Low-level Index Research Articles

Perioperative nutritional risk and its influencing factors in patients with oral cancer: a longitudinal study.

We aimed to investigate the nutritional risk status and dynamic changes in patients with perioperative oral cancer at different stages and analyze the factors influencing nutritional risk and the correlation among body mass index, nutrition-related symptoms, and nutritional risk. In total, 198 patients with oral cancer who were hospitalized in the Head & Neck Surgery Departments of a tertiary cancer hospital in Hunan Province, China, from May 2020 to January 2021, were selected as participants. The Nutritional Risk Screening 2002 scale and Head and Neck Patient Symptom Checklist were used to assess patients on admission day, 7 days post-surgery, and 1 month post-discharge. Multivariate analysis of variance, paired t-test, and generalized estimating equation were used to analyze the trajectory and influencing factors of nutritional risk in patients with perioperative oral cancer. Spearman's correlation analysis was used to explore the correlation among body mass index, symptoms, and nutritional risk. The nutritional risk scores of patients with oral cancer at the three time points were 2.30 ± 0.84, 3.21 ± 0.94, and 2.11 ± 0.84, respectively, and the differences were significant (p < 0.05). The incidences of nutritional risk were 30.3, 52.5, and 37.9%, respectively. The factors influencing nutritional risk included education level, smoking status, clinical stage, flap repair, and tracheotomy (β = -0.326, 0.386, 0.387, 0.336, and 0.240, respectively, p < 0.05). Nutritional risk was negatively correlated with body mass index (rs = -0.455, p < 0.01) and positively correlated with pain, loss of appetite, sore mouth, bothersome smells, swallowing difficulty, taste changes, depression, chewing difficulty, thick saliva, and anxiety (rs = 0.252, 0.179, 0.269, 0.155, 0.252, 0.212, 0.244, 0.384, 0.260, and 0.157, respectively, p < 0.05). The incidence of nutritional risk in patients with perioperative oral cancer was high, and the trajectory of nutritional risk changed over time. Strengthening the nutritional monitoring and management of postoperative patients or those with low education level, advanced-stage cancer, flap repair, tracheotomy, and low body mass index; strengthening tobacco control management; and controlling nutrition-related discomfort symptoms in perioperative oral cancer patients are necessary.

Real-time hierarchical risk assessment for UAVs based on recurrent fusion autoencoder and dynamic FCE: A hybrid framework

Effective risk assessment is critical for unmanned aerial vehicles (UAVs) to ensure their safety and reliability. Up to now, the researchers have proposed quite a few methods for the above target. However, these methods are mainly based on path planning and collision theory, the risk caused by the abnormal status of UAVs themselves is generally ignored, which limits the further improvement on their performance. In practice, due to factors such as complicated compositions, variable condition monitoring (CM) data, and scarce failure records, etc., it is always a great challenge to implement the complete information fusion and accurate risk assessment for UAVs based on their real-time status. In this regard, a novel hybrid framework is proposed in this paper, which integrates the qualitative knowledge and the quantitative CM data, to evaluate the real-time hierarchical risk of UAVs. Specifically, the complicated UAV is firstly abstracted as a multi-level evaluating index system considering its qualitative logic compositions. Then, for each low-level index, given its multivariate CM data of several time instants, recurrent fusion autoencoder (RFA), a novel unsupervised neural network architecture, is proposed to extract their robust and complete feature embeddings automatically, where not only the information of variate dimension but also the information of time dimension can be fully fused. Furthermore, the risk of each low-level index is quantified by the adaptive Gaussian mixture model in a probabilistic way, which is truly data-driven with the help of the Bayesian hyperparameter optimization. Finally, the dynamic fuzzy comprehensive evaluation is utilized to evaluate the hierarchical risk of UAVs level by level, it should be noticed that our method can dynamically adjust the weights of each index employing the variable weight coefficients, which can capture the preliminary risk of UAVs more timely compared with the traditional methods. The proposed framework is validated on two typical datasets: the turbofan engine datasets (simulation) and the UAV flight datasets (real). The experimental results demonstrate the effectiveness and superiority of the hybrid framework on robust information fusion and accurate hierarchical risk assessment.

