First Year Of Observation Research Articles

The dynamic system analysis of lemuru fishery in Bali strait by using biological parameter yield of some surplus production models

Stock assessment in any fisheries scientific study is an effort to determine the productivity of fishery resource, the effect of catch on resources and changes in catch patterns, for example due to implementation of management and development policies. It involves 3 (three) main aspects: the first, determine total biomass by using surplus production model; the second, determine recruitment (the number of fish that has reached the age during one recruitment season) can use Ricker model; the third, determine the equation of growth in the fishery can use Von Bertalanffy model. Mathematical models are mostly used to describe the dynamics of fish populations. In the use of appropriate models in stock assessment will result in a more appropriate basis in selecting fishing methods and advanced analysis of catches, hence required a plan in the sustainable management and utilization of fish resources. The study of sustainable dynamic of lemuru fisheries management in Bali strait is the dynamics of biomass of lemuru fishery by using the biological parameters yield of some surplus production models. By obtain the biological parameter values r, q and K, we obtain the dynamic trajectory between biomass and time, indicates that at the first year of observation, the biomass level is relatively high, but when several years later the biomass tends to decrease until it reaches the stable of biomass obtained for about 30 years and so on (t > 30).

APPLICATION OF RADIO-WAVES COAGULATION TECHNIQUE FOR THE TREATMENT OF HEMANGIOMAS OF THE MAXILLOFACIAL AREA

Statistics of the last years indicates the significant incidence of vascular neoplasms, the most of which are located at the maxillofacial area – 68–80 %, multi sites simultaneously – 20%. According to histological signs the capillary tumors are 51%, cavernous – 42%, combined – 4%, mixed – 3% of cases.
 Currently, in surgical dentistry, the problematic choice of new technical means and technologies that can increase the effectiveness of surgical treatment for the most common types of pathologies remains relevant.
 Despite numerous methods of treatment for benign vascular tumors (surgical, radiation, cryosurgical, electrosurgical, laser, sclerotherapy), the results leave much to be desired, as many authors note a significant percentage of tumor recurrence, as well as complications during the operation. As a rule, they are characterized by multiple procedures and are not accompanied by a more radical removal of hemangiomatous tissues, in this connection constant seek for new methods of hemangiomas treatment for children and adults is provided.
 At the same time, the expediency and effectiveness of radio wave coagulation remains an open question, as one of the latest among the high-tech methods of tissue dissection.
 This publication presents the results of cavernous hemangiomas treatment for the maxillofacial area by radio-wave coagulation.
 In all clinical cases, operations were performed practically with noninvasive technique. In the early postoperative period, there was a slight swelling of the tissues without the infiltration in the area of the wound. Healing process of the wound in all patients occurred below the crust, which persisted on average 7-10 days after the procedure, with the formation of the hardly noticeable scar, the shape, size and elasticity of which did not change during the first year of observation. The state of the scar in 52 cases (91%) was estimated as good (7-9 points according to the scale), in 5 (9%) – satisfactory (10-11 points according to the scale). A review in dynamics after 6 months allowed detecting recurrent disease in 4 patients (7%) with localization of hemangiomas in the scalp area, upper and lower lip. Recurrence cases of hemangiomas were noticed as small-spotted hemangiomatous lesions of the skin at the border of the tumor or in the area of the postoperative scarring, which were re-operated with a needle-shaped electrode of 0.02 mm in diameter.
 The application of radiosurgical technique allows us to conclude that this is a tool to minimize the risk of intra- and postoperative complications and reduce the period of rehabilitation of patients.
 Thus, the application of radio-wave coagulation for the treatment of maxillofacial hemangiomas is promising and allows us to discover the following advantages: greatly facilitates the work of the surgeon, reduces the traumatism and duration of surgical intervention; minimizes blood loss; reduces the percentage of postoperative complications; contributes to the formation of aesthetic scar.
 The obtained data indicate the expediency of using the method of radio-wave coagulation in the treatment of cavernous hemangiomas of the maxillofacial area.

THE RESULT OF LAPAROSCOPIC AND LAPAROTOMIC TREATMENT OF PATIENTS WITH EXTERNAL GENITAL ENDOMETRIOSIS USING IMMUNE RESPONSE MODIFIER

