BACKGROUND Major adverse cardiovascular(CV)events(MACEs)are the primary cause of morbidity and mortality in kidney transplantation(KT)recipients.The risk for MACEs is impacted by an array of traditional and transplant...BACKGROUND Major adverse cardiovascular(CV)events(MACEs)are the primary cause of morbidity and mortality in kidney transplantation(KT)recipients.The risk for MACEs is impacted by an array of traditional and transplant-related non-traditional CV risk factors.AIM To investigate the association between potential CV risk factors related to KT and MACEs,and their potential modification by hyperuricemia(HU).METHODS The relationship between CV risk factors related to KT and MACEs was examined in a cohort of 545 patients who underwent transplantation between 2008 and 2019.The mean age of patients at KT was 55.0 years±14.2 years(range 15.0–89.0 years).Univariate and multivariate logistic regression models were constructed to identify risk factors influencing MACEs.To explore the potential effect modification by uric acid(UA),patients were categorized into groups based on UA levels:(1)Low(<356μmol/L);(2)Normal(356–416μmol/L);(3)High(416–475μmol/L);and(4)Very high(>475μmol/L).RESULTS MACEs occurred in 145 of 545(26.6%)KT recipients.The most prevalent comorbidities were hypertension(87%),dyslipidemia(78%),secondary hyperparathyroidism(68%),HU(63%)and anemia(33%).In the multivariate logistic regression model,the most significant factors associated with MACEs were previous CV events[odds ratio(OR)=70.6,95%CI:24.9–200.1],left ventricular hypertrophy(LVH)(OR=12.6,95%CI:2.7–58.3),HU treatment(OR=4.3,95%CI:2.4–7.6),and anemia(OR=5.3,95%CI:2.9–9.8).Effect modification by the presence of HU revealed that independent factors associated with MACEs were age(OR=1.03,95%CI:1.0–1.1),previous CV events(OR=41.7,95%CI:13.6–127.6),LVH(OR=15.3,95%CI:2.0–116.6),HU treatment(OR=2.5,95%CI:1.3–4.6)and anemia(OR=5.4,95%CI:2.8–10.5).Effect modification by UA levels dichotomized at 475μmol/L(very high level of UA)revealed that HU treatment was not associated with MACEs in groups with or without very high UA levels.CONCLUSION A very high level of UA was observed to act as an effect-modifying factor for MACEs,especially when combined with other risk factors such as age,previous CV events,LVH,and anemia.展开更多
Purpose:The guidelines on the management of patients with heart failure support intensive patient education on self-care.The present study aimed to evaluate the short-term and long-term impacts of a structured educati...Purpose:The guidelines on the management of patients with heart failure support intensive patient education on self-care.The present study aimed to evaluate the short-term and long-term impacts of a structured education provided by a qualified heart failure nurse on patients'self-care behavior and disease knowledge.Methods:One hundred fifty patients(66±12 years)hospitalized for heart failure participated in a structured one-hour educational session by a heart failure nurse.Patients completed a questionnaire comprising 15 questions(nine questions from the European Heart Failure Self-Care Behavior Scale[EHFScB-9]and six on the patients'disease knowledge)one day before and one day and six months after the educational session.Possible responses for each question ranged from 1(complete agreement)to 5(complete disagreement).Results:After the educational session,the total EHFScB-9 score improved from 24.31±6.98 to 14.94±6.22,and the disease knowledge score improved from 18.03±5.44 to 10.74±4.30(both P<0.001).Scores for individual questions ranged from 1.26±0.81(adherence to the medication protocol)to 3.66±1.58(everyday weighing habits)before the education.The greatest improvement after education was observed on response to weight gain(-2.00±1.57),daily weight control(—1.77±1.64),and knowledge on the cause of patients'heart failure(-1.53±1.43).At 6-month follow-up,EHFScB-9 score was 17.33±7.23 and knowledge score was 12.34±5.30(both P<0.001 compared with baseline).No factor was predictive of an insufficient teaching effect.Conclusions:The educational program led by a qualified nurse improves patients'self-care behavior and disease knowledge with a persistent effect at 6-month follow-up.There are no patient characteristics which preclude the implementation of an educational session.展开更多