Analisa Pendugaan Laju Erosi Dengan Menggunakan Model Agricultural Non Point Source Pollution (AGNPS) di Sub Das Lesti Kabupaten Malang

Changes in landuse and the topographic are undulating and hilly with a slope of 8-45%, as well as the intensity of precipitation impacts on increased erosion rates in sub-watershed Lesti area. Continuous erosion of land causes shallows rivers in Sub-watershed Lesti. An analysis and mapping of the greater existential rates on erosion and sedimentation along with the erosion of sub-watershed Lesti as well as land conservation efforts to reduce the effects of such erosion.Calculations using a model Agricultural Non-Point Source Pollution (AGNPS) obtained an average watershed erosion rate of 163,119 tons / ha / year. The results analysis of the danger erosion levels and area based on erosion danger index by hammer (1981) is obtained with a low level index (&lt;1) 13,770 km2, a moderate level (index 1-4) 13,521 km2, a high level (index 4-10) 14,623 km2, and an exorbitant level (index &gt;10) 16,342 km2. Based on sediment delivery ratio (SDR), results of sediment are 144,820.54 tons / year or 120,683.96 m3 / year. The conservation of land to reduce the rate of erosion are carried out in several ways, either by using vegetative and mechanical methods.

Assessment of Body Composition From CT Images at the Level of the Third Lumbar Vertebra in Inflammatory Bowel Disease.

Although there are several reports of associations between body composition parameters and outcomes in patients with inflammatory bowel disease (IBD), it is not clear which muscle tissue parameters and/or adipose tissue parameters most strongly affect outcomes. Therefore, this study sought to determine the associations of such parameters determined at the level of the third lumbar vertebra (L3) on computed tomography (CT) images with outcomes in IBD patients. Subjects were IBD patients who were admitted to our hospital and underwent abdominal CT. The following parameters were assessed: skeletal muscle index, psoas muscle index, visceral adipose tissue/height index, visceral to subcutaneous adipose tissue area ratio, and intramuscular adipose tissue content. In this study, short- and long-term outcomes were defined as prolonged length of stay (≥30 days) and intestinal resection during the overall period of observation, respectively. In total, 187 patients were enrolled, 99 with Crohn's disease and 88 with ulcerative colitis. For all IBD patients, multivariate logistic regression analysis revealed that low albumin level and low psoas muscle index on admission were associated with prolonged length of stay. Multivariate Cox regression analysis revealed that male sex, Crohn's disease (not ulcerative colitis), low psoas muscle index, and high visceral to subcutaneous adipose tissue area ratio were associated with intestinal resection. This study revealed that muscle volume is associated with the short-term outcome of prolonged length of stay, whereas muscle volume and visceral adipose tissue volume (relative to subcutaneous adipose tissue volume) are associated with the long-term outcome of intestinal resection.

A Low-Level Index for Distributed Logic Programming

A distributed logic programming language with support for meta-programming and stream processing offers a variety of interesting research problems, such as: How can a versatile and stable data structure for the indexing of a large number of expressions be implemented with simple low-level data structures? Can low-level programming help to reduce the number of occur checks in Robinson's unification algorithm? This article gives the answers.

Self-Similarity Action Proposal

Temporal action proposal generation, which aims to locate temporal segments that may contain actions, is a key prepositive step of various video analysis tasks, like temporal action detection. In this letter, we present Self-Similarity Action Proposal (SSAP), a simple method that generates action proposals using the self-similarity of videos. Specifically, a basic low-level index, structural similarity, is adopted to measure the similarity between adjacent frames. Potential action boundaries are located by thresholding the similarity values and candidate action segments are successively generated by grouping the boundaries. A segment evaluation module (SEM) is further employed to score and refine the segments. The framework achieves state-of-the-art performance on THUMOS14 and competitive results on ActivityNet v1.3. Notably, on THUMOS14, it achieves over 4% improvement on the average recall at 50 proposals and 3.3% gain in mAP@0.7 when combined with an existing action classifier for temporal action detection.