The objective of the work was to make a comparative analysis of the result of external genital endometriosis treatment with the use of traditional surgical intervention and hormone therapy together with the use of low-molecular-weight metabolic immune response modifier 5-amino-1,2,3,4-tetrahydrophthalazine-1,4-dione of sodium salt. Materials and methods: the experimental part of the study was previously conducted on 50 female rats which consisted of studying the influence of the immune response modifier on the course of experimentally induced endometriosis in experimental animals, in particular on changes in the estrous cycle. Injection of the immune response modifier caused retrogression of endometrioid heterotopias and normalization of the estrous cycle in the animals. The comparative analysis of the results of external genital endometriosis treatment in 66 women was conducted on the basis of experimental research. 34 women, apart from surgical intervention and hormone therapy, were injected with the immune response modifier 5-amino-1,2,3,4-tetrahydrophthalazine-1,4-dione of sodium salt during the post surgical period. Cellular immunity, T- and B-lymphocytes, and equipment and instrumental methods, such as medical ultrasound of the organs of the lower pelvis and laparoscopy, were used to assess the results of treatment. As a result of the treatment with the use of the immune response modifier the indicators of cells immunity changed, pain severity decreased, menstrual function normalized, relapse frequency reduced, and the overall quality of life for patients improved. Socially significant effect of treatment of external genital endometriosis using metabolic immune response modifier is manifested in implementation of reproductive function ‒ elimination of infertility in 50 % of women during the first year of observation.

PF391 INFLUENCE OF ATORVASTATIN THERAPY ON GALECTIN‐3, VE‐CADHERIN, AND CARDIOVASCULAR RISK IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA

Background:The vast majority of chronic lymphocytic leukemia survivors experience late effect of treatment including cardiovascular events. These effects contribute most of the substantial effects excess mortality in patients with full or partial response to CLL treatment.Aims:We aimed to evaluate the impact of atorvastatin on galectin‐3 and VE‐cadherin, and cardiovascular risk in patients with chronic lymphocytic leukemia in remission.Methods:One hundred fifty seven out subjects with chronic lymphocytic leukemia in full or partial remission were enrolled in the study. Atorvastatin at doses 20 mg/d and 40 mg/d was prescribed for patients with hypercholesterinemia, dyslipidemia, coronary artery disease risk factors. Blood samples for biomarkers measurements were collected at the visit of inclusion into the study. Plasma levels of galectin‐3, and VE‐cadherin were measured by ELISA method at baseline and after 1 year of observation period.Results:Two hundred seventy cumulative clinical events occurred in 68 patients (43.3%) within the follow‐up, with their distribution being as follows: 12 deaths for cardiovascular reasons, 17 life‐threatening arrhythmias, 36 cardiac ischemic events, 9 strokes, 38 decompensated chronic heart failures, and 58 hospital admissions for cardiovascular reasons. Patients were divided to two groups depending on the atorvastatin treatment. At baseline there were no difference in levels of biomarkers between groups. In one year there were significant differences in levels of galectin‐3 (8,86 ± 5,62 ng/ml vs 16,74 ± 8,52 ng/ml; р = 0,035), VE‐cadherin (0,76 ± 0,64 ng/ml vs 2,19 ± 1,66 ng/ml; р = 0,046) in the group without atorvastatin treatment. The optimal cut‐off point of galectin‐3 level for distinguishing high cardiovascular risk patients from low risk ones was 11.75 ng/ml, with a sensitivity of 70.4% and a specificity of 96.8%; for VE‐cadherin – 0.53 ng/ml, with a sensitivity of 72.6% and a specificity of 95.2%. Combination of galectin‐3 and VE‐cadherin had high negative prognostic value (93.4%) for evaluation of cardiovascular events.Atorvastatin treatment were associated with decreasing of cumulative cardiovascular events with appearance of early differences between groups during 3 year observation time (long‐rank test, χ2 = 11,775, р = 0,001). During first year of observation event‐free survival were better for patients treated with atorvastatin 40 mg/d in comparing to patients treated with atorvastatin 20 mg/d (long‐rank test, χ2 = 6,147, р = 0,013).Summary/Conclusion:Among patients with chronic lymphocytic leukemia in remission galectin‐3 and VE‐cadherin are associated with increased risk of cardiovascular events within 3 year observation period. Atorvastatin prevents increasing of galectin‐3 and VE‐cadherin and reduces risk of cardiovascular events in this group of patients. It was proposed to prescribe atorvastatin to patients with level of galectin‐3 11.75 ng/ml or higher, and/or level of VE‐cadherin 0.53 mg/ml or higher for prevention of cardiovascular events during 3 year period.

METHODICAL APPROACHES TO THE ANALYSIS OF THE ACTIVITIES OF THE CANCER SERVICE ON THE BASIS OF THE FORMS OF STATE REPORTING AND THE DATABASE OF THE POPULATION CANCER REGISTER OF THE NORTHWESTERN FEDERAL DISTRICT. PART II

On the second part of the article the main attention is paid to the analysis of survival of patients with malignant tumors calculated on the base of the database of the population cancer register of the northwestern Federal district. The main criterion for assessing the state of oncological service is 1 and 5-years observed and relative survivals of patients with malignant tumors. Unfortunately, the number of cancer registers calculating survival rates of patients with malignant tumors according to international standards is limited in Russia. We present calculations of the dynamic series of the survival median. Defects of its objective assessment are revealed. Positive dynamics of 5-year observed survival of patients with malignant tumors in the Russian Federation is shown. Dynamics of 1 and 5 year survival of cancer patients is considered in pairs taking into account sex, age and stage of disease. There has been some improvement, especially among the female population. As can be seen from the data presented at the first year of observation, about 35 percent of patients die in the region, as in the most European countries.

