Nutrient effects on drought responses vary across common temperate grassland species.

Drought and nutrient input are two main global change drivers that threaten ecosystem function and services. Resolving the interactive effects of human-induced stressors on individual species is necessary to improve our understanding of community and ecosystem responses. This study comparatively assessed how different nutrient conditions affect whole-plant drought responses across 13 common temperate grassland species. We conducted a fully factorial drought-fertilization experiment to examine the effect of nutrient addition [nitrogen (N), phosphorus (P), and combined NP] on species' drought survival, and on drought resistance of growth as well as drought legacy effects. Drought had an overall negative effect on survival and growth, and the adverse drought effects extended into the next growing season. Neither drought resistance nor legacy effects exhibited an overall effect of nutrients. Instead, both the size and the direction of the effects differed strongly among species and between nutrient conditions. Consistently, species performance ranking under drought changed with nitrogen availability. The idiosyncratic responses of species to drought under different nutrient conditions may underlie the seemingly contradicting effects of drought in studies on grassland composition and productivity along nutrient and land-use gradients-ranging from amplifying to dampening. Differential species' responses to combinations of nutrients and drought, as observed in our study, complicate predictions of community and ecosystem responses to climate and land-use changes. Moreover, they highlight the urgent need for an improved understanding of the mechanisms that render species more or less vulnerable to drought under different nutrients.

Comparative drought resistance of temperate grassland species: testing performance trade-offs and the relation to distribution.

To improve projections of consequences of increasing intensity and frequency of drought events for grasslands, we need a thorough understanding of species performance responses to drought, of performance trade-offs and how drought resistance is related to species distributions. However, comparative and quantitative assessments of whole-plant drought resistance that allow to rigorously address these aspects are lacking for temperate grassland species. We conducted a common garden experiment with 40 common temperate grassland species to compare species survival and growth under intense drought and well-irrigated conditions. Overall, survival and growth were significantly reduced under drought, with the effect varying across species. Species ranking of drought damage and survival remained consistent with progressing drought. No performance trade-offs emerged between optimal growth and drought resistance of survival ('growth-stress tolerance' trade-off hypothesis), or between growth under well-watered and dry conditions ('growth rates' trade-off hypothesis). Species local- and large-scale association with moisture (Ellenberg F value and rainfall niche) was not related to their drought resistance. Overall, our results imply that trade-offs and differences of species fundamental drought resistance are not the main drivers of hydrological niche differentiation, species coexistence and their distribution across moisture gradients. The comparative experimental assessment of species whole-plant drought responses we present provides a basis to increase our understanding of current grassland responses to variation of moisture regimes and for projecting consequences of future changes.

In Vitro Prebiotic Effects of Malto-Oligosaccharides Containing Water-Soluble Dietary Fiber.

This study measured the proliferative activity of malto-oligosaccharide (MOS) as a prebiotic against Bifidobacteria, resistance to digestion in vitro, and changes during in vitro fermentation by human fecal microorganisms. It consisted of 21.74%, 18.84%, and 11.76% of maltotriose, maltotetraose, and maltopentaose produced by amylase (HATT), respectively. When 1% of MOS was added to a modified PYF medium as the carbon source, proliferation of Bifidobacterium breve was increased significantly. During the in vitro digestion test, MOS was partially degraded by intestinal enzymes. Fermentation characteristics by human fecal microorganisms were evaluated by adding 1% galacto-oligosaccharide (GOS), as well as 1% and 2% MOS as carbon sources to the basal medium, respectively. In comparison with the addition of 1% of MOS and GOS, the total short chain fatty acid (SCFA) content increased over time when 2% of MOS was added. The species diversity and richness of intestinal microbiota increased significantly with 2% MOS compared to those with 1% GOS. In addition, the 2% addition of MOS reduced intestinal pathobiont microorganisms and increased commensal microorganisms including Bifidobacterium genus. Collectively, MOS produced by amylase increased the SCFA production and enhanced the growth of beneficial bacteria during in vitro fermentation by human fecal microbiota.

Subacute feeding toxicity of low-sodium sausages manufactured with sodium substitutes and biopolymer-encapsulated saltwort (Salicornia herbacea) in a mouse model.

