[Translated article] One-year mortality and associated factors in patients undergoing surgery for hip fracture.

INTRODUCTION: Hip fractures are very common injuries in elderly patients and are associated with increased mortality. OBJECTIVE: To identify the factors associated with mortality in patients after one year of being operated for hip fracture in an Orthogeriatric Program. METHODS: We design an observational analytical study in subjects older than 65 years admitted to the Hospital Universitario San Ignacio for hip fracture who were treated in the Orthogeriatrics Program. Telephone follow-up was performed one year after admission. Data were analyzed using a univariate logistic regression model and a multivariate logistic regression model was applied to control the effect of the other variables. RESULTS: Mortality was 17.82%, functional impairment was 50.91%, and institutionalization was 13.9%. The factors associated with mortality were moderate dependence (OR=3.56, 95% CI=1.17-10.84, p=0.025), malnutrition (OR=3.42, 95% CI=1.06-11.04, p=0.039), in-hospital complications (OR=2.80, 95% CI=1.11-7.04, p=0.028), and older age (OR=1.09, 95% CI=1.03-1.15, p=0.002). The factor associated with functional impairment was a greater dependence at admission (OR=2.05, 95% CI=1.02-4.10, p=0.041), and with institutionalization was a lower Barthel index score at admission (OR=0.96, 95% CI=0.94-0.98, p=0.001). CONCLUSIONS: Our results shows that the factors associated with mortality one year after hip fracture surgery were: moderate dependence, malnutrition, in-hospital complications and advanced age. Having previous functional dependence is directly related to greater functional loss and institutionalization.

One-year mortality and associated factors in patients undergoing surgery for hip fracture. / Mortalidad al año y factores asociados en pacientes llevados a cirugía por fractura de cadera.

INTRODUCTION: Hip fractures are very common injuries in elderly patients and are associated with increased mortality. OBJECTIVE: To identify the factors associated with mortality in patients after one year of being operated for hip fracture in an Orthogeriatric Program. METHODS: We design an observational analytical study in subjects older than 65 years admitted to the Hospital Universitario San Ignacio for hip fracture who were treated in the Orthogeriatrics Program. Telephone follow-up was performed one year after admission. Data were analyzed using a univariate logistic regression model and a multivariate logistic regression model was applied to control the effect of the other variables. RESULTS: Mortality was 17.82%, functional impairment was 50.91%, and institutionalization was 13.9%. The factors associated with mortality were moderate dependence (OR=3.56, 95% CI=1.17-10.84, p=0.025), malnutrition (OR=3.42, 95% CI=1.06-11.04, p=0.039), in-hospital complications (OR=2.80, 95% CI=1.11-7.04, p=0.028), and older age (OR=1.09, 95% CI=1.03-1.15, p=0.002). The factor associated with functional impairment was a greater dependence at admission (OR=2.05, 95% CI=1.02-4.10, p=0.041), and with institutionalization was a lower Barthel index score at admission (OR=0.96, 95% CI=0.94-0.98, p=0.001). CONCLUSIONS: Our results shows that the factors associated with mortality one year after hip fracture surgery were: moderate dependence, malnutrition, in-hospital complications and advanced age. Having previous functional dependence is directly related to greater functional loss and institutionalization.

Síndrome de platipnea-ortodesoxia como causa de disnea en un paciente con neumonía COVID-19 / Platypnea-orthodeoxia syndrome as a cause of dyspnea in a patient with covid-19 pneumonia

El síndrome de platipnea-ortodesoxia (SPO) es una entidad escasamente descrita, causada principalmente por alteraciones a nivel cardiaco y/o pulmonar. Se caracteriza por disnea e hipoxemia en bipedestación que mejora con el decúbito supino. Dada la naturaleza sutil y posicional de los síntomas, representa un reto diagnóstico, en el que se debe considerar su multicausalidad, ya que el tratamiento puede aliviar los síntomas e incluso ser potencialmente curativo. A continuación, presentamos un caso clínico de disnea persistente en un paciente con neumonía COVID-19 que debuta con síndrome de platipnea-ortodesoxia de origen cardiorrespiratorio.(AU)

Platypnea-Orthodeoxia Syndrome (SPO) is a poorly described entity, mainly caused by alterations at the cardiac and/or pulmonary level, characterized by dyspnea and hypoxemia in the upright position that improves with supine position. Because of the subtle and positional nature of the symptoms, it constitutes a diagnostic challenge and its multi-causality must be considered. The treatment can control the symptoms and even be potentially curative. We present a clinical case of persistent dyspnea in a patient with COVID-19 pneumonia which debuts with platypnea-orthodeoxia syndrome of a cardio-respiratory origin.(AU)

Underlying SUSY in a generalized Jaynes-Cummings model.