PF739 SICKLE CELL DISEASE IN GERMANY IS HETEROGENEOUS AND RESULTS IN SEVERE MORBIDITY: ANALYSES FROM A NATIONAL REGISTRY

Background:Sickle Cell Disease (SCD) in Germany exclusively affects immigrants and their descendants. Its increasing prevalence results in challenges for medical care for these patients.Aims:The registry aims at describing the epidemiology, clinical course and treatment of patients with SCD in Germany.Methods:To date, 367 patients have been included in the registry by 36 mainly pediatric institutions. At initial registration, basic data including date of birth, date and circumstances of diagnosis, genotype, country of origin, blood type and complications in the patient's history are reported. Annual follow‐ups document details on complications, laboratory parameters and treatment. Data of 327 patients were analyzed for this abstract.Results:Genotypes of registry patients were homozygous SCD in 75% of patients, HbSC disease in 12%, HbS/β0thal in 6% and HbS/β+thal in 7%. The main regions of origin were sub‐Saharan Africa (in total 69% of patients, including Ghana 19%, Nigeria 19%, Togo 9%) and the Middle East (in total 21%, including Lebanon 6%, Turkey 5%, Syria 4%). Although pilot projects for newborn screening for SCD were in place in some of the centers, only 35% of patients were diagnosed during their first year of life, 85% before the age of six. SCD was diagnosed on the occasion of presenting symptoms in 60% of patients. The mean age at registration was 12 years (median 10), with 10% of patients being older than 21 years at registration. The most frequent complications in the patients’ prior history were pain crises with hospitalization (67% of patients), acute chest syndrome (32%), splenic sequestration (15%), aplastic crisis (10%), stroke (4%) and sepsis (4%).During the first year of observation, 47% of the registry patients were hospitalized, 11% required treatment on an intensive care unit. Red blood cell transfusions were given to 27% of patients. 96% of patients with homozygous SCD or with HbS/β0thal at an age of 2 years or older were prescribed hydroxycarbamide, 76% of these patients under the age of 18 were annually examined by transcranial Doppler ultrasound (TCD).Summary/Conclusion:Patients with SCD in Germany are genetically and ethnically highly heterogeneous and suffer from severe morbidity. The diagnosis is frequently made too late because of the lack of a routine newborn screening for SCD. While the high rate of hydroxycarbamide prescription indicates good care at the institutions that contribute to the registry, the insufficient proportion of patients receiving routine TCD checks indicates an incomplete availability of the diagnostic infrastructure required for the optimal care of this challenging group of patients.

Validación de las tablas del grupo CUETO para predecir la recurrencia y progresión del carcinoma urotelial de vejiga T1G3

Introduction and objectivesVarious studies tried to validate Club Urológico Español de Tratamiento Oncológico (CUETO) tables, yet, none of this papers focused on the high and very high risk bladder cancers. The aim of the study was to externally validate the CUETO model for predicting disease recurrence and progression in group of T1G3 tumors treated with BCG immunotherapy. Patients or materials and methodsData from 414 patients with primary T1G3 bladder cancer were analysed. To evaluate the model discrimination, Cox proportional hazard regression models were created and concordance indexes were calculated. ResultsThe median follow-up was 68 months. The recurrence was observed in 212 (51.2%) and 64 patients (15.5%) experienced the recurrence more than once during the study follow-up. Progression of the cancer was observed in 106 patients (25.6%). Radical cystectomy was performed in 115 patients (27.8%) and there were 64 (15.5%) cancer specific deaths. For recurrence and progression probability, the concordance index of the CUETO models was 0.633 and 0.697 respectively. CUETO tables underestimated significantly the risk of recurrence and marginally the risk of progression in the first year of observation. For 5 years of observation, the trend for the recurrence was much less clear. On the contrary, there was slight overestimation in the risk of progression. The study is limited by retrospective nature. ConclusionsIt was shown that the CUETO risk tables exhibit a fair discrimination for both disease recurrence and progression in T1G3 patients treated with BCG. CUETO scoring model underestimates the risk of tumor recurrence, but predicts well risk of progression.

Вплив показника глибокостегново-підколінного індексу на результати непрямих способів реваскуляризації нижніх кінцівок

Сhronic critical ischemia is recorded from 400 to 1000 cases per 1 million population per year. However, reconstructive surgery can only be performed in half of these patients, and without surgery, 95% of patients performed amputation of the lower extremity during the first year of observation. One of the important problems in the planning of the type of reconstruc-tion in chronic ischemia is the assessment of blood flow on the collateral branches and the condition of the arteries of the lower leg, occlusion which creates obstacles to adequate flow of blood to the distal limbs and is the cause of poor results of bypass surgery. Choosing a method for surgical treatment of patients with obliterating atherosclerosis of the lower extremi-ties is one of the most difficult problems in vascular surgery.

