Is a sedentary lifestyle an independent predictor for hospital and early mortality after elective cardiac surgery?

Objective

This study evaluates whether a sedentary lifestyle is an independent predictor for increased mortality after elective cardiac surgery.

Methods

Three thousand one hundred fifty patients undergoing elective cardiac surgery between January 2007 and June 2012 completed preoperatively the Corpus Christi Heart Project questionnaire concerning physical activity (PA). Based on this questionnaire, 1815 patients were classified as active and 1335 patients were classified as sedentary. The endpoints of the study were hospital mortality and early mortality.

Results

The study population had a mean age of 69.7 ± 10.1 (19–95) years and a mean logistic EuroSCORE risk of 5.1 ± 5.6 (0.88–73.8). Sedentary patients were significantly older (p = 0.001), obese (p = 0.001), had a higher EuroSCORE risk (p = 0.001), and a higher percentage of complications. Hospital mortality (1.1 % versus 0.4 % (p = 0.014)) and early mortality (1.5 % versus 0.6 % (p = 0.006)) were significantly higher in the sedentary group compared with the active group. However, a sedentary lifestyle was not identified as an independent predictor for hospital mortality (p = 0.61) or early mortality (p = 0.70).

Conclusion

Sedentary patients were older, obese and had a higher EuroSCORE risk. They had significantly more postoperative complications, higher hospital mortality and early mortality. Despite these results, sedentary behaviour could not be identified as an independent predictor for hospital or early mortality.     

Is the island biogeography model a poor predictor of biodiversity patterns in shallow lakes?

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Is Postoperative Imaging Mandatory after Meningioma Removal? Results of a Prospective Study

Background

Routine postoperative imaging (PI) following surgery for intracranial meningiomas is common practice in most neurosurgical departments. The purpose of this study was to determine the role of routine PI and its impact on clinical decision making after resection of meningioma.

Methods

Patient and tumor characteristics, details of radiographic scans, symptoms and alteration of treatment courses were prospectively collected for patients undergoing removal of a supratentorial meningioma of the convexity, falx, tentorium, or lateral sphenoid wing at the authors’ institution between January 1st, 2010 and March 31st, 2012. Patients with infratentorial manifestations or meningiomas of the skull base known to be surgically difficult (e.g. olfactory groove, petroclival, medial sphenoid wing) were not included. Maximum tumor diameter was divided into groups of < 3cm (small), 3 to 6 cm (medium), and > 6 cm (large).

Results

206 patients with meningiomas were operated between January 2010 and March 2012. Of these, 113 patients met the inclusion criteria and were analyzed in this study. 83 patients (73.5%) did not present new neurological deficits, whereas 30 patients (26.5%) became clinically symptomatic. Symptomatic patients had a change in treatment after PI in 21 cases (70%), while PI was without consequence in 9 patients (30%). PI did not result in a change of treatment in all asymptomatic patients (p<0.001) irrespective of tumor size (p<0.001) or localization (p<0.001).

Conclusions

PI is mandatory for clinically symptomatic patients but it is safe to waive it in clinically asymptomatic patients, even if the meningioma was large in size.     

Is elevated SUA associated with a worse outcome in young Chinese patients with acute cerebral ischemic stroke?

Background  

Elevated serum uric acid (SUA) levels can enhance its antioxidant prosperities and reduce the occurrence of cerebral infarction. Significantly elevated SUA levels have been associated with a better prognosis in patients with cerebral infarction; however, the results from some studies on the relationship between SUA and the prognosis of patients with cerebral infarction remain controversial.     

Do socioeconomic differences in mortality persist after retirement? 25 year follow up of civil servants from the first Whitehall study.

OBJECTIVE: To assess the risk of death associated with work based and non-work based measures of socioeconomic status before and after retirement age. DESIGN: Follow up study of mortality in relation to employment grade and car ownership over 25 years. SETTING: The first Whitehall study. SUBJECTS: 18,133 male civil servants aged 40-69 years who attended a screening examination between 1967 and 1970. MAIN OUTCOME MEASURE: Death. RESULTS: Grade of employment was a strong predictor of mortality before retirement. For men dying at ages 40-64 the lowest employment grade had 3.12 times the mortality of the highest grade (95% confidence interval 2.4 to 4.1). After retirement the ability of grade to predict mortality declined (rate ratio 1.86; 1.6 to 2.2). A non-work based measure of socioeconomic status (car ownership) predicted mortality less well than employment grade before retirement but its ability to predict mortality declined less after retirement. Using a relative index of inequality that was sensitive to the distribution among socioeconomic groups showed employment grade and car ownership to have independent associations with mortality that were of equal magnitude after retirement. The absolute difference in death rates between the lowest and highest employment grades increased with age from 12.9 per 1000 person years at ages 40-64 to 38.3 per 1000 at ages 70-89. CONCLUSIONS: Socioeconomic differences in mortality persist beyond retirement age and in magnitude increase with age. Social differentials in mortality based on an occupational status measure seem to decrease to a greater degree after retirement than those based on a non-work measure. This suggests that alongside other socioeconomic factors work itself may play an important part in generating social inequalities in health in men of working age.     

