Accuracy of hospital-based surveillance systems for surgical site infection after adult spine surgery: a Bayesian latent class analysis.

BACKGROUND: Surgical site infections (SSIs) of the spine are morbid and costly complications. An accurate surveillance system is required to properly describe the disease burden and the impact of interventions that mitigate SSI risk. Unfortunately, uniform approaches to conducting SSI surveillance are lacking because of varying SSI case definitions, the lack of a perfect reference case definition and heterogeneous data sources. AIM: To assess the accuracy of four independent data sources that capture SSIs after spine surgery, with estimation of a measurement-error-adjusted SSI incidence. METHODS: A Bayesian latent class model assessed the sensitivity/specificity of each data source to identify SSI and to estimate a measurement-error-adjusted incidence. The four data sources used were: the discharge abstract database (DAD), the National Surgical Quality Improvement Program (NSQIP) database, the Infection Prevention and Control Canada (IPAC) database, and the Spine Adverse Events Severity database. FINDINGS: A total of 904 patients underwent spine surgery in 2017. The most sensitive data source was DAD (0.799; 95% credible interval (CrI): 0.597-0.943); the least sensitive was NSQIP (0.497; 95% CrI: 0.308-0.694). The most specific data source was IPAC (0.997; 95% CrI: 0.993-1.000) and the least specific was DAD (0.969; 95% CrI: 0.956-0.981). The measurement-error-adjusted SSI incidence was 0.030 (95% CrI: 0.019-0.045). The crude incidence using the DAD overestimated the incidence, and the three other data sources underestimated it. CONCLUSION: SSI surveillance in the spine surgery population is feasible using several data sources, provided that measurement error is considered.

Kappa casein gene polymorphism in local Tunisian goats.

The genetic polymorphism of the goat Kappa casein was investigated in Tunisian goats. Blood samples were collected from local goat breeds. Samples of genomic DNA were obtained from leukocytes of 175 dairy goats and regions of interest in the gene were amplified by Polymerase Chain Reaction (PCR) and then evaluated in agarose gel. For a better characterization of the single nucleotide polymorphism, a PCR-Restriction Fragment Length Polymorphism was performed employing the endonuclease DNA amplification using 459 bp primers. The PCR products of primers (459 bp) digested by restriction enzyme Alw44I produced two fragments of 459 and 381 bp. The Kappa casein allelic variants in tested animals revealed different genotypes, two of them were homozygous: AA or BB, AC or BC and CC. Genotypic frequencies were 12.5, 60.5 and 27% for AA or BB, CC and AC or BC, respectively. Identification of different variants of the Kappa casein can be used for the improvement and conservation of Tunisian local goats.

Genetic parameters for tunisian holsteins using a test-day random regression model.

Genetic parameters of milk, fat, and protein yields were estimated in the first 3 lactations for registered Tunisian Holsteins. Data included 140,187; 97,404; and 62,221 test-day production records collected on 22,538; 15,257; and 9,722 first-, second-, and third-parity cows, respectively. Records were of cows calving from 1992 to 2004 in 96 herds. (Co)variance components were estimated by Bayesian methods and a 3-trait-3-lactation random regression model. Gibbs sampling was used to obtain posterior distributions. The model included herd x test date, age x season of calving x stage of lactation [classes of 25 days in milk (DIM)], production sector x stage of lactation (classes of 5 DIM) as fixed effects, and random regression coefficients for additive genetic, permanent environmental, and herd-year of calving effects, which were defined as modified constant, linear, and quadratic Legendre coefficients. Heritability estimates for 305-d milk, fat and protein yields were moderate (0.12 to 0.18) and in the same range of parameters estimated in management systems with low to medium production levels. Heritabilities of test-day milk and protein yields for selected DIM were higher in the middle than at the beginning or the end of lactation. Inversely, heritabilities of fat yield were high at the peripheries of lactation. Genetic correlations among 305-d yield traits ranged from 0.50 to 0.86. The largest genetic correlation was observed between the first and second lactation, potentially due to the limited expression of genetic potential of superior cows in later lactations. Results suggested a lack of adaptation under the local management and climatic conditions. Results should be useful to implement a BLUP evaluation for the Tunisian cow population; however, results also indicated that further research focused on data quality might be needed.

Lambda(0) polarization in 800-GeV/cpp --> p(f)(Lambda0K+).

We report results from a study of Lambda(0) polarization in the exclusive reaction pp --> p(f)(Lambda0K+) at 800-GeV/c. We observe a dependence of the polarization on the Lambda0K+ invariant mass with large (+71%) positive polarization at small mass (1.63-GeV/c(2)) and large (-43%) negative polarization at large mass (2.75-GeV/c(2)). This observation confirms the result of the CERN ISR R608 experiment and extends the range over which the effect is observed. The strong dependence of the polarization on the Lambda0K+ invariant mass suggests that the origin of the polarization is closely related to the production dynamics of the diffractively produced Lambda0K+ system.

Diffractively produced charm final states in 800-GeV/c pp collisions.

We report the first observation of diffractively produced open charm in 800-GeV/c pp collisions of the type pp-->pD*X. We measure cross sections of sigma(diff)(D*+) = (0.185+/-0.044+/-0.054) (mu)b and sigma(diff)(D(*-)) = (0.174+/-0.034+/-0.029) (mu)b. Our measurements are based on 4.3x10(9) events recorded by FNAL E690 in the fixed-target run of 1991. We compare our results with previous fixed-target charm experiments.

Merits of performing coronary artery by-pass grafts on the beating heart.