Different Treatment Regimens, Optimal Time Points and Threshold Level While Minimal Residual Disease Evaluation in AML Patients

Introduction. Minimal residual disease (MRD) detection by multicolor flow cytometry (MFC) after early induction or consolidation AML therapy is a well known factor of adverse prognosis, especially in intermediate risk group. New assessment of response in AML is complete remission with MRD-negative status. However, there is still no standardization of MFC method for AML patients (pts). Optimal time point for MRD status and its threshold value vary in different studies.Aim. To study different consolidation treatment regimens in AML pts by measuring of MRD reduction, to determine optimal time point and threshold level for additional risk stratification.Patients and methods. From March 2016 to February 2018 42 pts (younger than 60 y.o.) with newly diagnosed AML were included in prospective MRD study in hematology department of National Research Center for hematology. Initial leukemia-associated immunophenotype was analysed before any treatment, and bone marrow assessment for MRD detection was performed in CR pts after 1st and 2nd chemotherapy courses. The standard antibody panel included CD19, CD7, CD2, CD38, CD65, CD66b, CD99 (FITC); CD56, CD15, CD11b, CD13 (PE); CD33 (APC); HLA-DR, CD14, CD16, CD117 (PerCP-Cy 5.5); CD45 (APC-H7) and CD34(PE-Cy7). For results record BD FACSCanto II (Becton Dickinson) machine was used. The first course for all pts was the standard «7+3». Before March 2017 the second course was also «7+3» and included 25 pts, after March 2017 - 17 pts received intensive «Flarida» regimen (Fludarabine 30mg/m2 1-4, Ara-C 1g/m2 1-4, Idarubicin 8mg/m2 1,3). The 2nd MRD test was compared in these two groups. There was no difference between the two groups by pts in CR after the first «7+3», ELN status and age.Results. By using of special mathematical and statistical method the threshold value of 0,01% was estimated for long-term prognosis. Two years relapse-free survival (RFS) in MRD-positive (MRD+) and MRD-negative (MRD-) groups after the 1st induction was 23% and 87%, respectively (p<0,01). Probability of relapse (PoR) during the first year of observation in these two groups was 72% and 10%, respectively (p<0,01). After the second course 9 more pts in two groups became MRD-negative and 6 of them developed a relapse. RFS in MRD+ and MRD- after the 2nd course was 36% and 65% (p<0,01), and PoR - 71% and 34%, respectively (p<0,01). Multivariate analysis showed MRD factor as the only important in RFS compared to cytogenetic, molecular status, age and initial leukocyte count. OS and RFS in «7+3» and «Flarida» regimens during the first year were 100% vs 80% (p=0,27) and 74% vs 76% (p=0,63), respectively. MRD level reduction after different consolidation regimens («7+3» vs «Flarida») didn't show any variation (p=0,14) and there was no association between MRD status after induction in different ELN groups (p=0,52).Conclusion. MRD threshold value of 0,01% allows to distinguish the two cohorts of AML pts groups: with different prognosis even in any ELN risk subgroups. The RFS was reliably higher in pts with CR and MRD-negative status right after the first induction, which reflected the chemo sensitivity of the tumor. After the consolidation course MRD detection still has a prognostic value. MRD level reduction was not associated with intensification of chemotherapy. There is a great need to achieve MRD negative status in AML pts after the 1st induction course so new therapy approaches are pending. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Compulsory admission is associated with an increased risk of readmission in patients with schizophrenia: a 7-year, population-based, retrospective cohort study.

The aim of this study was to assess the risk of psychiatric readmission in patients with schizophrenia, compare it between patients prescribed compulsory admission and those consenting to voluntary admission, and determine risk factors for psychiatric readmission. This 7-year (2007-2013), population-based, cohort study retrospectively compared data of 2038 schizophrenic inpatients who initially underwent compulsory admission (the CA group) and of 8152 matched controls with schizophrenia who initially underwent voluntary admission (the VA group). During the study period, there were 1204 and 3806 readmissions in the CA and VA groups, respectively. Compared with the VA group, the CA group was associated with a greater risk of psychiatric readmission [adjusted hazard ratio (AHR) = 1.765; 95% confidence interval (CI) 1.389-2.243; P < 0.001]. Stratified analyses showed that the CA group was associated with a higher risk of subsequent compulsory (AHR = 1.307; 95% CI 1.029-1.661; P < 0.001) and voluntary (AHR = 1.801; 95% CI 1.417-2.289; P < 0.001) readmissions compared to the VA group. Sensitivity analyses, after excluding data from the first year of observation, also provided significant findings with respect to compulsory and voluntary readmissions. Kaplan-Meier curves revealed that cumulative survival rates of psychiatric readmissions, compulsory and voluntary readmissions were significantly lower in the CA group than in the VA group among patients with schizophrenia (log-rank test, P < 0.001). CA was associated with higher subsequent psychiatric readmissions, compulsory, and voluntary readmissions. Clinicians would need to focus on patients undergoing CAs to reduce readmissions.

