Development of a personalized fall rate prediction model in community-dwelling older adults: a negative binomial regression modelling approach.

BACKGROUND Around a third of adults aged 65 and older fall every year, resulting in unintentional injuries in 30% of the cases. Fractures are a frequent consequence of falls, primarily caused in individuals with decreased bone strength who are unable to cushion their falls. Accordingly, an individual's number of experienced falls has a direct influence on fracture risk. The aim of this study was the development of a statistical model to predict future fall rates using personalized risk predictors. METHODS In the prospective cohort GERICO, several fall risk factor variables were collected in community-dwelling older adults at two time-points four years apart (T1 and T2). Participants were asked how many falls they experienced during 12 months prior to the examinations. Rate ratios for the number of reported falls at T2 were computed for age, sex, reported fall number at T1, physical performance tests, physical activity level, comorbidity and medication number with negative binomial regression models. RESULTS The analysis included 604 participants (male: 122, female: 482) with a median age of 67.90 years at T1. The mean number of falls per person was 1.04 and 0.70 at T1 and T2. The number of reported falls at T1 as a factor variable was the strongest risk factor with an unadjusted rate ratio [RR] of 2.60 for 3 falls (95% confidence interval [CI] 1.54 to 4.37), RR of 2.63 (95% CI 1.06 to 6.54) for 4 falls, and RR of 10.19 (95% CI 6.25 to 16.60) for 5 and more falls, when compared to 0 falls. The cross-validated prediction error was comparable for the global model including all candidate variables and the univariable model including prior fall numbers at T1 as the only predictor. CONCLUSION In the GERICO cohort, the prior fall number as single predictor information for a personalized fall rate is as good as when including further available fall risk factors. Specifically, individuals who have experienced three and more falls are expected to fall multiple times again. TRIAL REGISTRATION ISRCTN11865958, 13/07/2016, retrospectively registered

Desenvolvimento de filmes monocamada pebdl e pead antimicrobianos e atóxicos para aplicação em embalagens flexíveis

Dissertação apresentada ao Programa de Pós-Graduação em Ciência e Engenharia de Materiais da Universidade do Extremo Sul Catarinense - UNESC, para a obtenção do título de Mestre em Ciência e Engenharia de Materiais.Neste trabalho foram desenvolvidas embalagens flexíveis para a indústria de alimentos com propriedades antimicrobianas e atóxicas desejadas. Foram utilizados dois grades comerciais de diferentes polímeros, PEAD e PEBDL, aditivados com dois princípios ativos de natureza química distinta: um composto inorgânico, de matriz vítrea dopado com íons de zinco - GZn; e um composto orgânico, conhecido como triclosan - TCS. Na caracterização dos princípios ativos foram aplicadas técnicas microbiológicas, toxicológicas e de migração. Ambos os princípios ativos demonstraram atividade antimicrobiana em bactérias do tipo gram-positiva Staphylococcus aureus (SA) e gram-negativa Escherichia coli (EC) sendo o TCS mais efetivo quando exposto aos microrganismos, em relação ao GZn. Os princípios também apresentaram capacidades de migração das espécies químicas para o meio externo, sendo que o TCS apresenta potencial de migração relativamente maior do que GZn. Porém, quanto as análises do tipo toxicológicas, o GZn não apresentou efeitos tóxicos quando exposto ao DNA devido aos menores valores de índice de fragmentação e freqüência de danos. Em comparação, o TCS mostrou-se extremamente tóxico, com valores muito maiores nos índices de fragmentação e freqüência nas concentrações utilizadas. Assim, o GZn foi definido e adotado como princípio ativo atóxico na produção de embalagens flexíveis de PEAD e PEBDL via processo de extrusão a balão monocamada. Foram empregadas análises microbiológicas e de absorção atômica na caracterização das embalagens a tóxicas. As análises apresentaram resultados satisfatórios de acordo com a temática do trabalho proposto. Ambas as embalagens de PEAD e PEBDL apresentaram efeito antimicrobiano desejável em bactérias gram-positivas (SA) e gram-negativas (EC) além de apresentar valores de migração na ordem de 2ppm, atendendo assim as exigências propostas pela ANVISA de até 25 ppm. Assim as embalagens mostraram-se adequadas quanto ao seu emprego pela indústria alimentícia no mercado de produtos cárneos, com propriedades antimicrobianas e atóxicas esperadas, sem riscos de interferir na segurança alimentar do produto.In this work, it was developed flexible packaging for the food industry with antimicrobial properties and nontoxic desired. It was used two commercial grades of different polymers, HDPE and LLDPE, additives with two active principles of distinct chemical nature: an inorganic compound, glassy matrix doped with zinc ions - GZn, and an organic compound known as triclosan - TCS. In the characterization of the active techniques were applied microbiological, toxicological and migration. Both active agents have demonstrated antimicrobial activity on type bacteria Gram-positive Staphylococcus aureus (SA) and gram negative Escherichia coli (EC) being the most effective TCS when exposed to microorganisms, in relation to GZn. The principles also had capacities of migration of chemical species to the external environment, with the potential for migration TCS with relatively greater than GZn. But the type of toxicological analyzes, the GZn showed no toxic effects when exposed to the DNA due to lower levels of fragmentation index and frequency of damage. In comparison, TCS was shown to be extremely toxic, with much higher values of index fragmentation in the concentrations utilized. Thus, GZn was defined and adopted as nontoxic active in production of flexible packaging HDPE and LLDPE, in the process extrusion blow monolayer. Microbiological analyzes and atomic absorption were employed characterization of nontoxic packaging. The analyzes showed satisfactory results according to the theme of the proposed work. Both HDPE and LLDPE packaging showed antimicrobial effect desirable in gram-positive bacteria (SA) and gram negative (CE) and presents values of the order of 2 ppm migration, thus meeting the requirements proposed by ANVISA 25 ppm. Therefore, the packages show up as appropriate to their employment by the food industry in the market of meat products with antimicrobial properties and nontoxic expected, without risk of interfering with the food safety of the product

