IntroductionExternal ventricular drainage (EVD)-related ventriculitis is one of the most severe complications associated with the use of EVDs. Establishing an early and certain diagnosis can be difficult in critically ill patients. We performed this prospective study to evaluate the usefulness of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) determination in cerebrospinal fluid (CSF) in the diagnosis of ventriculitis. Methods: Prospective observational study of seventy-three consecutive patients with EVDs. Samples of CSF for culture, cytobiochemical analysis and sTREM-1 determination were extracted three times a week. Ventriculitis diagnosis required a combination of microbiological, cytobiochemical and clinical criteria. Results: Seventy-three consecutive patients were included. EVD-related ventriculitis was diagnosed in six patients and EVD-colonization in ten patients. Patients without clinical or microbiological findings were considered controls. The median CSF sTREM-1 was 4,320?pg/ml (interquartile range (IQR): 2,987 to 4,886) versus 266?pg/ml (118 to 689); P <0.001. There were no differences when comparing colonized-patients and controls. The best cut-off sTREM-1 value for the diagnosis of ventriculitis was 2,388.79?pg/ml (sensitivity 100%, specificity 98.5%, positive predictive value 85.71%, negative predictive value 100%). Determination of CSF proteins, glucose and the ratio CSF/serum glucose were also significantly different (P?=?0.001). Serum biomarkers were not useful to diagnose EVD-related infection. These results were confirmed by a case?control study with ventriculitis patients (cases) and non-ventriculitis (control subjects) matched by age, comorbidities, severity scales and EVD duration (P?=?0.004). Conclusions: CSF sTREM-1 was useful in the diagnosis of ventriculitis, in a similar measure to classical CSF parameters. Furthermore, CSF sTREM-1 could prove the diagnosis in uncertain cases and discriminate between EVD-colonization and infection.
Background: Evidence has shown that single nucleotide polymorphism located in pre-miRNA or mature microRNA may modify various biological processes and affect the processing of carcinogenesis. Published results about the association between miR-146a rs2910164 G/C polymorphism and human gastric cancer susceptibility are inconclusive. The aim of this study was to acquire a more precise effect of the association between the miR-146a rs2910164 polymorphism and gastric risk by meta-analysis. Methods: Eligible genetic association studies were searched from PubMed, Web of Knowledge and Chinese Biomedicine Database on human subject. Quantitative data synthesis was conducted for the associations of miR-146a rs2910164 G/C polymorphism with susceptibility to gastric cancer. Results: Nine eligible studies that included a total of 3,885 gastric cancer patients and 5,396 controls were identified in the present meta-analysis. The overall OR indicated a potential association between rs2910164 polymorphism and GC but the effect was not statistically significant (GG vs. CG/ CC: OR =1.076, 95% CI 0.925-1.251, P =0.342). When stratifying for population, the result showed that miR-146a rs2910164 GG genotype was associated with increased gastric cancer risk among Chinese in recessive model (GG vs. CG/ CC: OR =1.171, 95% CI 1.050-1.306, P =0.005). Besides, no significant difference was found in gender, smoking, location, metastasis of lymph node and Laur?n?s classification. Conclusions: The present meta-analysis suggests an increased risk between miR-146a rs2910164 GG genotype and gastric cancer susceptibility in Chinese based on published literatures.
Background: Change in climatic and socio-economic situations is paving the way for the spread of malaria in highland areas which were generally known to be malaria free. Despite this, information regarding highland malaria transmission is scarce. Thus, the present study investigated entomological parameters linked to malaria transmission in the highlands of Southern Ethiopia. Methods: A longitudinal entomological study was conducted in three localities situated at different altitudes ranging between 1300 and 2650m above sea level in Derashe district, Southern Ethiopia. Larval and adult anopheline mosquitoes were collected between October 2011 and February 2012. Results: An. arabiensis and An. funestus s.l existed at significantly higher densities in the lowland (Wozeka) in contrast to An. christyi and An. Demeilloni, which were more abundant in the highland localities (P?