We present a general qubit-boson interaction Hamiltonian that describes the Jaynes-Cummings model and its extensions as a single Hamiltonian class. Our model includes non-linear processes for both the free qubit and boson field as well as non-linear, multi-boson excitation exchange between them. It shows an underlying algebra with supersymmetric quantum mechanics features allowing an operator based diagonalization that simplifies the calculations of observables. As a practical example, we show the evolution of the population inversion and the boson quadratures for an initial state consisting of the qubit in the ground state interacting with a coherent field for a selection of cases covering the standard Jaynes-Cummings model and some of its extensions including Stark shift, Kerr-like, intensity dependent coupling, multi-boson exchange and algebraic deformations.

Performance of the Short Physical Performance Battery in Identifying the Frailty Phenotype and Predicting Geriatric Syndromes in Community-Dwelling Elderly.

The early identification of seniors at high risk of geriatric syndromes is fundamental for targeting interventions to those who most need them. To date, the predictive value of the Short Physical Performance Battery (SPPB) for multifactorial clinical conditions has not been clearly established. Thus, the aim of the present study was to determine whether the SPPB could identify frailty and predict geriatric syndromes in community-dwelling older adults. Participants comprised men and women aged 60 years and older who participated in the Health and Well-being and Aging Survey in Colombia 2015 (n=4125, 57.6% women). A structured interview was administered to obtain socio-demographic data which included age, sex, ethnicity, socioeconomic status, and urbanicity. The study included the measurement of body mass, grip strength, SPPB, Lawton´s instrumental ADL scale, specific subjective memory complaints (SSMC), frailty phenotype (Fried and FRAIL Scale), and self-reported falls, geriatric syndromes and/or medical conditions. ROC analysis was used to examine the ability of the SPPB test to predict frailty and geriatric syndromes. The cutoff that maximized both sensitivity and specificity for the frailty phenotype was 8 points or below for men and 7 points or below for women. These cutoff values significantly predicted four geriatric syndromes in descending order: mild dementia (♂ ORajus 3.34, and ♀ ORajus 2.79), low grip strength (♂ ORajus 1.98, and ♀ ORajus 2.45), falls (♂ ORajus 1.39, and ♀ ORajus 1.49), and SSMC (♂ ORajus 1.39). In summary, the main finding of the present study was that SPPB score (i.e., ≤ 8 ♂ and ≤ 7 ♀) seems to be a useful measure for identifying the physical frailty phenotype and predicting geriatric syndromes in community-dwelling older adults.

Study of the heavily p-type doping of cubic GaN with Mg.

We have studied the Mg doping of cubic GaN grown by plasma-assisted Molecular Beam Epitaxy (PA-MBE) over GaAs (001) substrates. In particular, we concentrated on conditions to obtain heavy p-type doping to achieve low resistance films which can be used in bipolar devices. We simulated the Mg-doped GaN transport properties by density functional theory (DFT) to compare with the experimental data. Mg-doped GaN cubic epitaxial layers grown under optimized conditions show a free hole carrier concentration with a maximum value of 6 × 1019 cm-3 and mobility of 3 cm2/Vs. Deep level transient spectroscopy shows the presence of a trap with an activation energy of 114 meV presumably associated with nitrogen vacancies, which could be the cause for the observed self-compensation behavior in heavily Mg-doped GaN involving Mg-VN complexes. Furthermore, valence band analysis by X-ray photoelectron spectroscopy and photoluminescence spectroscopy revealed an Mg ionization energy of about 100 meV, which agrees quite well with the value of 99.6 meV obtained by DFT. Our results show that the cubic phase is a suitable alternative to generate a high free hole carrier concentration for GaN.

The Influence of Lifestyle Behaviors on the Incidence of Frailty.

