Above-median Group Research Articles

Expression of F0 ATP synthase C subunit in serum of patients with ischemic heart disease and its clinical implications

To investigate the expression and clinical significance of F0 ATP synthase C subunit (Csub) in patients with ischemic heart disease (IHD). The 101 patients with chest pain admitted to the department of emergency of the People's Hospital of Yuhuan from May 2019 to December 2020 were enrolled, including 59 patients with acute myocardial infarction (AMI) and 42 patients with unstable angina pectoris (UAP). At the same time, 50 age-matched healthy subjects in the health examination center were selected as the healthy control (HC). All patients had completed blood sampling before the intervention of drugs or other intervention measures in the emergency room. The content of serum Csub was detected by enzyme linked immunosorbent assay (ELISA), and the relationship between Csub and clinical characteristics was analyzed. At the same time, the contents of hypersensitivity cardiac troponin T (hs-cTnT) and MB isoenzyme of creatine kinase (CK-MB) in blood were detected by electrochemical luminescence. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the value of Csub, hs-cTnT, and CK-MB in the early diagnosis of IHD. The baseline data such as age, gender, and history of the three groups were balanced. There were significant differences in low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), CK-MB, hs-cTnT and B-type natriuretic peptide (BNP), but there were no significant differences in other biochemical indexes. The Csub content in the AMI group and the UAP group were significantly higher than those in the HC group [8.96% (6.37%, 11.53%), 4.27% (3.23%, 6.49%) vs. 1.56% (1.07%, 2.33%), both P < 0.01]. Moreover, the Csub in the AMI group with more severe myocardial ischemia was higher than UAP group [8.96% (6.37%, 11.53%) vs. 4.27% (3.23%, 6.49%), P < 0.01]. A total of 59 patients with AMI were treated with percutaneous coronary intervention (PCI). According to the median of Csub, AMI patients were subdivided into above-median group (29 cases) and below-median group (30 cases). The results showed that there were no significant differences in the number of coronary artery lesion branches, the number of stent implantation and postoperative medication between the two groups. ROC curve analysis showed that the area under the curve (AUC) and 95% confidence interval (95%CI) of Csub, hs-cTnT and CK-MB in the diagnosis of IHD were 0.98 (0.95-1.00), 0.99 (0.99-1.00), 0.94 (0.89-0.99), respectively. The diagnostic efficacy of Csub was slightly lower than that of hs-cTnT but higher than that of CK-MB. When the cut-off value of Csub was 4.74%, the sensitivity and specificity for the diagnosis of IHD were 100% and 87.0%, respectively. Csub increased significantly in the serum of IHD patients, and further increased with the severity of ischemia. It can be used as a new diagnostic biomarker for the diagnosis and evaluation of the development of myocardial ischemia.

The economic burden of health disparities related to socioeconomic status in Israel

BackgroundLow socioeconomic status (SES) is often associated with excess morbidity and premature mortality. Such health disparities claim a steep economic cost: Possibly-preventable poor health outcomes harm societal welfare, impair the domestic product, and increase health care expenditures. We estimate the economic costs of health inequalities associated with socioeconomic status in Israel.MethodsThe monetary cost of health inequalities is estimated relative to a counterfactual with a more equal outcome, in which the submedian SES group achieves the average health outcome of the above-median group. We use three SES measures: the socioeceonmic ranking of localities, individuals’ income, and individuals’ education level. We examine costs related to the often-worse health outcomes in submedian SES groups, mainly: The welfare and product loss from excess mortality, the product loss from excess morbidity among workers and working-age adults, the costs of excess medical care provided, and the excess government expenditure on disability benefits. We use data from the Central Bureau of Statistics’ (CBS) surveys and socio-health profile of localities, from the National Insurance Institute, from the Ministry of Health, and from the Israel Tax Authority. All costs are adjusted to 2014 terms.ResultsThe annual welfare loss due to higher mortality in socioeconomically submedian localities is estimated at about 1.1–3.1 billion USD. Excess absenteeism and joblessness occasioned by illness among low-income and poorly educated workers are associated with 1.4 billion USD in lost product every year. Low SES is associated with overuse of inpatient care and underuse of community care, with a net annual cost of about 80 million USD a year. The government bears additional cost of 450 million USD a year, mainly due to extra outlays for disability benefits. We estimate the total cost of the estimated health disparities at a sum equal to 0.7–1.6% of Israel’s GDP.ConclusionsOur estimates underline the substantial economic impact of SES-related health disparities in Israel. The descriptive evidence presented in this paper highlights possible benefits to the economy from policies that will improve health outcomes of low SES groups.