BACKGROUND: Low-sodium sausages were manufactured using sodium substitution and biopolymer encapsulation. A diet comprising 10% treatment sausages (six treatment groups: C (100% NaCl), T1 (55% sodium substitute + 45% saltwort salt), T2 (55% sodium substitute + 45% saltwort salt with chitosan), T3 (55% sodium substitute + 45% saltwort salt with cellulose), T4 (55% sodium substitute + 45% saltwort salt with dextrin), and T5 (55% sodium substitute + 45% saltwort salt with pectin)) was added to a 90% commercial mouse diet for 4 weeks. RESULTS: Subacute toxicity, hematology, liver function, and organ weight tests in low-sodium sausage groups showed results similar to those of the control group, and all toxicity test levels were within normal ranges. CONCLUSIONS: All low-sodium sausage types tested are suggested to be safe in terms of subacute toxicity. Moreover, low-sodium sausages can be manufactured by biopolymer encapsulation of saltwort using pectin, chitosan, cellulose, and dextrin without toxicity. © 2019 Society of Chemical Industry.

Interaction of livestock grazing and rainfall manipulation enhances herbaceous species diversity and aboveground biomass in a humid savanna.

Understanding of the interaction of livestock grazing and rainfall variability may aid in predicting the patterns of herbaceous species diversity and biomass production. We manipulated the amount of ambient rainfall received in grazed and ungrazed savanna in Lambwe Valley-Kenya. The combined influence of livestock grazing and rainfall on soil moisture, herbaceous species diversity, and aboveground biomass patterns was assessed. We used the number of species (S), Margalef's richness index (Dmg), Shannon index of diversity (H), and Pileou's index of evenness (J) to analyze the herbaceous community structure. S, Dmg, H and J were higher under grazing whereas volumetric soil water contents (VWC) and aboveground biomass (AGB) decreased with grazing. Decreasing (50%) or increasing (150%) the ambient rainfall by 50% lowered species richness and diversity. Seasonality in rainfall influenced the variation in VWC, S, Dmg, H, and AGB but not J (p = 0.43). Overall, Dmg declined with increasing VWC. However, the AGB and Dmg mediated the response of H and J to the changes in VWC. The highest H occurred at AGB range of 400-800 g m-2. We attribute the lower diversity in the ungrazed plots to the dominance (relative abundance > 70%) of Hyparrhenia fillipendulla (Hochst) Stapf. and Brachiaria decumbens Stapf. Grazing exclusion, which controls AGB, hindered the coexistence among species due to the competitive advantage in resource utilization by the more dominant species. Our findings highlight the implication of livestock grazing and rainfall variability in maintaining higher diversity and aboveground biomass production in the herbaceous layer community for sustainable ecosystem management.

Gender difference in the relationship between uric acid and pulse pressure among Korean adults.

Hyperuricemia is associated with cardiovascular disease, but the relationship between uric acid (UA) and pulse pressure (PP) is unclear. Therefore, the present study assesses the relationship between UA and PP among Korean adults. Data from 6,310 subjects (2,800 men and 3,510 women) in the seventh Korean National Health and Nutrition Examination Survey (2016) were analyzed. After adjusting for related variables, the odds ratios (ORs) of hyperuricemia (UA ≥ 7.0 mg/dL in men or ≥ 6.0 mg/dL in women) in the high PP group (PP > 65.0 mmHg) in overall populations (OR, 1.563; 95% confidence interval [CI], 1.144-2.136) and women (OR, 1.631; 95% CI, 1.046-2.544) were significantly higher than those in normal PP, but not in men (OR, 1.309; 95% CI, 0.840-2.040). In conclusion, uric acid was positively associated with pulse pressure in women, but not in men.

Relation between amniotic fluid infection or cytokine levels and hearing screen failure in infants at 32 wk gestation or less.

