Impact of long-term vs. short-term and single day vs. single dose of antibiotic prophylaxis in reducing infection rates after orthognathic surgery: a systematic review and meta-analysis.

BACKGROUND: This review was designed to examine the effect of long-term (≥2 days) vs. short-term (1 day) and single-day vs. single preoperative doses of antibiotic prophylaxis on surgical site infection (SSI) rates after orthognathic surgery. MATERIAL AND METHODS: PubMed, Web of Science, Embase, and Scopus were searched for randomized controlled trials (RCTs) without any date or language restriction till 1st September 2023. SSI rates were pooled to generate risk ratio (RR). RESULTS: Eight RCTs comparing long-term vs. short-term and three RCTs comparing single day vs. single preoperative dose of antibiotic prophylaxis were included. Meta-analysis showed that the use of long-term antibiotic prophylaxis significantly reduced the risk of SSI after orthognathic surgery as compared to short-term antibiotics [RR:0.42 (95% CI: 0.23, 0.76) I2=0%]. Meta-analysis also noted that patients receiving a single day of antibiotic prophylaxis had significantly reduced risk of SSI as compared to those receiving only a preoperative single dose of antibiotics [RR:0.28 (95%: 0.09, 0.82) I2=0%]. CONCLUSIONS: Evidence from a limited number of RCTs with moderate to high risk of bias shows that two to seven days of long-term antibiotic prophylaxis reduces the risk of SSI as compared to single-day antibiotic therapy. Also, a single day of antibiotics may be more beneficial than a single pre-operative dose of antibiotic.

IMpleMenting Effective infection prevention and control in ReSidential aged carE (IMMERSE): protocol for a multi-level mixed methods implementation study.

BACKGROUND: Older people living in residential aged care facilities are at high risk of acquiring infections such as influenza, gastroenteritis, and more recently COVID-19. These infections are a major cause of morbidity and mortality among this cohort. Quality infection prevention and control practice in residential aged care is therefore imperative. Although appointment of a dedicated infection prevention and control (IPC) lead in every Australian residential aged care facility is now mandated, all people working in this setting have a role to play in IPC. The COVID-19 pandemic revealed inadequacies in IPC in this sector and highlighted the need for interventions to improve implementation of best practice. METHODS: Using mixed methods, this four-phase implementation study will use theory-informed approaches to: (1) assess residential aged care facilities' readiness for IPC practice change, (2) explore current practice using scenario-based assessments, (3) investigate barriers to best practice IPC, and (4) determine and evaluate feasible and locally tailored solutions to overcome the identified barriers. IPC leads will be upskilled and supported to operationalise the selected solutions. Staff working in residential aged care facilities, residents and their families will be recruited for participation in surveys and semi-structured interviews. Data will be analysed and triangulated at each phase, with findings informing the subsequent phases. Stakeholder groups at each facility and the IMMERSE project's Reference Group will contribute to the interpretation of findings at each phase of the project. DISCUSSION: This multi-site study will comprehensively explore infection prevention and control practices in residential aged care. It will inform and support locally appropriate evidence-based strategies for enhancing infection prevention and control practice.

Development and multicenter validation of a novel radiomics-based model for identifying eosinophilic chronic rhinosinusitis with nasal polyps.

BACKGROUND: Reliable noninvasive methods are needed to identify endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP) to facilitate personalized therapy. Previous computed tomography (CT) scoring system has limited and inconsistent performance in identifying eosinophilic CRSwNP. We aimed to develop and validate a radiomics-based model to identify eosinophilic CRSwNP. METHODS: Surgical patients with CRSwNP were recruited from Tongji Hospital and randomly divided into training (n = 232) and internal validation cohort (n = 61). Patients from two additional hospitals served as external validation cohort-1 (n = 84) and cohort-2 (n = 54), respectively. Data were collected from October 2013 to May 2021. Eosinophilic CRSwNP was determined by histological criterion. The least absolute shrinkage and selection operator and the logistic regression (LR) algorithm were used to develop a radiomics model. Univariate and multivariate LR were employed to build models based on CT scores, clinical characteristics, and the combination of radiological and clinical characteristics. Model performance was evaluated by assessing discrimination, calibration, and clinical utility. RESULTS: The radiomics model based on 10 radiomic features achieved an area under the curve (AUC) of 0.815 in the training cohort, significantly better than the CT score model based on ethmoid-to-maxillary sinus score ratio with an AUC of 0.655. The combination of radiomic features and blood eosinophil count had a further improved performance, achieving an AUC of 0.903. The performance of these models was confirmed in all validation cohorts with satisfying predictive calibration and clinical application value. CONCLUSIONS: A CT radiomics-based model is promising to identify eosinophilic CRSwNP. This radiomics-based method may provide novel insights in solving other clinical concerns, such as guiding personalized treatment and predicting prognosis in patients with CRSwNP.