Intracellular Nanoparticle Coating Stability Determines Nanoparticle Diagnostics Efficacy and Cell Functionality

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Laparoscopic liver resection: personal experience with 107 cases

OBJETIVO: analisar nossa experiência após 107 hepatectomias videolaparoscópicas e discutir a evolução técnica da hepatectomia laparoscópica nos últimos cinco anos. MÉTODOS: entre abril de 2007 e abril de 2012 foram realizadas 107 hepatectomias laparoscópicas em 105 pacientes. A média de idade foi 53,9 anos (17 a 85). Cinquenta e três pacientes eram do sexo masculino. Todas as intervenções foram realizadas pelos autores do trabalho. RESULTADOS: do total de 107 operações, houve necessidade de conversão para a técnica aberta em três casos (2,8%). Dezesseis pacientes (14,9%) apresentaram complicações. Dois pacientes foram a óbito, mortalidade de 1,87%. Um óbito foi decorrente de infarto maciço do miocárdio, sem relação com a hepatectomia laparoscópica, que transcorreu sem intercorrências e não apresentou conversão nem sangramento. O outro óbito foi decorrente de falha do grampeador. Vinte pacientes (18,7%) necessitaram de transfusão sanguínea. O tipo de hepatectomia mais frequente foi a bissegmentectomia, segmentos 2-3, (33 casos), seguida de hepatectomia direita (22 casos). Setenta e duas cirurgias (67,3%) foram realizadas por meio da técnica de acesso Glissoniano. CONCLUSÃO: a divulgação dos resultados é de extrema importância. As dificuldades técnicas, complicações e mesmo mortalidade, inerentes a este complexo tipo de cirurgia, necessitam ser divulgados com clareza. Este procedimento deve ser realizado em centro especializado e por equipe capacitada. A técnica de acesso Glissoniano por via laparoscópica, descrita pela nossa equipe, facilita a realização de hepatectomias anatômicas

A High-Performance Design, Implementation, Deployment, and Evaluation of The Slim Fly Network

Novel low-diameter network topologies such as Slim Fly (SF) offer significant cost and power advantages over the established Fat Tree, Clos, or Dragonfly. To spearhead the adoption of low-diameter networks, we design, implement, deploy, and evaluate the first real-world SF installation. We focus on deployment, management, and operational aspects of our test cluster with 200 servers and carefully analyze performance. We demonstrate techniques for simple cabling and cabling validation as well as a novel high-performance routing architecture for InfiniBand-based low-diameter topologies. Our real-world benchmarks show SF's strong performance for many modern workloads such as deep neural network training, graph analytics, or linear algebra kernels. SF outperforms non-blocking Fat Trees in scalability while offering comparable or better performance and lower cost for large network sizes. Our work can facilitate deploying SF while the associated (open-source) routing architecture is fully portable and applicable to accelerate any low-diameter interconnect

The impact of albendazole treatment on the incidence of viral- and bacterial-induced diarrhea in school children in southern Vietnam: study protocol for a randomized controlled trial