BACKGROUND: To determine whether the presence of intra-amniotic infection and elevated proinflammatory cytokine levels in amniotic fluid (AF) are associated with failure in the newborn hearing screen (NHS) test in very preterm neonates. METHODS: This is a retrospective cohort study of 112 premature singleton neonates born to women with preterm labor or preterm premature rupture of membranes at ≤32 wk. AF obtained through amniocentesis was cultured, and interleukin-6 (IL-6) and IL-8 levels were determined. RESULTS: Fourteen (12.5%) neonates failed the NHS test. The prevalence of a positive AF culture was 40% (45/112). Multiple logistic regression analyses indicated that intra-amniotic infection was significantly associated with failure in the NHS test after adjusting for baseline covariates such as maternal white blood cell count (WBC) and periventricular leukomalacia. However, the IL-6 and IL-8 levels in AF were not significantly associated with hearing screen failure. Moreover, neither gestational age at birth nor birth weight was associated with NHS failure. CONCLUSION: The presence of intra-amniotic infection, but not elevated levels of AF IL-6 and IL-8, may contribute to the risk for failure in the NHS test in very preterm neonates. This finding suggests that intra-amniotic infection in utero might contribute to the development of congenital sensorineural hearing loss.

The Association Between the Metabolic Syndrome and Metabolic Syndrome Score and Urine Microalbumin/Urine Creatinine Ratio and Glomerular Filtration Rate in Korean Adults With Obesity.

OBJECTIVE: This study assessed the association between metabolic syndrome (MetS) and metabolic syndrome score (MSS) and the levels of urine microalbumin-urine creatinine ratio (uACR) and glomerular filtration rate (GFR) in Korean adults with obesity. METHODS: Analyses of data obtained during the 2012 Korean National Health and Nutrition Examination Survey were restricted to that obtained from 1,612 adults aged ≥20 years with obesity. RESULTS: After adjusting for relevant variables (excluding age), uACR levels were positively associated with MetS (P < .001) and MSS (P < .001), and GFR levels were inversely associated with MetS (P < .001) and MSS (P < .001). However, when further adjusting for age, uACR levels were positively associated with MetS (P < .001) and MSS (P < .001) levels, but GFR levels were not associated with MetS (P = .632) and MSS (P = .275) levels. CONCLUSION: MetS and MSS were positively associated with uACR levels in Korean adults with obesity, but were not associated with GFR levels.

Amniotic Fluid Infection, Cytokine Levels, and Mortality and Adverse Pulmonary, Intestinal, and Neurologic Outcomes in Infants at 32 Weeks' Gestation or Less.

To what extent the risks of neonatal morbidities are directly related to premature birth or to biological mechanisms of preterm birth remains uncertain. We aimed to examine the effect of exposure to amniotic fluid (AF) infection and elevated cytokine levels on the mortality and pulmonary, intestinal, and neurologic outcomes of preterm infants, and whether these associations persist after adjustment for gestational age at birth. This retrospective cohort study included 152 premature singleton infants who were born at ≤ 32 weeks. AF obtained by amniocentesis was cultured; and interleukin-6 (IL-6) and IL-8 levels in AF were determined. The primary outcome was adverse perinatal outcome defined as the presence of one or more of the followings: stillbirth, neonatal death, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage, and periventricular leukomalacia. Logistic regression analysis was adjusted for gestational age at birth and other potential confounders. In bivariate analyses, elevated AF IL-6 and IL-8 levels were significantly associated with adverse perinatal outcome. These results were not changed after adjusting for potential confounders, such as low Apgar scores, mechanical ventilation, and surfactant application. However, the independent effect of elevated cytokine levels in AF disappeared when additionally adjusted for low gestational age at birth; consequently, low gestational age remained strongly associated with the risk of adverse perinatal outcome. In conclusion, elevated levels of pro-inflammatory cytokines in AF are associated with increased risk of adverse perinatal outcomes, but this risk is not independent of low gestational age at birth. Culture-proven AF infection is not associated with this risk.

Maternal Characteristics, Short Mid-Trimester Cervical Length, and Preterm Delivery.

We aimed to determine the maternal characteristics (demographics, an obstetric history, and prior cervical excisional procedure) associated with a short mid-trimester cervical length (CL, defined as a CL of ≤ 25 mm) and whether having a short cervix explains the association between these maternal characteristics and spontaneous preterm delivery (SPTD, defined as a delivery before 34 weeks). This is a single-center retrospective cohort study of 3,296 consecutive women with a singleton pregnancy who underwent routine CL measurement between 20 and 24 weeks. Data were collected on maternal age, weight, height, parity, obstetric history (nulliparity; a history of at least 1 SPTD; and at least 1 term birth and no preterm birth [low-risk history group]), and prior cervical excisional procedure. In the multivariate regression analysis, an obstetric history, prior cervical excisional procedure, and gestational age at measurement were the variables significantly associated with short CL. In contrast, maternal weight, height, age, and parity were not significantly associated with short CL. By using the likelihood of SPTD as an outcome variable, logistic regression indicated that short CL and obstetric history, but not prior cervical excisional procedure, were significantly associated with SPTD after adjustment for potential confounders. A history of SPTD and prior cervical excisional procedure were associated with an increased risk of a short mid-trimester CL. A history of SPTD, but not prior cervical excisional procedure, is associated with an increased risk of SPTD, independent of a short CL.

