Significance of Beta-Catenin Expression for the Incidence of Pathological Fractures in Giant Cell Tumors of Bone

Aim of the study is to determine the possible roles of p53, cyclin D1, B-catenin and Ki-67 in the increase in risk of fractures in patients with giant cell tumor of bone. The study included a total of 164 patients with giant cell tumor of bone (GCTB), 21 (12.8%) with and 143 (87.2%) without fracture. The samples were analyzed immunohistochemically for expression of Ki-67, p53, cyclin D1 and beta-catenin. According to the immunohistochemical expression of p53 and Ki-67 in mononuclear stromal cells, as well as of cyclin D1 in multinuclear giant cells, there was no significant association with immunopositivity and risk of fractures. However, our research revealed that patients with cytoplasmic expression of beta-catenin in stromal cells had three times more frequent occurrence of pathological fractures, which was highly statistically significant (chi(2) = 7.065; p = 0.008). Moreover, a highly statistically significant correlation between the nuclear expression of beta-catenin in giant cells and the incidence of pathological fractures was also found (chi(2) = 8.824; p = 0.003). The study showed that beta-catenin expression highly correlates with the incidence of pathological fractures in patients with GCTB. Taking into account that beta-catenin is closely linked to activation of the Wnt signaling pathway in GCTB pathogenesis, one could postulate that activation of the Wnt pathway is one of the contributing factors to locally destructive behavior of this tumor, as well as to the incidence of pathological fractures

“SQiD, the Single Question in Delirium; can a single question help clinicians to detect delirium in hospitalised cancer patients?” running heading Single Question in Delirium” (Bcan-D-20-01665)

AimA serious syndrome for cancer in-patients, delirium risk increases with age and medical acuity. Screening tools exist but detection is frequently delayed or missed. We test the 'Single Question in Delirium' (SQiD), in comparison to psychiatrist clinical interview.MethodsInpatients in two comprehensive cancer centres were prospectively screened. Clinical staff asked informants to respond to the SQiD: "Do you feel that [patient's name] has been more confused lately?". The primary endpoint was negative predictive value (NPV) of the SQiD versus psychiatrist diagnosis (Diagnostic and Statistics Manual criteria). Secondary endpoints included: NPV of the Confusion Assessment Method (CAM), sensitivity, specificity and Cohen's Kappa coefficient.ResultsBetween May 2012 and July 2015, the SQiD plus CAM was applied to 122 patients; 73 had the SQiD and psychiatrist interview. Median age was 65 yrs. (interquartile range 54-74), 46% were female; median length of hospital stay was 12 days (5-18 days). Major cancer types were lung (19%), gastric or other upper GI (15%) and breast (14%). 70% of participants had stage 4 cancer. Diagnostic values were similar between the SQiD (NPV = 74, 95% CI 67-81; kappa = 0.32) and CAM (NPV = 72, 95% CI 67-77, kappa = 0.32), compared with psychiatrist interview. Overall the CAM identified only a small number of delirious cases but all were true positives. The specificity of the SQiD was 87% (74-95) The SQiD had higher sensitivity than CAM (44% [95% CI 41-80] vs 26% [10-48]).ConclusionThe SQiD, administered by bedside clinical staff, was feasible and its psychometric properties are now better understood. The SQiD can contribute to delirium detection and clinical care for hospitalised cancer patients

Agricultural Academy

Diversity of the fi sh species important for fi shery on the territory of Serbia has changed both spatially and temporally. Temporal changes are connected with historical and anthropogenic factors, while spatial changes are mostly the results of anthropogenic activity. Based on the analysis of the "BAES-ex situ" national database, there are two temporal and spatial periods. The fi rst period (from 1860 to 1950) is characterised by great diversity of the fi sh species important for fi shery in natural ecosystems, above all in rivers. The second period (from 1950 until today) is characterised by reduction in the diversity of the fi sh species important for fi shery, especially sturgeon species, in natural ecosystems, predominantly rivers, and the increasing diversity in anthropogenic water ecosystems. The increasing diversity in accumulations is predominantly related to Cyprinidae and Percidae species. The reduction in diversity in natural ecosystems is most often the result of irrational fi shery, habitat degradation, prominent anthropogenic infl uence and presence of introduced species. Many species important for fi shery are, according to the newest legal regulations of the Republic of Serbia, classifi ed in the category of strictly protected and protected species, and the permanent close hunting season or close season in certain periods and ban on hunting for individuals below prescribed size was declared for many of them. Taking into consideration prominent reduction in diversity, some of the fi sh species important for fi shery are also in "The preliminary list of species for the Serbian red list of vertebrates" because they are in danger of being extinct

