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Multifactorial
Terms modified by Multifactorial Selected AbstractsEpidemiologic Analysis of Factors Associated with Local Disappearances of Native Ranid Frogs in ArizonaCONSERVATION BIOLOGY, Issue 2 2008CARMEL L. WITTE análisis de factores de riesgo; declinación de anfibios; declinación de ranas; epidemiología de vida silvestre; métodos de control de casos Abstract:,We examined factors that may independently or synergistically contribute to amphibian population declines. We used epidemiologic case,control methodology to sample and analyze a large database developed and maintained by the Arizona Game and Fish Department that describes historical and currently known ranid frog localities in Arizona, U.S.A. Sites with historical documentation of target ranid species (n= 324) were evaluated to identify locations where frogs had disappeared during the study period (case sites) and locations where frog populations persisted (control sites). Between 1986 and 2003, 117 (36%) of the 324 sites became case sites, of which 105 were used in the analyses. An equal number of control sites were sampled to control for the effects of time. Risk factors, or predictor variables, were defined from environmental data summarized during site surveys and geographic information system data layers. We evaluated risk factors with univariate and multifactorial logistic-regression analyses to derive odds ratios (OR). Odds for local population disappearance were significantly related to 4 factors in the multifactorial model. Disappearance of frog populations increased with increasing elevation (OR = 2.7 for every 500 m, p < 0.01). Sites where disappearances occurred were 4.3 times more likely to have other nearby sites that also experienced disappearances (OR = 4.3, p < 0.01), whereas the odds of disappearance were 6.7 times less (OR = 0.15, p < 0.01) when there was a source population nearby. Sites with disappearances were 2.6 times more likely to have introduced crayfish than were control sites (OR = 2.6, p= 0.04). The identification of factors associated with frog disappearances increases understanding of declines occurring in natural populations and aids in conservation efforts to reestablish and protect native ranids by identifying and prioritizing implicated threats. Resumen:,Examinamos los factores que pueden contribuir independiente o sinérgicamente a la declinación de poblaciones de anfibios. Utilizamos una metodología epidemiológica de control de casos para muestrear y analizar una base de datos desarrollada y mantenida por el Departamento de Caza y Pesca de Arizona que describe las localidades históricas y actuales de ranas en Arizona, E. U. A. Los sitios con documentación histórica de las especies de ránidos (n= 324) fueron evaluados para identificar localidades donde las ranas desaparecieron durante el período de estudio (sitios caso) y localidades donde las poblaciones de ranas persistieron (sitios control). Entre 1986 y 2003, 36% (117) de los 324 sitios se volvieron sitios caso, de los cuales 105 fueron utilizados en los análisis. El mismo número de sitios control fueron muestreados para controlar los efectos del tiempo. Los factores de riesgo, o variables predictivas, fueron definidos a partir de datos ambientales obtenidos de los muestreos en los sitios y de capas de datos de un sistema información geográfica. Evaluamos los factores de riesgo con análisis de regresión logística univariada y multivariada para derivar proporciones de probabilidades (PP). Las probabilidad para la desaparición de una población local estuvo relacionada significativamente con 4 factores en el modelo multifactorial. La desaparición de poblaciones de ranas incrementó con la elevación (PP = 2.7 por cada 500 m, p < 0.01). Los sitios donde ocurrieron las desapariciones fueron 4.3 veces más propensos a estar cerca de otros sitios donde ocurrieron desapariciones (PP = 4.3, p < 0.01), mientras que la probabilidad de desaparición fue 6.7 veces menos (PP = 0.15, p < 0.01) cuando había una población fuente cercana. Los sitios con desapariciones fueron 2.6 veces más propensos a tener langostinos introducidos que los sitios control (PP = 2.6, p= 0.04). La identificación de factores asociados con la desaparición de ranas incrementa el conocimiento de las declinaciones de poblaciones naturales y ayuda a los esfuerzos de conservación para el reestablecimiento y la protección de ránidos nativos mediante la identificación y priorización de las amenazas implicadas. [source] Role of Sun Exposure in MelanomaDERMATOLOGIC SURGERY, Issue 4 2006GIL B. IVRY BS BACKGROUND Malignant melanoma is the third most common skin cancer in the United States. It is commonly thought that sun exposure is causative in these tumors. Recently, however, the significance of the role of sun exposure in melanoma has come into question. Some have suggested that other factors, such as genetics, play a larger role, and that sun protection may even be harmful. OBJECTIVE AND METHODS To investigate the role of sun exposure in melanoma etiology. An extensive review of basic science and clinical literature on this subject was conducted. RESULTS Although exceptions exist, sun exposure likely plays a large role in most melanomas. The pattern of this exposure, however, is not fully known, and controversy exists, especially in the use of sunscreens. Sun exposure may interact with genetic factors to cause melanomas, and sun protective measures appear to be prudent. CONCLUSIONS The cause of melanoma is probably variable and multifactorial. Sun exposure may play a primary or supporting role in most melanoma tumors. [source] A Case of Foul Genital Odor Treated with Botulinum Toxin ADERMATOLOGIC SURGERY, Issue 9 2004Jae-Bong Lee MD Background. Genital odor is an uncommon condition characterized by an offensive and malodorous smell in the genital area. Although the etiology of foul genital odor is multifactorial, an important cause is sweat secretion and decomposition of sweat components by bacteria. Different methods are effective in reducing body odor secondary to bromhidrosis. Conservative methods only act for a short period of time, and more invasive surgical methods carry risk of