PO-394 DNA methylation of ADAM23 is negatively associated with haematogenous spread in breast cancer

IntroductionCirculating tumour cells (CTCs) are associated with metastatic potential in a variety of human cancers. Although DNA methylation of cancer-related genes is a promising diagnostic and prognostic tool, it was rarely studied in relation to the presence of CTCs. ADAM23 gene, member of ADAM (a disintegrin and metalloproteinase domain) family, is involved in various biological events such as cell adhesion, fusion, migration, membrane protein shedding and proteolysis. The aberrant DNA methylation of ADAM23 was associated with expression silencing in breast, gastric, brain and other tumours. In our study we investigated the role of ADAM23 methylation in hematogenous spread of breast cancer (BC).Material and methodsTo detect CTCs, we analysed expression levels of KRT19, SLUG and TWIST genes in the CD45- enriched peripheral blood samples of 203 primary BC patients. The methylation levels of ADAM23 were quantified by pyrosequencing in formalin-fixed, paraffin-embedded tumour tissues. The hypermethylation cut-off was defined as mean ±2 standard deviation of DNA methylation in healthy breast tissues. Protein expression was evaluated in the same material by ImmunoReactive Score (German IRS system), based on the proportion of positive cells and the staining intensity of the nuclei or cytoplasm. A logistic regression was used to determine the effect of studied variables on presence of CTCs in peripheral blood.Results and discussionsCTC positivity (epithelial or mesenchymal markers) was identified in 23% of patients (16% mesenchymal, 9% epithelial and 2% both). ADAM23 hypermethylation (DNA methylation ≥10%) did not occur in mesenchymal CTC positive patients, while it was present in 28.8% of mesenchymal CTC negative patients (p=0.001). Among studied variables, the multivariate analysis identified low ADAM23 methylation level (p=0.004) and high ki67 proliferation index (p=0.005) as two most significant predictors of mesenchymal CTCs. It was shown recently that although ADAM23 inhibition enhanced invasion in breast cancer, it was not sufficient to trigger metastasis (Costa et al., 2015).ConclusionOur data indicate possible involvement of ADAM23 in hematogenous spread of BC cells. Better understanding of reversible epigenetic regulations hold promise for development of novel therapeutic approaches.This study was supported by the grants APVV-0076–10, APVV-16–0010, ITMS 26240220058 and VEGA grants no. 2/0092/15, 2/0102/17 and 1/0271/17.

Multi-scale contrast and relative motion-based key frame extraction

The huge amount of video data available these days requires effective management techniques for storage, indexing, and retrieval. Video summarization, a method to manage video data, provides concise versions of the videos for efficient browsing and retrieval. Key frame extraction is a form of video summarization which selects only the most salient frames from a given video. Since the automatic semantic understanding of the video contents is not possible so far, most of the existing works employ low level index features for extracting key frames. However, the usage of low level features results in loss of semantic details, thus leading to a semantic gap. In this context, the saliency-based user attention modeling technique can be used to bridge this semantic gap. In this paper, a key frame extraction scheme based on a visual attention mechanism is proposed. The proposed scheme builds static visual attention method based on multi-scale contrast instead of usual color contrast. The dynamic visual attention model is developed based on novel relative motion intensity and relative motion orientation. An efficient fusion scheme for combining three visual attention values is then proposed. A flexible technique is then used for key frame extraction. The experimental results demonstrate that the proposed mechanism provides excellent results as compared to the some of the other prominent techniques in the literature.