In this study, we explored to combine traffic maps and smartphone trajectories to model traffic air pollution, exposure and health impact. The approach was step-by-step modeling through the causal chain: engine emissi...In this study, we explored to combine traffic maps and smartphone trajectories to model traffic air pollution, exposure and health impact. The approach was step-by-step modeling through the causal chain: engine emission, traffic density versus traffic velocity, traffic pollution concentration, exposure along individual trajectories, and health risk. A generic street with 100 km/h speed limit was used as an example to test the model. A single fixed-time trajectory had maximum exposure at velocity of 45 km/h at maximum pollution concentration. The street population had maximum exposure shifted to a velocity of 15 km/h due to the congestion density of vehicles. The shift is a universal effect of exposure. In this approach, nearly every modeling step of traffic pollution depended on traffic velocity. A traffic map is a super-efficient pre-processor for calculating real-time traffic pollution exposure at global scale using big data analytics.展开更多
We describe two cases of prosthetic joint infection(PJI) of the hip due to Salmonella. The first patient presented with an early infection 5 d after being discharged following a total hip replacement and the second pa...We describe two cases of prosthetic joint infection(PJI) of the hip due to Salmonella. The first patient presented with an early infection 5 d after being discharged following a total hip replacement and the second patient presented at the emergency ward with a late infection, thirteen years following a total hip replacement. Both cases occurred within one month of each other at our institution and both were successfully treated with a one-stage revision. PJI caused by Salmonella species is very rare: so far only 20 Salmonella PJIs of the hip have been described. Therefore, full consensus on the best treatment approach has not yet been reached. An aggressive two-stage approach is advised because of the virulence of Salmonella, although a limited number of successful one-stage approaches have been describedas well. According to the latest guidelines, one-stage revision has comparable success rates and less morbidity compared to two-stage treatment, when selecting the right patients. In our opinion, PJI caused by Salmonella should be treated just as PJI caused by other bacteria, with consideration of the selection criteria as mentioned in several treatment guidelines. As illustrated by these two cases, one-stage revision can be successful in both early and late Salmonella PJI of the hip.展开更多
Interleukin-11(IL-11)is a member of the IL-6 family of cytokines.1 IL-11 activates its target cells via binding to the IL-11 receptor(IL-11R),which also exists in soluble forms generated by proteolytic cleavage(sIL-11...Interleukin-11(IL-11)is a member of the IL-6 family of cytokines.1 IL-11 activates its target cells via binding to the IL-11 receptor(IL-11R),which also exists in soluble forms generated by proteolytic cleavage(sIL-11R,required for trans-signaling).2 Formation of the IL-11/IL-11R complex leads to the recruitment and homodimerization of two molecules of the signal-transducingβ-receptor gp130,which then activates intracellular signaling cascades,including the Jak/STAT,PI3K and ERK pathways.展开更多
Emerging antibiotic resistance is a major global health threat. The analysis of nucleic acid sequences linked to susceptibility phenotypes facilitates the study of genetic antibiotic resistance determinants to inform ...Emerging antibiotic resistance is a major global health threat. The analysis of nucleic acid sequences linked to susceptibility phenotypes facilitates the study of genetic antibiotic resistance determinants to inform molecular diagnostics and drug development. We collected genetic data (11,087 newly-sequenced whole genomes) and culture-based resistance profiles (10,991 out of the 11,087 isolates comprehensively tested against 22 antibiotics in total) of clinical isolates including 18 main species spanning a time period of 30 years. Species and drug specific resistance patterns were observed including increased resistance rates for Acinetobacter baumannii to carbapenems and for Escherichia coli to fluoroquinolones. Species-level pan-genomes were constructed to reflect the genetic repertoire of the respective species,including conserved essential genes and known resis-tance factors. Integrating phenotypes and genotypes through species-level pan-genomes allowed to infer gene–drug resistance associations using statistical testing. The isolate collection and the analysis results have been integrated into GEAR-base,a resource available for academic research use free of charge at https://gear-base.com.展开更多
