Pearson X2 Research Articles

Comparison of Two Methods of Laparoscopic Single Port Appendectomy and Conventional Three Port Laparoscopic Appendectomy

Purpose: Acute appendicitis is a type of abdominal disease that requires emergency surgery. Over the past three decades, laparoscopic appendectomy has become the standard operation for acute appendicitis. The aim of this paper is to compare the m ethods of single port appendectomy and conventional appendectomy and to illustrate the advantages of single port appendectomy. Methods: The first group of patients underwent single port appendectomy using a surgical glove (Group 1), and those in the second group underwent surgery using the TriPort system (Group 2). The third group of patients underwent conventional three port surgery (Group 3). Questionnaires regarding patient satisfaction with scars were administered via telephone interview. Patient characteristics, histopathological data, postoperative data, and satisfaction score were analyzed by t-test and Pearson x² test. Results: A statistically significant difference in satisfaction scores was observed among the three groups. Overall, patients in the single port group using a surgical glove would be more likely to recommend the procedure to friends and family than would patients in the other two groups. Better cosmetic results were achieved for both groups of patients who underwent laparoscopic single port appendectomy, compared to those who underwent conventional three port laparoscopic appendectomy, with statistically significant difference. Conclusion: Laparoscopic single port appendectomy using a surgical glove is a feasible and safe procedure and shows no differences in terms of risk, such as postoperative complication, compared to a conventional three-trocar technique. Use of this m ethod resulted in better satisfaction compared with the other two groups, illustrating its cosmetic improvement.

Factors associated with menopausal symptom severity in middle-aged Brazilian women from the Brazilian Western Amazon

ObjectiveTo determine the frequency and severity of menopausal symptoms and associated factors in middle-aged Brazilian women. MethodsA cross-sectional study was carried out involving 1415 women aged 35–65 years attended at the Outpatient unit of the Clinicas Hospital of Rio Branco, Acre state, Brazil. The Menopause Rating Scale (MRS) was used to assess the severity of menopause symptoms. The Stata 10 statistical package was used for all data analysis whereas Pearson's x2 nonparametric association test was used for bivariate analysis, adopting a level of statistical significance of 5%. On the multivariate analysis, independent variables positively associated with the dependent model were retained in the final model (p<0.005). ResultsOverall, 54.1% of participants were premenopausal, 10.1% perimenopausal, and 35.8% postmenopausal. Irritability was the most frequent symptom (78.3%), followed by joint and muscular discomfort (74.8%), and anxiety (72.7%). Mean total MRS score was 15.6+8.8 (median 15). After adjusting for confounding factors, the logistic regression analysis found low educational level (OR:1.53; [95% CI:1.21–1.95]; p<0.001); self-perceived poor/very poor health (OR:4.48; [95% CI: 3.53–5.69]; p<0.001), and menopausal transition phase (OR:1.73; [95% CI:1.18–2.53]; p=0.005) to be statistically significantly associated with more severe menopausal symptoms. ConclusionAmong Brazilian women, atypical symptoms of the menopause were the most frequently reported. Severe menopausal symptoms were more likely in women with low educational level, self-perceived poor health and at the menopausal transition phase.

Predictive markers in metastatic transitional cell carcinoma (mTCC) patients treated with carboplatin plus pemetrexed regimen.

