Factors influencing hospital conveyance following ambulance attendance for people with diabetes: A retrospective observational study.

AIM: To assess variables contributing to hospital conveyance for people with diabetes and the interactions between them. A secondary aim was to generate hypotheses for further research into interventions that might reduce avoidable hospital admissions. METHODS: A national retrospective data set including 30 999 diabetes-related callouts from the Scottish Ambulance Service was utilized covering a 5-year period between 2013 and 2017. The relationship between diabetes-related hospital conveyance and seven potential risk factors was analysed. Independent variables included: age, gender, deprivation, paramedic attendance, treatment at the scene, first blood glucose measurement and day of the week. RESULTS: In Scotland, hyperglycaemia was associated with a higher number of people being conveyed to hospital than hypoglycaemia (49.8% with high blood glucose vs. 39.3% with low glucose, P ≤ 0.0001). Treatment provided in pre-hospital care was associated with reduced conveyance rates (47.3% vs. 58.2% where treatment was not administered, P ≤ 0.0001). Paramedic attendance was also associated with reduced conveyance to hospital (51.4% vs. 59.5% where paramedic was not present, P ≤ 0.0001). Paramedic attendance in hyperglycaemic cases was associated with significantly reduced odds of conveyance (odds ratio 0.52, P ≤ 0.001). CONCLUSIONS: A higher rate of conveyance associated with hyperglycaemic cases indicates a need for more resources, education and training in this area. Higher conveyance rates were also associated with no paramedic being present and no treatment being administered. This suggests that paramedic attendance may be crucial in reducing avoidable admissions. Developing and validating protocols for pre-hospital services and treatment may help to reduce hospital conveyance rates.

Meta-analysis of the impact of postoperative infective complications on oncological outcomes in colorectal cancer surgery.

BACKGROUND: Cancer outcomes are complex, involving prevention, early detection and optimal multidisciplinary care. Postoperative infection and surgical site-infection (SSI) are not only uncomfortable for patients and costly, but may also be associated with poor oncological outcomes. A meta-analysis was undertaken to assess the oncological effects of SSI in patients with colorectal cancer. METHODS: An ethically approved PROSPERO-registered meta-analysis was conducted following PRISMA guidelines. PubMed and Scopus databases were searched for studies published between 2007 and 2017 reporting the effects of postoperative infective complications on oncological survival in colorectal cancer. Results were separated into those for SSI and those concerning anastomotic leakage. Articles with a Methodological Index for Non-Randomized Studies score of at least 18 were included. Hazard ratios (HRs) with 95 per cent confidence intervals were computed for risk factors using an observed to expected and variance fixed-effect model. RESULTS: Of 5027 articles were reviewed, 43 met the inclusion criteria, with a total of 154 981 patients. Infective complications had significant negative effects on overall survival (HR 1·37, 95 per cent c.i. 1·28 to 1·46) and cancer-specific survival (HR 2·58, 2·15 to 3·10). Anastomotic leakage occurred in 7·4 per cent and had a significant negative impact on disease-free survival (HR 1·14, 1·09 to 1·20), overall survival (HR 1·34, 1·28 to 1·39), cancer-specific survival (HR 1·43, 1·31 to 1·55), local recurrence (HR 1·18, 1·06 to 1·32) and overall recurrence (HR 1·46, 1·27 to 1·68). CONCLUSION: This meta-analysis identified a significant negative impact of postoperative infective complications on overall and cancer-specific survival in patients undergoing colorectal surgery.

ANTECEDENTES: Los resultados del cáncer son complejos, implican prevención, detección precoz y atención multidisciplinaria óptima. La infección postoperatoria y la infección del sitio quirúrgico (surgical site infection, SSI) no solo son inconvenientes para los pacientes y costosas, sino que también pueden estar asociadas con malos resultados oncológicos. Este estudio realizó un metaanálisis para evaluar los efectos oncológicos de la SSI en pacientes con cáncer colorrectal. MÉTODOS: Se realizó un metaanálisis registrado en PROSPERO, aprobado por el comité ético, siguiendo las pautas de PRISMA y utilizando las bases de datos PubMed y Scopus para estudios entre 2007-2017 que describían los efectos de las complicaciones infecciosas postoperatorias en la supervivencia oncológica en el cáncer colorrectal. Los resultados se separaron para el grupo de infección del sitio quirúrgico (SSI) y de fuga anastomótica. Se incluyeron los artículos con una puntuación ≥ 18 según el índice MINORS. Para los factores de riesgo se calcularon los cocientes de riesgos instantáneos (hazard ratios, HR) mediante un modelo de efectos aleatorios y el método de Mantel-Haenszel con los i.c. del 95% utilizando el programe RevMan5. RESULTADOS: Se revisaron 5.027 artículos de los cuales 43 cumplieron con los criterios de inclusión. En total fueron 154.981 pacientes en los cuales las complicaciones infecciosas tuvieron efectos negativos significativos en la supervivencia global (HR: 1,37 i.c. del 95%: 1,28-1,46) y la supervivencia específica relacionada con el cáncer (HR: 2,58 i.c. del 95%: 2,15-3,10). La fuga anastomótica ocurrió en un 7,4% de los casos e impactó negativa y significativamente en la supervivencia libre de enfermedad (HR: 1,14 i.c. del 95%: 1,09-1,20), en la supervivencia global (HR: 1,34 i.c. del 95%: 1,28-1,39), en la supervivencia específica relacionada con el cáncer (HR: 1,43 i.c. del 95% 1.31-1.55), en la recidiva local (HR: 1,18 i.c. del 95%: 1,06-1,32) y en la recidiva global (HR: 1,46 i.c. del 95%: 1,27-1,68). CONCLUSIÓN: Este metaanálisis identificó un impacto negativo significativo en la supervivencia global y en la supervivencia específica relacionada con el cáncer en pacientes con complicaciones postoperatorias infecciosas sometidos a cirugía colorrectal.