Stent pretreatment for internal carotid artery exposed to necrotic lesions in nasopharyngeal carcinoma.

BACKGROUND: Post radiation nasopharyngeal necrosis (PRNN) invading the internal carotid artery (ICA) contributes to the death of 69.2-72.7% of PRNN patients. ICA occlusion is an effective treatment to avoid fatal bleeding, while some patients are intolerant. We present a novel method that allows for these patients without interrupting blood flow through the ICA. METHODOLOGY: This study enrolled patients with PRNN-invaded ICA who were not suitable for ICA occlusion from April 2020 to November 2022. ICA stent pretreatment was performed in the 36 patients and followed the endoscopic nasopharyngectomy (ENPG) or conservative treatment for PRNN. We report the survival outcome and incidence of complications after stent implantation and compare the survival outcomes of ENPG and conservative treatment for PRNN followed by stent implantation. RESULTS: ICA stent pretreatment was performed in the 36 enrolled patients, among which 14 underwent ENPG, and 22 received conservative treatment. 27.8% patients died after a median follow-up of 15 months. The Kaplan-Meier estimates of overall survival were higher in the ENPG group than in the conservative treatment group. Karnofsky performance status (KPS) was significantly higher in the ENPG group than in the non-ENPG group. CONCLUSIONS: The innovative application of ICA stents is a promising treatment to improve outcomes in patients with PRNN invading the ICA who are unsuitable for ICA embolization, especially when followed by endoscopic surgery. However, methods to avoid postoperative cerebral ischemia and nasopharyngeal hemorrhage still require further study.

Exogenous melatonin prevents type 1 diabetes mellitus-induced bone loss, probably by inhibiting senescence.

Exogenous melatonin inhibited the senescence of preosteoblast cells in type 1 diabetic (T1D) mice and those cultured in high glucose (HG) by multiple regulations. Exogenous melatonin had a protective effect on diabetic osteoporosis, which may depend on the inhibition of senescence. INTRODUCTION: Senescence is thought to play an important role in the pathophysiological mechanisms underlying diabetic bone loss. Increasing evidence has shown that melatonin exerts anti-senescence effects. In this study, we investigated whether melatonin can inhibit senescence and prevent diabetic bone loss. METHODS: C57BL/6 mice received a single intraperitoneal injection of 160 mg/kg streptozotocin, followed by the oral administration of melatonin or vehicle for 2 months. Then, tissues were harvested and subsequently examined. MC3T3-E1 cells were cultured under HG conditions for 7 days and then treated with melatonin or not for 24 h. Sirt1-specific siRNAs and MT1- or MT2-specific shRNA plasmids were transfected into MC3T3-E1 cells for mechanistic study. RESULTS: The total protein extracted from mouse femurs revealed that melatonin prevented senescence in T1D mice. The micro-CT results indicated that melatonin prevented bone loss in T1D mice. Cellular experiments indicated that melatonin administration prevented HG-induced senescence, whereas knockdown of the melatonin receptors MT1 or MT2 abolished these effects. Sirt1 expression was upregulated by melatonin administration but significantly reduced after MT1 or MT2 was knocked down. Knockdown of Sirt1 blocked the anti-senescence effects of melatonin. Additionally, melatonin promoted the expression of CDK2, CDK4, and CyclinD1, while knockdown of MT1 or MT2 abolished these effects. Furthermore, melatonin increased the expression of the polycomb repressive complex (PRC), but knockdown of MT1 or MT2 abolished these effects. Furthermore, melatonin increased the protein levels of Sirt1, PRC1/2 complex-, and cell cycle-related proteins. CONCLUSION: This work shows that melatonin protects against T1D-induced bone loss, probably by inhibiting senescence. Targeting senescence in the investigation of diabetic osteoporosis may lead to novel discoveries.

Evaluation of IMproving Palliative care Education and Training Using Simulation in Dementia (IMPETUS-D) a staff simulation training intervention to improve palliative care of people with advanced dementia living in nursing homes: a cluster randomised controlled trial.