Development of Spatial Distribution Model using GIS to Identify Social Support Index Among Drug-Abuse Inmates

This study was to identify the spatial distribution of Social Support Index (SSI) among drug-abuse inmates throughout Peninsular Malaysia. Factor Analysis (FA) and Discriminant Analysis (DA) were applied to analyses the level of social support (SS) among drug-abuse inmates and develop the spatial model using Geographic Information System (GIS). Five significant index categories were generated from FA: excellent, good, moderate, low and poor Quality of Life Index (QoLi) and the nine of SS variables are expected to be derived from family, friends and other social factor. DA showed each category differed from others in terms of different compositions, stepwise backward and forward modes gave 99.75% correct classification. GIS analysis show the distribution of SSI categorized on family and friends factor were moderately for where the prisoners came. Besides that, Perlis classified as low-level index and Melaka as high-level index of other social factor. The distribution model of SSI in moderately-level showed Jelebu, Sungai Petani, Pengkalan Chepa and Simpang Renggang as the better SS factor to quality of life compared to the Penor, Pahang. The procedures of FA, DA and GIS were used in this study proved the source apportionment of SS and QoLi among drug-abuse inmates in Peninsular Malaysian prisons.

Dynamic noninvasive markers predict hepatocellular carcinoma in chronic hepatitis C patients without sustained virological response after interferon-based therapy: Prioritize who needs urgent direct-acting antiviral agents.

Some patients with hepatitis C virus (HCV) infections who fail to achieve sustained virological responses (SVRs) after interferon (IFN) therapy do not develop hepatocellular carcinoma (HCC). Risk stratification of these patients may help identify those who would benefit most from treatment with direct-acting antivirals (DAAs).A total of 552 HCV-infected patients with non-SVR status were enrolled. Laboratory data before and after IFN treatment were analyzed to determine the relationship of changes in serum markers with development of HCC during the 7-year study period.HCC developed in 93 patients. The risk factors for HCC were pre-existing liver cirrhosis, low hemoglobin level at baseline, low pretreatment platelet count, high post-treatment alpha-fetoprotein (AFP) level (≥15 ng/mL), and high post-treatment Fibrosis 4 (FIB4) index (>3.25). For patients without pre-existing cirrhosis, those with high post-treatment AFP level and FIB4 index had the highest risk of HCC (1 year: 6.7%; 3 years: 10.9%; 5 years: 29.7%), followed by those with high post-treatment AFP level and low post-treatment FIB4 index (5 years: 25%), and those with low post-treatment AFP level and high post-treatment FIB4 index (1 year: 3.7%; 3 years: 5.2%; 5 years: 10.6%). The risk was even lower for patients with low post-treatment AFP level and FIB4 index (1 year: 0%; 3 years: 0.4%; 5 years: 2.5%). None of the patients with FIB4 indexes consistently below 1.45 developed HCC.The combined use of post-treatment AFP level and FIB4 index was useful for risk stratification of HCV-infected patients with non-SVR status after IFN therapy. These data may help clinicians to identify patients who most urgently need DAA treatment.

Clinical Characteristics of Overhydration in Patients with Idiopathic Edema

Background: Idiopathic edema (IE) is a common clinical syndrome. Designing treatment plans for IE is problematic because of the difficulty in assessing volume status. We aimed to evaluate volume status, measured by bioimpedance spectroscopy (BIS), and investigated clinical parameters associated with volume overload (VO) in patients with IE. Methods: Patients with IE were defined as those with symptomatic edema and without abnormal renal function or any other apparent cause of edema. A total of 124 patients were included. Overhydration (OH) and extracellular water (ECW) were calculated using BIS. Relative hydration status (ΔHS) was defined as OH/ECW. Patients were classified into 2 groups: overhydrated group (OG; ΔHS ≥7%) and non-OG (NOG; ΔHS <7). Simple and multiple logistic regression analyses were used to assess the influence of several variables on the incidence of VO. Results: Of 124 patients, 37 (29.8%) were in the OG. The proportion of men in the OG was higher than that in the NOG (p = 0.020). Patients in the OG showed more frequent pretibial pitting edema (PTPE, p < 0.001) and had lower hemoglobin (p = 0.008) and serum albumin levels (p < 0.001). The multivariate analysis showed that the presence of PTPE (OR 10.62, 95% CI 1.98-57.1), low serum albumin level (OR 0.01, 95% CI 0.00-0.25) and lower fat tissue index (OR 0.78, 95% CI 0.63-0.97) were independent risk factors for the presence of VO. Conclusions: BIS helps to identify volume status and body composition in patients with IE.