Anthelmintics are one of the more commonly available classes of drugs to treat infections by parasitic helminths (especially nematodes) in the human intestinal tract. As a result of their cost-effectiveness, mass school-based deworming programs are becoming routine practice in developing countries. However, experimental and clinical evidence suggests that anthelmintic treatments may increase susceptibility to other gastrointestinal infections caused by bacteria, viruses, or protozoa. Hypothesizing that anthelmintics may increase diarrheal infections in treated children, we aim to evaluate the impact of anthelmintics on the incidence of diarrheal disease caused by viral and bacterial pathogens in school children in southern Vietnam.This is a randomized, double-blinded, placebo-controlled trial to investigate the effects of albendazole treatment versus placebo on the incidence of viral- and bacterial-induced diarrhea in 350 helminth-infected and 350 helminth-uninfected Vietnamese school children aged 6-15 years. Four hundred milligrams of albendazole, or placebo treatment will be administered once every 3 months for 12 months. At the end of 12 months, all participants will receive albendazole treatment. The primary endpoint of this study is the incidence of diarrheal disease assessed by 12 months of weekly active and passive case surveillance. Secondary endpoints include the prevalence and intensities of helminth, viral, and bacterial infections, alterations in host immunity and the gut microbiota with helminth and pathogen clearance, changes in mean z scores of body weight indices over time, and the number and severity of adverse events.In order to reduce helminth burdens, anthelmintics are being routinely administered to children in developing countries. However, the effects of anthelmintic treatment on susceptibility to other diseases, including diarrheal pathogens, remain unknown. It is important to monitor for unintended consequences of drug treatments in co-infected populations. In this trial, we will examine how anthelmintic treatment impacts host susceptibility to diarrheal infections, with the aim of informing deworming programs of any indirect effects of mass anthelmintic administrations on co-infecting enteric pathogens.ClinicalTrials.gov: NCT02597556 . Registered on 3 November 2015

Delayed Development of Aneurysmal Dilatations in Patients with Extracranial Carotid Artery Dissections

Peer reviewe

The relevance of tissue angiotensin-converting enzyme: manifestations in mechanistic and endpoint data

Angiotensin-converting enzyme (ACE) is primarily localized (>90%) in various tissues and organs, most notably on the endothelium but also within parenchyma and inflammatory cells. Tissue ACE is now recognized as a key factor in cardiovascular and renal diseases. Endothelial dysfunction, in response to a number of risk factors or injury such as hypertension, diabetes mellitus, hypercholesteremia, and cigarette smoking, disrupts the balance of vasodilation and vasoconstriction, vascular smooth muscle cell growth, the inflammatory and oxidative state of the vessel wall, and is associated with activation of tissue ACE. Pathologic activation of local ACE can have deleterious effects on the heart, vasculature, and the kidneys. The imbalance resulting from increased local formation of angiotensin II and increased bradykinin degradation favors cardiovascular disease. Indeed, ACE inhibitors effectively reduce high blood pressure and exert cardio- and renoprotective actions. Recent evidence suggests that a principal target of ACE inhibitor action is at the tissue sites. Pharmacokinetic properties of various ACE inhibitors indicate that there are differences in their binding characteristics for tissue ACE. Clinical studies comparing the effects of antihypertensives (especially ACE inhibitors) on endothelial function suggest differences. More comparative experimental and clinical studies should address the significance of these drug differences and their impact on clinical events

Gene co-expression analysis identifies brain regions and cell types involved in migraine pathophysiology

Migraine is a common disabling neurovascular brain disorder typically characterised by attacks of severe headache and associated with autonomic and neurological symptoms. Migraine is caused by an interplay of genetic and environmental factors. Genome-wide association studies (GWAS) have identified over a dozen genetic loci associated with migraine. Here, we integrated migraine GWAS data with high-resolution spatial gene expression data of normal adult brains from the Allen Human Brain Atlas to identify specific brain regions and molecular pathways that are possibly involved in migraine pathophysiology. To this end, we used two complementary methods. In GWAS data from 23,285 migraine cases and 95,425 controls, we first studied modules of co-expressed genes that were calculated based on human brain expression data for enrichment of genes that showed association with migraine. Enrichment of a migraine GWAS signal was found for five modules that suggest involvement in migraine pathophysiology of: (i) neurotransmission, protein catabolism and mitochondria in the cortex; (ii) transcription regulation in the cortex and cerebellum; and (iii) oligodendrocytes and mitochondria in subcortical areas. Second, we used the high-confidence genes from the migraine GWAS as a basis to construct local migraine-related co-expression gene networks. Signatures of all brain regions and pathways that were prominent in the first method also surfaced in the second method, thus providing support that these brain regions and pathways are indeed involved in migraine pathophysiology