reported barriers to recovery: A qualitative systematic review

Background/Aim: To inform understanding of the experience of long-term opiate maintenance and identify barriers to recovery. Methods: A qualitative systematic review. Results: 14 studies in 17 papers, mainly from the USA (65%), met inclusion criteria, involving 1,088 participants. Studies focused on methadone prescribing. Participants reported stability; however, many disliked methadone. Barriers to full recovery were primarily ‘inward focused'. Conclusion: This is the first review of qualitative literature on long-term maintenance, finding that universal service improvements could be made to address reported barriers to recovery, including involving ex-users as positive role models, and increasing access to psychological support. Treatment policies combining harm minimisation and abstinence-orientated approaches may best support individualised recovery

Extreme Technicolor & The Walking Critical Temperature

We map the phase diagram of gauge theories of fundamental interactions in the flavor-temperature plane using chiral perturbation theory to estimate the relation between the pion decaying constant and the critical temperature above which chiral symmetry is restored. We then investigate the impact of our results on models of dynamical electroweak symmetry breaking and therefore on the electroweak early universe phase transition.Comment: RevTeX, 18 pages, 3 figure

Non-esterified fatty acids impair insulin-mediated glucose uptake and disposition in the liver

n/

Cavitons and spontaneous hot flow anomalies in a hybrid-Vlasov global magnetospheric simulation

In this paper we present the first identification of foreshock cavitons and the formation of spontaneous hot flow anomalies (SHFAs) with the Vlasiator global magnetospheric hybrid-Vlasov simulation code. In agreement with previous studies we show that cavitons evolve into SHFAs. In the presented run, this occurs very near the bow shock. We report on SHFAs surviving the shock crossing into the down-stream region and show that the interaction of SHFAs with the bow shock can lead to the formation of a magnetosheath cavity, previously identified in observations and simulations. We report on the first identification of long-term local weakening and erosion of the bow shock, associated with a region of increased foreshock SHFA and caviton formation, and repeated shock crossings by them. We show that SHFAs are linked to an increase in suprathermal particle pitch-angle spreads. The realistic length scales in our simulation allow us to present a statistical study of global caviton and SHFA size distributions, and their comparable size distributions support the theory that SHFAs are formed from cavitons. Virtual spacecraft observations are shown to be in good agreement with observational studies.Peer reviewe