A meta-analysis of socio-demographic factors for perinatal mortality in developing countries: a subgroup analysis of the national surveys and small scale studies.

Although the perinatal mortality in low income countries is about five-folds higher than in the high income countries, little is known about the association of socio-demographic factors with perinatal mortality. National and small scale studies so far reported have shown very contradictory results. The objective of this meta-analysis was to assess the association of perinatal mortality with selected sociodemographic factors. A computer based literature search was conducted mainly in the databases of African Journals Online, MEASURE Demographic and Health Survey (DHS), Google Scholar, HINARI, PUBMED, MEDLINE and the Cochrane Library. The inclusion criteria were: 1) studies that assessed the perinatal mortality in developing countries in relation to socio-demographic predictors and 2) studies published in English and conducted after the year 1990. Subgroup meta-analyses of perinatal mortality were performed for mothers' age, residence, educational level and wealth status. Sensitivity analysis and heterogeneity testing were done. In this meta-analysis, several inconsistent associations of perinatal mortality with the selected socio-demographic variables were observed in the primary studies level, both DHS and small scale studies. However, the overall odds ratio (OR) demonstrated statistically significant association of perinatal mortality with low maternal age (OR=1.2) and short birth interval (OR=1.4) but was not influenced by the mothers' residence, low educational level and household wealth index. Very consistently, the highest perinatal mortality rates reported when the birth intervals were either too short (<15 months) or too long (>39 months). Because of the disagreement among previous studies, the present study demonstrated a small effect size on the increased risk of perinatal mortality among women who were pregnant during teenage ages and gave birth too frequently or after a long interval. Therefore, to confirm the strong predictors of perinatal mortality, further studies on sociodemographic factors are needed.

Efficiency and cost analysis of cell saver auto transfusion system in total knee arthroplasty.

Blood loss and replacement is still a controversial issue in major orthopaedic surgery. Allogenic blood transfusion may cause legal problems and concerns regarding the transmission of transfusion-related diseases. Cellsaver Systems (CSS) were developed as an alternative to allogenic transfusion but CSS transfusion may cause coagulation, infection and haemodynamic instability. Our aim was to analyse the efficiency and cost analysis of a cell saver auto-transfusion system in the total knee arthroplasty procedure. Retrospective comparative study. Those patients who were operated on by unilateral, cemented total knee arthroplasty (TKA) were retrospectively evaluated. Group 1 included 37 patients who were treated using the cell saver system, and Group 2 involved 39 patients who were treated by allogenic blood transfusion. The groups were compared in terms of preoperative haemoglobin and haematocrit levels, blood loss and transfusion amount, whether allogenic transfusion was made, degree of deformity, body mass index and cost. No significant results could be obtained in the statistical comparisons made in terms of the demographic properties, deformity properties, preoperative laboratory values, transfusion amount and length of hospital stay of the groups. Average blood loss was calculated to be less in Group 1 (p<0.05) and cost was higher in Group 1 (p<0.05). Cell saver systems do not decrease the amount of allogenic blood transfusion and costs more. Therefore, the routine usage of the auto-transfusion systems is a controversial issue. Cell saver system usage does not affect allogenic blood transfusion incidence or allogenic blood transfusion volume. It was found that preoperative haemoglobin and body mass index rates may affect allogenic blood transfusion. Therefore, it is foreseen that auto-transfusion systems could be useful in patients with low haemoglobin level and body mass index.

Abstract 826: SCL8A1 negatively regulated by miR-223 is one candidate for sodium/calcium transportation and low level of apoptosis in penile carcinomas.