complications or are inapplicable for the genital region. Methods. A patient with localized foul odor in the genital hair bearing area was treated with botulinum toxin A. Results. Botulinum toxin A was effective in creating an odorless and anhydrous response in the genital region, and no major adverse effects were noted during a follow-up of 9 months after injection. Conclusion. Local injection of botulinum toxin A appears to be a useful treatment for foul genital odor related to sweat glands activity. [source] The medical and surgical therapy of pseudofolliculitis barbaeDERMATOLOGIC THERAPY, Issue 2 2004Sharon Bridgeman-Shah ABSTRACT:, Pseudofolliculitis barbae (PFB) is a common, chronic, inflammatory skin disorder seen mainly in individuals with curly hair. This condition is seen most frequently in black men who shave their beards but may also be seen in women of all races who wax or shave the axillary and pubic skin. The etiology of PFB is multifactorial, and heretofore a cure has been considered impossible for those desiring a clean-shaven face. The following article serves to discuss the current medical and surgical therapies available for this condition. Medical treatments for this condition include various combinations of topical antibiotics, corticosteroids, and retinoids. In the surgical arena, laser therapy has revolutionized the treatment of PFB and has enabled cure for the first time for those plagued by this disorder and for whom a beardless face is acceptable. [source] Ingrown and pincer nails: evaluation and treatmentDERMATOLOGIC THERAPY, Issue 2 2002E. Haneke Ingrown toenails are mainly a condition of children and young adults, whereas ingrown fingernail and pincer nails are seen in adults. Their etiology is multifactorial. Different types of ingrowing nails require different treatments. Neonatal ones are always treated conservatively. The hypertrophic lateral nail wall seldom requires surgery. Congenital misalignment of the big toenail may resolve spontaneously, but delay in treatment may cause permanent nail dystrophy. The juvenile type is most common and is treated conservatively in its early stages. Selective matrix horn phenolization or excision is the treatment of choice for later stages. Pincer nails are due to widening of the base of the distal phalanx. Treatment is aimed at reducing the outward pressure of the lateral osteophytes on the matrix horns and permanently flattening the nail. A variety of different methods are discussed. [source] The effects of lipid-lowering drug therapy on cardiovascular responsiveness in type 2 diabetic patientsDIABETES OBESITY & METABOLISM, Issue 1 2006Laurence Guy HowesArticle first published online: 18 MAR 200 Type 2 diabetes is associated with a high prevalence of dyslipidaemia and a high incidence of cardiovascular disease. Lipid lowering therapy with HMG Co-A reductase inhibitors (statins) reduce the risk of cardiovascular events in type 2 diabetic and non-diabetic patients, effects which are believed to be partly due to improvements in vascular function. The aetiology of abnormal vascular function in type 2 diabetics is likely to be multifactorial and the pattern of vascular dysfunction in type 2 diabetes may differ from that which occurs in non-diabetic patients with dyslipidaemia. Abnormalities in endothelium derived hyperpolarising factor (EDHF) mediated vasodilation in resistance vessels may be more prominent in both type 1 and type 2 diabetes than in non-diabetic patients with endothelial dysfunction. The effects of lipid lowering therapy on vascular responsiveness may differ in type 2 diabetic patients from those found in non-diabetic patients. Statin therapy does not appear to improve responses to endothelial dependent vasodilators in type 2 diabetics, but may alter the ratio between nitric oxide (NO) and EDHF mediated responses. Fibrate therapy improves flow mediated dilation of brachial arteries in type 2 diabetic patients, but only appears to improve endothelium dependant vasodilator responses in resistance vessels when given in conjunction with co-enzyme Q. [source] Insulin resistance in type 2 diabetes: role of fatty acids,DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S2 2002Peter Arner Abstract Insulin resistance is one of the key factors responsible for hyperglycaemia in type 2 diabetes and can result in a number of metabolic abnormalities associated with cardiovascular disease (insulin resistance syndrome), even in the absence of overt diabetes. The mechanisms involved in the development of insulin resistance are multifactorial and are only partly understood, but increased availability of free fatty acids (FFAs) is of particular importance for the liver and skeletal muscle. The role of FFAs in type 2 diabetes is most evident in obese patients who have several abnormalities in FFA metabolism. Because of a mass effect, the release of FFAs from the total adipose tissue depot to the blood stream is increased and the high concentration of circulating FFAs impairs muscle uptake of glucose by competitive inhibition. In upper-body obesity, which predisposes individuals to type 2 diabetes, the rate of lipolysis is accelerated in visceral adipose tissue. This results in a selective increase in FFA mobilisation to the portal vein, which connects visceral fat to the liver. A high ,portal' FFA concentration has undesirable effects on the liver, resulting in dyslipidaemia, hyperinsulinaemia, hyperglycaemia and hepatic insulin resistance. Recently, a new class of antidiabetic agents, the thiazolidinediones (TZDs) or ,glitazones' has been developed. A prominent effect of these agents is the lowering of circulating FFA levels and it is believed, but not yet proven, that this interaction with FFAs constitutes a major mechanism behind the glucose-lowering effect of the TZDs. Copyright © 2002 John Wiley & Sons, Ltd. [source] Epidemiology of unarmed threats in the emergency departmentEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2005Jonathan C Knott Abstract Objective:, To evaluate the precipitants, subject characteristics, nature and outcomes of unarmed threats in the ED. Methods:, A 12 month prospective survey of security codes precipitated by an unarmed threat (Code