e15558 Background: Treatment with platinum derivatives plus pemetrexed has shown a benefit in metastatic transitional cell bladder carcinoma (mTCC); however, the subset of patients most likely to benefit has not yet been identified. Predictive markers of pemetrexed response can be inferred from its mechanism of action in inhibiting nucleotide synthesis. In the present study we evaluated the predictive role of BRCA1, RAP80, TS, REV3 and AEG1 mRNA levels in a series of mTCC samples from patients treated with carboplatin plus pemetrexed (CP) and correlated with pathological response to chemotherapy and median survival. Methods: We retrospectively analyzed 18 patients with mTCC. Eligible patients received pemetrexed 500 mg/m2 in combination with carboplatin at an area under the concentration curve of 5. Total treatment dose was given on day 1 of each cycle and repeated every 21 days for 6 cycles. Gene expression levels were quantified by real-time quantitative PCR from paraffin-embedded pre-treatment tumor samples obtained by transurethral resection. Results: Patients were male, mean age 71 years (range 51-83). Median overall survival was 3.5 years (95% CI, 0.377-3.623). Non-responders had average survival of 2.2 years (SE=0.436) compared to an average of 5.5 years for responders (SE=0.661) (Pearson X2=4.667, p=0.031). We found an association between non-responders and elevated RAP80 expression (paired t (df)=-2.69, p=0.028) (paired t (df)=2.372, p=0.039). In the multivariate analysis elevated TS level was the variable most predictive of shorter survival (OR=1.158, p=0.047). Conclusions: CP regimen demonstrated moderate activity in patients with mTCC. Our data indicates that RAP80 and TS could be predictors of poor outcome. Also, RAP80 expression may predict efficacy of CP as first-line treatment and could be a useful tool to customize therapy in bladder cancer patients. A prospective study is warranted to validate these observations.

Effect of Shanghai's standardized training of residents on the history taking mode of physicians

Objective To evaluate the needs of performing a standardized communication skill training program for residents according to the differences in history taking mode of residents with different degrees and before and after the standardized training in Shanghai Changhai Hospital in 2010.Methods History taking modes of 81 residents in 2010 before and after the standardized training in Shanghai Changhai hospital were categorized.History taking modes were classified into:no effectiveness mode,traditional mode,disease-sickness mode and Calgary-Cambridge Guide mode.Distribution differences of history taking mode of residents with different medical degrees were analyzed by Fisher exact probability method (α =0.05).Distribution differences of history taking mode of residents before and after standardized training were analyzed by Pearson x2 test (α =0.05).Results 19.8％ residents took no effectiveness mode,53.0％ took traditional mode and 27.2％ used disease-sickness mode.There were significant differences in history taking modes among residents with different medical degrees (P =0.008).After training,history taking modes of residents were significantly changed (P=0.001),only 1.2％ residents used no effectiveness mode,59.3％ used traditional mode and 34.6％ used disease-sickness mode.But residents using the Calgary-Cambridge mode were not increased.Conclusions There are significant differences in history taking modes among residents with different medical degrees.History taking mode of residents changed after standardized training.But some of the residents still use non-optimal history taking modes; therefore a standardized communication skill training program might be needed in the future. Key words: History taking; Standardized training of resident physicians; Communication skills ; Medical education; Evaluation

Cost-Sharing as a Financing Mechanism in the Greek Primary Health Care: An Assessment from the Managers’ Perspective

Cost-sharing was recently introduced in the Greek Primary Health Care, as a supplementary mechanism to finance spiraling health expenditure and to make patients cost-conscious.A specific questionnaire was distributed to the 188 managers of the health centres in Greece (response rate 93 per cent). The research was conducted from June 2011 to May 2012. Statistical analysis was performed using the Pearson x2 test, the Kolmogorov-Smirnov test, the t-test and the Mann-Whitney test at p<0.05 level of significance. 73 per cent of the managers stated that the introduction of the cost-sharing had a positive impact on patients’ compliance and 66.3 per cent that the financing mechanism has contributed to cost consciousness from both the patients and personnel. The revenues from medical fees do not cover the running costs of health centres (81.5 per cent) and they do not promote a more effective delivery of services (80 per cent). 61 per cent of managers characterise cost-sharing as a positive step and 80 per cent support the economic autonomy of health centres.Managers stated that cost-sharing has a positive impact on patients’ cost-consciousness and in the financing of the primary health care in Greece, but this policy option alone doesn’t assure the financial and administrative viability of the health centres.