BACKGROUND: People with dementia have unique palliative and end-of-life needs. However, access to quality palliative and end-of-life care for people with dementia living in nursing homes is often suboptimal. There is a recognised need for nursing home staff training in dementia-specific palliative care to equip them with knowledge and skills to deliver high quality care. OBJECTIVE: The primary aim was to evaluate the effectiveness of a simulation training intervention (IMPETUS-D) aimed at nursing home staff on reducing unplanned transfers to hospital and/or deaths in hospital among residents living with dementia. DESIGN: Cluster randomised controlled trial of nursing homes with process evaluation conducted alongside. SUBJECTS & SETTING: One thousand three hundred four people with dementia living in 24 nursing homes (12 intervention/12 control) in three Australian cities, their families and direct care staff. METHODS: Randomisation was conducted at the level of the nursing home (cluster). The allocation sequence was generated by an independent statistician using a computer-generated allocation sequence. Staff from intervention nursing homes had access to the IMPETUS-D training intervention, and staff from control nursing homes had access to usual training opportunities. The predicted primary outcome measure was a 20% reduction in the proportion of people with dementia who had an unplanned transfer to hospital and/or death in hospital at 6-months follow-up in the intervention nursing homes compared to the control nursing homes. RESULTS: At 6-months follow-up, 128 (21.1%) people with dementia from the intervention group had an unplanned transfer or death in hospital compared to 132 (19.0%) residents from the control group; odds ratio 1.14 (95% CI, 0.82-1.59). There were suboptimal levels of staff participation in the training intervention and several barriers to participation identified. CONCLUSION: This study of a dementia-specific palliative care staff training intervention found no difference in the proportion of residents with dementia who had an unplanned hospital transfer. Implementation of the intervention was challenging and likely did not achieve adequate staff coverage to improve staff practice or resident outcomes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618002012257 . Registered 14 December 2018.

Accuracy of the Clinical Frailty Scale for perioperative frailty screening: a prospective observational study.

PURPOSE: Perioperative frailty increases postoperative complications, mortality, and new functional dependence. Despite this, routine perioperative frailty screening is not widespread. We aimed to assess the accuracy of the Clinical Frailty Scale (CFS) as a screening tool prior to anesthesia, and to determine which health domains are affected by frailty. METHODS: In a prospective, single-centre observational study, we enrolled 218 patients aged ≥ 65 yr undergoing elective and emergency surgery. The screening performance of the CFS was compared with the Edmonton Frail Scale, including the effect in individual frailty domains, and outcomes including discharge location and mortality. RESULTS: The median [interquartile range] age of the enrolled subjects was 74 [69-80] yr and 24% of the patients were frail. The CFS and Edmonton scales were highly correlated (Spearman correlation coefficient, 0.81; 95% confidence interval [CI], 0.77 to 0.86), and in substantial agreement (kappa coefficient, 0.76; 95% CI, 0.70 to 0.81), with an area under the receiver operating characteristic curve of 0.91 (95% CI, 0.86 to 0.94) indicating excellent discrimination for the CFS in predicting frailty status based on the Edmonton scale. Frail patients had higher 30-day mortality (odds ratio, 5.26; 95% CI, 1.28 to 21.62), and were less likely to be discharged home. Frail patients had poorer health throughout frailty domains, including functional dependence (42% of frail vs 4% of non-frail patients; P < 0.001), malnutrition (48% vs 19%, P < 0.001), and poor physical performance (47% vs 7%, P < 0.001). CONCLUSION: The CFS is a valid and accurate tool to screen for perioperative frailty, which encompasses the spectrum of health-related domains.