BACKGROUND: Frailty is a clinical state defined as an increase in an individual's vulnerability to developing adverse health-related outcomes. OBJECTIVES: We propose that healthy behaviors could lower the incidence of frailty. The aim is to describe the association between healthy behaviors (physical activity, vaccination, tobacco use, and cancer screening) and the incidence of frailty. DESIGN: This is a secondary longitudinal analysis of the Mexican Health and Aging Study (MHAS) cohort. SETTING: MHAS is a population-based cohort, of community-dwelling Mexican older adults. With five assessments currently available, for purposes of this work, 2012 and 2015 waves were used. PARTICIPANTS: A total of 6,087 individuals 50-year or older were included. MEASUREMENTS: Frailty was defined using a 39-item frailty index. Healthy behaviors were assessed with questions available in MHAS. Individuals without frailty in 2012 were followed-up three years in order to determine their frailty incidence, and its association with healthy behaviors. Multivariate logistic regression models were used to assess the odds of frailty occurring according to the four health-related behaviors mentioned above. RESULTS: At baseline (2012), 55.2% of the subjects were male, the mean age was 62.2 (SD ± 8.5) years old. The overall incidence (2015) of frailty was 37.8%. Older adults physically active had a lower incidence of frailty (48.9% vs. 42.2%, p< 0.0001). Of the activities assessed in the adjusted multivariate models, physical activity was the only variable that was independently associated with a lower risk of frailty (odds ratio: 0.79, 95% confidence interval 0.71-0.88, p< 0.001). CONCLUSIONS: Physically active older adults had a lower 3-year incidence of frailty even after adjusting for confounding variables. Increasing physical activity could therefore represent a strategy for reducing the incidence of frailty. Other so-called healthy behaviors were not associated with incident frailty, however there is still uncertainty on the interpretation of those results.

Factors Influencing Longitudinal Stair Climb Performance from Midlife to Early Late Life: The Study of Women's Health Across the Nation Chicago and Michigan Sites.

OBJECTIVES: To quantify the longitudinal change in stair climb performance (a measure indicative of both physical function and muscle power), determine whether physical activity is related to slower decline in performance, and to identify factors that modify the longitudinal change in performance among women from midlife to late life. DESIGN: Longitudinal cohort study with up to 15 study visits. SETTING: Two sites of the Study of Women's Health Across the Nation. PARTICIPANTS: Black (n=411) and white (N=419) women followed from median age 47.0 (44.6-49.6) to 62.0 (55.8-65.3) years. INTERVENTIONS: N/A. MEASUREMENTS: Performance on a stair climb test (ascend/descend 4 steps, 3 cycles) was timed. Physical activity (PA) was assessed using the Kaiser Physical Activity Survey (KPAS; possible range 0-15 points). Sociodemographic and health factors were assessed via self-report. BMI was calculated with measured height and weight. Mixed-effects regression modeled longitudinal change in stair climb performance. RESULTS: Average baseline stair climb time was 18.12 seconds (95% CI: 17.83-18.41), with 0.98% (95% CI: 0.84%-1.11%) annual slowing. In fully adjusted models, higher levels of PA were associated with faster stair climb times (2.09% faster per point higher, 95% CI: -2.87%- -1.30%), and black women had 5.22% (95% CI: 2.43%-8.01%) slower performance compared to white women. Smoking, financial strain, diabetes, osteoarthritis, fair/poor health, and stroke were associated with 3.36% (95% CI: 0.07%-6.65%), 7.56% (95% CI: 4.75%-10.37%), 8.40% (95% CI: 2.89%-13.92%), 8.46% (95% CI: 5.12%-11.79%), 9.16% (95% CI: 4.72%-13.60%), and 16.94% (95% CI: 5.37%-28.51%) slower performance, respectively. In separate models, higher BMI (per 1-unit), osteoarthritis, fair/poor health, and diabetes, were each associated with 0.06% (95% CI:0.04%-0.08%), 0.48% (95% CI:0.12%-0.84%), 0.81% (95% CI:0.35%-1.28%), and 0.84% (95% CI:0.22%-1.46%), additional slowing per year over time. CONCLUSION: Significant declines in function were evident as women transitioned from midlife to early late life. Declines were amplified by indicators of poor health, emphasizing the importance of health in midlife for promoting healthy aging.

TWO-WAY Bridge between Muscular Dysfunction and Cognitive Impairment: Secondary Analyses of SABE - Bogota Study.