Abstract Background: Penile cancer (PeCa) is a rare disease in developed countries, but with high incidence in South America and Africa. Surgery is frequently used for local control of the disease and can lead to partial or complete amputation of the organ. Integrative analysis of large-scale gene expression and genomic alterations in PeCa showed down-expression of the solute carrier family 8 (SLC8A1, sodium/calcium exchanger) with no genomic changes suggesting that other mechanisms, such as micro-RNAs, could be involved in gene regulation. Intracellular Ca2+ can contribute to cancer cell proliferation and tumor progression, but can also induce tumor apoptosis by calcium-regulated cell death pathways. Therefore, we speculated if the down-expression of SLC8A1 mediated, at least in part, by miR-223 in penile carcinomas could lead to a reduction of cellular calcium levels and apoptosis suppression and to contribute for increased cell proliferation. Aim: This study aimed to confirm the gene expression patterns of SLC8A1 and miR-223 in PeCa and normal tissues and to evaluate calcium levels and apoptosis in in a subset of the samples showing these alterations. Methods: RNA was obtained from 39 fresh PeCa and 4 normal penile tissues. SLC8A1 gene and miRNA-223 transcript levels were evaluated by RT-qPCR. Fresh PeCa (n=2) matched with adjacent (n=1) and normal tissue from autopsy (n=1) showing alterations of SLC8A1 and miRNA-233 were selected and evaluated for calcium distribution by Laser Ablation Inductively Coupled Plasma Mass Spectrometry (LA-ICP-MS). Caspase-3 and Ki-67 were evaluated by immunohistochemistry in 9 selected PeCa. Results: Significant down-expression of SLC8A1 (P=0.010) and overexpression of miR-223 (P=0.0072) was detected in tumors in the comparison with normal controls. A significant negative correlation was detected between SLC8A1 transcript levels and miR-223 (P=0.015, r = -0.482), suggesting that this gene is regulated by this miRNA. LA-ICP-MS mapping revealed decreased calcium levels in tumor cells compared with adjacent normal cells and also compared with a normal tissue. Penile carcinoma tissue showed lower calcium counts (Ca44/C13 ratio=5,14 +/- 0,81) compared with normal tissues (Ca44/C13 ratio=6,34 +/- 4,63). In addition, PeCa presented considerably higher sodium counts (counts per second = 6.5 x 10ˆ5) compared with normal tissues (counts per second = 4 x 10ˆ5). Decreased caspase-3 and increased Ki-67 levels were detected in tumor tissues, indicating that low-level apoptosis and high cell proliferation index occurred in these samples. Conclusions: The results suggested that down-regulation of SLC8A1 gene probably mediated by miR-223 can contribute to calcium levels reduction in PeCa and consequently in apoptosis suppression of these cells. Further functional studies are needed to prove this hypothesis. Citation Format: Juan J. Muñoz, Sandra A. Drigo, Mateus C. Barros, Fábio Marchi, Fernando A. Soares, Gustavo Pessoa, Gustavo Pessoa, José Vassallo, Marco A. Arruda, Silvia R. Rogatto. SCL8A1 negatively regulated by miR-223 is one candidate for sodium/calcium transportation and low level of apoptosis in penile carcinomas. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 826. doi:10.1158/1538-7445.AM2013-826

Gender differences in mortality and CD4 count response among virally suppressed HIV-positive patients.

Treatment outcomes for antiretroviral therapy (ART) patients may vary by gender, but estimates from current evidence may be confounded by disease stage and adherence. We investigated the gender differences in treatment response among HIV-positive patients virally suppressed within 6 months of treatment initiation. We analyzed data from 7,354 patients initiating ART between April 2004 and April 2010 at Themba Lethu Clinic, a large urban public sector treatment facility in South Africa. We estimated the relations among gender, mortality, and mean CD4 response in HIV-infected adults virally suppressed within 6 months of treatment initiation and used inverse probability of treatment weights to correct estimates for loss to follow-up. Male patients had a 20% greater risk of death at both 24 months and 36 months of follow-up compared to females. Older patients and those with a low hemoglobin level or low body mass index (BMI) were at increased risk of mortality throughout follow-up. Men gained fewer CD4 cells after treatment initiation than did women. The mean differences in CD4 count gains made by women and men between baseline and 12, 24, and 36 months were 28.2 cells/mm(3) (95% confidence interval [CI] 22.2-34.3), 60.8 cells/mm(3) (95% CI 71.1-50.5 cells/mm(3)), and 83.0 cells/mm(3) (95% CI 97.1-68.8 cells/mm(3)), respectively. Additionally, patients with a current detectable viral load (>400 copies/mL) and older patients had a lower mean CD4 increase at the same time points. In this initially virally suppressed population, women showed consistently better immune response to treatment than did men. Promoting earlier uptake of HIV treatment among men may improve their immunologic outcomes.