Differential Expression of p16INK4A and Cyclin D1 in Benign and Malignant Salivary Gland Tumors: A Study of 44 Cases

Salivary gland tumors (SGT) are a heterogeneous group of lesions. There is conflicting data concerning the molecular events involving the tumour suppressor retinoblastoma protein (pRb) pathway in these tumors. Few studies examined the alterations in components of the Rb pathway by immunohistochemical (IHC) methods in benign and malignant SGTs. Furthermore, recent evidence implicates human papillomavirus (HPV) in mucoepidermoid carcinoma (MEC) carcinogenesis. The purpose of our study is to examine p16(INK4A) and cyclin D1 expression in a variety of benign and malignant salivary gland tumors, and to investigate p16(INK4A) expression as a surrogate marker for HPV infection in MEC. Our series includes 30 malignant tumors [14 MEC, 6 acinic cell carcinomas (ACC), 5 polymorphous low grade adenocarcinomas (PLGA), 5 (AdCC)] and 14 benign tumors (4 benign cysts, 5 Warthin tumors and 5 pleomorphic adenomas (PA). All cases were tested by IHC for p16(INK4A) and cyclin D1. Testing for HPV wide spectrum (HPV-WS) was performed by in situ hybridization in all MEC cases. Staining intensity was recorded semi quantitatively (on a scale from 0 to 4+). Fisher's exact test and Pearson X2 test with a p < 0.05 were used. Cyclin D1 and p16(INK4A) are expressed similarly in malignant and benign tumors (p = 0.146 and p = 0.543, respectively). None of the MEC cases showed nuclear reactivity for HPV-WS. Statistical analysis showed positive correlation between cyclin D1 and p16(INK4A) expression. Our findings suggest that p16(INK4A) overexpression is likely secondary to cyclin D1 gene upregulation or amplification. Further molecular studies are warranted.

High-risk of obstructive sleep apnea and excessive daytime sleepiness among commercial intra-city drivers in Lagos metropolis.

Background:The burden of obstructive sleep apnea among commercial drivers in Nigeria is not known.Aim:To assess the prevalence of high risk of obstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) among intra-city commercial drivers.Setting and Design:A descriptive cross-sectional study in three major motor parks in Lagos metropolis.Materials and Methods:Demographic, anthropometric and historical data was obtained. The risk of OSA and EDS was assessed using the STOP BANG questionnaire and the Epworth Sleepiness Scale, respectively.Statistical Analysis:The relationship between the OSA risk, EDS risk and past road traffic accident (RTA) was explored using the Pearson's chi square. Independent determinants of OSA risk, EDS risk and past RTA, respectively, were assessed by multiple logistic regression models.Result:Five hundred male commercial drivers (mean age (years) ±SD = 42.36 ± 11.17 and mean BMI (kg/m2) ±SD = 25.68 ± 3.79) were recruited. OSA risk was high in 244 (48.8%) drivers and 72 (14.4%) had EDS. There was a positive relationship between OSA risk and the risk of EDS (Pearson's X2 = 28.2, P < 0.001). Sixty-one (12.2%) drivers had a past history of RTA but there was no significant relationship between a past RTA and either OSA risk (X2 = 2.05, P = 0.15) or EDS risk (X2 = 2.7, P = 0.1), respectively. Abdominal adiposity, regular alcohol use and EDS were independent determinants of OSA risk while the use of cannabis and OSA risk were independent determinants of EDS. No independent risk factor for past RTA was identified.Conclusion:A significant proportion of commercial drivers in Lagos metropolis are at high risk of OSA and EDS.