Factors predicting peripheral blood stem cell (PBSC) mobilization with plerixafor in multiple myeloma patients who had inadequate mobilization with G-CSF.

Background & Aim Autologous transplant utilizing G-CSF mobilized peripheral blood stem cells (PBSC) is considered standard practice for eligible multiple myeloma (MM) patients. G-CSF is often utilized as the preferred agent and Plerixafor added if there is inadequate PBSC mobilization with G-CSF alone. To the best of our knowledge, there are no studies predicting the response of the poor mobilizers to plerixafor. Methods, Results & Conclusion METHODS MM patients undergoing PBSC collection in our institution were retrospectively studied. Patients received 10 μg/kg G-CSF SQ daily. Stem cell collection started on day 4 (after 3 doses of G-CSF) if blood CD34 count on day 4 was at least 10 /μL (Good mobilizer). If not (Poor mobilizer), patients received 240 μg/kg plerixafor SQ and another dose of G-CSF on day 4 followed by collection starting day 5. Complete blood count was measured before G-CSF (day 0) and on days +2, +3, and +4, . and CD34 count on day +5 . Based on day +5 CD34 count patients were categorized into two groups; Above Median (AM) with CD34 count above median or Below Median (BM; CD34 = Results 73 patients were studied. Median age 61 yr, (39-74), 44 (61%) were men. Median CD34 count on day +5 was 41.9/µL, 37 were in BM and 36 in AM groups. Disease duration prior to mobilization strongly correlated with plerixafor response (25.9m v 15.1m in BM v AM, p=0.02) . Mean day 0, day 2 and day 3 platelet count was higher in AM compared to BM (236 v 192,P =0.0075 on day 0, 182 v 148, p=0.0003 on day 2, and 195 v 152 p=0.0001 on day 3). Platelet count dropped from day 0 to day 2 in the whole cohort but more so in the BM compared to AM group (mean drop 20.7% v 15.6%, p=0.04) . Day 0 ANC was not different (2.7 v 2.5,P =0.47) but ANC on day 2 was higher (25.9) in AM compared to 18.6 in BM group, p=0.007. Low CD34 count on day 3 prior to plerixafor administration strongly correlated with plerixafor response (4.5 v 6.7 in BM v AM, p=0.0006) Discussion We found that disease duration, day 0 and day + 2 platelet counts, day +2 ANC and day +3 CD34 counts were sensitive predictors for Plerixafor response. Also we observed that extent of platelet and ANC count change between day 0 and day +2 were predictors of plerixafor response.. These findings have implications for choosing mobilization strategies for patients who have inadequate CD34 mobilization with G-CSF alone.

Revisiting Bowman’s Paradox in Accounting Risk and Return: New Indian Evidence

This study revisits the Bowman’s (1980, 1984) risk-return Paradox using accounting risk and return proxies, for 1004 Indian firms, existing continuously between 2000 to 2015. We find strong evidence of a ‘partial’ paradox. Firms which are poorly performing or below-median in the ranking exhibit a paradox (negative risk-return association), while firms which are relatively superior performers (above-median), exhibit mostly a puzzling ‘U’ pattern (initially negative and then becoming positive). It seems that the relatively poor performing firms within the above-median group, are driven by high ‘aspirations’ to move up the pecking order, having required to face stronger challenges and competition, resort to desperate but risky measures without much success, resulting in a negative risk-return association. The relatively superior performers within this group however, are successful in leveraging their current superior position and adopt risky but successful strategies. These overall patterns seem to be robust and stand good across full sample, across sub-samples based on age, size, leverage or time even after adjustment for industry and the firm’s own past performance.