Cactus cladodes (Opuntia humifusa) extract minimizes the effects of UV irradiation on keratinocytes and hairless mice.

CONTEXT: Cactus cladodes [Opuntia humifusa (Raf.) Raf. (Cactaceae)] is one of the cactus genera, which has long been used as a folk medicine for skin disorders. OBJECTIVE: This study investigated the skincare potential of cactus cladodes extract (OHE), including its ability to regulate ultraviolet B (UVB)-induced hyaluronic acid (HA) production. MATERIALS AND METHODS: Gene expression levels of hyaluronic acid synthases (HASs) and hyaluronidase (HYAL) were measured in UVB-irradiated HaCaT cells with OHE treatment (10, 25, 50, 100 µg/mL) by real-time polymerase chain reaction (PCR). The HA content was analyzed in hairless mice (SKH-1, male, 6 weeks old) treated with OHE for 10 weeks by using enzyme-linked immunosorbent assay (ELISA). Haematoxylin and eosin (H&E) and immunohistological staining were performed to examine epidermal thickness and levels of CD44 and hyaluronic acid-binding protein (HABP). RESULTS: HA synthases (HAS,1 HAS2, HAS3) mRNA levels were increased by 1.9-, 2.2- and 1.6-fold, respectively, with OHE treatment (100 µg/mL), while UVB-induced increase of hyaluronidase mRNA significantly decreased by 35%. HA content in animal was decreased from 42.9 to 27.1 ng/mL by OHE treatment. HAS mRNA levels were decreased by 39%, but HYAL mRNA was increased by 50% in OHE group. CD44 and HABP levels, which were greatly increased by UVB-irradiation, were reduced by 64 and 60%, respectively. Epidermal thickness, transepidermal water loss (TEWL), and erythema formation was also decreased by 45 (45.7 to 24.2 µm), 48 (48.8 to 25 g/h/m2) and 33%, respectively. CONCLUSION: OHE protects skin from UVB-induced skin degeneration in HaCaT cells and hairless mice.

A normalization method for combination of laboratory test results from different electronic healthcare databases in a distributed research network.

PURPOSE: Distributed research networks (DRNs) afford statistical power by integrating observational data from multiple partners for retrospective studies. However, laboratory test results across care sites are derived using different assays from varying patient populations, making it difficult to simply combine data for analysis. Additionally, existing normalization methods are not suitable for retrospective studies. We normalized laboratory results from different data sources by adjusting for heterogeneous clinico-epidemiologic characteristics of the data and called this the subgroup-adjusted normalization (SAN) method. METHODS: Subgroup-adjusted normalization renders the means and standard deviations of distributions identical under population structure-adjusted conditions. To evaluate its performance, we compared SAN with existing methods for simulated and real datasets consisting of blood urea nitrogen, serum creatinine, hematocrit, hemoglobin, serum potassium, and total bilirubin. Various clinico-epidemiologic characteristics can be applied together in SAN. For simplicity of comparison, age and gender were used to adjust population heterogeneity in this study. RESULTS: In simulations, SAN had the lowest standardized difference in means (SDM) and Kolmogorov-Smirnov values for all tests (p < 0.05). In a real dataset, SAN had the lowest SDM and Kolmogorov-Smirnov values for blood urea nitrogen, hematocrit, hemoglobin, and serum potassium, and the lowest SDM for serum creatinine (p < 0.05). CONCLUSION: Subgroup-adjusted normalization performed better than normalization using other methods. The SAN method is applicable in a DRN environment and should facilitate analysis of data integrated across DRN partners for retrospective observational studies.