Grey). Results:, Data were collected on 151 subjects. The Code Grey rate was 3.2/1000 ED presentations. They were most frequent on Saturday and in the late evening/early morning. There were verbal or physical threats of violence made to staff on 104 occasions (69%, 95% confidence interval [CI] 61,76) and a perceived threat of patient self-harm on 114 occasions (76%, 95% CI 68,82). Median time to be seen by a doctor was 8 min (interquartile range [IQR]: 2,21 min) and median time from presentation to Code was 59 min (IQR: 5,222 min). Sixteen subjects (11%, 95% CI 6,17) had a history of violence, 45 (30%, 95% CI 23,38) were affected by alcohol, 25 (17%, 95% CI 11,24) had used illicit drugs and 79 (52%, 95% CI 44,60) had a significant mental illness contributing to the Code Grey. Seventy-one patients (47%, 95% CI 39,55) required psychiatric admission, 49 (79%, 95% CI 66,88) involuntarily. Conclusion:, Acutely agitated subjects pose a threat to themselves and the staff caring for them. The reason for the agitation is multifactorial and the majority arrive in a behaviourally disturbed state requiring early intervention. The times most likely to result in a Code Grey coincide with least available resources: ED and hospital risk management policies must account for this. A coherent approach by ED to this population is required to optimize patient and staff outcomes. [source] On the Association Between Valproate and Polycystic Ovary SyndromeEPILEPSIA, Issue 3 2001Pierre Genton Summary: Recent studies by Isojärvi et al. have raised the issue of an increased incidence of polycystic ovary syndrome (PCOS) in women with epilepsy treated with valproate (VPA) and have proposed replacement with lamotrigine (LTG). Polycystic ovaries (PCO) are a common finding, with a prevalence >20% in the general population, and are easily detected by pelvic or vaginal ultrasonography, whereas PCOS is comparatively rare: few women with PCO have fully developed PCOS, which includes hirsutism, acne, obesity, hypofertility, hyperandrogenemia, and menstrual disorders. From an extensive review of the current literature, it appears that there are no reliable data on the actual prevalence of PCOS in normal women and in women with epilepsy. The pathogenesis of PCO is multifactorial, including genetic predisposition and the intervention of environmental factors, among which weight gain and hyperinsulinism with insulin resistance may play a part. The roles of central (hypothalamic/pituitary), peripheral, and local ovarian factors are still debated. PCO and PCOS appear to be more frequent in women with epilepsy, but there are no reliable data showing a greater prevalence after VPA. The recent studies by Isojärvi et al. may have been biased by the retrospective selection of patients. To date, there is no reason to contraindicate the use of VPA in women with epilepsy. However, patients should be informed about the risk of weight gain and its consequences. [source] Mechanisms of renal hyporesponsiveness to ANP in heart failureEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 9 2003A. Charloux Abstract The atrial natriuretic peptide (ANP) plays an important role in chronic heart failure (CHF), delaying the progression of the disease. However, despite high ANP levels, natriuresis falls when CHF progresses from a compensated to a decompensated state, suggesting emergence of renal resistance to ANP. Several mechanisms have been proposed to explain renal hyporesponsiveness, including decreased renal ANP availability, down-regulation of natriuretic peptide receptors and altered ANP intracellular transduction signal. It has been demonstrated that the activity of neutral endopeptidase (NEP) is increased in CHF, and that its inhibition enhances renal cGMP production and renal sodium excretion. In vitro as well as in vivo studies have provided strong evidence of an increased degradation of intracellular cGMP by phosphodiesterase in CHF. In experimental models, ANP-dependent natriuresis is improved by phosphodiesterase inhibitors, which may arise as new therapeutic agents in CHF. Sodium-retaining systems likely contribute to renal hyporesponsiveness to ANP through different mechanisms. Among these systems, the renin-angiotensin-aldosterone system has received particular attention, as angiotensin II and ANP have renal actions at the same sites and inhibition of angiotensin-converting enzyme and angiotensin-receptor blockade improve ANP hyporesponsiveness. Less is known about the interactions between the sympathetic nervous system, endothelin or vasopressin and ANP, which may also blunt ANP-induced natriuresis. To summarize, renal hyporesponsiveness to ANP is probably multifactorial. New treatments designed to restore renal ANP efficiency should limit sodium retention in CHF patients and thus delay the progression to overt heart failure. [source] Mouse models for genetic dissection of polygenic gastrointestinal diseasesEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 2 2003S. Hillebrandt Abstract Many diseases with a major public health impact are the result of complex interactions between environmental factors and multiple genes. In the past decade, methods for genome analysis, in particular quantitative trait locus (QTL) analysis in animal models, were developed to identify and localize the genes responsible for multifactorial (polygenic) diseases; QTL analysis is based on experimental crosses between inbred strains with high and low genetic susceptibility. Recently the genes underlying several QTLs could be cloned successfully. Here we describe the impact of these genomic approaches in mice on our understanding of the multifactorial genetics of three gastrointestinal diseases related to metabolism (cholesterol cholelithiasis), development (gastroschisis), and colorectal cancer. The examples demonstrate how mouse models continue to be an invaluable tool in unravelling complex pathomechanisms and unlocking our understanding of human diseases. [source] An evolutionary concept for altered steroid hormone metabolism in patients with rheumatoid arthritisEXPERIMENTAL DERMATOLOGY, Issue 2 2005Rainer H. Straub The pathogenesis of chronic disabling inflammatory diseases (CDIDs) is partly understood. The presently used concepts focus mainly on abnormalities of the immune system but this view is incomplete. The presented concept is a new framework for the pathogenesis of CDIDs. It integrates evolutionary theories with the classical immunological standpoint, which is further linked with a neuroendocrine immune view of erroneous homeostatic adaptation of the other supersystems (nervous system, endocrine system, reproductive system): 1. In CDIDs, the loss of tolerance against self and harmless foreign antigens leads to continuous immune aggression which is dependent on a multifactorial genetically polymorph background (the initiation). 