RéSUMé: OBJECTIF: La fragilité périopératoire augmente les complications postopératoires, la mortalité et une nouvelle dépendance fonctionnelle. Le dépistage de routine de la fragilité périopératoire n'est cependant pas une pratique répandue. Nous avions pour objectif d'évaluer la précision de l'échelle de mesure de fragilité CFS (pour Clinical Frailty Scale) comme outil de dépistage préanesthésique et de déterminer quels domaines de la santé étaient affectés par la fragilité. MéTHODE: Nous avons recruté 218 patients âgés de plus de 65 ans et subissant une chirurgie non urgente ou urgente dans notre étude observationnelle prospective et monocentrique. Les résultats du dépistage de la CFS ont été comparés à l'échelle de fragilité d'Edmonton (Edmonton Frail Scale), y compris en ce qui a trait à l'effet de la fragilité sur les domaines individuels de fragilité et aux résultats tels que la destination au congé et la mortalité. RéSULTATS: L'âge médian [écart interquartile] des patients recrutés était de 74 [69­80] ans et 24 % des patients étaient fragiles. Les échelles CFS et d'Edmonton avaient une forte corrélation (coefficient de corrélation de Spearman, 0,81; intervalle de confiance [IC] 95 %, 0,77 à 0,86) et étaient en accord substantiel (coefficient kappa, 0,76; IC 95 %, 0,70 à 0,81), avec une surface sous la courbe de fonction d'efficacité de l'observateur de 0,91 (IC 95 %, 0,86 à 0,94), indiquant une discrimination excellente de la CFS pour prédire l'état de fragilité fondé sur l'échelle d'Edmonton. Les patients fragiles souffraient d'une mortalité à 30 jours plus élevée (rapport de cotes, 5,26; IC 95 %, 1,28 à 21,62) et il était moins probable qu'ils reçoivent leur congé de l'hôpital à la maison. Les patients fragiles étaient en moins bonne santé dans tous les domaines de fragilité, notamment en dépendance fonctionnelle (42 % des patients fragiles vs 4 % des patients non fragiles; P < 0,001), en malnutrition (48 % vs 19 %, P < 0,001) et en mauvaise performance physique (47 % vs 7 %, P < 0,001). CONCLUSION: L'échelle CFS constitue un outil valable et précis pour dépister la fragilité périopératoire, qui englobe l'éventail des domaines liés à la santé.

Persistent Barriers to Smoking Cessation Among Urban, Underserved Women: A Feasibility Study of Tailored Barriers Text Messages.

OBJECTIVES: Despite health risks for themselves and their children, urban underserved women smoke at high rates postpartum. The postpartum period is a stressful transition time that presents unique barriers to sustained cessation. There is limited extant evidence of efficacious psychosocial programs to maintain postpartum smoking cessation. METHODS: Guided by the Cognitive-Social Health Information Processing model, we explored the feasibility of TxT2Commit, a text-messaging intervention designed to prevent postpartum smoking relapse. Participants (n = 43) received supportive cessation-focused text messages for one month postpartum. Using a convergent mixed method design, surveys and interviews assessed changes in psychosocial factors and smoking status through a three month follow-up. RESULTS: Participants reported satisfaction with TxT2Commit, rating text messages as helpful, understandable, supportive, and not bothersome. However, a majority of women (n = 28, 65.1%) relapsed by three months. Participants who stayed smoke free (i.e., non-relapsers) reported significantly less temptation to smoke at one and three months postpartum compared to relapsers (ps < .01). While relapsers had significantly less temptation at one month compared to baseline, temptation increased by three months (p < .01). Consistent with the quantitative results, qualitative interviews identified informational and coping needs, with continued temptation throughout the three months. Non-relapsers were able to manage temptation and reported greater support. CONCLUSIONS FOR PRACTICE: TxT2Commit demonstrates preliminary feasibility and acceptability among urban, underserved postpartum women. However, most participants relapsed by three months postpartum. Additional research is needed to identify targeted messaging to best help women avoid temptation and bolster support to stay smoke free in this uniquely stressful period.

Characterization and proteomic profiling of pancreatic cancer-derived serum exosomes.

Pancreatic cancer (PC) is one of the most lethal cancers known worldwide, and its prognosis is poor in most patients. Exosomes are nanosized extracellular vesicles, which are released from various cell types. They are involved in cellular communication. The diagnosis and treatment of PC were improved substantially with exosomes. In this study, we isolated PC-derived exosomes and investigated their proteomic profile. Then, we conducted bioinformatic analysis on proteomic data. Differential ultracentrifugation was performed to isolate exosomes from human serum samples and four PC cell lines. Transmission electron microscopy and Western blot analysis were used to characterize the isolated exosomes. Liquid chromatography coupled with tandem mass spectrometry was conducted to identify the proteome of serum exosomes. Proteomic analysis demonstrated that all the serum exosomes were derived from three cohorts of human subjects; these serum exosomes contained a total of 655 proteins, out of which 315 proteins overlapped with ExoCarta database. Gene oncology and kyoto encyclopedia of genes and genomes analyses provided the functional annotation of the proteome. Interestingly, 18 or 14 proteins were upregulated and 11 or 14 proteins were downregulated in serum exosomes derived from patients with PC as compared with in serum exosomes derived from healthy volunteers or from pancreatitis patients respectively. Annexin A11, a calcium-dependent phospholipid-binding protein, was expressed in a PC cell line (CFPAC-1)-derived exosomes and in tumor tissues of patients with PC, respectively. Our data provided a basic foundation for further studies on the protein composition of PC-derived exosomes and its involvement in PC biology.