Background: To directly compare traditional lipid ratios (total cholesterol [TC]/high density lipoprotein cholesterol [HDL-C], non-HDL-C/HDL-C, low density lipoprotein cholesterol [LDL-C]/HDL-C, and triglycerides [TG]/HDL-C), apolipoprotein B (apoB)/apolipoprotein A-I (apoA-I) ratio, visceral adiposity index (VAI), lipid accumulation product (LAP), and the product of TG and fasting glucose (TyG) for strength and independence as risk factors for insulin resistance (IR). Methods: We conducted a cross-sectional analysis of 7629 Chinese adults using data from the China Health and Nutrition Survey 2009. Results: For all lipid ratios (traditional lipid ratios and apoB/apoA-I), among both sexes, TG/HDL-C explained the most additional percentage of variation in HOMA-IR (2.9% in men, and 2.3% in women); for all variables of interest, the variability in HOMA-IR explained by VAI and TG/HDL-C were comparable; TyG had the most significant association with HOMA-IR, which explained 9.1% for men and 7.8% for women of the variability in HOMA-IR. Logistic regression analysis showed the similar patterns. Receiver operating characteristic (ROC) curve analysis showed that, among both sexes, TG/HDL-C was a better discriminator of IR than apoB/apoA-I; the area under the ROC curve (AUC) for VAI (0.695 in men and 0.682 in women) was greater than that for TG/HDL-C (AUC 0.665 in men and 0.664 in women); TyG presented the greatest value of AUC (0.709 in men and 0.711 in women). Conclusion: The apoB/apoA-I performs no better than any of the traditional lipid ratios in correlating with IR. The TG/HDL-C, VAI and TyG are better markers for early identification of IR individuals.
Background: The physical characteristics of the environment influence the composition, distribution and behavior of the vectors and mammalian hosts involved in the transmission of visceral leishmaniasis (VL), thereby affecting the epidemiology of the disease. In Brazil, urbanization of human VL is a recent phenomenon and represents an issue of particular concern to local health authorities. The present study aimed to establish the degree of spatial dependency between canine and human VL in the municipality of Divin?polis, Minas Gerais, Brazil, and to identify priority risk areas in which stricter control measures should be implemented. Methods: The selected canine population comprised 3,652 dogs distributed within 11 strata and 1,247 urban blocks. Serum samples were collected between March 2013 and February 2014. Serodiagnosis of dogs was performed using the enzyme-linked immunosorbent assay and the indirect fluorescent-antibody test. The blocks sampled for canine VL and the addresses of the 16 confirmed cases of human VL notified in Divin?polis during the period 2007?2013 were georeferenced. Spatial analysis of the data was performed using Kernel density estimation, Ripley?s bivariate K-function and directional distribution methods. Results: The overall prevalence of seropositive animals was 4.63% (range 3.95 - 5.31) (n =169) and varied in different strata between 0.9 (range 0.0 - 1.91) and 8.73% (range 5.65 - 11.81). A positive spatial dependency was detected between human and canine VL in which the occurrence of human cases of the disease tended to concentrate in locations that were close to areas with a higher incidence of canine VL. The priority risk area could be clearly distinguished from Kernel density estimation and standard deviational ellipse plots in which the human VL ellipse was totally enclosed within the canine VL ellipse. Conclusions: The results presented herein will enable the Municipal Health Office of Divin?polis to devise a more effective management plan for human VL in which specific strategies would be applied to areas presenting different levels of risk. This spatial evaluation of leishmaniasis model could be applied in other urban areas of Brazil.