文摘BACKGROUND Major adverse cardiovascular(CV)events(MACEs)are the primary cause of morbidity and mortality in kidney transplantation(KT)recipients.The risk for MACEs is impacted by an array of traditional and transplant-related non-traditional CV risk factors.AIM To investigate the association between potential CV risk factors related to KT and MACEs,and their potential modification by hyperuricemia(HU).METHODS The relationship between CV risk factors related to KT and MACEs was examined in a cohort of 545 patients who underwent transplantation between 2008 and 2019.The mean age of patients at KT was 55.0 years±14.2 years(range 15.0–89.0 years).Univariate and multivariate logistic regression models were constructed to identify risk factors influencing MACEs.To explore the potential effect modification by uric acid(UA),patients were categorized into groups based on UA levels:(1)Low(<356μmol/L);(2)Normal(356–416μmol/L);(3)High(416–475μmol/L);and(4)Very high(>475μmol/L).RESULTS MACEs occurred in 145 of 545(26.6%)KT recipients.The most prevalent comorbidities were hypertension(87%),dyslipidemia(78%),secondary hyperparathyroidism(68%),HU(63%)and anemia(33%).In the multivariate logistic regression model,the most significant factors associated with MACEs were previous CV events[odds ratio(OR)=70.6,95%CI:24.9–200.1],left ventricular hypertrophy(LVH)(OR=12.6,95%CI:2.7–58.3),HU treatment(OR=4.3,95%CI:2.4–7.6),and anemia(OR=5.3,95%CI:2.9–9.8).Effect modification by the presence of HU revealed that independent factors associated with MACEs were age(OR=1.03,95%CI:1.0–1.1),previous CV events(OR=41.7,95%CI:13.6–127.6),LVH(OR=15.3,95%CI:2.0–116.6),HU treatment(OR=2.5,95%CI:1.3–4.6)and anemia(OR=5.4,95%CI:2.8–10.5).Effect modification by UA levels dichotomized at 475μmol/L(very high level of UA)revealed that HU treatment was not associated with MACEs in groups with or without very high UA levels.CONCLUSION A very high level of UA was observed to act as an effect-modifying factor for MACEs,especially when combined with other risk factors such as age,previous CV events,LVH,and anemia.
基金supported by a grant of the German Foundation for the Chronically Ill,Alexander strasse 26,90762 Furth,Germany.
文摘Purpose:The guidelines on the management of patients with heart failure support intensive patient education on self-care.The present study aimed to evaluate the short-term and long-term impacts of a structured education provided by a qualified heart failure nurse on patients'self-care behavior and disease knowledge.Methods:One hundred fifty patients(66±12 years)hospitalized for heart failure participated in a structured one-hour educational session by a heart failure nurse.Patients completed a questionnaire comprising 15 questions(nine questions from the European Heart Failure Self-Care Behavior Scale[EHFScB-9]and six on the patients'disease knowledge)one day before and one day and six months after the educational session.Possible responses for each question ranged from 1(complete agreement)to 5(complete disagreement).Results:After the educational session,the total EHFScB-9 score improved from 24.31±6.98 to 14.94±6.22,and the disease knowledge score improved from 18.03±5.44 to 10.74±4.30(both P<0.001).Scores for individual questions ranged from 1.26±0.81(adherence to the medication protocol)to 3.66±1.58(everyday weighing habits)before the education.The greatest improvement after education was observed on response to weight gain(-2.00±1.57),daily weight control(—1.77±1.64),and knowledge on the cause of patients'heart failure(-1.53±1.43).At 6-month follow-up,EHFScB-9 score was 17.33±7.23 and knowledge score was 12.34±5.30(both P<0.001 compared with baseline).No factor was predictive of an insufficient teaching effect.Conclusions:The educational program led by a qualified nurse improves patients'self-care behavior and disease knowledge with a persistent effect at 6-month follow-up.There are no patient characteristics which preclude the implementation of an educational session.
