Factors influencing lenght of hospital stay in community-acquired pneumonia: a study in 27 community hospitals

We did a retrospective study of 1920 episodes of community-acquired pneumonia (CAP) in 27 community hospitals and analysed inter-hospital variability in length of hospital stay (LOS), mortality and readmission rates. The overall adjusted LOS (mean¡S.D.) was 10. 0¡9. 8 days. LOS increased according to the Pneumonia Severity Index (PSI) risk class: 7.3 days for class I to 11. 3 days for class V (P<0.001). In a multiple regression model, LOS increased (P<0.001) according to the hospital (inter-hospital variability), PSI risk class, complications during hospitalization, admission to ICU, need of oxygen and transfer to a nursing home. Hospitals with shorter LOS did not show an increased readmission rate (adjusted OR 1.02, 95% CI 0. 51-2.03, P=0.97) and post-discharge mortality (adjusted OR 1.20, 95% CI 0.70-2.05, P=0.51). There are significant inter-hospital variations in LOS in patients with CAP which are related to differences in clinical management. The reduction of these differences will further improve efficiency and quality of care

Oral antibiotic prophylaxis lowers surgical site infection in elective colorectal surgery: results of a pragmatic cohort study in Catalonia

Background: The role of oral antibiotic prophylaxis (OAP) and mechanical bowel preparation (MBP) in the prevention of surgical site infection (SSI) after colorectal surgery is still controversial. The aim of this study was to analyze the effect of a bundle including both measures in a National Infection Surveillance Network in Catalonia. Methods: Pragmatic cohort study to assess the effect of OAP and MBP in reducing SSI rate in 65 hospitals, comparing baseline phase (BP: 2007-2015) with implementation phase (IP: 2016-2019). To compare the results, a logistic regression model was established. Results: Out of 34,421 colorectal operations, 5180 had SSIs (15.05%). Overall SSI rate decreased from 18.81% to 11.10% in BP and IP, respectively (OR 0.539, CI95 0.507-0.573, p < 0.0001). Information about bundle implementation was complete in 61.7% of cases. In a univariate analysis, OAP and MBP were independent factors in decreasing overall SSI, with OR 0.555, CI95 0.483-0.638, and OR 0.686, CI95 0.589-0.798, respectively; and similarly, organ/space SSI (O/S-SSI) (OR 0.592, CI95 0.494-0.710, and OR 0.771, CI95 0.630-0.944, respectively). However, only OAP retained its protective effect at both levels at multivariate analyses. Conclusions: oral antibiotic prophylaxis decreased the rates of SSI and O/S-SSI in a large series of elective colorectal surger

Deoxycholic acid induces the overexpression of intestinal mucin, MUC2, via NF-kB signaling pathway in human esophageal adenocarcinoma cells

<p>Abstract</p> <p>Background</p> <p>Mucin alterations are a common feature of esophageal neoplasia, and alterations in MUC2 mucin have been associated with tumor progression in the esophagus. Bile acids have been linked to esophageal adenocarcinoma and mucin secretion, but their effects on mucin gene expression in human esophageal adenocarcinoma cells is unknown.</p> <p>Methods</p> <p>Human esophageal adenocarcinoma cells were treated 18 hours with 50–300 μM deoxycholic acid, chenodeoxycholic acid, or taurocholic acid. MUC2 transcription was assayed using a MUC2 promoter reporter luciferase construct and MUC2 protein was assayed by Western blot analysis. Transcription Nuclear factor-κB activity was measured using a Nuclear factor-κB reporter construct and confirmed by Western blot analysis for Nuclear factor-κB p65.</p> <p>Results</p> <p>MUC2 transcription and MUC2 protein expression were increased four to five fold by bile acids in a time and dose-dependent manner with no effect on cell viability. Nuclear factor-κB activity was also increased. Treatment with the putative chemopreventive agent aspirin, which decreased Nuclear factor-κB activity, also decreased MUC2 transcription. Nuclear factor-κB p65 siRNA decreased MUC2 transcription, confirming the significance of Nuclear factor-κB in MUC2 induction by deoxycholic acid. Calphostin C, a specific inhibitor of protein kinase C (PKC), greatly decreased bile acid induced MUC2 transcription and Nuclear factor-κB activity, whereas inhibitors of MAP kinase had no effect.</p> <p>Conclusion</p> <p>Deoxycholic acid induced MUC2 overexpression in human esophageal adenocarcinoma cells by activation of Nuclear factor-κB transcription through a process involving PKC-dependent but not PKA, independent of activation of MAP kinase.</p