Long-term outcomes and quality of life following ligation of the intersphincteric fistula tract for high transsphincteric fistulas.

AIM: Published outcomes following ligation of the intersphincteric fistula tract (LIFT) for high transsphincteric fistulas (HTFs) are equivocal probably because most trials are small and comprise mixed patient populations. The aim of this study was to highlight the long-term efficacy of LIFT for HTFs in a large homogeneous sample and to determine the risk factors that contribute to non-healing resulting in failure and recurrence. METHOD: A retrospective study was performed which assessed patients with HTFs treated by LIFT without prior loose setons from September 2012 to December 2017. Continence function was evaluated by the Wexner incontinence scale and anal manometry. Quality of life was assessed by using the faecal incontinence quality of life (FIQL) scale with four domains: lifestyle, coping, depression and embarrassment. RESULTS: Seventy patients with HTFs underwent 71 LIFT procedures. The primary healing rate was 81.7% with a median follow-up duration of 16.5 (range 4.5-68) months. The healing rates of mature and immature fistulas were 83.7% and 77.3%, respectively. Two patients suffered failure with an unhealed intersphincteric wound. Recurrence occurred in 11 patients. Incontinence of flatus, present in four patients before surgery, improved postoperatively. Two patients undergoing LIFT combined with fistulotomy complained of flatus incontinence after surgery. No significant differences between preoperative and postoperative Wexner score, maximum resting pressure and maximum squeeze pressure were detected. The FIQL was improved in lifestyle, coping and depression. No risk factor for non-healing was found. CONCLUSION: LIFT has a promising long-term outcome for HTFs, with negligible impairment on continence and improved quality of life.

[The basic characteristics and medical status of pneumoconiosis patients under different investigation methods].

Objective: To analyze the characteristics of pneumoconiosis patients and the basic status of medical treatment. Methods: Research objects were chosen by stratified sampling method and typical survey method from existing pneumoconiosis patients in China. The survey was carried out from March 2017 to January 2018 in nine provinces including provinces from east, medium and western region in China. Source of pneumoconiosis cases were inpatient cases, outpatient or physical-examined cases and household-investigation cases. The survey mainly included demographic and sociological characteristics, economic status, occupational history and dust exposure history, disease status, work-related injury insurance and social security status and related indicators of pneumoconiosis treatment. Results: Investigated 1037 pneumoconiosis cases which included 186 (19.9%) household-investigation cases, 212 (20.4%) outpatient or physical-examined cases and 639 (61.7%) inpatient cases. Demographic and sociological characteristics, individual monthly income, economic source, occupational history and work-related injury insurance were statistically significant among different source of pneumoconiosis patients (P<0.05) . Among all of the household-investigation cases, there were 74 cases (40.2%) had no income, 117 cases (62.9%) used to work in private enterprises, 36 cases (19.4%) had work-related injuries insurance, 95 cases (51.1%) were at three phase of pneumoconiosis, 108 cases (59.0%) haven't had any drugs for pneumoconiosis. 65 cases (39.4%) haven't went to the clinic, 53 cases (28.5%) hadn't seek medical advice although they needed medical treatment very much. Among all of the outpatient or physical-examined cases, there were 95 cases (46.1%) had no income, 36 cases (17.0%) had work-related injuries Insurance, 139 cases (65.6%) went to the clinic for treatment of pneumoconiosis, 81 cases (38.2%) went to the clinic for more than ten times. Among all the inpatient cases, 310 cases' (49.3%) personal monthly income was above 2000 yuan, 352 cases (55.1%) had work-related injuries Insurance, 588 cases (92.2%) were taking drugs for treatment of pneumoconiosis, 153 canses (24.2%) had hospitalization for than ten times. Conclusion: Household-investigation cases have lower economic conditions, lower rates of Insurance coverage for work-related injuries, severer pneumoconiosis and higher clinical service utilization. Clinical or physical-examined cases have lower economic conditions, lower rates of Insurance coverage for work-related injuries and higher clinical service utilization. Hospitalized cases have better economic conditions, higher rates of insurance coverage for work-related injuries and higher hospitalization service utilization.

[Hospitalized but not admitted and influencing factors for pneumoconiosis patients].