Forecasting the Maturation of Electronic Health Record Functions Among US Hospitals: Retrospective Analysis and Predictive Model.

BackgroundThe Meaningful Use (MU) program has promoted electronic health record adoption among US hospitals. Studies have shown that electronic health record adoption has been slower than desired in certain types of hospitals; but generally, the overall adoption rate has increased among hospitals. However, these studies have neither evaluated the adoption of advanced functionalities of electronic health records (beyond MU) nor forecasted electronic health record maturation over an extended period in a holistic fashion. Additional research is needed to prospectively assess US hospitals’ electronic health record technology adoption and advancement patterns.ObjectiveThis study forecasts the maturation of electronic health record functionality adoption among US hospitals through 2035.MethodsThe Healthcare Information and Management Systems Society (HIMSS) Analytics’ Electronic Medical Record Adoption Model (EMRAM) dataset was used to track historic uptakes of various electronic health record functionalities considered critical to improving health care quality and efficiency in hospitals. The Bass model was used to predict the technological diffusion rates for repeated electronic health record adoptions where upgrades undergo rapid technological improvements. The forecast used EMRAM data from 2006 to 2014 to estimate adoption levels to the year 2035.ResultsIn 2014, over 5400 hospitals completed HIMSS’ annual EMRAM survey (86%+ of total US hospitals). In 2006, the majority of the US hospitals were in EMRAM Stages 0, 1, and 2. By 2014, most hospitals had achieved Stages 3, 4, and 5. The overall technology diffusion model (ie, the Bass model) reached an adjusted R-squared of .91. The final forecast depicted differing trends for each of the EMRAM stages. In 2006, the first year of observation, peaks of Stages 0 and 1 were shown as electronic health record adoption predates HIMSS’ EMRAM. By 2007, Stage 2 reached its peak. Stage 3 reached its full height by 2011, while Stage 4 peaked by 2014. The first three stages created a graph that exhibits the expected “S-curve” for technology diffusion, with inflection point being the peak diffusion rate. This forecast indicates that Stage 5 should peak by 2019 and Stage 6 by 2026. Although this forecast extends to the year 2035, no peak was readily observed for Stage 7. Overall, most hospitals will achieve Stages 5, 6, or 7 of EMRAM by 2020; however, a considerable number of hospitals will not achieve Stage 7 by 2035.ConclusionsWe forecasted the adoption of electronic health record capabilities from a paper-based environment (Stage 0) to an environment where only electronic information is used to document and direct care delivery (Stage 7). According to our forecasts, the majority of hospitals will not reach Stage 7 until 2035, absent major policy changes or leaps in technological capabilities. These results indicate that US hospitals are decades away from fully implementing sophisticated decision support applications and interoperability functionalities in electronic health records as defined by EMRAM’s Stage 7.

Deconstructing progression of amyotrophic lateral sclerosis in stages: a Markov modeling approach

Objectives: Propose an empirical amyotrophic lateral sclerosis (ALS) staging approach called Fine’til 9 (FT9) based on how many of the patient’s ALS functional rating scale (ALSFRS-R) subscores are 9 or less (of normal 12). Gain insights into progression of ALS by applying Markov models to ALS stages by multiple systems (King’s, Milan–Torino system (MITOS) and FT9).Methods: Patients from the Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT) dataset were staged using ALSFRS-R responses. Risks of progression through stages and death were estimated, as were effects of prognostic variables on these risks.Results: A total of 29,947 time points in 3199 patients from the PRO-ACT dataset were assigned stages. Although the three systems were moderately correlated, MITOS stages were heavily skewed toward advanced disease, whereas King’s and FT9 stages were more balanced. Non-sequential progression was observed with King’s system. Markov models adequately described transitions from stage to stage in the first year of observation, but underestimated risks beyond that point. Regardless of staging method, initial rate of ALSFRS-R decline had a powerful effect on rate of progression through sequential stages, whereas age predominantly influenced stage-specific mortality.Conclusion: King’s and FT9 are more sensitive to observed progression of disease in clinical trials than MITOS. FT9 can partition the course similar to King’s, and may have advantages of sequential progression and easy applicability to retrospective data. Markov transition intensity estimates may be of value for counseling, health economic studies, and research design. In particular, this framework permits estimation of multidimensional effects of variables (including treatment) on outcome.