2. However, advantageous or disadvantageous adaptation to CDIDs were not evolutionary conserved because CDIDs severely impaired reproduction or appeared after the reproductive phase and, thus, imply a strong negative selection pressure. 3. Reactions of all supersystems are evolutionary conserved for transient inflammatory reactions such as the elimination of infectious agents, wound healing, foreign body reaction and many others. 4. The sum of the false reactions of all supersystems , conserved for transient inflammation , provide the pathogenetic background for the chronification of CDIDs because a continuous aggressive situation is created (the chronification). The human disease of rheumatoid arthritis is used as a prototypic CDID to illustrate the integrated view point. The synovial tissue innervation is in the focus of this concept. [source] Aggregative adherence of uropathogenic Proteus mirabilis to cultured epithelial cellsFEMS IMMUNOLOGY & MEDICAL MICROBIOLOGY, Issue 2 2007Sérgio P.D. Rocha Abstract Proteus mirabilis is an important cause of urinary tract infection (UTI) in patients with complicated urinary tracts. Thirty-five strains of P. mirabilis isolated from UTI were examined for the adherence capacity to epithelial cells. All isolates displayed the aggregative adherence (AA) to HEp-2 cells, a phenotype similarly presented in LLC-MK2 cells. Biofilm formation on polystyrene was also observed in all strains. The mannose-resistant Proteus -like fimbriae (MR/P), Type I fimbriae and AAF/I, II and III fimbriae of enteroaggregative Escherichia coli were searched by the presence of their respective adhesin-encoding genes. Only the MR/P fimbrial subunits encoding genes mrpA and mrpH were detected in all isolates, as well as MR/P expression. A mutation in mrpA demonstrated that MR/P is involved in aggregative adherence to HEp-2 cells, as well as in biofilm formation. However, these phenotypes are multifactorial, because the mrpA mutation reduced but did not abolish both phenotypes. The present results reinforce the importance of MR/P as a virulence factor in P. mirabilis due to its association with AA and biofilm formation, which is an important step for the establishment of UTI in catheterized patients. [source] Analysis of chromosomal changes in serous ovarian carcinoma using high-resolution array comparative genomic hybridization: Potential predictive markers of chemoresistant diseaseGENES, CHROMOSOMES AND CANCER, Issue 1 2007Sang Wun Kim The mechanism of drug resistance in cancer is multifactorial, and the accumulation of multiple genetic changes may lead to drug-resistant phenotypes. This study sought to determine characteristic genetic changes in chemoresistant serous ovarian carcinomas using high-resolution array comparative genomic hybridization (aCGH), and identified genomic aberrations that could be used as predictive markers of chemoresistant disease. Seventeen primary ovarian tumors from optimally debulked stage IIIc serous ovarian carcinoma patients were analyzed using aCGH. Ten patients had chemoresistant disease (progression within 12 months of initial chemotherapy), whereas seven patients had chemosensitive disease (no recurrence for more than 36 months). Receiver operating characteristics curve analysis was used to select chromosomal aberrations that could help distinguish chemoresistant disease from chemosensitive disease. In 17 tumors, frequent increases in DNA copy number were seen on 1p36.33, 3q26.2, 8q24.3, 10q26.3, 12p11.21, 20q13.33, and 21q22.3, and frequent losses were observed on 4p12, 5q13.2, 7q11.21, 8p23.1, 14q32.33, Xq13.3, and Xq21.31. The gains on 5p15.33 and 14q11.2, and losses on 4q34.2, 4q35.2, 5q15, 8p21.1, 8p21.2, 11p15.5, 13q14.13, 13q14.2, 13q32.1, 13q34, 16q22.2, 17p11.2, 17p12, and 22q12.3 were more frequent in chemoresistant disease. The losses on 13q32.1 and 8p21.1 had the largest areas under the curve (AUC 0.90 and 0.85, respectively). The most reliable combination of chromosomal aberrations for detecting chemoresistant disease was the loss on 13q32.1 and 8p21.1 (AUC 0.950). Our findings suggest that these chromosomal aberrations are potential predictive markers of chemoresistant disease in patients with serous ovarian carcinomas. © 2006 Wiley-Liss, Inc. [source] Diabetes mellitus and geriatric syndromesGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 2 2009Atsushi Araki Diabetes mellitus is associated with an increased prevalence and incidence of geriatric syndrome: functional disabilities, depression, fall, urinary incontinence, malnutrition and cognitive impairment. Geriatric syndrome not only leads to frailty, loss of independence and low quality of life, but also becomes a major obstacle in the treatment and care of diabetic people. The risk factors or contributing factors of geriatric symptoms are micro- and macrovascular complications, age-rated comorbid disease and aging per se. Comprehensive geriatric assessment of geriatric syndrome, including basic activities of daily living, instrumental activities of daily living, gait and balance, visual acuity, the Mini-Mental State Examination, depression scores, history and risk of fall, urination and nutrition, should be performed as part of the care of elderly diabetic patients, in particular old-old patients. Because geriatric syndromes are multifactorial and share risk factors, diabetic people with any geriatric symptoms should be treated with a common concentric strategy, such as supervised exercise therapy including muscle-strengthening training, psychological support, social support for adherence, and