Intrachromatid excision of telomeric DNA as a mechanism for telomere size control in Saccharomyces cerevisiae.

We have previously identified a process in the yeast Saccharomyces cerevisiae that results in the contraction of elongated telomeres to wild-type length within a few generations. We have termed this process telomeric rapid deletion (TRD). In this study, we use a combination of physical and genetic assays to investigate the mechanism of TRD. First, to distinguish among several recombinational and nucleolytic pathways, we developed a novel physical assay in which HaeIII restriction sites are positioned within the telomeric tract. Specific telomeres were subsequently tested for HaeIII site movement between telomeres and for HaeIII site retention during TRD. Second, genetic analyses have demonstrated that mutations in RAD50 and MRE11 inhibit TRD. TRD, however, is independent of the Rap1p C-terminal domain, a central regulator of telomere size control. Our results provide evidence that TRD is an intrachromatid deletion process in which sequences near the extreme terminus invade end-distal sequences and excise the intervening sequences. We propose that the Mre11p-Rad50p-Xrs2p complex prepares the invading telomeric overhang for strand invasion, possibly through end processing or through alterations in chromatin structure.

[Women's opinion of the risk of breast cancer]. / Ryzyko zachorowania na raka piersi w opinii kobiet.

UNLABELLED: The basic element of preparing primary prophylactic is the designation of factors of the risks. In this connexion it has been decided that we acquaint ourselves with the opinions of women. Regarding the factors of the risks of falling ill with breast cancer, to be found on them. The research has been carried out among 149 women in the period of procreation. In order to obtain the material required for the research we hare used the questionnaire of the poll of their proper ownership. The gathered material was subjected to a statistic and descriptive analysis. Most of surveyed (138, it. 92.6%) has estimated the degree of the risks of falling ill with breast cancer. The women associated this fact with the cases of falling in their families or the changes on their breast. When asked, what increases the risks oh falling ill with breast cancer in their it was connected with women's gynaecological and maternity post. CONCLUSIONS: 1. Over halt of the women (53.6%) has estimated the risks of falling ill with breast cancer giving 1-2 points (within the scale 0-5 points). 2. In the families of the surveyed there were cases of falling ill with malignant breast tumour (3%). 3. The vast majority (78.5%) undertakes the steps in order (wholesome falling in advantageous to their health and controlling their state of health) to protect themselves against tumourous disease. 4. The variables accepted while working did not differentiate the surveyed opinions.

[Women in reproductive age in the face of prophylactic gynaecological examinations]. / Kobiety w wieku rozrodczym wobec profilaktycznych badan ginekologicznych.

In this study attitudes of young women towards prophylactic gynaecological examination were presented. 149 women were included into the questionnaire, all with secondary education in medical field. The most frequent reason of a first visit was the appearance of symptoms and sings, causing anxiety, and fear the second frequent reason was simply a check--visit. The majority of women (64.5%) confirmed the choice of one, regular doctor, to whom they used to report their various health problems.

An extrachromosomal fragment of telomeric DNA in wheat.

A procedure developed originally for selective extraction of viral (extrachromosomal) DNA from virus-infected mammalian cells was applied to cell nuclei isolated from uninfected wheat embryos. The resulting nuclear extrachromosomal DNA (exDNA) was enriched for telomere-type sequences by isopycnic centrifugation and inserted into the Sma I site of pUC119. A cloned DNA fragment (241 bp) was found to consist primarily of tandemly repeated heptamere units of the same sequence (5'-CCCTAAA-3') that is known to predominate in telomeric DNA of Arabidopsis thaliana. Hybridization experiments indicate that extrachromosomal telomeric repeats are abundant in resting embryos and disappear rapidly during germination.

Molecular cytogenetic analysis of DNA sequences with flanking telomeric repeats in Triticum aestivum cv. Begra.

A cloned genomic DNA fragment (pTa241) formerly derived from a DNA fraction obtained from isolated nuclei of embryos of a Polish cultivar of wheat (Triticum aestivum cv. Begra) comprises a tandem repeat of the telomeric array CCCTAAA, and hybridizes in situ exclusively to the telomeres of all chromosome arms of the somatic chromosome complement of wheat. A second cloned fragment (pTa637) derived from the same fraction is 637 bp long, flanked by 28 bp of the same telomeric repeat unit, and hybridizes in situ to the entire lengths of all the chromosomes of the complement. The same pattern of hybridization was observed when the flanking telomeric sequences were removed. A third DNA fragment (pTa1439), derived from unfractionated genomic DNA and flanked with 62 bp of the same telomeric unit, showed the same patterns of distribution. Together with additional evidence from Southern analysis, these observations were interpreted to mean that these sequences are associated with mobile DNA elements and are distributed widely throughout the genome. The chromosomal distribution of the non-telomeric parts of the clones is consistent with the dispersed genomic distribution characteristic of transposons and retroelements.

The pattern of myelin proteins in triethyltin (TET) intoxication.

Myelin proteins isolated from the brain of Wistar rats intoxicated chronically with triethyltin sulfate (TET) according to the technique of ETO et al. (1971) were investigated. Among the various protein fractions, the Agraval protein happened to be most evidently affected, demonstrating considerably reduced percentages. However the results did not prove that any of the individual myelin proteins was specifically affected by TET intake. The interesting point in chronic TET poisoning was that some clinical symptoms as well as disturbances in myelin proteins demonstrated a clear tendency to retrogression despite of the continued intoxication. These observations indicate obviously that during chronic TET intake, some kind of biochemical adaptation to the noxious action of the poison on the myelin sheath takes place.