Państwo, gospodarka, społeczeństwo w integrującej się Europie TOM 3

Ze wstępu: "1 maja 2004 przyniesie radykalną zmianą sytuacji dotychczasowych kandydatów do Unii Europejskiej. Z roli aplikanta i petenta przekształcą się we współdecydenta. Już dziś z przyszłymi członkami konsultuje się większość kwestii wymagających strategicznych decyzji. Przez ostatnie dziesięć lat wysiłek polityczny i intelektualny był skierowany na uzyskanie członkostwa Unii, a w ostatnim okresie negocjacji - na osiągnięcie najlepszych według polityków i ekonomistów warunków akcesji. 1 ten etap mamy już za sobą. Pora zacząć patrzeć przed siebie, lecz niejako petent, ale kraj współodpowiedzialny za dalsze funkcjonowanie i rozwój powiększonej Unii. Z tej perspektywy istotnajest analiza gospodarki europejskiej, z którąjuż dziś gospodarka państw kandydackich, także Polski, jest silnie powiązana. Wiedza na ten temat jest uboga i ograniczona do przeglądu bieżących wskaźników makroekonomicznych. Zarówno w ośrodkach rządowych, jak i pozarządowych dominuje podejście analizujące, co z konkretnego wydarzenia w innym kraju wynika dla gospodarki polskiej. Stanowczo nie wystarczy to do pełnienia odpowiedzialnej roli współdecydenta. Potrzebna jest pogłębiona wiedza na temat gospodarki europejskiej jako całości i poszczególnych krajów, a także najważniejszych partnerów handlowych i gospodarczych zjednoczonej Europy. Konieczne są pogłębione prace studialne dotyczące mechanizmów międzynarodowych, gdyż organy unijne będą się zajmować w najbliższych latach dalszym rozwojem europejskiego jednolitego Rynku, rywalizacją gospodarczą z USA i krajami azjatyckimi, liberalizacjąhandlu światowego."(...

Undifferentiated and differentiated PC12 cells protected by huprines against injury induced by hydrogen peroxide

Oxidative stress is implicated in the pathogenesis of neurodegenerative disorders and hydrogen peroxide (H2O2) plays a central role in the stress. Huprines, a group of potent acetylcholinesterase inhibitors (AChEIs), have shown a broad cholinergic pharmacological profile. Recently, it has been observed that huprine X (HX) improves cognition in non transgenic middle aged mice and shows a neuroprotective activity (increased synaptophysin expression) in 3xTg-AD mice. Consequently, in the present experiments the potential neuroprotective effect of huprines (HX, HY, HZ) has been analyzed in two different in vitro conditions: undifferentiated and NGF-differentiated PC12 cells. Cells were subjected to oxidative insult (H2O2, 200 µM) and the protective effects of HX, HY and HZ (0.01 µM- 1 µM) were analyzed after a pre-incubation period of 24 and 48 hours. All huprines showed protective effects in both undifferentiated and NGF-differentiated cells, however only in differentiated cells the effect was dependent on cholinergic receptors as atropine (muscarinic antagonist, 0.1 µM) and mecamylamine (nicotinic antagonist, 100 µM) reverted the neuroprotection action of huprines. The decrease in SOD activity observed after oxidative insult was overcome in the presence of huprines and this effect was not mediated by muscarinic or nicotinic receptors. In conclusion, huprines displayed neuroprotective properties as previously observed in in vivo studies. In addition, these effects were mediated by cholinergic receptors only in differentiated cells. However, a non-cholinergic mechanism, probably through an increase in SOD activity, seems to be also involved in the neuroprotective effects of huprines

Textbook outcome and survival after gastric cancer resection with curative intent: a population-based analysis

Background: the concept of textbook outcome (TO) has been proposed for analyzing quality of surgical care. This study assessed the incidence of TO among patients undergoing curative gastric cancer resection, predictors for TO achievement, and the association of TO with survival. Method: all patients with gastric and gastroesophageal junction cancers undergoing curative gastrectomy between January 2014-December 2017 were identified from a population-based database (Spanish EURECCA Registry). TO included: macroscopically complete resection at the time of operation, R0 resection, ≥15 lymph nodes removed and examined, no serious postoperative complications (Clavien-Dindo ≥II), no re-intervention, hospital stay ≤14 days, no 30-day readmissions and no 90-day mortality. Logistic regression was used to assess the adjusted achievement of TO. Cox survival regression was used to compare conditional adjusted survival across groups. Results: in total, 1293 patients were included, and TO was achieved in 541 patients (41.1%). Among the criteria, "macroscopically complete resection" had the highest compliance (96.5%) while "no serious complications" had the lowest compliance (63.7%). Age (OR 0.53 for the 65-74 years and OR 0.34 for the ≥75 years age group), Charlson comorbidity index ≥3 (OR 0.53, 95%CI 0.34-0.82), neoadjuvant chemoradiotherapy (OR 0.24, 95%CI 0.08-0.70), multivisceral resection (OR 0.55, 95%CI 0.33-0.91), and surgery performed in a community hospital (OR 0.65, CI95% 0.46-0.91) were independently associated with not achieving TO. TO was independently associated with conditional survival (HR 0.67, 95%CI 0.55-0.83). Conclusion: TO was achieved in 41.1% of patients who underwent gastric cancer resection with curative intent and was associated with longer survival