Background: The liver has a crucial role in metabolic homeostasis as well as being the principal detoxification centre of the body, removing xenobiotics and waste products which could potentially include some nanomaterials (NM). With the ever increasing public and occupational exposure associated with accumulative production of nanomaterials, there is an urgent need to consider the possibility of detrimental health consequences of engineered NM exposure. It has been shown that exposure via inhalation, intratracheal instillation or ingestion can result in NM translocation to the liver. Traditional in vitro or ex vivo hepatic nanotoxicology models are often limiting and/or troublesome (i.e. reduced metabolism enzymes, lacking important cell populations, unstable with very high variability, etc.). Methods: In order to rectify these issues and for the very first time we have utilised a 3D human liver microtissue model to investigate the toxicological effects associated with a single or multiple exposure of a panel of engineered NMs (Ag, ZnO, MWCNT and a positively charged TiO2). Results: Here we demonstrate that the repeated exposure of the NMs is more damaging to the liver tissue as in comparison to a single exposure with the adverse effects more significant following treatment with the Ag and ZnO as compared with the TiO2 and MWCNT NMs (in terms of cytotoxicity, cytokine secretion, lipid peroxidation and genotoxicity). Conclusions: Overall, this study demonstrates that the human microtissue model utilised herein is an excellent candidate for replacement of traditional in vitro single cell hepatic models and further progression of liver nanotoxicology.
Background: The myocardial effects of phosphodiesterase type 5 inhibitors (PDE5i) have recently received consideration in several preclinical studies. The risk/benefit ratio in humans remains unclear. Methods: We performed a meta-analysis of randomized, placebo-controlled trials (RCTs) to evaluate the efficacy and safety of PDE5i on cardiac morphology and function. From March 2012 to December 2013 (update: May 2014), we searched English-language studies from MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and SCOPUS-selecting RCTs of continuous PDE5i administration that reported cardiovascular outcomes: cardiac geometry and performance, afterload, endothelial function and safety. The pooled estimate of a weighted mean difference between treatment and placebo was obtained for all outcomes using a random effects model. A test for heterogeneity was performed and the I2 statistic calculated. Results: Overall, 1,622 subjects were treated, with 954 randomized to PDE5i and 772 to placebo in 24 RCTs. According to our analysis, sustained PDE5 inhibition produced: (1) an anti-remodeling effect by reducing cardiac mass (−12.21 g/m2, 95% confidence interval (CI): −18.85; −5.57) in subjects with left ventricular hypertrophy (LVH) and by increasing end-diastolic volume (5.00 mL/m2; 95% CI: 3.29; 6.71) in non-LVH patients; (2) an improvement in cardiac performance by increasing cardiac index (0.30 L/min/m2, 95% CI: 0.202; 0.406) and ejection fraction (3.56%, 95% CI: 1.79; 5.33). These effects are parallel to a decline of N-terminal-pro brain natriuretic peptide (NT-proBNP) in subjects with severe LVH (−486.7 pg/ml, 95% CI: −712; -261). PDE5i administration also produced: (3) no changes in afterload parameters and (4) an improvement in flow-mediated vasodilation (3.31%, 95% CI: 0.53; 6.08). Flushing, headache, epistaxis and gastric symptoms were the commonest side effects. Conclusions: This meta-analysis suggests for the first time that PDE5i have anti-remodeling properties and improve cardiac inotropism, independently of afterload changes, with a good safety profile. Given the reproducibility of the findings and tolerability across different populations, PDE5i could be reasonably offered to men with cardiac hypertrophy and early stage heart failure. Given the limited gender data, a larger trial on the sex-specific response to long-term PDE5i treatment is required.
Background: Unintentional injury leads all other causes of death for those 1 to 45 years old. The expense of medical care for injured people is estimated to exceed $406 billion annually. Given this burden on the population, the Centers for Disease Control and Prevention consistently refers to injury prevention as a national priority. We postulated that exposure to crime and the density of alcohol outlets in one's neighborhood will be positively associated with the incidence of hospitalization for and mortality from traumatic injuries, independent of other neighborhood characteristics. Methods: We conducted a cross-sectional study with ecological and individual analyses. Patient-level data for traumatic injury, injury severity, and hospital mortality due to traumatic injury in 2010 were gathered from the Dallas-Fort Worth Hospital Council Foundation. Each case of traumatic injury or death was geospatially linked with neighborhood of origin information from the 2010 U.S. Census within Dallas County, Texas. This information was subsequently linked with crime data gathered from 20 local police departments and the Texas Alcoholic Beverage Commission alcohol outlet dataset. The crime data are the Part One crimes reported to the Federal Bureau of Investigation. Results: The proportion of persons 65 years old or older was the strongest predictor of the incidence of hospitalization for traumatic injury (b = 12.64, 95% confidence interval (CI) 8.73 to 16.55). In turn, the incidence of traumatic injury most strongly predicted the severity of traumatic injury (b = 0.008, 95% CI 0.0003 – 0.0012). The tract-level unemployment rate was associated with a 5% increase in the odds of hospital mortality among hospitalized trauma patients. Conclusions: Several neighborhood characteristics were associated with the incidence, severity, and hospital mortality from traumatic injury. However, crime rates and alcohol outlet density carried no such association. Prevention efforts should focus on neighborhood characteristics such as population density, mean age of the residents, and unemployment rate, regardless of crime rates and alcohol outlet density.