Exploring disparities in acute myocardial infarction events between Aboriginal and non-Aboriginal Australians: roles of age, gender, geography and area-level disadvantage

We investigated disparities in rates of acute myocardial infarction (AMI) between Aboriginal and non-Aboriginal people in the 199 Statistical Local Areas (SLAs) in New South Wales, Australia. Using routinely collected and linked hospital and mortality data from 2002 to 2007, we developed multilevel Poisson regression models to estimate the relative rates of first AMI events in the study period accounting for area of residence. Rates of AMI in Aboriginal people were more than two times that in non-Aboriginal people, with the disparity greatest in more disadvantaged and remote areas. AMI rates in Aboriginal people varied significantly by SLA, as did the Aboriginal to non-Aboriginal rate ratio. We identified almost 30 priority areas for universal and targeted preventive interventions that had both high rates of AMI for Aboriginal people and large disparities in rates

Mortality after admission for acute myocardial infarction in Aboriginal and non-Aboriginal people in New South Wales, Australia: a multilevel data linkage study

Background - Heart disease is a leading cause of the gap in burden of disease between Aboriginal and non-Aboriginal Australians. Our study investigated short- and long-term mortality after admission for Aboriginal and non-Aboriginal people admitted with acute myocardial infarction (AMI) to public hospitals in New South Wales, Australia, and examined the impact of the hospital of admission on outcomes. Methods - Admission records were linked to mortality records for 60047 patients aged 25–84 years admitted with a diagnosis of AMI between July 2001 and December 2008. Multilevel logistic regression was used to estimate adjusted odds ratios (AOR) for 30- and 365-day all-cause mortality. Results - Aboriginal patients admitted with an AMI were younger than non-Aboriginal patients, and more likely to be admitted to lower volume, remote hospitals without on-site angiography. Adjusting for age, sex, year and hospital, Aboriginal patients had a similar 30-day mortality risk to non-Aboriginal patients (AOR: 1.07; 95% CI 0.83-1.37) but a higher risk of dying within 365 days (AOR: 1.34; 95% CI 1.10-1.63). The latter difference did not persist after adjustment for comorbid conditions (AOR: 1.12; 95% CI 0.91-1.38). Patients admitted to more remote hospitals, those with lower patient volume and those without on-site angiography had increased risk of short and long-term mortality regardless of Aboriginal status. Conclusions - Improving access to larger hospitals and those with specialist cardiac facilities could improve outcomes following AMI for all patients. However, major efforts to boost primary and secondary prevention of AMI are required to reduce the mortality gap between Aboriginal and non-Aboriginal people

Health, ageing and private health insurance: baseline results from the 45 and Up Study cohort

Correction to Banks E, Jorm L, Lujic S, Rogers K. Health, ageing and private health insurance: baseline results from the 45 and Up Study cohort. ANZ Health Policy 2009; 6: 16

Inequalities in potentially preventable hospitalisation rates between Aboriginal and non-Aboriginal children in New South Wales, Australia