The renal tubular damage marker urinary N-acetyl-\u03b2-d-glucosaminidase may be more closely associated with early detection of atherosclerosis than the glomerular damage marker albuminuria in patients with type 2 diabetes

BackgroundTo determine the association between urinary N-acetyl-β-d-glucosaminidase (NAG), a marker of renal tubulopathy, and carotid intima-media thickness (IMT) and plaques in patients with type 2 diabetes mellitus (T2D) and to compare the predictive value of NAG versus albuminuria, a marker of renal glomerulopathy.MethodsA total of 343 participants were enrolled in this retrospective cross-sectional study. We recruited participants with T2D who were tested for blood glucose parameters, urinary NAG, and urinary albumin-to-creatinine ratio (ACR) and had been checked for carotid ultrasonography.ResultsWe classified participants into a below-median urinary NAG group (Group I; n = 172) or an above-median group (Group II; n = 171). Mean, maximum, and mean of maximum carotid IMT and the proportion of patients with carotid plaques were significantly higher in Group II compared with Group I. In multiple linear regression analyses, high urinary NAG (Group II) was significantly associated with carotid IMT, independently of urinary ACR and other confounding factors. In terms of carotid plaques, both urinary NAG and ACR were significantly higher in participants with carotid plaques than in those without carotid plaques. After adjustment for confounding factors, both urinary NAG and ACR were significantly associated with the presence of carotid plaques.ConclusionsElevated urinary NAG, a marker of renal tubular damage, was related to increased carotid IMT and the presence of carotid plaques in patients with T2D. Urinary NAG may be a more sensitive biomarker than urinary albumin for early detection of atherosclerosis.

일부지역 노인종합복지관 노인들의 주관적 구강상태와 구강건강영향지수(OHIP-14)와의 관련성

본 연구는 노인의 주관적 구강상태와 구강건강영향지수와의 관련성을 알아보고, 이를 통해 삶의 질 향상 및 구강관리 방안을 위한 기초자료로 제시하고자 하였다. 2011년 5월부터 6월까지 조사, 연구대상은 65세이상 노인 231명으로 하였다. OHIP-14의 중위값을 산출하여 중위값(2.08) 보다 높은 그룹을 상위그룹으로, 평균보다 낮은 그룹을 하위그룹으로 나누어 구강보건행태와 주관적인 구강상태를 교차분석으로 측정하였고, 구강건강영향지수에 영향을 미치는 요인을 알아보기 위해 상관분석과 회귀분석을 실시하였다. 구강보건행태에 따른 구강건강영향지수는 유의하지 않았으며, 주관적 구강상태에 따른 구강건강영향지수는 현재 구강상태, 저작지장, 치통, 잇몸질환, 구강건조증, 구취 항목이 구강건강영향지수에 영향을 주고 있었다. 또한 구강건강영향지수에 영향을 미치는 요인을 확인하기 위한 회귀분석결과 저작지장, 치통, 구강건조증, 잇몸질환 경험이 높을수록 가장 영향을 미치는 것으로 나타났다. 이는 구강건강 영향지수가 높을수록 주관적 구강상태가 건강하지 못하다는 것을 알 수 있었다. 향후 노인의 삶의 질 향상을 위한 구강건강증진 예방프로그램 개발과 적극적인 구강관리 방안이 필요할 것으로 사료된다. This study aimed to examine the relation between subjective oral hygiene status of the elderly and oral health impact profile and to present it as basic data for the improvement of quality of life and oral care. The study subjects were 231 elderly people aged 65 and over. This study measured the oral health behavior and subjective oral hygiene status based on cross analysis by calculating the median of OHIP-14 to divide the above-median group into a subgroup and the below-median group into a superordinate group. Correlation and regression analyses were performed to examine the effects on the oral health impact profile. The oral health impact profile according to oral health behaviors was not significant. The oral health impact profile based on the subjective oral hygiene states is currently affected by oral hygiene status, masticatory problems, toothache, xerostomia and halitosis. As a result of regression analysis to confirm the effect on the oral health impact profile, much experience of masticatory problems, toothache, xerostomia and gum diseases is the most influential. This shows that the subjective oral hygiene status is not healthy as the oral health impact profile is high. It is considered necessary to establish an oral health promotion program to improve the quality of life of the elderly and active oral care methods in the future.