good glycemic control with avoidance of hypoglycemia. [source] Nurses on the Move: A Global OverviewHEALTH SERVICES RESEARCH, Issue 3p2 2007Mireille Kingma Objective. To look at nurse migration flows in the light of national nursing workforce imbalances, examine factors that encourage or inhibit nurse mobility, and explore the potential benefits of circular migration. Principal Findings. The number of international migrants has doubled since 1970 and nurses are increasingly part of the migratory stream. Critical nursing shortages in industrialized countries are generating a demand that is fueling energetic international recruitment campaigns. Structural adjustments in the developing countries have created severe workforce imbalances and shortfalls often coexist with large numbers of unemployed health professionals. A nurse's motivation to migrate is multifactorial, not limited to financial incentives, and barriers exist that discourage or slow the migration process. The migration flows vary in direction and magnitude over time, responding to socioeconomic factors present in source and destination countries. The dearth of data on which to develop international health human resource policy remains. There is growing recognition, however, that migration will continue and that temporary migration will be a focus of attention in the years to come. Conclusions. Today's search for labor is a highly organized global hunt for talent that includes nurses. International migration is a symptom of the larger systemic problems that make nurses leave their jobs. Nurse mobility becomes a major issue only in a context of migrant exploitation or nursing shortage. Injecting migrant nurses into dysfunctional health systems,ones that are not capable of attracting and retaining staff domestically,will not solve the nursing shortage. [source] Factors affecting outcome in liver resectionHPB, Issue 3 2005CEDRIC S. F. LORENZO Abstract Background. Studies demonstrate an inverse relationship between institution/surgeon procedural volumes and patient outcomes. Similar studies exist for liver resections, which recommend referral of patients for liver resections to ,high-volume' centers. These studies did not elucidate the factors that underlie such outcomes. We believe there exists a complex interaction of patient-related and perioperative factors that determine patient outcomes after liver resection. We sought to delineate these factors. Methods. Retrospective review of 114 liver resections by a single surgeon from 1993,2003: Records were reviewed for demographics; diagnosis; type/year of surgery; American Society of Anesthesiologists (ASA) score; preoperative albumin, creatinine, and bilirubin; operative time; intraoperative blood transfusions; epidural use; and intraoperative hypotension. Main outcome measurements were postoperative morbidities, mortalities and length of stay (LOS). Data were analyzed using a multivariate linear regression model (SPSS v10.1 statistical analysis program). Results. Primary indications for resections were hepatocellular carcinoma (HCC) (N=57), metastatic colorectal cancer (N=25), and benign disease (N=18). There were no intraoperative mortalities and 4 perioperative (30-day) mortalities (3.5%). Mortality occurred in patients with malignancies who were older than 50 years. Morbidity was higher in malignant (15.6%) versus benign (5.5%) disease. Complications included bile leak/stricture (N=6), liver insufficiency (N=3), postoperative bleeding (N=2), myocardial infarction (N=2), aspiration pneumonia (N=1), renal insufficiency (N=1), and cancer implantation into the wound (N=1). Average LOS for all resections was 8.6 days. Longer operative time (p=0.04), lower albumin (p<0.001), higher ASA score (p<0.001), no epidural use (p=0.04), and higher creatinine (p<0.001) all correlated positively with longer LOS. ASA score and creatinine were the strongest predictors of LOS. LOS was not affected by patient age, sex, diagnosis, presence of malignancy, intraoperative transfusion requirements, intraoperative hypotension, preoperative bilirubin, case volume per year or year of surgery. Conclusions. Liver resections can be performed with low mortality/morbidity and with acceptable LOS by an experienced liver surgeon. Outcome as measured by LOS is most influenced by patient comorbidities entering into surgery. Annual case volume did not influence LOS and had no impact on patient safety. Length of stay may not reflect surgeon/institution performance, as LOS is multifactorial and likely related to patient population, patient selection and increased high-risk cases with a surgeon's experience. [source] Major affective disorders and schizophrenia: a common molecular signature?,HUMAN MUTATION, Issue 9 2006Ann Van Den Bogaert Abstract Psychiatric disorders, including affective disorders (AD) and schizophrenia (SZ) are among the most common disabling brain diseases in Western populations and result in high costs in terms of morbidity as well as mortality. Although their etiology and pathophysiology is largely unknown, family-, twin-, and adoption studies argue for a strong genetic determination of these disorders. These studies indicate that there is between 40 and 85% heritability for these disorders but point also to the importance of environmental factors. Therefore, any research strategy aiming at the identification of genes involved in the development of AD and SZ should account for the complex nature (multifactorial) of these disorders. During the last decade, molecular genetic studies have contributed a great deal to the identification of genetic factors involved in complex disorders. Here we provide a comprehensive review of the most promising genes for AD and SZ, and the methods and approaches that were used for their identification. Also, we discuss the current knowledge and hypotheses that have been formulated regarding the effect of variations on protein functioning as well as recent observations that point to common molecular mechanisms. Hum Mutat 27(9), 833,853, 2006. © 2006 Wiley-Liss, Inc. [source] Atypical antipsychotic-induced diabetes mellitus: an update on epidemiology and postulated mechanismsINTERNAL MEDICINE JOURNAL, Issue 7 2008S. Buchholz