簡易嗅覚測定法の開発—二点比較式臭袋法を用いた低濃度臭気指数の測定—

簡易嗅覚測定法の開発—二点比較式臭袋法を用いた低濃度臭気指数の測定—

Molecular Interactions of Leptin and Prostate Cancer

Epidemiological studies have found obesity to be a risk factor for prostate cancer. Our prior independent studies in women have reported a strong relationship between variants of OB (leptin) gene, body mass index, and age at menarche and sporadic breast cancer. The current study investigates an association between genetic variants of the human obesity gene, serum leptin levels, and body mass index in subjects with prostate carcinoma and in age- and gender-matched normal subjects. Blood samples from 69 patients with prostate cancer and 137 age-matched control subjects were collected. Serum leptin level was investigated by radioimmunoassay, and body mass index was calculated. Allele sizes were determined via standard polymerase chain reaction. Statistical analysis was performed using SPSS10.0 computer software. There was a strong association with significantly elevated serum leptin levels, high body mass index, and higher frequency of LEPR longer alleles in patients with prostate cancer than in control subjects. By contrast, a modest but not significant increase in the frequency of LEP short alleles was found in patients with prostate cancer as compared with control subjects. Analysis within groups 1 (low leptin level and low body mass index) and 2 (other) showed a significant association only in group 2, with high frequency of OB gene variants (LEPR long alleles and LEP short alleles) in patients with prostate cancer but not in control subjects. These results represent the first report of a significant association between specific leptin gene alleles, serum leptin levels, and body mass index in subjects with prostate cancer. Consistent with prior reports, we also report a significantly elevated serum leptin level in patients with prostate cancer, suggesting a strong link with obesity as an increased risk factor.

Pressure ulcer risk factors in patients undergoing surgery

This paper reports a study to identify risk factors associated with pressure ulcer development among a mixed group of adult patients undergoing surgery. Few studies have been carried out with patients undergoing surgery to assess the risk of pressure ulcer development, and so there is a little knowledge of the risk factors for this group. However, studies among non-surgical patients have shown that nutritional predictors such as low serum albumin level and low body mass index (BMI) are of great importance. An additional predictive factor may be low blood pressure. It is important to study these predictors further among patients undergoing surgery, using techniques such as multiple regression techniques, designed to identify the most important predictors for pressure ulcer development. A prospective comparative study was carried out in 1996-1998 with 286 adult patients undergoing surgical treatment. The data were collected from patient records by Registered Nurses preoperatively, for seven days postoperatively and thereafter once a week for up to 12 weeks. Perioperative data were also collected. The Risk Assessment Pressure Sore Scale was used, and data were collected on general physical condition, activity, mobility, moisture, food intake, fluid intake, sensory perception, friction and shear, body temperature and serum albumin. Forty-one (14.3%) patients developed pressure ulcers during the observation period. The most common type was non-blanchable erythema. Those who developed pressure ulcers were significantly older, weighed less, and had a lower BMI and serum albumin. More women than men developed pressure ulcers. Risk factors identified in multiple stepwise regression analyses were female gender, American Society of Anaesthesiologists (ASA) status or New York Heart Association (NYHA) status and food-intake. Special attention, with regard to risk of pressure ulcer development, should be paid to patients undergoing surgery who have low ASA or NYHA scores, low food intake and/or are women.