Goodness-of-fit testing for accident models with low means

The modeling of relationships between motor vehicle crashes and underlying factors has been investigated for more than three decades. Recently, many highway safety studies have documented the use of negative binomial (NB) regression models. On rare occasions, the Poisson model may be the only alternative especially when crash sample mean is low. Pearson's X2 and the scaled deviance (G2) are two common test statistics that have been proposed as measures of goodness-of-fit (GOF) for Poisson or NB models. Unfortunately, transportation safety analysts often deal with crash data that are characterized by low sample mean values. Under such conditions, the traditional test statistics may not perform very well.This study has three objectives. The first objective is to examine all the traditional test statistics and compare their performance for the GOF of accident models subjected to low sample means. Secondly, this study proposes a new test statistic that is not dependent on the sample size for Poisson regression model, as opposed to the grouped G2 method. The proposed method is easy to use and does not require grouping data, which is time consuming and may not be feasible to use if the sample size is small. Moreover, the proposed method can be used for lower sample means than documented in previous studies. Thirdly, this study provides guidance on how and when to use appropriate test statistics for both Poisson and negative binomial (NB) regression models.

Improving RBC K Transport and Hemoglobin-O2 Binding by Amiloride: A Novel Therapeutic Approach for Reversion of Angina and Myocardial Ischemia in Coronary Heart Diseases

Coronary heart disease (CHD) is the leading cause of morbidity and mortality across the entire world, in which reversion of angina or improvement of ECG remains an unrealistic therapeutic option for most patients, suggesting that microvascular dysfunction or impaired oxygen delivery might be critical factors in CHD. This research article, thus presents the rationale basis, clinical and experimental, for the first therapeutic innovation addressing the role of red blood cell (RBC) H/K and O2/CO2 exchanges in CHD. It is followed by a randomized single-blind trial of Amiloride and Optimal Medical Therapy (OMT, n=35 cases) vs OMT alone (n=35 cases) in patients having angina, ST-T alteration and a defective RBC-K transport. All patients had serial clinical evaluation, Ion Transport Studies, ECGs and non-invasive aortic waveform and cardiovascular hemodynamic recordings. Statistical analysis was performed by SAS. Amiloride rapidly improved RBC-K (93.5 ±4 vs 84.5 ±4 mmol/lc, p= < 0.001), angina (80% of cases, 1.5 ±0.3 weeks, CI:1.72 to 1.45), CCS Class (1.3 ±0.5 vs 3.1 ±0.8, p < 0.001) vs patients with OMT alone CCS Class (3.2 ± 0.4 vs 3.3 ± 0.5, p =0.21). Reversion of angina was sustained through the next 6-months (87% vs 26 % in OMT, RR 2.1, odds ratio 6.31, Pearson x2 34.6,p < 0.0001 at 95% CI) and 1-year (85% vs 37% OMT). At 6-months of amiloride, ECG became normal (29% vs 0%, RR ∞ uncalculated-time, odds ratio ∞, Pearson x2 42.4 at 95% CI, p < 0.0001), improved (55% vs 29%; RR2.1, odds ratio 3.16, 95% CI, p < 0.0001) or unchanged (15% vs 67% OMT). At 1-year, seven patients on amiloride (18%) exhibited evidence of electrical regeneration of the heart, not observed with placebo. This therapeutical innovation of amiloride improves RBC H/K and O2/CO2 function, and reverses angina, ST-T alterations while inducing electrical regeneration of the heart, in patients receiving optimal medical treatment for angina. The article has short discussion on the relevant patents to the topic.