Objective: To investigate the situation where pneumoconiosis patients who should be in hospital are not hospitalized, to analyze the main reasons and influencing factors for their restricted use of hospitalization medical services, and to provide a reference for relevant policy making. Methods: Subjects were sampled in nine provinces, including Zhejiang, Jiangsu, Shandong, and Hebei, using a method that combined stratified sampling and typical sampling, from March 2017 to January 2018. These subjects were patients occupationally diagnosed with pneumoconiosis and patients clinically diagnosed with pneumoconiosis. The questionnaire The health seeking behaviors of pneumoconiosis patients and their influencing factors was used as the survey tool to investigate their health seeking behaviors such as going to the outpatient clinic and being hospitalized. Andersen's Behavioral Model of Health Services Use was used as the analysis model; The χ2 test was used for univariate analysis, and the multivariate logistic regression model was used for multivariate analysis. Results: A total of 1 037 patients with pneumoconiosis were surveyed, with a mean age of 55.9±11.2 years and 67.5% (700/1 037) living in rural areas for a long time. Occupational injury insurance and medical insurance for urban and rural residents were the main insurances used, accounting for 40.9% (424/1 037) and 59.4% (616/1 037) of the cases, respectively. A total of 177 (17.1%) patients were once advised by the doctors to be hospitalized because of pneumoconiosis, while they did not. The proportion of patients who should be in hospital but did not do so among rural patients was significantly higher than that in urban patients (20.1% (141/700) vs 10.7% (36/337) , P<0.05) . Financial difficulties (12.0%, 124/1 037) and self-rated mild symptoms (3.2%, 33/1 037) were the main reasons for not being hospitalized. Model analysis showed that the propensity factor, ability factor, health needs, health seeking behaviors, and self-rated health factor in the Anderson model were all statistically significant (P<0.05) . The main features of high proportion of patients who should be in hospital but did not do so were as follows: personal monthly income below 1 000 RMB (odds ratio[OR]of no income=2.92, 95% confidence interval[CI]: 1.14-7.48; OR of less than 1 000 RMB=3.55, 95%CI: 1.35-9.35) , no occupational injury insurance (OR=2.05, 95%CI: 1.16-3.43) , and concurrent emphysema (OR= 1.98, 95%CI: 1.12-3.50) . Conclusion: Low income, no occupational injury insurance, and concurrent emphy-sema are the main constraining factors for hospitalization services use in pneumoconiosis patients.

[Influencing factors of no seeking medical treatment among pneumoconiosis patients].

Objective: To study the causes and influencing factors of no seeking medical treatment among pneumoconiosis patients. Methods: Using stratified sampling method and typical survey method, we carried out the questionnaire survey in nine provinces in China including the east, the medium and the western region using a questionnaire on the seeking medical behavior pf pneumoconiosis patients and the influencing factors. The subjects include occupational pneumoconiosis cases and clinically diagnosed cases and the response rate is 94.3 percent. The data was entered twice with epidate3.1 and error detection and statistical analysis was completed with SPSS 20.0. Chi-square test was used for univariate analysis, and multivariate logistic regression was used for multivariate analysis. Results: One thousand and thirty-seven subjects were investigated with average age 55.9±11.2 years. Seventy percent of them were silicosis and 21.9 percent were coal worker's pneumoconiosis with 67.5 percent of them residing permanently in the countryside, and 37.9 percent of their education background were primary school culture and 33.1 percent of them had junior high school culture. Thirty two point six percent of respondents had no personal income with a median monthly income of 1 200 yuan. Four hundred and thirty four of subjects hadn't seek medical treatment since they got the pneumoconiosis accounting for 41.9 percent with three hundred and thirty seven of them hospitalized directly. The reasons of no seeking medical treatment for the respondents mainly include the self-induction symptoms lighter, the high cost of treatment and cannot claiming the payment of the medical expenses, buying drugs in drugstore, thinking that no medicine can cure pneumoconiosis or no effect, complex procedures, too far away from medical institutions, no unaccompanied, needing a long time or no time, communication disorders, etc. accounting for 44.4 percent, 24.6 percent, 10.9 percent, 9.1 percent, 6.9 percent, 4.4percent, 3.2 percent, 2.9 percent, 1.9 percent, 1.5 percent, respectively. The results of multivariate analysis showed the main characteristics of subjects with restrictions to the outpatient health service utilization are as follows: demographic sociological indicators such as registered permanent residence area is western (OR(western)=2.18, 95%CI:1.38-3.43) , more than seventy five years old (OR(over 75)=6.82, 95%CI:2.04-22.9) , unemployment, temporary or permanent employment (OR (unemployment)=1.90, 95%CI:1.17-3.08; OR(temporary employment)=3.11, 95%CI:1.57-6.14; OR(permanent employment)=2.10, 95%CI:1.18-3.74) , self-rated health score of 50 or above (OR(self-rated-70)=2.04, 95%CI:1.18-3.51; OR(self-rated-90)=3.00, 95%CI:1.97-5.37; OR(self-rated 90)=2.95, 95%CI:1.74-8.07) ; with increase to the outpatient health service utilization are breath with difficulty (OR=0.57, 95%CI:0.41-0.78) , emphysema (OR=0.48, 95%CI:0.26-0.90) , hospitalized with pneumo-coniosis (OR=0.12, 95%CI:0.07-0.20) . Conclusion: Pneumoconiosis patients no covered by injury insurance should be orderly included in the basic medical security system, and be given the medical treatment actively; It should be strengthened the health management for the pneumoconiosis patients and correctly guided the utilization of medical services.