An empiric analysis of 5 counter measures against surgical site infections following spine surgery—a pragmatic approach and review of the literature

BACKGROUND CONTEXTSurgical site infections (SSI) following spine surgery are debilitating complications to patients and costly to the healthcare system. PURPOSEReview the impact and cost effectiveness of 5 SSI prevention interventions on SSI rates in an orthopedic spine surgery practice at a major quaternary healthcare system over a 10-year period. STUDY DESIGNRetrospective observational study. PATIENT SAMPLEAll of the surgical patients of the 5 spine surgeons in our department over a 10-year period were included in this study. OUTCOME MEASURESSSI rates per year, standardized infection ratios (SIR) for laminectomies and fusions during the most recent 3-year period, year of implementation, and frequency of use of the different interventions, cost of the techniques. METHODSThe SSI prevention techniques described in this paper include application of intrawound vancomycin powder, wound irrigation with dilute betadine solution, preoperative chlorhexidine gluconate scrubs, preoperative screening with nasal swabbing, and decolonization of S. aureus, and perioperative antibiotic administration. Our institution's infection prevention and control data were analyzed for the yearly SSI rates for the orthopedic spine surgery department from 2006 to 2016. In addition, our orthopedic spine surgeons were polled to determine with what frequency and duration they have been using the different SSI prevention interventions. RESULTSSSI rates decreased from almost 6% per year the first year of observation to less than 2% per year in the final 6 years of this study. A SIR of less than 1.0 for each year was observed for laminectomies and fusions for the period from 2013 to 2016. All surgeons polled at our institution uniformly used perioperative antibiotics, Hibiclens scrub, and the nasal swab protocol since the implementation of these techniques. Some variability existed in the frequency and duration of betadine irrigation and application of vancomycin powder. A cost analysis demonstrated these methods to be nominal compared with the cost of treating a single SSI. CONCLUSIONSIt is possible to reduce SSI rates in spine surgery with easy, safe, and cost-effective protocols, when implemented in a standardized manner.

Monitoring of hospital acquired pneumonia in patients with severe brain injury on first access to intensive neurological rehabilitation: First year of observation.

Nosocomial or hospital acquired pneumonia (HAP) is an illness contracted during a hospital stay, generally with onset 48 hours or more after admission to hospital, or within 14 days of discharge from hospital. HAP is divided into subgroups: Ventilator-associated pneumonia (VAP), accounting for 86% of hospital acquired pneumonia, and stroke-associated pneumonia (SAP). The incidence of SAP in neurological intensive care units (NICUs) is 4.1-56.6%, in medical intensive care units (MICUs) it is 17-50%, in stroke units it is 3.9-44% and in rehabilitation it is 3.2-11%, whereas in intensive rehabilitation following severe cranial trauma, the reported incidence of HAP is between 3.9 and 12% of cases. The aim of this study is to evaluate the cases of HAP occurring in a continuous series of patients with severe acquired brain injury (sABI) admitted to intensive rehabilitation units. The data collected can help evaluate the growing complexity of early rehabilitation of these patients, starting from how lung infections interfere with hospital stays and rehabilitation outcomes. This prospective observational cohort study evaluates, from 01/01/2015 to 31/12/2015, for patients with sABI on first admission to intensive neurological rehabilitation, the frequency of HAP and its impact on patient outcomes and complexity of care. A total of 61 patients were enrolled: 39 males and 22 females, average age 59.5 years (17-88 yrs, SD 3.53), coming from critical care (n=52), medical units (n=5), neurosurgery (n=3) and surgical units (n=1). The aetiology of hospital admission was haemorrhagic in 36% of cases, traumatic in 36%, anoxic in 13.1%, infectious in 6.5%, ischaemic in 4.9%, and other causes in 3.2%. Among the patients, 93.44% had received antibiotic therapy in their unit of provenance, and in 61.27% of cases a multidrug resistant (MDR) bacterium was isolated. On enrolment, 26 patients presented respiratory insufficiency, 29 subjects were in oxygen therapy, and 4 under invasive mechanical ventilation. There were 54 tracheostomized patients, 33 patients with percutaneous endoscopic gastrostomy (PEG) tubes, and 23 with nasogastric (NG) tubes. In 2015, among these subjects admitted to neurological rehabilitation, the incidence of HAP was 13.1%. For these 8 pneumonia cases, it was possible to isolate the bacterium in 62.5% of cases, and the detected microorganisms were K. pneumoniae (n=2), P. aeruginosa (n=1), P. mirabilis (n=1), S. maltophilia (n=1), E. cloacae + MRSCoN (n=1). Compared to the literature data, the results of the first year of monitoring show a slight increase in HAP cases (13.1%) in severe brain injury patients on first admission to neurological rehabilitation. These preliminary results need to be further confirmed and monitored over time. The findings moreover confirm the criticality and complexity of care for these patients admitted to neurological rehabilitation units.