Prediction of spontaneous preterm birth in women with cervical insufficiency: Comprehensive analysis of multiple proteins in amniotic fluid.

AIM: The purpose of this study is to determine whether proinflammatory cytokines and matrix metalloproteinases (MMPs) in amniotic fluid (AF), alone or in combination with clinical risk factors, can predict spontaneous preterm delivery (SPTD) at < 34 weeks in women with cervical insufficiency. METHODS: This retrospective cohort study included 57 consecutive singleton pregnant women (17-28 gestational weeks) with cervical insufficiency who underwent amniocentesis. AF was assayed for five cytokines (interleukin [IL]-6, IL-8, monocyte chemotactic protein-1, macrophage inflammatory protein [MIP]-1α, and MIP-1ß) and five MMPs (MMP-1, MMP-2, MMP-3, MMP-8, and MMP-9) using multiplex immunoassay kits. The primary outcome measure was SPTD at < 34 weeks. RESULTS: The AF concentrations of MMP-1, MMP-3, MMP-8, MMP-9, IL-6, IL-8, MIP-1α and MIP-1ß were significantly higher in women with SPTD at < 34 weeks. Women who had SPTD at < 34 weeks were younger, had significantly more advanced cervical dilatation at presentation and a higher rate of positive AF cultures. Using stepwise regression analysis, a combined prediction model was developed that included maternal age, cervical dilatation at presentation, AF MMP-1 and AF MMP-8 (area under the curve [AUC] 0.951). The AUC for this model was significantly greater than for any single protein alone in AF or for each of the clinical risk factors alone. CONCLUSION: A model combining proteins in AF and clinical factors can improve the accuracy of risk prediction for preterm birth and this combination is more accurate than each of the biomarkers alone in women with cervical insufficiency.

Prediction of impending preterm delivery based on sonographic cervical length and different cytokine levels in cervicovaginal fluid in preterm labor.

AIMS: The aim of this study was to determine whether cervicovaginal interleukin (IL)-1ß, IL-6 and IL-8 levels, and cervical length, alone or in combination, could predict impending preterm delivery in women with preterm labor and intact membranes. MATERIAL AND METHODS: Cervicovaginal swab samples for IL-1ß, IL-6, and IL-8 assays were taken from 136 consecutive women with preterm labor (23-34 weeks) before the transvaginal ultrasonography examination to measure cervical length. The primary outcome measurement was spontaneous preterm delivery within 7 days of sampling. RESULTS: Spontaneous preterm delivery within 7 days occurred in 28.6% (39/136) of patients. Receiver-operator characteristic (ROC) curves indicated that cervical length (P < 0.001), cervicovaginal IL-6 (P < 0.001) and IL-8 (P = 0.014), but not IL-1ß, could predict delivery within 7 days. According to the logistic regression analysis, high cervicovaginal IL-8 (P = 0.008) and IL-6 (P = 0.038) levels and short cervical length (P < 0.001) were significantly associated with delivery within 7 days, even after controlling for baseline variables. A combination of cervix length and cervicovaginal IL-8 increased the specificity of detecting delivery within 7 days to 92.8%, which was superior to either test alone (P < 0.001), but the sensitivity was only 56.4%. CONCLUSION: In women with preterm labor, among the parameters assessed, cervicovaginal IL-6 and IL-8 and cervical length are the most important parameters in predicting impending preterm delivery. A combination of cervix length and cervicovaginal IL-8 appeared to be the best for predicting impending preterm delivery, but the relatively low sensitivity of this test may limit its clinical usefulness.

Prediction of the risk of cesarean delivery after labor induction in twin gestations based on clinical and ultrasound parameters.