Using graphical representations to enhance the quality-of-care for colorectal cancer patients.

The study was to enhance adherence to quality-of-care guidelines for colorectal cancer (CRC) patients through plotting graphical representations. Rasch analysis was performed to examine the unidimensional measurement of the 13 core indicators. An author-made Excel module was applied to plot the so-called Wright map and KIDMAP in education field to report physicians' adherence to the quality-of-life guidelines. We found that the scale of the quality-of-care guidelines for patients with colon cancer is unidimensional. A total of 15 (3.8%) and 14 (3.5%) persons' response patterns (i.e., Outfit MNSQs >2.0 and 4.0, respectively) are aberrantly dispersed from the majority of sample according to their estimated parameters of persons and indicators. It can be used for investigating the root cause of the 1ow measures and/or the most unexpected aberrant pattern of responses using Rasch analysis once any one indicator of unexpectedly aberrant treatment (p < .05) presents. The Rasch model can deal with these binary and/or missing data frequently seen in clinical settings. We confirm this computer module can contribute to ensuring that hospitals adhere to the treatment guidelines for patients with colon cancer.

Medical student-led patient education prior to hospital discharge improves 1-month adherence rates.

Approximately 40% of patients are non-adherent to their medications. A prospective study of 80 patients evaluated the effectiveness of medical student-led pre-discharge medication education sessions. A significantly greater proportion of patients in the intervention group were adherent to their regular medications at 1 month compared with the control group (76.3% compared to 60.3%, P = 0.037). Medical student-led patient education significantly improved medication adherence rates.

[Detection of metals and metalloids in the lavage fluid of whole-lung lavage of the cases of pneumoconiosis].

Objective: To detect of the components and concentration of the metals and metalloids in the lavage fluid of whole-lung lavage (WLL) of the cases of pneumoconiosis, and analyze the characteristics, and explore the method to sample and process the samples of bronchoalveolar lavage fluid (BAL) . Methods: The samples of urine and serum of three cases of pneumoconiosis were collected before WLL, and the samples of BAL were collected during the WLL from the left and right lungs according to the sequence of four pressured gas flow and five negative pressure drainage. Each of 10ml original samples of WLL was collected firstly, and the left was centrifuged to acquire all the sediment samples and each of 10 ml samples from the centrifuge clear liquids, The components and concentration of the metals and metalloids in the samples were measured by Inductively Coupled Plasma mass spectrometer (ICP-MS) . Results: The average volume of BAL from unilat-eral lung for 3 patients was 10 758.3±1518 ml, and the average recovery rate was 89.7%. The average dry weight of sediment samples of BAL of three cases of pneumoconiosis was 0.292 gram with the right lung sam-ples slightly higher than the left lung samples. The detectable elements from the samples included Barium (Ba) , Strontium (Sr) , Calcium (Ca) , Magnesium (Mg) , Manganum (Mn) , Ferrum (Fe) , Cuprum (Cu) , Zinc (Zn) , Kalium (K) , Natrium (Na) , Selenium (Se) , Silicon (Si) and Uranium (U) . Each of concentration dis-tributions of these elements were not normal. Except for Cuprum, Selenium and Uranium, the concentrations of the other ten elements in the supernatant samples, mixture samples and sediments samples were statistical-ly different with the nonparametric test of Kruskal-Wallis. The concentrations of Natrium, Kalium and Barium in supernatant samples were higher, while the others in precipitation samples were higher. The concentration of elements in the sample from the right lung was slightly higher than that from the left lung, but there was no statistically significant difference (P>0.05) . There were statistical difference in term of element concentration of precipitates samples before and after pressured gas flow (P<0.05) . The concentration of K、Ca、Mg、Si and Se in se-rum, urine, supernatant and sediment samples had a good correlation. The correlation coefficient of Silicon between serum and precipitation was 0.676 and that between urine and precipitation was 0.524. Conclusion: The concentra-tions of the metals and metalloid in sediment samples were more stable than that of supernatant and mixture samples. The sampling of one-side lung lavage fluid was representative in the detection of metals and metalloid in the BAL. It was the best time for sampling sediment from the BAL after the first pressured gas flow among the WLL.