On the relationship between vertical ozone distribution and the synoptic situation

The purpose of the paper is to provide a statistical view of the role of circulation patterns and the origin of low stratospheric air in connection with vertical ozone distribution below the ozone maximum, and also with the total ozone amount. Ozonesonde data from the aerological observatory of the Czech Hydrometeorological Institute (CHMI) Prague-Libus (50·0N, 14·7E) for January to April during the period 1979–1990 have been analyzed using an objective method to find the distribution of laminae in the vertical profile of the ozone partial pressure related to the different types of circulation patterns. The synoptic classification following Grosswetterlagen (GWL) was used, the parameters of the ozone profile such as number, magnitude, thickness and height of laminae, or the appearance of the large laminae were obtained for the individual types of GWL and used in other procedures. The total ozone data from the ozone observatory of CHMI in Hradec Kralove (50·2N, 15·8E) was also included together with the height of the tropopause and parameters of ozone profiles in the cluster analysis to investigate connections between the ozone distribution and circulation patterns (types of synoptic situation). The ozone “low-level index” (LLI), defined as the ratio of the integral amount of ozone in D.U. from the surface up to 50 hPa and total ozone were introduced to provide better information about ozone profile response to circulation patterns and thus provide a better grouping of similar types of GWL. The presented results imply the strong confirmation of the huge ozone laminae below the ozone maximum as the source of total ozone positive extremes under appropriate synoptic situations with the near location of the polar vortex edge, which could be used in common forecasts of atmospheric ozone as well as in remote sensing applications.

Epidemic Visceral Leishmaniasis in Southern Sudan: Treatment of Severely Debilitated Patients under Wartime Conditions and with Limited Resources

1) To determine the proportions of patients with visceral leishmaniasis who had various treatment outcomes when cared for under wartime conditions and with limited resources and 2) to identify patient characteristics associated with the outcomes. Cohort study. Médecins sans Frontières-Holland's treatment center in Duar, Western Upper Nile Province, an area in southern Sudan that has been severely affected by Sudan's civil war and a massive epidemic of visceral leishmaniasis. 3076 consecutive patients who had visceral leishmaniasis, were admitted to the treatment center the first year the center was operational (August 1990 to July 1991), and were treated with the pentavalent antimonial compound sodium stibogluconate. Patient characteristics on admission and four mutually exclusive treatment outcomes (default during first admission, death during first admission, discharge and readmission for retreatment [relapse], and discharge and no readmission for retreatment [successful treatment]). The patients had a median age of 15 years and were notably anemic (median hemoglobin level, 77g/L) and malnourished (median body mass index of adults [> or = 18 years of age], 15.2 kg/m2); most (91.0%) had been sick less than 5 months. Although patients could not be monitored after treatment to document cure, most (2562 [83.3%]) were successfully treated; 336 (10.9%) died during their first admission, and 79 are known to have relapsed (3.0% of those discharged alive [that is, those whose final treatment outcome was successful treatment or relapse]). In univariable analysis, young and older age (<5 or > or = 45 years of age), long duration of illness (> or = 5 months), markedly low hemoglobin level or body mass index, large spleen, high parasite density, and vomiting at least once during the treatment course were associated with death. In multiple logistic regression analysis of data for a subgroup of 1207 adults (those who did not default or relapse and for whom data were recorded on age, sex, duration of illness, hemoglobin level, body mass index, and spleen size), the approximate risk ratios for death were 2.2 (95% Cl, 1.4 to 3.6) for those with a long duration of illness, 3.6 (Cl, 2.1 to 5.9) for those 45 years of age or older, 4.6 (Cl, 2.2 to 9.4) for those with a hemoglobin level less than 60 g/L, and 12.2 (Cl, 3.2 to 47.2) for those with a body mass index less than 12.2 kg/m2. CONCLUSION; Despite the severe debility of the patients and the exceptionally difficult circumstances under which they were treated, most fared remarkably well.