AIMS: To develop a model based on clinical and ultrasound parameters to predict the risk of cesarean delivery after labor induction in near-term twin gestations. METHODS: This retrospective cohort study included 189 consecutive women with twin gestations at ≥ 36.0 weeks scheduled for labor induction. The Bishop score and transvaginal ultrasonographic measurements of cervical length were obtained immediately before labor induction. Parameters studied included maternal age, height, weight, parity, gestational age, Bishop score, cervical length, epidural analgesia, method of conception, chorionicity and birth weight. Prostaglandin E2 (dinoprostone) and oxytocin were used for labor induction. Logistic regression analysis and receiver operating characteristic curve were used to generate a predictive model for cesarean delivery. RESULTS: Fifty (26.5%) of the 189 women had cesarean deliveries. According to logistic regression analysis, maternal height (P = 0.004), parity (P = 0.005) and cervical length (P = 0.016), but not Bishop score (P = 0.920), were identified as independent predictors of cesarean delivery. A risk score based on a model of these three parameters was calculated for each patient. The model was shown to have an adequate goodness of fit (P = 0.201) and the area under the curve was 0.722, indicating fairly good discrimination. CONCLUSIONS: Maternal height, parity and cervical length were independent parameters for predicting the risk of cesarean delivery after labor induction in twin gestations. A predictive model using these parameters may provide useful information for deciding whether or not to induce labor.

Can coagulopathy in post-partum hemorrhage predict maternal morbidity?

AIM: The purpose of this study was to evaluate the clinical implications of coagulopathy in women with post-partum hemorrhage (PPH). METHODS: This retrospective cohort study included 262 consecutive women referred for management of PPH at a single tertiary hospital between 2009 and 2012. We reviewed medical records, including vital signs at arrival, laboratory values (hemoglobin, prothrombin time international normalized ratio [PT-INR], platelet, fibrinogen), and total amount of transfused blood product. Results of arterial embolization, need for hysterectomy, and significant morbidity such as pulmonary edema, endometritis or brain lesions were reviewed. Multivariate logistic analysis was used to identify risk of massive transfusion and significant morbidity. RESULTS: The prevalence of coagulopathy (PT-INR > 1.5) was 29.3% (77/262). Of the 262 women, pelvic arterial embolization was performed in 153 women, and was successful in 146 (95.4%). Hysterectomy was performed in 18 women (6.2%). The presence of coagulopathy led to increased risk for massive transfusion (odds ratio [OR], 23.96; 95%CI: 11.65-49.27), hysterectomy (OR, 9.94; 95%CI: 3.16-31.33), and significant morbidity (OR, 9.37; 95%CI: 4.95-17.75). Even after adjusting for other confounding factors, coagulopathy was independently associated with massive transfusion (adjusted OR, 12.24; 95%CI: 4.49-14.28), hysterectomy (adjusted OR, 4.66; 95%CI: 1.12-19.48), and significant morbidity (adjusted OR, 4.67; 95%CI: 2.05-10.64). CONCLUSION: Coagulopathy in PPH is the single most important predictor for massive transfusion and hysterectomy, and is related to maternal morbidity.

Addition of adjuvant progesterone to physical-exam-indicated cervical cerclage to prevent preterm birth.

AIM: The aim of this study was to assess the effect of vaginal progesterone as an adjuvant therapy to physical-exam-indicated cervical cerclage (PEICC). METHODS: This retrospective cohort study included 53 consecutive singleton women who underwent PEICC because of acute cervical insufficiency at 17-24 gestational weeks. The study population was divided into two groups: the adjuvant progesterone group (n = 18) and the non-adjuvant group (n = 35). A 200-mg dose of vaginal micronized natural progesterone was administered after cerclage in the adjuvant progesterone group. Primary outcome measure was spontaneous preterm birth (SPTB) at <36 weeks. RESULTS: The SPTB rate at <36 weeks in the adjuvant group was significantly lower than in the non-adjuvant group (17% vs 51%, P < 0.05). Adjuvant progesterone therapy was significantly associated with a reduction in SPTB at <36 weeks (adjusted odds ratio, 0.12; 95% confidence interval, 0.02-0.69, P < 0.05) even after adjusting for known covariates, including a visible membrane size of ≥4 cm, gestational age, prior SPTB, and use of amnioreduction. The frequency of SPTB at <32 weeks, birthweight < 2500 g, and neonatal intensive care unit admission was significantly lower in the adjuvant progesterone group than in the non-adjuvant group (P < 0.05 for all). CONCLUSION: Adjuvant vaginal progesterone therapy with PEICC was associated with reductions in SPTB, low birthweight, and neonatal intensive care unit admission.

Non-invasive prediction of intra-amniotic infection and/or inflammation in patients with cervical insufficiency or an asymptomatic short cervix (≤15 mm).