Sexual violence and pregnancy-related physical symptoms

BackgroundFew studies have investigated the impact of sexual violence on health during pregnancy. We examined the association between sexual violence and the reporting of physical symptoms during pregnancy.MethodsA population-based national cohort study conducted by The Norwegian Mother and Child Cohort study (MoBa) collected data from pregnant women through postal questionnaires at 17 and 32 weeks gestation. Three levels of sexual violence were measured: 1) mild (pressured into sexual relations), 2) moderate (forced with violence into sexual relation) and 3) severe (rape). Differences between women reporting and not reporting sexual violence were assessed using Pearson’s X2 test and multiple logistic regression analyses.ResultsOf 78 660 women, 12.0% (9 444) reported mild, 2.8% (2 219) moderate and 3.6% (2 805) severe sexual violence. Sexual violence was significantly associated with increased reporting of pregnancy-related physical symptoms, both measured in number of symptoms and duration/degree of suffering. Compared to women not reporting sexual violence, the probability of suffering from ≥8 pregnancy-related symptoms estimated by Adjusted Odds Ratio (AOR) was 1.49 (1.41–1.58) for mild sexual violence, 1.66(1.50–1.84) for moderate and 1.78 (1.62–1.95) for severe. Severe sexual violence both previously and recently had the strongest association with suffering from ≥8 pregnancy-related symptoms, AOR 6.70 (2.34–19.14).ConclusionA history of sexual violence is associated with increased reporting of pregnancy-related physical symptoms. Clinicians should consider the possible role of a history of sexual violence when treating women who suffer extensively from pregnancy-related symptoms.

The infrared radiation spectrum of acupoint Taiyuan (LU 9) in asthma patients

ObjectiveTo analyze the distinctive pathological characteristics in the spectrums of spontaneous infrared radiation at the Taiyuan (LU 9) acupoint in patients with asthma. MethodsA highly sensitive infrared spectrum detecting device was used to detect the spectrums of spontaneous infrared radiation at Taiyuan (LU 9) in 37 asthma patients and 34 healthy volunteers. ResultsAsthma patients had significantly lower infrared intensity than that of the healthy volunteers (P>0.01). Asthma patients had significantly lower overall infrared radiation intensity at the left Taiyuan (LU 9) than that of healthy volunteers (P> 0.05), but there was no significant difference between healthy volunteers and asthma patients at the right Taiyuan (LU 9) (P>0.05). The infrared radiation intensity of 17 wavelength spots at the left Taiyuan (LU 9) and 4 wavelength spots at the right Taiyuan (LU 9) in asthma patients were significantly lower than those of healthy volunteers (P>0.05). At 2 µm, the infrared radiation intensity of asthma patients was significantly stronger than that of healthy volunteers (P>0.05). At 19 wavelength spots in the healthy volunteers and at 4 wavelength spots in the asthma patients, the left Taiyuan (LU 9) showed a significantly stronger intensity than that of the right Taiyuan (LU 9) (P>0.05). By Pearson's X2 test, healthy volunteers had more wavelength spots that were significantly different between the left and right Taiyuan (LU 9) than the asthma patients (P>0.01). ConclusionChanges in the infrared spectrum at the Taiyuan (LU 9) acupoint in asthma patients may reflect distinct pathological changes. Certain acupuncture points may be related to specific organs.

Detecting Local Item Dependence in Polytomous Adaptive Data

A rapidly expanding arena for item response theory (IRT) is in attitudinal and health‐outcomes survey applications, often with polytomous items. In particular, there is interest in computer adaptive testing (CAT). Meeting model assumptions is necessary to realize the benefits of IRT in this setting, however. Although initial investigations of local item dependence have been studied both for polytomous items in fixed‐form settings and for dichotomous items in CAT settings, there have been no publications applying local item dependence detection methodology to polytomous items in CAT despite its central importance to these applications. The current research uses a simulation study to investigate the extension of widely used pairwise statistics, Yen's Q3 Statistic and Pearson's Statistic X2, in this context. The simulation design and results are contextualized throughout with a real item bank of this type from the Patient‐Reported Outcomes Measurement Information System (PROMIS).