ObjectiveOur study aimed to quantify potentially preventable hospital (PPH) admission rates for acute, chronic and vaccine- preventable conditions, and the inequality in these rates, in large whole-of-population cohort of Aboriginal and non-Aboriginal children living in Australia's most populous state, New South Wales (NSW).ApproachWe conducted a retrospective cohort study using linked hospital and mortality records for NSW from July 1, 2000 to December 31, 2008. A cohort of 653,575 children (2.6% Aboriginal) born in a NSW hospital between July 1, 2000, and December 31, 2007, were included in the analysis. The study outcome was PPH admissions. Admission rates per 1000 person-years were calculated with 95% confidence intervals (CIs) for acute, chronic and vaccine-preventable conditions, and stratified by demographic and birth characteristics (i.e. age, sex, low birth weight, prematurity, private patient/health insurance status, geographical remoteness and socioeconomic status).ResultsThere were 103,569 PPH admissions among the cohort during the study period, of which 5% were in Aboriginal children. The PPH admission rate was 63.9 and 33.4 per 1000 person-years in Aboriginal and non-Aboriginal children, respectively. Acute conditions accounted for almost two thirds of PPH admissions, and rates were highest in younger children. The size of the inequality was largest among 0-1 year olds for acute, chronic and vaccine-preventable PPH admissions. PPH admission rates were higher among more socioeconomically disadvantaged children, and the inequality between Aboriginal and non- Aboriginal children was largest among the most disadvantaged. Although PPH admission rates were higher in more remote areas regardless of Aboriginality, there was a significant inequality between Aboriginal and non-Aboriginal children in major cities, regional and remote areas.ConclusionThere is potential to achieve substantial health gains for Aboriginal children, and to reduce hospital admissions, through improved access, availability and culturally appropriate provision of preventative and primary care to Aboriginal communities, and through broader initiatives to address the entrenched disadvantage experienced by Australian Aboriginal people

Predictors and Sources of Variation in 30-day Unplanned Readmission Following Isolated Coronary Artery Bypass Graft (CABG) Surgery in Australia

BackgroundBetween-hospital variation in rates of 30-day unplanned readmission after coronary artery bypass graft (CABG) surgery has significant clinical and policy implications, but little is known about the relative contributions of patient- and hospital-level factors to this variation and how these may differ by the cause of readmission.MethodsWe identified a patient cohort who underwent isolated CABG between 2002 and 2018 and survived for at least 30 days post-discharge using linked hospital morbidity and death records for New South Wales residents. Predictors of 30-day unplanned readmission (all cause; stratified by major cardiovascular disease [CVD] or other primary diagnosis) were assessed using multilevel logistic regression models. Proportional changes in variance were used to estimate how much between-hospital variation was explained by patient- and hospital-level factors.ResultsOf 51,868 CABG patients (mean age 66 years, 20% female), 14.3% had unplanned readmission within 30 days. Female sex, older age, obesity, emergency procedure, longer hospital stay, and various comorbidities were associated with all-cause readmission. Three-quarters of readmissions had primary diagnoses other than major CVD (including respiratory causes, non-specific cardiac symptoms, and infections) and they contributed to greater between-hospital variation. Observed patient-level factors explained 74% of between-hospital variation for readmissions with major CVD, while for other readmissions, they explained only 31% and further 42% was explained by hospital-level factors (public vs. private status and CABG volume).ConclusionsReadmissions with non-CVD diagnoses drive much of the between-hospital variation in readmission rates, suggesting there is scope for hospital-level intervention to reduce unplanned readmission after CABG

Physical activity and psychological distress in older men: Findings from the New South Wales 45 and Up Study

Physical activity is an important factor in healthy aging and has been shown to reduce depressive symptoms. This association, however, is relatively understudied in older men. This study was a cross-sectional analysis of the association between physical activity (Active Australia Survey) and psychological distress (Kessler-10). Participants were a sample of 17,689 men age ≥65 yr drawn from a large-scale Australian cohort study of people age 45 years and over (The 45 and Up Study). The likelihood of reporting high or very high levels of psychological distress decreased with increasing weekly sessions of physical activity. Compared with participants reporting no sessions of physical activity, the fully adjusted odds ratio for high or very high psychological distress was .66 (95% CI .51-.85) for men who undertook 1-6 sessions of physical activity per week and decreased to .57 (95% CI, .43-.79) for men who reported 16 or more weekly sessions. The cross-sectional findings show that older men who are more active are less likely to report psychological distress, regardless of their level of functional limitation. Further research, informed by these findings, is required to investigate causal pathways and the temporal sequence of events.</p