Description of self‐reported fluid intake and its effects on body weight, symptoms, quality of life and physical capacity in patients with stable chronic heart failure

To describe the self-reported fluid intake and its effects on body weight, signs and symptoms of heart failure, quality of life, physical capacity and thirst, in patients with stabilised chronic heart failure. Patients with chronic heart failure are often recommended a fluid restriction of 1.5 l/day but there is no evidence in the literature for this recommendation and little is known about the fluid intake consequences. Crossover study. Chronic heart failure patients, clinically stabilised after an unstable state, were randomised to a 32-week cross-over study assessing the clinical importance of fluid prescription. In a secondary analysis of 63 patients, efficacy variables were analysed in relation to the self-reported median fluid intake of 19 ml/kg body weight/day. The mean fluid intake was 16 ml/kg/day in the below-median group and 24 ml/kg/day in the above-median group. No between-group differences were found in change in body weight, signs and symptoms, diuretic use, quality of life or physical capacity. However, the above-median group significantly decreased sense of thirst and difficulties to adhere to the fluid prescription compared with the below-median group. In clinically stabilised chronic heart failure patients on optimal pharmacological treatment, a larger fluid intake was associated with decreasing thirst without any measurable negative effects on signs and symptoms of heart failure, diuretic use or physical capacity. Thus, a more liberal fluid intake may be advisable in chronic heart failure patients who have been stabilised after an initial unstable clinical state. Nurses involved in the care for patients with heart failure known how troublesome thirst can be and how difficult it can be to follow a restricted fluid intake. This study indicates that it is possible to reassess and recommend a less strict fluid intake in stabilised patients with chronic heart failure.

Mercaptopurine metabolism and risk of relapse in childhood lymphoblastic leukaemia

Many months' treatment with daily oral mercaptopurine is an important part of therapy for nearly all children with lymphoblastic leukaemia (ALL). Even when prescribed the same dose based on body surface area, patients have widely different intracellular concentrations of drug metabolites. Whether this variation matters in terms of disease control is not yet clear. To find out, we followed up a large group of children with ALL in whom mercaptopurine-derived thioguanine nucleotides in the red cells were measured during treatment with an identical dose of mercaptopurine early in first remission. 172 unselected children (100 boys, 72 girls) were recruited between 1980 and 1992. At median follow-up of 5 years from diagnosis 42 (24%) had relapsed; 30 had erythrocyte thioguanine nucleotide concentrations below the group median (284 pmol per 8 × 108 erythrocytes) and 12 had values above the median. The actuarial relapse-free survival at 5 years was 63% in the below-median group and 84% in the above-median group (difference 21% [95% Cl 3-39%], p=0·0018). Multivariate analysis showed that erythrocyte thioguanine nucleotide concentration was independent of other prognostic variables including age, leukaemia immunophenotype, white-blood-cell count at diagnosis, trial protocol, and sex. Whatever the cause, in childhood ALL variable formation of intracellular mercaptopurine metabolites seems to be clinically important. Therapeutic schedules that include long-term daily oral mercaptopurine might be more effective if such metabolites are monitored.