&lt;p align="center"&gt;Sources of resistance to the erineum strain of Colomerus vitis (Acari: Eriophyidae) in grapevine cultivars

The erineum strain of Colomerus vitis (GEM) is the most destructive pest of vineyards in western Iran and sometimes causes considerable damages to the grapevine. Little information is available on the susceptibility of the grapevine to this pest and its knowledge can be useful for a sustainable management of GEM. The present study was aimed at evaluating the responses of the plants to the infestation of GEM in order to compare the resistance/susceptibility of some native cultivars to this pest. Also, the profiling of JA, SA and IAA in leaves of infested plants of Sezdang was studied. The experiment was carried out on eighteen native cultivars and the non-native Muscat Gordo which were selected amongst the most common in southern and western Iran. Potted plants were cultivated under greenhouse conditions at a temperature of 32 ± 3.8°C, 75 ± 5% R.H. and a photoperiod of L16: D8 h. The impact of GEM was evaluated on the basis of the leaf area and weight, number and size of the erinea, and percentage of leaves with erinea three months after the infestation. The cane length was measured, too. Mite density on galled leaves (three months after the infestation) and in buds (at the bud breaking) was assessed. Cluster analysis based on the leaf damage index induced by GEM allowed to distinguish highly affected (Sezdang, Khalili, Ghalati and Rishbaba), moderately affected (Neyshaboori, Gazne, Muscat, Lale, Shahani Sefid, Ahmad, Monagha and Sia) and scarcely affected (Yaghuti, Rotabi, White Thompson, Atabaki, Koladari and Sahebi and Shahani Gerd) cultivars. The mite density into the buds and on the galled leaves was higher in the medium-late (Rishbaba and Khalili) and late ripening (Sezdang and Ghalati) cultivars rather than in the early (Sahebi and Shahani Gerd) and early-medium (Atabaki) ripening ones. The leaf damaged area, the leaf weight, the shoot length and the erineum development were correlated to the mite density and were the highest on Sezdang, Khalili, Ghalati and Rishbaba and the lowest on Atabaki, Koladari, Sahebi and Shahani Gerd. The highest density of the overwintering population was detected in proximal buds of all treated cultivars. The plant responses and the mite density were investigated also in the second and third year after the first mite infestation on highly affected (Sezdang, Khalili, Ghalati, Rishbaba), a few of the moderately affected (Neyshaboori, Gazne, Muscat) and the scarcely affected cultivars (White Thompson, Atabaki, Koladari, Sahebi, Shahani Gerd). The leaf damaged area, the percentage of galled leaves, the percentage of cane length reduction and the mite density strongly decreased during all three years of observations on the highly affected Sezdang, Khalili and Gazne. On the contrary, Ghalati and Rishbaba displayed an increase of the leaf damaged area, leaf damaged index and mite density on galled leaves during the same period in comparison to the first year of observation. The percentage of the leaves with erinea, the leaf damaged area and the mite density of Sezdang were highly and positively correlated with IAA while a negative correlation was found between the leaf damaged area and the mite density with SA and JA in the assayed years. Almost all data currently collected allowed a recognition of White Thompson, Atabaki, Koladari, Sahebi and Shahani Gerd as the least affected cultivars.

Seasonal fluctuation of Agriotes lineatus, A. obscurus and A. sputator click beetles caught using pheromone traps in Poland

The trap catch of Agriotes species and dynamics of the occurrence of adult click beetles using pheromone traps were determined, and the relationship between the dynamics of the caught wireworms and the placement of traps in selected agricultural crops was investigated. The study was conducted in 2011–2014 in the fields of different crops at five localities in two regions in Poland. The effectiveness of trapping the Elateridae beetles using pheromone traps varied in different localities. The results of the analysis of variance indicate statistically significant differences in the number of A. lineatus beetles only in individual years of research. On average, most individuals of this species were observed in the first year of observation (72.62), and the least – in 2012 (18.5). Statistically significant differences in the occurrence of beetles in each month were observed for all species except A. obscurus. No statistically significant differences between populations of the tested Agriotes species were observed in different localities. Their effectiveness was influenced largely by weather conditions. Pheromone traps work well and can be a part of an assessment system for the integrated pest management of Agriotes species.

Previous Antibiotic Exposure and Antimicrobial Resistance Patterns of Acinetobacter spp. and Pseudomonas aeruginosa Isolated from Patients with Nosocomial Infections.

Background:The alarming spread of antibiotic-resistant bacteria causing healthcare-associated infections has been extensively reported in recent medical literature.Aims:To compare trends in antimicrobial consumption and development of resistance among isolates of Acinetobacter spp. and Pseudomonas aeruginosa that cause hospital infections.Study Design:Cross-sectional study.Methods:A study was conducted in a tertiary healthcare institution in central Serbia, during the 7-year period between January 2009 and December 2015. The incidence rate of infections caused by Acinetobacter or Pseudomonas, as well as their resistance density to commonly used antibiotics, were calculated. Utilization of antibiotics was expressed as the number of defined daily doses per 1000 patient-days.Results:A statistically significant increase in resistance density in 2015 compared to the first year of observation was noted for Acinetobacter, but not for Pseudomonas, to third-generation cephalosporins (p=0.008), aminoglycosides (p=0.005), carbapenems (p=0.003), piperacillin/tazobactam (p=0.025), ampicillin/sulbactam (p=0.009) and tigecycline (p=0.048).Conclusion:Our study showed that there is an association between the resistance density of Acinetobacter spp. and utilization of carbapenems, tigecycline and aminoglycosides. A multifaceted intervention is needed to decrease the incidence rate of Acinetobacter and Pseudomonas hospital infections, as well as their resistance density to available antibiotics.