Abstract Diabetic ketoacidosis and hyperglycaemic hyperosmolar syndrome are rare, but potentially fatal complications of antipsychotic-associated hyperglycaemia. The mechanisms for this remain unclear, but are probably multifactorial. The suggested reasons include drug-induced weight gain and adiposity, development of the metabolic syndrome, antagonism of serotonin (5-hydroxytryptamine) receptors, drug-induced leptin resistance, dyslipidaemia mediated pancreatic ,-cell damage and hepatocyte transcription factor dysregulation. Patients with schizophrenia are known to be at a higher genetic risk of developing diabetes mellitus and cardiovascular disease. This review emphasizes a rare case of hyperosmolar hyperglycaemic syndrome in a young man with schizophrenia and discusses proposed mechanisms for the development of antipsychotic-associated diabetes mellitus. [source] Risk factors for symptomatic hyponatraemia: the role of pre-existing asymptomatic hyponatraemiaINTERNAL MEDICINE JOURNAL, Issue 3 2007M. Bissram Abstract Background: Hyponatraemia is associated with substantial morbidity and mortality. Identification of the risk factors associated with the development of symptomatic hyponatraemia is important in determining preventive strategies. Methods: A retrospective analysis of the risks factors associated with the development of severe, symptomatic hyponatraemia requiring hospital admission over the past 3 years at our institution was carried out. Results: Forty-seven patients (26 women, 21 men) with a hospital admission serum sodium <134 mmol/L were identified. Of these patients, 31 (65.9%) had associated changes in the mental status that improved with the treatment of the hyponatraemia suggesting causality. The average admission sodium level of this cohort was 118.8 mmol/L. Symptomatic hyponatraemia was associated with volume depletion (32.6%), congestive heart failure (26%), syndrome of inappropriate antidiuretic hormone (26%), thiazide diuretic use (26%) and selective serotonin re-uptake inhibitor use (26%). In 21.7% of cases, the cause was multifactorial (congestive heart failure, syndrome of inappropriate antidiuretic hormone or medication use with volume depletion). In 11% of cases, patients were taking both thiazide diuretics and serotonin re-uptake inhibitors. Most importantly, 70.9% of all patients admitted with symptomatic hyponatraemia had pre-existing hyponatraemia that was untreated and believed to be asymptomatic (P < 0.05). This was the most common risk factor identified. We next investigated the prevalence of presumed asymptomatic hyponatraemia in the outpatient setting. Out of 27 496 patients analysed, 14% had serum sodium levels less than or equal to 134 mEq/L and 4% had values less than 130 mEq/L. Conclusion: Pre-existing asymptomatic hyponatraemia is a common finding and is associated with a high risk for the development of worsening hyponatraemia with altered mental status. [source] New insights into the pathophysiology of postoperative cognitive dysfunctionACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2010L. KRENK There is evidence that postoperative cognitive dysfunction (POCD) is a significant problem after major surgery, but the pathophysiology has not been fully elucidated. The interpretation of available studies is difficult due to differences in neuropsychological test batteries as well as the lack of appropriate controls. Furthermore, there are no internationally accepted criteria for defining POCD. This article aims to provide an update of current knowledge of the pathogenesis of POCD with a focus on perioperative pathophysiology and possible benefits achieved from an enhanced postoperative recovery using a fast-track methodology. It is concluded that the pathogenesis of POCD is multifactorial and future studies should focus on evaluating the role of postoperative sleep disturbances, inflammatory stress responses, pain and environmental factors. Potential prophylactic intervention may include minimal invasive surgery, multi-modal non-opioid pain management and pharmacological manipulation of the inflammatory response and sleep architecture. [source] The genetics of aspirin resistanceINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2007Timothy Goodman Summary Aspirin is widely used for the prophylaxis of cardiovascular events in patients with cardiovascular risk factors or established atherosclerotic disease. However, despite aspirin treatment, a substantial number of patients experience recurrent events. Such ,aspirin resistance' is generally defined as failure of aspirin to produce an expected biological response, for example inhibition of platelet aggregation or of thromboxane A2 synthesis. Whilst its aetiology is multifactorial, genetic factors are also likely to play their part. Here we review the evidence for and against such a genetic contribution, as well as the data suggesting the involvement of specific genes. [source] No evidence for association of the TP53 12139 and the BAX,248 polymorphisms with endemic pemphigus foliaceus (fogo selvagem)INTERNATIONAL JOURNAL OF IMMUNOGENETICS, Issue 2 2006K. F. Köhler Summary Pemphigus foliaceus (PF) is an autoimmune bullous epidermal disease, characterized by autoantibodies specific to the desmosomal protein desmoglein 1 (dsg1) and by acantholysis, the rupture of the cellular junctions among keratinocytes. Known also as fogo selvagem (wild fire) in Brazil, the disease has distinct epidemiological characteristics, being endemic in certain regions of South America. It is a multifactorial (complex) disease, with oligo- or polygenic disease susceptibility. In view of the previously reported evidences of a role for apoptosis dysregulation in pemphigus pathogenesis, we hypothesized that genetic variants of molecules participating in apoptosis may contribute to interindividual variation of susceptibility to PF. The TP53 12139(G,C) and the BAX,248(G,A) single nucleotide polymorphisms (SNP) were analysed in a genetic association study. The allelic, genotypic and allele carrier frequencies for these SNPs did not differ statistically between the patient and the control groups, for both the Euro- and the Afro-Brazilian population strata. The results of this