Migraine is associated with better cognition in the middle-aged and elderly: the Rotterdam Study.

BACKGROUND AND PURPOSE: Converging evidence suggests that migraine has, in part, a vascular basis. In turn, vascular pathology is a strong risk factor for cognitive decline. In this population-based study, we studied cognition amongst individuals with and without migraine. METHODS: In 6708 participants of the Rotterdam Study, migraine was assessed using a validated questionnaire. Cognition was assessed by the Mini Mental State Examination (MMSE) and a dedicated cognitive test battery. Participants were classified as non-migraineurs (n = 5399), migraineurs (n = 1021) or probable migraineurs (n = 288). Multivariable linear regression was used to cross-sectionally evaluate the association between migraine and cognition, adjusting for age, sex and cardiovascular risk factors. Additionally, we stratified the analysis by sex and by migraine subtype. RESULTS: Migraineurs had higher mean MMSE scores [unstandardized regression coefficient 0.21, (95% confidence interval, 0.08; 0.34)] and global cognition [0.10 (0.04; 0.15)] than non-migraineurs. This difference was particularly marked for migraineurs with aura [MMSE: 0.39 (0.13; 0.66); global cognition: 0.13 (0.01; 0.24)]. Migraineurs performed better on tests of executive function and fine motor skills amongst specific cognitive domains. The difference in MMSE between migraineurs and non-migraineurs was greater in women [0.25 (0.10; 0.40)] than in men [0.13 (-0.15; 0.40)], whereas the difference in global cognition was similar in men and women [0.15 (0.04; 0.27) and 0.09 (0.02; 0.15), respectively]. CONCLUSIONS: Migraineurs, particularly migraineurs with aura, tend to score higher in cognition tests than non-migraineurs. More studies are needed to corroborate these findings.

The clinical frailty scale predicts functional decline and mortality when used by junior medical staff: a prospective cohort study.

BACKGROUND: Increasing frailty is associated with risk of mortality and functional decline in hospitalized older adults, but there is no consensus on the best screening method for use by non-geriatricians. The objective of this study is to determine whether the clinical frailty scale (CFS) can be used to identify patient baseline frailty status in the acute general medical setting when used by junior medical staff using information obtained on routine clinical assessment. METHODS: This was a prospective cohort study in an acute general medical unit. All patients aged 65 and over admitted to a general medical unit during August and September 2013 were eligible for the study. CFS score at baseline was documented by a member of the treating medical team. Demographic information and outcomes were obtained from medical records. The primary outcomes were functional decline and death within three months. RESULTS: Frailty was assessed in 95 % of 179 eligible patients. 45 % of patients experienced functional decline and 11 % died within three months. 40 % of patients were classified as vulnerable/mildly frail, and 41 % were moderately to severely frail. When patients in residential care were excluded, increasing frailty was associated with functional decline (p = 0.011). Increasing frailty was associated with increasing mortality within three months (p = 0.012). CONCLUSIONS: A high proportion of eligible patients had the frailty measure completed, demonstrating the acceptability of the CFS to clinicians. Despite lack of training for medical staff, increasing frailty was correlated with functional decline and mortality supporting the validity of the CFS as a frailty screening tool for clinicians.

Myxoid leiomyosarcoma of the uterus: a case report and review of the literature.

A para 1, 52-year-old female was admitted with complaints of irregular vaginal bleeding for the previous six months. Ultrasonography revealed a 4x6-cm tumor extending into the uterine cavity and cervical canal. On vaginal examination, a 2x2-cm tumor protruding from the cervical os was found, and an enlarged uterus was palpated. Vaginal intrauterine tumor resection was performed, and the patient was diagnosed with uterine myxoid leiomyosarcoma. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed, followed by postoperative chemotherapy. Twenty-one months after surgery, the patient died of tumor recurrence. Uterine myxoid leiomyosarcoma is an extremely rare variant of uterine sarcoma with a poor prognosis and malignant biological behavior.