PURPOSE: To identify non-invasive parameters to predict intra-amniotic infection and/or inflammation (IAI) in patients with cervical insufficiency or an asymptomatic short cervix (≤15 mm). METHODS: This retrospective cohort study included 72 asymptomatic women with cervical insufficiency (n = 54) or an asymptomatic short cervix (n = 18) at 17-28 weeks. Maternal blood was collected for the determination of the C-reactive protein (CRP) level and white blood cell (WBC) count, and sonography was performed to measure the cervical length shortly after amniocentesis. Amniotic fluid (AF) was cultured and interleukin-6 (IL-6) level and WBC count were determined. RESULTS: The prevalence of intra-amniotic inflammation and a positive AF culture was 22.2 % (16/72) and 8.3 % (6/72), respectively. The best cut-off value for AF IL-6 in predicting the presence of intra-amniotic infection was ≥7.6 ng/mL and was used to diagnose the presence of intra-amniotic inflammation. Women with intra-amniotic inflammation, regardless of culture results, were at increased risk for preterm delivery and adverse outcomes compared to women without intra-amniotic inflammation. In multivariable regression, CRP was the only non-invasive variable statistically significantly associated with IAI. Moreover, the area under the curves for the CRP and AF WBC were not significantly different. CONCLUSIONS: In women with cervical insufficiency or a short cervix, the risk for IAI can be predicted fairly and non-invasively by measurements of serum CRP. Overall, this non-invasive parameter appears to have similar accuracy to the AF WBC counts for predicting IAI.

Differences among admitting departments in alerts and alert overrides for drug-drug interaction.

OBJECTIVE: To determine differences in the incidence and risk factors of alerts for drug-drug interaction (DDI) and the rate of alert overrides by an admitting department. METHODS: A retrospective cohort study was performed using electronic health records of a Korean tertiary teaching hospital including all hospitalized adult patients for 18 months. The main outcome measures included incidence rates of alerts for DDI and their override, hazard ratios (HRs) for DDI alerts, and odds ratios (ORs) for alert overrides by admitting department (emergency department [ED], general ward [GW], and intensive care unit [ICU]) after adjusting for other known risk factors. RESULTS: Among 102 379 incident admissions, 6060 had alerts for DDI (5.4/person-year). After adjusting for covariates, patients admitted to the ED (HR, 4.02; confidence interval [CI], 3.69-4.38) or ICU (HR, 1.62; CI, 1.29-2.04) showed higher risks for DDI compared with those admitted to the GW. The alert-override rate was significantly higher in the ED (OR 1.68) than in the GW; however, there was no significant difference between GW and ICU. The prevalence of DDI alerts and their override rate were also demonstrated. DISCUSSION: The incidence of DDI and the alert-override rate differed by admitting department. The ED and ICU were associated with higher risks for alerts on DDI than did the GW after adjusting for other known risk factors. CONCLUSIONS: Admitting department was an independent risk factor for alerts and alert overrides. Strategies to reduce alerts and alert overrides should consider the admitting department.

L-ascorbic acid addition to chitosan reduces body weight in overweight women.

Previously, we have found that the addition of L-ascorbic acid to chitosan enhanced the reduction in body weight gain in guinea pigs fed a high-fat diet. We hypothesized that the addition of L-ascorbic acid to chitosan would accelerate the reduction of body weight in humans, similar to the animal model. Overweight subjects administered chitosan with or without L-ascorbic acid for 8 weeks, were assigned to three groups: Control group (N=26, placebo, vehicle only), Chito group (N=27, 3 g/day chitosan), and Chito-vita group (N=27, 3 g/day chitosan plus 2 g/day L-ascorbic acid). The body weights and body mass index (BMI) of the Chito and Chito-vita groups decreased significantly (p<0.05) compared to the Control group. The BMI of the Chito-vita group decreased significantly compared to the Chito group (Chito: -1.0 kg/m2 vs. Chito-vita: -1.6 kg/m2, p<0.05). The results showed that the chitosan enhanced reduction of body weight and BMI was accentuated by the addition of L-ascorbic acid. The fat mass, percentage body fat, body circumference, and skinfold thickness in the Chito and Chito-vita groups decreased more than the Control group; however, these parameters were not significantly different between the three groups. Chitosan combined with L-ascorbic acid may be useful for controlling body weight.