study lead us to conclude that, although the TP53 and BAX alleles analysed differ functionally, this variation does not alter the functionality of the molecules in a way that would interfere with the development of the disease. [source] Absconding: A review of the literature 1996,2008INTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 5 2008Eimear Muir-Cochrane ABSTRACT:, Absconding is a significant problem with potential for harm to patients or the general public. The consequences of absconding include physical harm, prolonged treatment time, and substantial economic costs. The aim of this systematic literature review is to synthesize quality literature about absconding from psychiatric facilities, identify gaps in knowledge, and make recommendations for practice. An electronic search yielded 39 journal articles that met the review criteria. Findings demonstrate that a single definition of absconding remains elusive, making the prevalence of absconding difficult to establish. Absconding events are multifactorial, with environmental, psychosocial, and organic aspects. Negative consequences exist including violence, aggression, and self-neglect and harm to self and others. Papers are clustered around the following themes: harm and risk, absconder profiles, absconding rates, and perceptions of nurses and patients. Nursing interventions designed to decrease absconding have been implemented with success, but only in a few studies and in Australia, none have been reported in the literature to date. Further research is required to identify appropriate nursing-based interventions that may prove useful in reducing the risk of absconding. [source] The modulating effect of culture on the expression of dental anxiety in children: a literature reviewINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 4 2004M. O. FOLAYAN Summary. The experience of anxiety is a universal human phenomenon. Studies have shown a world-wide variation in the prevalence of dental anxiety with estimates ranging between 3% and 43%. The aetiology of dental anxiety is multifactorial, with factors acting in synergy to affect its expression. For children, age and gender play fundamental roles in its expression. However, these two factors are modulated by other variables such as culture which may influence the context in which anxiety is experienced, the interpretation of its meaning and responses to it. The modulating effect of culture in synergy with other variables may be one of the reasons why reports on dental anxiety have varied from region to region. This paper attempts to identify the interrelating roles of culture, age and gender, and how these relationships may affect variability in the expression and measurement of dental anxiety in children. [source] Evaluating the Cost-Effectiveness of Fall Prevention Programs that Reduce Fall-Related Hip Fractures in Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2010Kevin D. Frick PhD OBJECTIVES: To model the incremental cost-utility of seven interventions reported as effective for preventing falls in older adults. DESIGN: Mathematical epidemiological model populated by data based on direct clinical experience and a critical review of the literature. SETTING: Model represents population level interventions. PARTICIPANTS: No human subjects were involved in the study. MEASUREMENS: The last Cochrane database review and meta-analyses of randomized controlled trials categorized effective fall-prevention interventions into seven groups: medical management (withdrawal) of psychotropics, group tai chi, vitamin D supplementation, muscle and balance exercises, home modifications, multifactorial individualized programs for all elderly people, and multifactorial individualized treatments for high-risk frail elderly people. Fall-related hip fracture incidence was obtained from the literature. Salary figures for health professionals were based on Bureau of Labor Statistics data. Using an integrated healthcare system perspective, healthcare costs were estimated based on practice and studies on falls in older adults. Base case incremental cost utility ratios were calculated, and probabilistic sensitivity analyses were conducted. RESULTS: Medical management of psychotropics and group tai chi were the least-costly, most-effective options, but they were also the least studied. Excluding these interventions, the least-expensive, most-effective options are vitamin D supplementation and home modifications. Vitamin D supplementation costs less than home modifications, but home modifications cost only $14,794/quality-adjusted life year (QALY) gained more than vitamin D. In probabilistic sensitivity analyses excluding management of psychotropics and tai chi, home modification is most likely to have the highest economic benefit when QALYs are valued at $50,000 or $100,000. CONCLUSION: Of single interventions studied, management of psychotropics and tai chi reduces costs the most. Of more-studied interventions, home modifications provide the best value. These results must be interpreted in the context of the multifactorial nature of falls. [source] Blood,brain barrier breakdown in septic encephalopathy and brain tumours*JOURNAL OF ANATOMY, Issue 6 2002D. C. DaviesArticle first published online: 28 JUN 200 Abstract Septic encephalopathy is associated with breakdown of the blood,brain barrier and cerebral oedema. These features are also common properties of brain tumours. Perimicrovessel oedema, disruption of associated astrocyte end feet and neuronal injury occur in a porcine model of acute septic encephalopathy. The adrenergic system has been implicated in the inflammatory response to sepsis and may play a role in controlling blood,brain barrier permeability, since the ,2 -adrenoceptor agonist dopexamine inhibits perimicrovessel oedema formation whereas the ,1 -adrenoceptor agonist methoxamine provokes it. Electron microscopy revealed tight junction opening in high-grade astrocytoma microvessels. Expression of the tight junction protein occludin is reduced in these microvessels and this reduction is inversely correlated with the degree of cerebral oedema. Normal astrocytes secrete factors that induce barrier properties in endothelial cells, whereas