Correlation between cefepime utilisation and Pseudomonas aeruginosa resistance rates to β-lactams and carbapenems in patients with healthcare-associated infections.

There is direct link between overutilisation or abuse of antibiotics and Pseudomonas aeruginosa resistance rates, but other factors may also influence the resistance rate. This study aimed to observe changes in P. aeruginosa resistance rates in patients with hospital-acquired infections (HAIs) following a period of cefepime unavailability in an ICU. The study was designed as a retrospective observational analysis of trends in antibiotic utilisation and density of antibiotic resistance. It covered only P. aeruginosa isolates causing HAIs obtained from patients aged >18years. Isolates taken <48h after admission to the ICU and duplicate isolates were excluded. The effects of cefepime withdrawal from prescribing during the 2-year period on P. aeruginosa resistance density trends were also followed. During the study period (2009-2016), a total of 318 non-duplicate P. aeruginosa isolates causing HAIs in the ICU were collected. The predominant anatomical localisation of these infections (nearly 95%) was the lungs (pneumonia), surgical sites and urinary tract (69.18%, 18.24% and 6.92%, respectively). The isolates showed a lower resistance density (per/1000 PDs) in the last year (2016) compared with the first year of observation (2009) for all monitored antibiotics, with a peak in 2011. Although a decreasing trend of resistance density was recorded for all examined drugs, statistical significance was noted only for imipenem, meropenem and piperacillin/tazobactam (P<0.05) CONCLUSIONS: Temporary withdrawal of cefepime in a hospital resulted in a significant decrease in the density of P. aeruginosa isolates resistant to imipenem, meropenem, piperacillin/tazobactam, ceftazidime and cefepime.

Intracanalicular Vestibular Schwannomas: Initial Clinical Manifestation, Imaging Classification, and Risk Stratification for Management Proposal.

There is no consensus about the use of observation as a therapeutic modality for intracanalicular vestibular schwannoma (ICVS). The objective of this study was to describe tumor evolution, its correlation with initial size, stage of vestibular schwannoma, clinical presentation and to propose a risk classification for tumor growth with a therapeutic decision algorithm. Fifty-three patients with ICVS were followed prospectively from 2010 to 2015. The mean follow-up was 32 months. Patients underwent clinical examination, audiogram, magnetic resonance imaging at 6, 12, and then 12 months intervals within the first 5 years of initial diagnosis. We analyzed the patient's clinical course, audiologic changes, initial tumor location, and correlation of different parameters with ICVS growth. Fourteen patients (26%) deteriorated their hearing level and 17 patients (27%) showed tumor growth during the follow-up period. Growth was noted during the first year of observation in 13 patients (76.5%). Considering initial presentation: tumor size, intracanalicular staging, and hearing level, patients with larger vestibular schwannoma, extension to the fundus regardless of tumor size, higher initial pure-tone average, and speech recognition test showed a significantly higher rate of tumor growth. ICVS evolution was not correlated with hearing deterioration with time. We should consider observation a therapeutic modality. We valid the intrameatal staging as prognostic factor and propose a stratification of patients into low, moderate, or high risk for potential tumor growth to guide the initial management of ICVS.

Quantification of Biodiversity Related to the Active Protection of Grassland Habitats in the Eastern Lublin Region of Poland Based on the Activity of Soil Enzymes

This study focused on the impact of extensive sheep grazing on soil enzymatic activity in the grassland habitats of the Eastern Lublin region of Poland, situated within the ecological Natura 2000 network of: K ą ty (PLH060010), Stawska G o ra (PLH060018), and Zachodniowo l y n ska Dolina Bugu (PLH060035). This study involved soils under sheep grazing and soils in uncultivated areas (wasteland). Two-year study was conducted in 2 periods of each year: spring (before the start of sheep grazing) and autumn (after grazing). Beneficial effects were found for extensive grazing by sheep on soil enzymatic activity within each tested habitat. It is worth underlining that a clear stimulation of enzyme activity was detected already in the first year of observation. In the second year, the enzyme activity in the soils of habitats under sheep grazing was approximately 1.5 times higher than in the soils without grazing. The observed higher activity of the tested enzymes in soils under sheep grazing indicated the usefulness of studies on the enzymatic activity of soils as a sensitive indicator of soil response, such as observed here with the applied active system of biodiversity protection in the valuable natural grassland habitats of Natura 2000.