文摘In this study, we explored to combine traffic maps and smartphone trajectories to model traffic air pollution, exposure and health impact. The approach was step-by-step modeling through the causal chain: engine emission, traffic density versus traffic velocity, traffic pollution concentration, exposure along individual trajectories, and health risk. A generic street with 100 km/h speed limit was used as an example to test the model. A single fixed-time trajectory had maximum exposure at velocity of 45 km/h at maximum pollution concentration. The street population had maximum exposure shifted to a velocity of 15 km/h due to the congestion density of vehicles. The shift is a universal effect of exposure. In this approach, nearly every modeling step of traffic pollution depended on traffic velocity. A traffic map is a super-efficient pre-processor for calculating real-time traffic pollution exposure at global scale using big data analytics.
文摘We describe two cases of prosthetic joint infection(PJI) of the hip due to Salmonella. The first patient presented with an early infection 5 d after being discharged following a total hip replacement and the second patient presented at the emergency ward with a late infection, thirteen years following a total hip replacement. Both cases occurred within one month of each other at our institution and both were successfully treated with a one-stage revision. PJI caused by Salmonella species is very rare: so far only 20 Salmonella PJIs of the hip have been described. Therefore, full consensus on the best treatment approach has not yet been reached. An aggressive two-stage approach is advised because of the virulence of Salmonella, although a limited number of successful one-stage approaches have been describedas well. According to the latest guidelines, one-stage revision has comparable success rates and less morbidity compared to two-stage treatment, when selecting the right patients. In our opinion, PJI caused by Salmonella should be treated just as PJI caused by other bacteria, with consideration of the selection criteria as mentioned in several treatment guidelines. As illustrated by these two cases, one-stage revision can be successful in both early and late Salmonella PJI of the hip.
基金supported by a grant from the Deutsche Forschungsgemeinschaft(No.125440785,SFB877,A10).
文摘Interleukin-11(IL-11)is a member of the IL-6 family of cytokines.1 IL-11 activates its target cells via binding to the IL-11 receptor(IL-11R),which also exists in soluble forms generated by proteolytic cleavage(sIL-11R,required for trans-signaling).2 Formation of the IL-11/IL-11R complex leads to the recruitment and homodimerization of two molecules of the signal-transducingβ-receptor gp130,which then activates intracellular signaling cascades,including the Jak/STAT,PI3K and ERK pathways.
基金supported by Siemens Healthcare, the Curetis Groupparts by the Best Ageing Program from the European Union (Grant No. 306031)the Austrian Research Promotion Agency (Grant Nos 866389 and 863729)
文摘Emerging antibiotic resistance is a major global health threat. The analysis of nucleic acid sequences linked to susceptibility phenotypes facilitates the study of genetic antibiotic resistance determinants to inform molecular diagnostics and drug development. We collected genetic data (11,087 newly-sequenced whole genomes) and culture-based resistance profiles (10,991 out of the 11,087 isolates comprehensively tested against 22 antibiotics in total) of clinical isolates including 18 main species spanning a time period of 30 years. Species and drug specific resistance patterns were observed including increased resistance rates for Acinetobacter baumannii to carbapenems and for Escherichia coli to fluoroquinolones. Species-level pan-genomes were constructed to reflect the genetic repertoire of the respective species,including conserved essential genes and known resis-tance factors. Integrating phenotypes and genotypes through species-level pan-genomes allowed to infer gene–drug resistance associations using statistical testing. The isolate collection and the analysis results have been integrated into GEAR-base,a resource available for academic research use free of charge at https://gear-base.com.