BACKGROUND AND OBJECTIVE: Muscular dysfunction and cognitive impairment are both disabling states, affecting especially the elderly. Thus, are important subjects of research. Our goal is to describe the association between these two entities in the elderly. METHODS: This is a secondary analysis from the SABE 2012 Bogota survey, which is a cross-sectional study. We define muscular dysfunction as an abnormal result in gait speed and/or handgrip strength tasks. Cognitive impairment was defined as an abnormal result in Mini Mental State Examination. Other independent variables were measured. RESULTS: A total of 1,564 older adults were included in the analysis. Cognitive impairment showed statistically significant association with both low handgrip strength (OR: 2.25; CI 1.52 - 3.33) and low gait speed (OR: 2.76; CI 1.83 - 4.15) in the adjusted model. CONCLUSION: In older adults, muscular dysfunction is associated with cognitive impairment. New studies should address the causality and temporality of this relationship.

Novel aqueous chitosan-based dispersions as efficient drug delivery systems for topical use. Rheological, textural and release studies.

The use of a novel cross-linked thiolated chitosan (CTS) was investigated as the main component of aqueous dispersions (at 1% and 3% w/v) for topical drug delivery systems. The nonionic theophiline (Th) and the cationic diltiazem(.)HCl (Dt) (at 0.5% w/v concentration) were used as model drugs. All aqueous dispersions behaved as viscoelastic fluids. The CTS 1% dispersions showed predominance of viscous component and low viscosity. However, in the CTS 3% dispersions, both the elastic component and high viscosities prevailed. So, texture parameters improved from CTS 1% to 3% dispersions and CTS 3%-Dt showed greater cohesion and adhesion than CTS 3%-Th, but always below CTS alone. All dispersions showed a Fickian diffusion mechanism. Despite release profiles of both drugs almost fully overlapped at 1% CTS, diffusion coefficients confirmed Dt released faster than Th at 3% CTS. The rheological behavior and the chemical nature of the drugs explained these results.

Estudio de patrones capilaroscópicos en población sana / Capillarroscopic patterns in healthy population

La capilaroscopia es un método no invasivo y seguro que permite la visualización de los capilares a nivel del lecho periungueal de los dedos de las manos. Es útil en la evaluación del Fenómeno de Raynaud y de las colagenopatías, principalmente de la esclerodermia; sin embargo, se conoce poco acerca de la prevalencia y distribución de los cambios capilaroscópicos en sujetos sanos, siendo el objetivo de este estudio evaluar y describir las alteraciones capilaroscópicas en este grupo. A 100 participantes seleccionados por criterios de inclusión y exclusión se les realizó una videocapilaroscopia del lecho ungueal del cuarto y quinto dedo de la mano no dominante; el 86% de la población estudiada presentó hallazgos capilaroscópicos como: capilares tortuosos, entrecruzados y arborificados. Además, las alteraciones capilaroscópicas fueron más frecuentes en sujetos que consumían tabaco, se encontró una relación significativa entre el tabaco y la presencia de arborificaciones. Este es el primer estudio descriptivo de alteraciones capilaroscópicas en sujetos sanos en el Ecuador.

Capillaroscopy is a noninvasive and safe method that allows visualizationof capillaries in the nailbed. It is useful in the assesment ofRaynaud’s phenomenon and collagen diseases, especially scleroderma;however, little is known about the prevalence and distributionof capillaroscopic changes in healthy subjects, hence the aim ofthis study was to assess and describe the microvascular alterationsin this group. 100 participants selected by inclusion and exclusioncriteria underwent videocapillaroscopy of the nailfold of the fourthand fifth fingers of the nondominant hand; 86% of the study populationpresented capillaroscopic findings such as tortuous capillaries,crisscrossing and arborifications. Also, the microvascular alterationswere more frequent in subjects who had history of tobaccosmoking: a significant relationship between smoking and the presenceof arborifications was found. This is the first descriptive studyof microvascular alterations in healthy subjects in Ecuador.

3D Parylene sheath neural probe for chronic recordings.