A retrospective study of 1006 patients was undertaken to evaluate the benefit of a change of strategy in performing coronary artery by-pass grafting surgery. Group A consisted of 500 patients who were consecutively operated on cardiopulmonary by-pass and group B consisted of 506 patients who were consecutively operated on using "off pump" techniques. Pre-operative risk profile in both groups were similar as was as in the operating time. There was distinct benefit in amount of homologous transfusion, period of ICU stay, increased usage of radial artery conduit and improvement in transoesophageal echocardiography assessment of ischaemic mitral incompetence immediately after revascularisation in off pump (group B). Though there was a lower mortality in group B ie, 3/506 vis-a-vis 10/500 in group A this is not of statistical significance. Improvement in left ventricular ejection fraction >5.0% occurred more frequently in one month follow-up visits of group B patients. Period of return to active life was also shorter (28 versus 56 days). Based on observations, we conclude that there is a distinct benefit in avoiding cardiopulmonary by-pass while performing coronary artery by-pass grafting.

[The place of enalapril in the management of hypertension]. / Az enalapril helye a magasvérnyomás-betegség kezelésében.

In Hungary the use of angiotensin converting enzyme inhibitor enalapril has emerged as one of the most important drugs in the treatment of hypertension. The aim of our study was to evaluate the antihypertensive effect of enalapril of Hungarian production in combination therapy and alone, according to sexes, to the body mass index, among smokers and non smokers as well as non diabetic and in patients with diabetes (IDDM and NIDDM). The diurnal blood pressure values were registered by a 24 hour ambulatory blood pressure monitor. During the 6 weeks of the enalapril therapy (n = 28) both the daytime (141/84 vs. 135/80 mmHg) and the night-time (130/78 vs. 124/72 mmHg) blood pressure values decreased; the increase of diurnal indices during the therapy (SI/DI 6/8% vs. 8/10) reflect the 24 hour long lasting effect of the drug. The body mass index had no influence on the efficacy of treatment. Our results indicate that enalapril manufactured in Hungary is an effective antihypertensive drug both in monotherapy and in combination, in both sexes (especially in men), irrespective of the body weight, in non-smokers and especially in smokers, in insulin dependent and in non-insulin dependent diabetes mellitus alike.

Residents' evaluation of a therapeutic community.

OBJECTIVE: To determine former residents' views of a therapeutic community and factors associated with a good response to therapy. METHOD: Retrospective, using a self-report questionnaire. RESULTS: Of 51 contactable former residents, 32 completed the questionnaire. Responses were generally very positive, although the best outcome was reported by those who held a social-interpersonal rather than a biological view of psychiatric disorder, and who scored close to normal on a measure of intropunitiveness. Respondents emphasized the crucial role of feedback and confrontation by staff and co-residents in changing their unhelpful behaviour and attitudes, although a few thought that confrontations were too forceful. The mean duration of psychiatric disorder (mainly substance abuse and personality disorder) was more than 4.5 years. Many respondents emphasized the failure of orthodox treatments to help them, adding that their disorders would probably have continued indefinitely without treatment in a therapeutic community.

Hypothyroidism and the heart. Examination of left ventricular function in subclinical hypothyroidism.

For revealing whether cardiac performance is changed in subclinical hypothyroidism, the left ventricular ejection fraction (LVEF), a value characterizing left ventricular function, was studied in this clinical state. The results were compared to those obtained in euthyroid subjects and patients with overt hypothyroidism. In a part of subclinical cases, there is a subnormal resting LVEF, which on isometric exercise, increases, but to a lesser extent than in euthyroid controls. In overt hypothyroidism resting LVEF is considerably lower than in euthyroid and subclinically hypothyroid subjects and its value does not respond to exercise. There has been evidence that heterogeneous subclinical hypothyroidism is an intermediate state between euthyroidism and overt hypothyroidism; the majority of patients are euthyroid, a part of them, however, based on systolic time intervals and LVEF studies, are suspect of developing 'tissue' hypothyroidism, although their serum thyroid hormone level is still within normal limits.

Serum-"free"-thyroxine and triiodothyronine levels: their significance in preclinical hyperthyroidism and subclinical hypothyroidism.

A study was performed to establish whether the serum-"free" T4 and T3 levels contributed to the diagnosis of latent thyroid disease. The results suggested that in case of autonomous adenoma an increase in the serum free T3-level is the most reliable indicator of the transformation of the thyroid nodule, and that this hormone concentration, in addition to the TSH--IRMA procedure contributed to the differentiation between euthyroid and hyperthyroid state. In subclinical hypothyroidism, regarded as a heterogeneous subgroup, the mean "free" T4 levels, though still within the normal range, were below those of the controls. Measurement of "free" T4 alone was, however, not sufficient for the diagnosis of subclinical hypothyroidism, but contributed to the differentiation of subclinical from manifest hypothyroidism. Subclinical hypothyroidism raised the possibility that a reduction in the serum hormone levels, though still within the normal limits, may be perceived by the peripheral tissues. Preliminary studies indicated that measurement of the systolic time interval may offer information on this issue.

Effects of methysergide, bromocriptine and naloxone on prolactin, growth hormone and TSH release induced by D-Met2,Pro5-enkephalinamide in man.

D-Met2,Pro5-enkephalinamide (EA) 10 mg, given SC, induced a dramatic rise in serum prolactin (PRL) and growth hormone (GH) levels in healthy male volunteers. The TSH content was also moderately elevated. Naloxone 0.8 mg administered IV abolished these effects. Bromocriptine 2.5 mg given per os also antagonized EA-induced PRL and TSH release but potentiated the GH surge. Methysergide 2.0 mg administered orally partially reversed EA-elicited PRL release, further augmented GH liberation and did not modify TSH output. The data indicate that inhibition of the dopaminergic tone and/or activation of certain serotonergic mechanisms play an important role in the EA-induced release of PRL and TSH. However, primarily other neurotransmitters might mediate the GH liberation elicited by this opioid peptide.