Massive accumulation of N‐acylethanolamines after stroke. Cell signalling in acute cerebral ischemia?

We investigated levels and compositions of N-acylethanolamines (NAEs) and their precursors, N-acyl phosphatidylethanolamines (N-acyl PEs), in a rat stroke model applying striatal microdialysis for glutamate assay. Rats (n = 18) were treated with either intravenous saline (control), NMDA receptor antagonist MK801 (1 mg/kg), or CB1 receptor antagonist SR141716A (1 mg/kg) 30 min after permanent middle cerebral artery occlusion (MCAO). MK801 significantly attenuated the release of glutamate in the infarcted striatum (79 +/- 22 micromol/L) as compared with controls (322 +/- 104 micromol/L). The administration of CB1 antagonist SR141716A had no statistically significant effect on glutamate release (340 +/- 89 micromol/L), but reduced infarct volume at 5 h after MCAO significantly by approximately 40%, whereas MK801 treatment resulted in a non-significant (18%) reduction of infarct volume. In controls, striatal and cortical NAE concentrations were about 30-fold higher in the infarcted than in the non-infarcted hemisphere, whereas ipsilateral N-acyl phosphatidylethanolamine (N-acyl PE) levels exceeded contralateral levels by only a factor of two to three. Treatment with MK801 or SR141716A, or glutamate release in the infarcted tissue, had no significant effect on these levels. NAE accumulation during acute stroke may be due to increased synthesis as well as decreased degradation, possibly by inhibition of fatty acid amide hydrolase (FAAH).     

Is productivity of mesic savannas light limited or water limited? Results of a simulation study

A soil–plant–atmosphere model was used to estimate gross primary productivity (GPP) and evapotranspiration (ET) of a tropical savanna in Australia. This paper describes model modifications required to simulate the substantial C4 grass understory together with C3 trees. The model was further improved to include a seasonal distribution of leaf area and foliar nitrogen through 10 canopy layers. Model outputs were compared with a 5‐year eddy covariance dataset. Adding the C4 photosynthesis component improved the model efficiency and root‐mean‐squared error (RMSE) for total ecosystem GPP by better emulating annual peaks and troughs in GPP across wet and dry seasons. The C4 photosynthesis component had minimal impact on modelled values of ET. Outputs of GPP from the modified model agreed well with measured values, explaining between 79% and 90% of the variance and having a low RMSE (0.003–0.281 g C m^?2 day^?1). Approximately, 40% of total annual GPP was contributed by C4 grasses. Total (trees and grasses) wet season GPP was approximately 75–80% of total annual GPP. Light‐use efficiency (LUE) was largest for the wet season and smallest in the dry season and C4 LUE was larger than that of the trees. A sensitivity analysis of GPP revealed that daily GPP was most sensitive to changes in leaf area index (LAI) and foliar nitrogen (N_f) and relatively insensitive to changes in maximum carboxylation rate (V_cmax), maximum electron transport rate (J_max) and minimum leaf water potential (ψ_min). The modified model was also able to represent daily and seasonal patterns in ET, (explaining 68–81% of variance) with a low RMSE (0.038–0.19 mm day^?1). Current values of N_f, LAI and other parameters appear to be colimiting for maximizing GPP. By manipulating LAI and soil moisture content inputs, we show that modelled GPP is limited by light interception rather than water availability at this site.     

Is solubility in vitro a reliable predictor of iron bioavailability?

In this paper we have described physiological factors that are likely to influence iron bioavailability, reviewed chemical properties of iron important to its absorption, and addressed the question posed in the title. Intestinal transit times, luminal pH, and diffusion barriers resulting from gastrointestinal mucus may affect absorption. The tendency of iron to form large-molecular-weight species and to bind to macromolecules may limit its absorption. Iron solubility following in vitro gastrointestinal digestion is a reliable predictor of ascorbic acid effects on bioavailability but not of protein effects. Solubility of low-molecular-weight iron is better than simple solubility for predicting iron bioavailability.     

Is a genome a codeword of an error-correcting code?