OBJECTIVE: Reliable chronic recordings from implanted neural probes remain a significant challenge; current silicon-based and microwire technologies experience a wide range of biotic and abiotic failure modes contributing to loss of signal quality. APPROACH: A multi-prong alternative strategy with potential to overcome these hurdles is introduced that combines a novel three dimensional (3D), polymer-based probe structure with coatings. Specifically, the Parylene C sheath-based neural probe is coated with neurotrophic and anti-inflammatory factors loaded onto a Matrigel carrier to encourage the ingrowth of neuronal processes for improved recording quality, reduce the immune response, and promote improved probe integration into brain tissue for reliable, long-term implementation compared to its rigid counterparts. MAIN RESULTS: The 3D sheath structure of the probe was formed by thermal molding of a surface micromachined Parylene C microchannel, with electrode sites lining the interior and exterior regions of the lumen. Electrochemical characterization of the probes via cyclic voltammetry and electrochemical impedance spectroscopy was performed and indicated suitable electrode properties for neural recordings (1 kHz electrical impedance of ∼200 kΩ in vitro). A novel introducer tool for the insertion of the compliant polymer probe into neural tissue was developed and validated both in vitro using agarose gel and in vivo in the rat cerebral cortex. In vivo electrical functionality of the Parylene C-based 3D probes and their suitability for recording the neuronal activity over a 28-day period was demonstrated by maintaining the 1 kHz electrical impedance within a functional range (<400 kΩ) and achieving a reasonably high signal-to-noise ratio for detection of resolvable multi-unit neuronal activity on most recording sites in the probe. Immunohistochemical analysis of the implant site indicated strong correlations between the quality of recorded activity and the neuronal/astrocytic density around the probe. SIGNIFICANCE: The provided electrophysiological and immunohistochemical data provide strong support to the viability of the developed probe technology. Furthermore, the obtained data provide insights into further optimization of the probe design, including tip geometry, use of neurotrophic and anti-inflammatory drugs in the Matrigel coating, and placement of the recording sites.

Racial/ethnic differences in hepatic steatosis in a population-based cohort of post-menopausal women: the Michigan Study of Women's Health Across the Nation.

AIMS: The prevalence of hepatic steatosis may differ between post-menopausal African-American women and non-Hispanic white women and by sex hormone binding globulin level. We examined prevalence of hepatic steatosis by race/ethnicity and associations with sex hormone binding globulin. METHODS: Participants included post-menopausal women who underwent hepatic ultrasound (n = 345) at the Michigan site of the Study of Women's Health Across the Nation, a population-based study. We examined hepatic steatosis prevalence by race/ethnicity and used logistic regression models to calculate the odds of hepatic steatosis with race/ethnicity and sex hormone binding globulin, after adjustment for age, alcohol use, waist circumference, high density lipoprotein cholesterol, triglycerides, systolic blood pressure and use of medications reported to lower intrahepatic fat. RESULTS: Fewer African-American women than non-Hispanic white women had hepatic steatosis (23 vs. 36%, P = 0.01). African-American women had lower triglyceride and low-density lipoprotein cholesterol levels, but higher blood pressure and follicle-stimulating hormone levels (P < 0.05). In the optimal-fitting multivariable models, women in the highest tertile of sex hormone binding globulin (60.2-220.3 nmol/l) had a lower odds of hepatic steatosis (odds ratio 0.43, 95% CI 0.20-0.93) compared with women in the lowest tertile of sex hormone binding globulin (10.5-40.3 nmol/l). There was an interaction between race/ethnicity and medication use whereby non-Hispanic white women using medications had three times higher odds of hepatic steatosis compared with African-American women not using medications (odds ratio 3.36, 95% CI 1.07-10.58). Interactions between race/ethnicity and other variables, including sex hormone levels, were not significant. CONCLUSIONS: Hepatic steatosis on ultrasound may be more common in post-menopausal non-Hispanic white women than African-American women and was associated with lower levels of sex hormone binding globulin.

Sex dimorphism in the association of cardiometabolic characteristics and osteophytes-defined radiographic knee osteoarthritis among obese and non-obese adults: NHANES III.