Comparison of the Frequency of the Methylenetetrahydrofolate Reductase (MTHFR) C677T Polymorphism in Depressed Versus Nondepressed Patients

Numerous studies have found an association between low serum folate levels and incidence of depression. Folic acid supplementation has been successfully used as an adjunct to treat depression in these patients. However, some individuals have a genetic deficiency in the methylene tetrahydrofolate reductase (MTHFR) gene that limits conversion of folic acid to its biologically active form, L-methylfolate. Several studies have identified a higher frequency of genetic variations in the MTHFR gene in depressed patients than in nondepressed controls. This study evaluated the frequency of the most common genetic variation MTHFR C667T in a group of depressed U.S. Caucasians and compared results with those of a control group of nondepressed U.S. Caucasians. Subjects were recruited from a psychiatric practice, an ambulatory care clinic, and the community. Informed consent and a cheek swab sample were obtained from each subject for analysis using real-time polymerase chain reaction (PCR). Allele and genotype frequencies were compared using Pearson X2 analysis. Complete data were obtained for 156 subjects. No significant differences were found in frequency of the MTHFR C667T T allele (0.415 vs 0.365; p=0.408) or the MTHFR C667T TT genotype (20.7% vs 17.6%; p=0.619) between the depressed and non-depressed controls, respectively. Therefore, use of L-methylfolate without an additional indication of need does not appear to be warranted in this group of U.S. Caucasians. Some patients may benefit from L-methylfolate, but an evidence-based approach, such as MTHFR genotyping, should be used to identify these specific patients. Additional research is also needed to confirm the benefit of L-methylfolate in specific patient populations (e.g., MTHFR TT genotype).

Expressions of CD34 and CD117 in human hepatocellular carcinomas and the clinical significance

To study the expressions of CD34 and CD117 in the tissues of hepatocelluar carcinoma (HCC) and to explore the relationship with clinical pathology and it's evaluation on the prognosis of HCC patients. The expressions of CD34 and CD117 were examined by two-step methods of PV-9000 of immunohistochemistry in 55 HCC cases, 10 liver cirrhotic specimens and 6 normal liver specimens. Clinical-pathological data, tumor recurrent rate and survival rate after hepatectomy were recorded and analyzed with Fisher's Exact Test, Pearson X2 Test, Kaplan-Meier, Log-Rank Test and Cox Regression. The positive expression of CD34 was found in 65.4% of HCC, 20% of cirrhostic liver specimens and 16.7% of normal liver specimens, respectively. Significant differences found among the three groups, and the CD34 expression was significantly associated with vessel embolus (X2 = 4.000, P = 0.046) and the histological grades (X2 = 11.008, P = 0.001). The positive expression of CD117 was 47.3%, 10% and 0% in HCC, cirrhotic liver specimens and normal liver tissues, respectively, and statistical differences esxisted among the three groups. The CD117 expression was dramatically related to the histological grades (X2 = 5.115, P = 0.024) and clinical stages (X2 = 15.459, P = 0.000). Median disease free survival time after hepatectomy was significantly shorter in the group with positive-expression of CD34 (X2 = 4.105, P = 0.043) and CD117 (X2 = 28.023, P = 0.000) than the negative-expressed groups, respectively. Multivariate analysis showed that CD117 expression status, serum AFP levels and the size of tumor were independently prognostic factors for HCC patients. Tthe results demonstrated that CD34 and CD117 might play an important role in liver carcinogenesis and the progression of HCC, and they might potentially serve as markers for HCC prognosis.

Structural assessment of the Scottish stratified sheep production system

This paper deals with a new approach of describing Scottish stratified sheep production system using information about the breed/crossbreed structure of 133 flocks surveyed in 2006. The aim was to develop a more accurate tool that could simplify the assessment and description of structural changes of this system. The methodology involves grouping sheep breeds, creating a Flock Type pattern based on the parents breed and the potential outputs that could be carried out in the flocks, and finally stratifying the flocks using a Classification Tree procedure to get an approximation to the traditional hill–upland–lowland description of the system. Scottish stratified sheep production system is described using categorical variables from the survey and a Pearson X2 statistic.The results emphasise that stratified structure is an important part of the Scottish sheep production system, and that stratified management is in turn an important part of the stratified structure. Breed structure, breeding goal and flock replacement changes are explained, and how they are affecting the present system. After comparing the results with other studies, the Scottish sheep production system seems to be moving towards a less dynamic system, with a new balance of breeds, more introductions of Terminal Sire breeds and in which Self Contained breeds and other crossbreeds ewes could compete with Mules.