“Allopurinol Does Not Help Me”: An Assessment of Medication Effectiveness in Hmong Adults with Gout

Abstract from the 2016 Research & Innovation Forum held at HealthPartners in Bloomington, MNCulhane-Pera, Kathleen A.; Roman, Youssef M.; Lo, Muaj; Kue, Nhia Pao; Lo, May Xia; Yang, John; Yang, Shoua; Thao, Noel Kee; Thao, Lissee; Straka, Robert J.. (2016). “Allopurinol Does Not Help Me”: An Assessment of Medication Effectiveness in Hmong Adults with Gout. Retrieved from the University Digital Conservancy, https://hdl.handle.net/11299/182060

The impact of additional margin coagulation with radiofrequency in liver resections with subcentimetric margin: can we improve the oncological results? A propensity score matching study

Background: Whereas the usefulness of radiofrequency (RF) energy as haemostatic method in liver surgery has become well established in the last decades, its intentional application on resection margins with the aim of reducing local recurrence is still debatable. Our goal was to compare the impact of an additional application of RF energy on the top of the resection surface, namely additional margin coagulation (AMC), on local recurrence (LR) when subjected to a subcentimeter margin. Methods: We retrospectively analyzed 185 patients out of a whole cohort of 283 patients who underwent radical hepatic resection with subcentimetric margin. After propensity score adjustment, patients were classified into two balanced groups according to whether RF was applied or not. Results: No significant differences were observed within groups in baseline characteristics after PSM adjustment. The LR rate was significantly higher in the Control than AMC Group: 12 patients (14.5%) vs. 4 patients (4.8%) (p = 0.039). The estimated 1, 3, and 5-year LR-free survival rates of patients in the Control and AMC Group were: 93.5%, 86.0%, 81.0% and 98.8%, 97.2%, 91.9%, respectively (p = 0.049). Univariate Cox analyses indicated that the use of the RF applicator was significantly associated with lower LR (HR = 0.29, 95% confidence interval 0.093-0.906, p = 0.033). The Control Group showed smaller coagulation widths than the AMC group (p < 0.001). Conclusions: An additional application of RF on the top of the resection surface is associated with less local hepatic recurrence than the use of conventional techniques.This work was partially supported by the Spanish Ministerio de Ciencia, Innovación y Universidades under “Programa Estatal de I+D+i Orientada a los Retos de la Sociedad”, Grants Nº “ RTI2018-094357-B-C21 ” and “ RTI2018-094357-B-C22”

Kingsnorth's modified score as predictor of complications in open inguinal hernia repair

Purpose: This study aims to analyse the postoperative complications (30 days) on unilateral primary inguinal hernia repair and prove their correlation with the preoperative modified scoring system of Kingsnorth (KN). Methods: Prospective study design collecting data from patients who underwent surgery for unilateral primary inguinal hernia in a University Hospital. The data were collected in the National Inguinal Hernia Registry (EVEREG). A statistical analysis to assess the association between the presence of postoperative complications and the preoperative and intraoperative variables was performed. The patients were classified depending on their KN score. Surgical complications and their relationship with the classification were specifically analysed. Study design was performed following STROBE statements. Results: The sample included 403 patients who met the inclusion criteria from which 62 (15.3%) subjects presented postoperative complications. The variables that presented a statistically significant relationship with the appearance of complications were a KN score of 5-8 (OR 2.7; 95% CI 1.07-4.82; P = 0.03) and the involvement of a member of the abdominal wall surgery unit in the procedure (OR 0.28; 95% CI 0.08-0.92; P = 0.03). The KN score correlated with a longer duration of surgery (Pearson's correlation 0.291; P < 0.0001). Conclusion: The KN classification can predict the onset of surgical wound complications on patients who undergo a primary unilateral inguinal hernia surgery. A KN score of 5-8 has a higher probability of wound complications. When surgery is performed by the abdominal wall surgery unit, the chances of postoperative complications decrease