OBJECTIVE: To examine the relationship of knee osteoarthritis (OA) with cardiovascular and metabolic risk factors by obesity status and gender. METHODS: Data from 1,066 National Health and Nutrition Examination Survey III participants (≥60 years of age) was used to examine relationships of osteophytes-defined radiographic knee OA and cardiovascular and metabolic measures. Analyses were considered among obese [body mass index (BMI)≥30 kg/m(2)] and non-obese (BMI<30 kg/m(2)) men and women. RESULTS: The prevalence of osteophytes-defined radiographic knee OA was 34%. Leptin levels and homeostatic model assessment-insulin resistance (HOMA-IR), a proxy measure of insulin resistance, were significantly associated with knee OA; those with knee OA had 35% higher HOMA-IR values and 52% higher leptin levels compared to those without knee OA. The magnitude of the association between HOMA-IR and knee OA was strongest among men, regardless of obesity status; odds ratios (ORs) for HOMA-IR were 34% greater among non-obese men (OR=1.18) vs obese women (OR=0.88). Among obese women, a 5-µg/L higher leptin was associated with nearly 30% higher odds of having knee OA (OR=1.28). Among men, ORs for the association of leptin and knee OA were in the opposite direction. CONCLUSIONS: Cardiometabolic dysfunction is related to osteophytes-defined radiographic knee OA prevalence and persists within subgroups defined by obesity status and gender. A sex dimorphism in the direction and magnitude of cardiometabolic risk factors with respect to knee OA was described including HOMA-IR being associated with OA prevalence among men while leptin levels were most important among women.

Post-discharge tobacco cessation rates among hospitalized US veterans with and without diabetes.

AIMS: Smoking is a major risk factor for cardiovascular complications among patients with diabetes. Hospitalization has been shown to enhance cessation rates. The purpose of this study was to compare 6-month post-hospitalization tobacco cessation rates among US veterans with and without diabetes. METHODS: This was a longitudinal study among inpatient veterans who used tobacco in the past month (n = 496). Patients were recruited and surveyed from three Midwestern Department of Veterans Affairs hospitals during an acute-care hospitalization. They were also asked to complete a follow-up survey 6 months post-discharge. Bivariate- and multivariable-adjusted analyses were conducted to determine differences in tobacco cessation rates between patients with and without a diagnosis of diabetes. RESULTS: The mean age of patients was 55.2 years and 62% were white. Twenty-nine per cent had co-morbid diabetes. A total of 18.8% of patients with diabetes reported tobacco cessation at 6 months compared with 10.9% of those without diabetes (P = 0.02). Cotinine-verified cessation rates were 12.5 vs. 7.4% in the groups with and without diabetes, respectively (P = 0.07). Controlling for psychiatric co-morbidities, depressive symptoms, age, self-rated health and nicotine dependence, the multivariable-adjusted logistic regression showed that patients with diabetes had three times higher odds of 6-month cotinine-verified tobacco cessation as compared with those without diabetes (odds ratio 3.17, P = 0.005). CONCLUSIONS: Post-hospitalization rates of smoking cessation are high among those with diabetes. Intensive tobacco cessation programmes may increase these cessation rates further.

Kinetics of regulatory dendritic cells in inflammatory responses during Trypanosoma evansi infection.

Trypanosoma evansi (T. evansi) causes a wasting disease in almost all mammals. Trypanosoma evansi infection gives rise to the inflammatory responses that contribute to the development of inflammation-associated tissue injury. To determine what kinds of inflammatory molecules play roles in the pathogenicity of T. evansi infection, polymerase chain reaction array analysis was performed on samples from the infected and uninfected mice. The inflammatory cytokine and chemokine storm, caused mainly by macrophages, was observed. On the other hand, the expression levels of Ccl8 and Il10 in splenocytes were also markedly increased. These results suggested an augmentation in the number and activity of regulatory dendritic cells (DCs). Therefore, the kinetics of regulatory DCs in T. evansi-infected mice were investigated. During T. evansi infection, the regulatory DCs became prevalent, with reducing the amount of inflammatory DCs. Interestingly, when the regulatory DCs were implanted into T. evansi-infected mice, the survival was prolonged, and the expression levels of inflammatory molecules were suppressed. Taken together, these results showed that a subset of regulatory DCs acted as a potential regulator of the inflammatory responses.

Short communication: Prevalence and risk factors of subclinical mastitis as determined by the California Mastitis Test in water buffaloes (Bubalis bubalis) in Nueva Ecija, Philippines.

A retrospective analysis using records of lactating Bulgarian Murrah buffaloes subjected to the California Mastitis Test in a herd in Nueva Ecija, Philippines was done to determine the prevalence of subclinical mastitis (SCM) and to identify risk factors that may influence its occurrence and recurrence. Results showed that SCM prevalence was 42.76%, whereas its recurrence was 75.03%. Age and lactation length influenced the occurrence of SCM. In contrast to the conclusions for dairy cows, younger buffalo cows were more susceptible compared with those at least 6 yr old. Dams younger than 3 yr have a 76% probability, whereas those age 3 yr have an 82% probability of having SCM.