41 Tracking of Adhd-Like Symptoms From Childhood to Adolescence in a Greek Birth Cohort and Associated Factors

Aim: To explore the prevalence of inattention, hyperactivity and impulsivity (ADHD-like symptoms) at the ages of 7 and 18 and associated factors in a representative Greek population. Methods: Information was derived from a population-based sample of 11,048 newborn infants, followed-up at 7 and 18 years, through questionnaire surveys. After applying a matching procedure, a data set of 2,695 individuals covering all the three time periods was compiled and used in this study. Pearson X2 test and multivariate logistic regression analysis were used to assess associations between ADHD-like symptoms and various perinatal and childhood factors. Results: In childhood, the prevalence of hyperactivity was 7%, inattention 9.5 % and impulsivity 7%, while a substantial decline of these symptoms was observed at 18 years. The male to female ratio was 3 to 1. Adverse perinatal factors, poor academic performance, comorbidity, physical punishment and frequent report of accidents and conflicts with peers were found to be associated with ADHD-like symptoms at 7 years. The factors found to be associated with ADHD-like symptoms during adolescence were gender, maternal smoking during pregnancy, maternal stress and physical punishment during childhood. Conclusion: The tracking of ADHD-like symptoms in the Greek population and the associated factors coincided with the international trends of this disorder. Recommendations to decrease adverse perinatal outcomes, maternal smoking during pregnancy, maternal stress and physical punishment of the child should be evaluated in future longitudinal investigations.

Higher risk of pregnancy complications in women with polycystic ovary syndrome

OBJECTIVE: Previous studies have evaluated pregnancy outcome parameters in small cohorts of women with polycystic ovary syndrome (PCOS). The aim of this study is to assess obstetric and perinatal outcomes in PCOS women. DESIGN: Case control study. MATERIALS AND METHODS: Normogonadotropic anovulatory patients (classification according to the World Health Organization) received a questionnaire. PCOS was diagnosed according to the Rotterdam criteria. Pregnancy outcome parameters of the PCOS women who gave birth between 2000 and 2005 were compared with data from the Netherlands Perinatal Registry (PRN). The PRN contains population based detailed information on pregnancies, deliveries and (re)admissions in the Netherlands registered by midwives, obstetricians and paediatricians. Controls were matched by age, parity, year of delivery and postal code. Outcome parameters were compared between PCOS women and controls using Wilcoxon and Pearson's X2 tests. RESULTS: Questionnaires were sent to 1187 normogonadotropic anovulatory patients, 567 (47,7%) women agreed to participate. PCOS was diagnosed in 497 (88%) women. Of them, 444 (78,3%) patients tried to conceive and 382 women got pregnant at least one time. In total 554 ongoing pregnancies in PCOS women were studied. The singleton pregnancies (n=518) were included in the analysis and compared to 2980 pregnancies in controls. PCOS women showed a significantly higher risk to develop gestational diabetes (p-value < 0.0001), hypertension (p-value < 0.0001) and pre-eclampsia (p-value 0.012). Furthermore, more PCOS women gave birth by unplanned cesarean section (p-value < 0.0001). Finally, their children were more frequently admitted at a neonatal intensive care unit (p-value < 0.0001). CONCLUSION: This large uniform phenotyped cohort study shows that pregnant women with PCOS are at increased risk for obstetric problems and their children for neonatal complications. These risks should be considered during their antenatal, intrapartum and neonatal care.