Since a genome is a discrete sequence, the elements of which belong to a set of four letters, the question as to whether or not there is an error-correcting code underlying DNA sequences is unavoidable. The most common approach to answering this question is to propose a methodology to verify the existence of such a code. However, none of the methodologies proposed so far, although quite clever, has achieved that goal. In a recent work, we showed that DNA sequences can be identified as codewords in a class of cyclic error-correcting codes known as Hamming codes. In this paper, we show that a complete intron-exon gene, and even a plasmid genome, can be identified as a Hamming code codeword as well. Although this does not constitute a definitive proof that there is an error-correcting code underlying DNA sequences, it is the first evidence in this direction.     

Do neuroleptic drugs hasten cognitive decline in dementia? Prospective study with necropsy follow up.

OBJECTIVE: To investigate the contribution of neuroleptic drugs to cognitive decline in dementia. DESIGN: Two year prospective, longitudinal study consisting of interviews every four months, with necropsy follow up. SETTING: Community settings in Oxfordshire. SUBJECTS: 71 subjects with dementia, initially living at home with informant. MAIN OUTCOME MEASURES: Cognitive function (score from expanded minimental state examination); behavioural problems (physical aggression, hallucinations, persecutory ideas, and disturbance of diurnal rhythm); and postmortem neuropathological assessment (cortical Lewy body pathology). RESULTS: The mean (SE) decline in cognitive score in the 16 patients who took neuroleptics was twice that in the patients who did not (20.7 (2.9) v 9.3 (1.3), P = 0.002). An increased rate of decline was also associated with aggression, disturbed diurnal rhythm, and persecutory ideas. However, only use of neuroleptics and severity of persecutory ideas were independently associated with more rapid cognitive decline when all other variables were adjusted for. The start of neuroleptic treatment coincided with more rapid cognitive decline: median rate of decline was 5 (interquartile range 8.5) points per year before treatment and 11 (12) points per year after treatment (P = 0.02). Cortical Lewy body pathology did not account for association between neuroleptic use and more rapid decline. CONCLUSIONS: Neuroleptic drugs that are sometimes used to treat behavioural complications of dementia may worsen already poor cognitive function. Randomised controlled trials are needed to confirm a causal relation.     

Is the F(ST) a good predictor of extinction?

The organization of neutral genetic variation has long been used as a diagnostic tool to infer demographic properties of populations, and recently it has been shown that this information can also be used to estimate the magnitude of genetic deterioration in small or fragmented populations. A further step of this research is to assess whether neutral genetic indicators can serve to predict and compare the viabilities of endangered species. I use modeling to explore how ecological metapopulation settings are related to neutral genetic indicators (such as the fixation index [F(ST)]), changes in genetic load, and metapopulation viability. The analysis indicates that genetic indicators are generally strongly and consistently correlated with the genetic load, population size and structure, and time of extinction but identifies two potential limitations for their use in viability assessments. First, the regime of environmental perturbations is not accurately reflected by neutral indicators, so that their predictive power may be reduced in variable environments. Second, many species are threatened by recent human-induced changes of their habitat configuration. In most cases, genetic indicators may not have reached their equilibrium value in the altered habitat, which limits their ability to compare species with heterogeneous histories and life-history traits.     

Do most practices have an age-sex register? Results of the West Midlands age-sex register study.

A cross sectional study based on all (1260) general practices in the West Midlands was conducted in late 1984 and early 1985. Responses to a postal questionnaire were received from 762 (60.5%) practices, and of these, 387 (50.8%) stated that they had an age-sex register; 104 (13.6%) practices replied that they had definite plans to establish an age-sex register within six months, and a random sample of these was later telephoned to see if the plans had come to fruition. A random telephone sample was also made from the 498 (39.5%) non-responders. It was concluded that the current prevalence of age-sex registers in the West Midlands is 52% (+/- 5% for 95% confidence) of all practices. A register has now been established of 422 practices (35.5% of the total number in the West Midlands) that have an age-sex register. This is being used as a database for other research. The most common reason stated for not having an age-sex register was that it would be too time consuming. Most of the practices that had one stated that it was used for research, disease recording, screening, surveillance, or health education, which implies that the registers are being used.     

Microemboli-monitoring during the acute phase of ischemic stroke: Is it worth the time?

Background  

The prevalence of microembolic signals (MES) during the acute phase of ischemic stroke and its influence on outcome is not well studied. The aim of our study was to determine the prevalence of MES, the different factors that are associated with the presence of MES and the association between MES and outcomes in stroke patients investigated within 6 hours after the onset of ischemic stroke.     

Is Fecal Leukocyte Test a good predictor of Clostridium difficile associated diarrhea?

Alcaligenes xylosoxidans is an aerobic, motile, oxidase and catalase positive, nonfermentative Gram negative bacillus. This bacterium has been isolated from intestine of humans and from various hospital or environmental water sources. A.xylosoxidans is both waterborne and results from the poor-hygienic conditions healthcare workers are in. In this case report, the bacteremia which appeared in a patient with pancreas cancer after ERCP was described.