Ethnicity predicts perceptions of smoking and smoking cessation among veterans.

The objective of this study was to determine if race/ethnicity predicts motivation to quit smoking and preferences for cessation services among smokers serviced by a primarily psychiatric Veterans Affairs hospital. A self-administered survey was given to a convenience sample of smokers (n=146) at the Battle Creek Veterans Affairs Medical Center. Univariate, bivariate and multivariate regression analyses were calculated to determine the association between race/ethnicity and motivation to quit smoking. Forty-two per cent of the sample was non-white. Non-white patients smoked significantly less cigarettes per day as compared with white patients (P=0.002). In the multivariate analyses, compared with whites, non-whites had 3.5 times greater odds of thinking that quitting smoking was extremely/very important to health (P= 0.01), 4.0 times greater odds of thinking of quitting using tobacco products in the next 30 days (P=0.004) and 3.4 times greater odds of being interested in receiving smoking cessation services (P=0.007). Yet, non-white patients were less likely to be interested in intensive nurse counselling and cessation medications. As the number of non-whites continues to increase in the military, novel strategies may be needed to capitalize on the high motivation to quit smoking and preference for non-traditional interventions among non-white smokers treated in Veterans Affairs hospitals.

Outcomes of patients with cystic fibrosis undergoing lung transplantation with and without cystic fibrosis-associated liver cirrhosis.

People with severe cystic fibrosis (CF) lung disease with co-existent CF-associated liver disease (CFLD) are often excluded from consideration of sole lung transplantation, largely because of the concerns that they will subsequently develop hepatic decompensation. This retrospective cohort study aimed at determining whether patients with severe cirrhosis caused by CFLD have any differences in perioperative and relevant post-transplant outcomes compared to CF patients without CFLD when undergoing sole lung transplantation. Six patients with CFLD were matched with 18 CF patients without CFLD undergoing sole lung transplant at the same institution. There were no differences in total operative time or intra-operative requirements for cardiopulmonary bypass or blood products. Over a period of five yr post-transplant, no differences were observed between the two groups in body mass index, six-min walk, lung function, and survival. None of the CFLD subjects developed variceal bleeding; however, one developed hepatocellular and renal failure at four yr post-transplant and is being assessed for liver-kidney transplant. One additional patient with CFLD required repeat lung transplantation for bronchiolitis obliterans syndrome. This study provides evidence that CF patients with liver cirrhosis caused by CFLD can safely be considered for sole lung transplantation provided there is no evidence of significant hepatocellular dysfunction with decompensated cirrhosis or hepatic synthetic failure.

Longitudinal changes of serum COMP and urinary CTX-II predict X-ray defined knee osteoarthritis severity and stiffness in women.

OBJECTIVE: To ascertain the predictive role of longitudinally acquired biochemical measures of cartilage turnover in relation to X-ray defined knee osteoarthritis (OAK), knee pain and functioning. METHODS: This is a feasibility study based on 72 enrollees of the Michigan site of Study of Women's Health Across the Nation (SWAN), a longitudinal, population-based cohort study with 11 annual visits to characterize health at the mid-life. At visits in 1996, 1998 and 2007, radiographs were evaluated for the presence of OAK [>or=2 on the Kellgren and Lawrence (K-L) scale]. Knee pain and stiffness were assessed by interview. Functioning was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Cartilage oligomeric matrix protein (COMP) and Type II collagen telopeptides (CTX-II) were assayed in serum and urine samples collected on alternate years from 1997 to 2006. We related trajectories of the cartilage biochemical markers from these five time points to OAK severity (no OAK, K-L score<2; mild OAK, K-L score=2; moderate/severe OAK, K-L score=3 or 4), pain, stiffness, or functioning, using longitudinal non-linear mixed modeling. RESULTS: The 2007 prevalence of X-ray defined OAK was 50% in these 72 women. Upward trajectories of COMP (P=0.02) and CTX-II (P=0.006) were associated with increased OAK severity and body size. COMP trajectories were associated with pain and stiffness, but not functioning. CTX-II trajectories were associated with stiffness scores, but not knee pain or functioning scores. CONCLUSION: Multiple, biennial measures of COMP or CTX-II taken over a 10-year period were predictive of subsequent OAK and knee stiffness.