high-grade astrocytomas secrete vascular endothelial growth factor, which stimulates angiogenesis, down regulates occludin and increases endothelial cell permeability. The water channel protein aquaporin-4 is normally expressed in astrocyte foot processes around cerebral microvessels. Its expression is massively up-regulated in high-grade astrocytoma and around metastatic adenocarcinoma. There is a significant correlation between aquaporin-4 expression and the degree of cerebral oedema, but it is not clear whether increased aquaporin-4 expression enhances oedema formation or clearance. These results suggest that the pathophysiology of brain oedema is multifactorial, but that there may be common processes operating regardless of the aetiology. [source] Analysis of the role of bacterial endospore cortex structure in resistance properties and demonstration of its conservation amongst speciesJOURNAL OF APPLIED MICROBIOLOGY, Issue 2 2001A. Atrih Aims: The aim of this work was to compare the chemical structure of the spore cortex of a range of species, and to determine any correlation between cortex structure and spore resistance properties. Methods and Results: The fine chemical structure of the cortex of Bacillus subtilis, Bacillus megaterium, Bacillus cereus and Clostridium botulinum was examined by muropeptide analysis using reverse phase HPLC. There is a conserved basic structure between peptidoglycan of these species, with the only difference being the level of de -N -acetylation of an amino sugar. In order to determine if an alteration in cortex structure correlates with heat resistance properties, the peptidoglycan structure and properties of B. subtilis spores prepared under different conditions were compared. Peptidoglycan from spores prepared in Nutrient Broth (NB) showed reduction in single L -alanine substituted muramic acid to only 13·9% compared with 20·6% in CCY-grown spores. NB-prepared spores are also unstable, with 161-fold less heat resistance (60 min, 85°C) and 43 times less Mn2+ content than CCY-grown spores. Addition of MnCl2 to NB led to a peptidoglycan profile similar to CCY-grown spores, sevenfold more heat resistance (60 min, 85°C) and an 86-fold increase in Mn2+ content. Addition of CCY salts to NB led all parameters to be comparable with CCY-grown spore levels. Conclusions: It has been shown that peptidoglycan structure is conserved in four spore-forming bacteria. Also, spore heat resistance is multifactorial and cannot be accounted for by any single parameter. Significance and Impact of the Study: Endospores made by diverse species most likely have common mechanisms of heat resistance. However, the molecular basis for their resistance remains elusive. [source] Age-Related Changes in the Osteogenic Differentiation Potential of Mouse Bone Marrow Stromal Cells,,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 7 2008Weixi Zhang Abstract Age-dependent bone loss has been well documented in both human and animal models. Although the underlying causal mechanisms are probably multifactorial, it has been hypothesized that alterations in progenitor cell number or function are important. Little is known regarding the properties of bone marrow stromal cells (BMSCs) or bone progenitor cells during the aging process, so the question of whether aging alters BMSC/progenitor osteogenic differentiation remains unanswered. In this study, we examined age-dependent changes in bone marrow progenitor cell number and differentiation potential between mature (3 and 6 mo old), middle-aged (12 and 18 mo old), and aged (24 mo old) C57BL/6 mice. BMSCs or progenitors were isolated from five age groups of C57BL/6 mice using negative immunodepletion and positive immunoselection approaches. The osteogenic differentiation potential of multipotent BMSCs was determined using standard osteogenic differentiation procedures. Our results show that both BMSC/progenitor number and differentiation potential increase between the ages of 3 and 18 mo and decrease rapidly thereafter with advancing age. These results are consistent with the changes of the mRNA levels of osteoblast lineage-associated genes. Our data suggest that the decline in BMSC number and osteogenic differentiation capacity are important factors contributing to age-related bone loss. [source] Low Systemic Vascular Resistance After Cardiopulmonary Bypass: Incidence, Etiology, and Clinical ImportanceJOURNAL OF CARDIAC SURGERY, Issue 5 2000T. Carrel M.D. The etiology is not completely elucidated and the clinical importance remains speculative. Methods: In this prospective clinical trial, we assessed the incidence of postoperative low systemic vascular resistance in 800 consecutive patients undergoing elective coronary artery bypass grafting and/or valve replacement. We have attempted to identify the predictive factors responsible for the presence of low systemic vascular resistance and we have examined the subsequent postoperative outcome of those patients who developed early postoperative vasoplegia. The severity of vasoplegia was divided into three groups according either to the value of systemic resistance and/or the dose of vasoconstrictive agents necessary to correct the hemodynamic. Results: Six hundred twenty-five patients (78.1%) did not develop vasoplegia, 115 patients (14.4%) developed a mild vasoplegia, and 60 patients (7.5%) suffered from severe vasoplegia. Low systemic vascular resistance did not affect hospital mortality but was the cause for delayed extubation and prolonged stay on the intensive care unit IICU). Logistic regression analysis identified temperature and duration of cardiopulmonary bypass, total cardioplegic volume infused, reduced left ventricular function, and preoperative treatment with angiotensin-converting enzyme (ACE)-inhibitors, out of 25 parameters, as predictive factors for early postoperative vasoplegia. Conclusion. The occurrence of low systemic vascular resistance following cardiopulmonary bypass is as high as 21.8%. The etiology of this clinical condition is most probably multifactorial. Mortality is not affected by vasoplegia, but there is a trend to higher morbidity and prolonged stay in the ICU. [source] | ||||||||||||||||||||||||||||||||||||||||||||||