IntroductionThe Surviving Sepsis Campaign guidelines recommend goal-directed therapy (GDT) for the early resuscitation of patients with sepsis. However, the findings of the ProCESS (Protocolized Care for Early Septic Shock) trial show no benefit from GDT for reducing mortality rates in early septic shock. We performed a meta-analysis to integrate these findings with existing literature on this topic and evaluate the effect of GDT on mortality from sepsis. Methods: We searched the PubMed, EMBASE, CENTRAL, and reference lists of articles. Randomized controlled trials comparing GDT with standard therapy or usual care in patients with sepsis were included. The prespecified primary outcome was overall mortality. Results: In total, 13 trials involving 2,525 adult patients were included. GDT significantly reduced overall mortality in the random-effect model (relative risk (RR) 0.83, 95% confidence interval (CI) 0.71 to 0.96, P =0.01, I2?=?56%). Predefined subgroup analysis according to the timing of GDT for resuscitation suggested that mortality benefit was seen only in the subgroup of early GDT within the first six hours (seven trials; RR 0.77, 95% CI 0.67 to 0.89, P =0.0004, I2?=?40%) but not in the subgroup with a late or unclear timing of GDT (six trials; RR 0.92, 95% CI 0.69 to 1.24, P =0.59, I2?=?56%). GDT was significantly associated with the use of dobutamine (five trials; RR 2.71, 95% CI 1.20 to 6.10, P =0.02). Conclusions: The current meta-analysis suggests that GDT significantly reduces overall mortality in patients with sepsis, especially when initiated early. However, due to the variable quality of the studies, strong and definitive recommendations can not be made.
Background: Parasites have adverse effects on the life and survival of many migratory waterbirds, especially birds on the endangered species list. Hooded Cranes are large migratory colonial waterbirds wintering in wetlands, which are prone to parasite infection, thus monitoring the diversity of parasites is important for sound wetland management and protection of this species. Methods: From November 2012 to April 2013, we collected 821 fresh faecal samples from the three lakes (Poyang, Caizi and Shengjin Lake) in the lower and middle Yangtze River floodplain, and detected with saturated brine floating and centrifugal sedimentation methods. Parasite eggs were quantified with a modified McMaster’s counting method. Results: In this study, 11 species of parasites were discovered, i.e., two coccidium (Eimeria gruis, E. reichenowi), five nematodes (Capillaria sp., Strongyloides sp., Ascaridia sp., Trichostrongylus sp., Ancylostomatidae), three trematodes (Echinostoma sp., Echinochasmus sp., Fasciolopsis sp.) and one cestode (Hymenolepis sp.). About 57.7% of the faecal samples showed parasitic infection. All species of parasites were found at the three sites except Hymenolepis which was not found at Poyang Lake. While most samples were affected by only one or two species of parasites, infection by Eimeria spp. was the most common (53.1%). From One-Way ANOVA analysis of the three lakes, parasite species richness index (p = 0.656), diversity index (p = 0.598) and evenness index (p = 0.612) showed no significant difference. According to the statistical analysis of our data, there were no significant difference in parasite species richness index (p = 0.678) and evenness index (p = 0.238) between wintering periods, but a strong difference in diversity index (p < 0.05). Conclusions: Our study suggests that in the wintering Hooded Crane populations, parasite diversity is more sensitive to changes in the overwintering periods than to locations. This also indicates that with the limitations of migration distance, the parasites may not form the differentiation in Hooded Crane populations of the three lakes.