Variation in the Type and Frequency of Postoperative Invasive Staphylococcus aureus Infections According to Type of Surgical Procedure

To determine the epidemiological characteristics of postoperative invasive Staphylococcus aureus infection following 4 types of major surgical procedures.design. Retrospective cohort study. Eleven hospitals (9 community hospitals and 2 tertiary care hospitals) in North Carolina and Virginia. Adults undergoing orthopedic, neurosurgical, cardiothoracic, and plastic surgical procedures. We used previously validated, prospectively collected surgical surveillance data for surgical site infection and microbiological data for bloodstream infection. The study period was 2003 through 2006. We defined invasive S. aureus infection as either nonsuperficial incisional surgical site infection or bloodstream infection. Nonparametric bootstrapping was used to generate 95% confidence intervals (CIs). P values were generated using the Pearson chi2 test, Student t test, or Wilcoxon rank-sum test, as appropriate. In total, 81,267 patients underwent 96,455 procedures during the study period. The overall incidence of invasive S. aureus infection was 0.47 infections per 100 procedures (95% CI, 0.43-0.52); 227 (51%) of 446 infections were due to methicillin-resistant S.aureus. Invasive S. aureus infection was more common after cardiothoracic procedures (incidence, 0.79 infections per 100 procedures [95%CI, 0.62-0.97]) than after orthopedic procedures (0.37 infections per 100 procedures [95% CI, 0.32-0.42]), neurosurgical procedures (0.62 infections per 100 procedures [95% CI, 0.53-0.72]), or plastic surgical procedures (0.32 infections per 100 procedures [95% CI, 0.17-0.47]) (P < .001). Similarly, S. aureus bloodstream infection was most common after cardiothoracic procedures (incidence, 0.57 infections per 100 procedures [95% CI, 0.43-0.72]; P < .001, compared with other procedure types), comprising almost three-quarters of the invasive S. aureus infections after these procedures. The highest rate of surgical site infection was observed after neurosurgical procedures (incidence, 0.50 infections per 100 procedures [95% CI, 0.42-0.59]; P < .001, compared with other procedure types), comprising 80% of invasive S.aureus infections after these procedures. The frequency and type of postoperative invasive S. aureus infection varied significantly across procedure types. The highest risk procedures, such as cardiothoracic procedures, should be targeted for ongoing preventative interventions.

Usefulness of monitoring serum carcinoembryonic antigen (CEA) to define response to chemotherapy and its correlation with survival in patients with non-small cell lung cancer with abnormal baseline CEA levels.

e18044 Background: Carcinoembryonic antigen (CEA, CEACAM5) is an oncofetal protein that functions as a cell-adhesion molecule. It is usually over-expressed in a variety of neoplasms; moreover, high serum CEA levels are an independent prognostic factor for recurrence and survival in patients with non small-cell lung cancer (NSCLC). To date, there are no markers that satisfactorily predict objective response to chemotherapy in NSCLC. Methods: The aim of the study was to evaluate the relationship of a change in serum CEA levels at baseline and after two cycles of treatment, to compare them with objective response (measured by RECIST) and to correlate it with progression free-survival (PFS) and overall survival (OS). Results: 182 (67.4%) of 270 patients had a baseline CEA serum level > 5 ng/mL (range 5-7,440). Treatment was platinum-based chemotherapy in 169 (92.9%) patients and a tyrosine kinase inhibitor was used in 13 (7.1%). The mean follow-up time was 12.6 mo. After two cycles of treatment, objective global response was 29.7% and ≤ 25% CEA reduction was found in 32.4%. One hundred percent of patients with complete response had a ≤ 25% CEA reduction value, 60% for partial response, 24.7% for stable disease and 9.3% for progressive disease (Pearson's X2 value 38.49, p < 0.0001). Sensitivity, specificity, positive predictive value and negative predictive value were 80%, 62%, 57% and 83% respectively. PFS was longer in patients with a 25% reduction in CEA (11.3 mo [CI 95% 9.5-13.1] vs 8.7 mo [CI 95% 7.5-9.8], p = 0.04) and OS showed a tendency for longer survival (19.9 mo [CI 95%12.3-27.5] vs 14.7 mo [CI 95% 13.2-16.1] p = 0.09). Conclusions: A 25% reduction from baseline CEA is associated with objective response and PFS. CEA is an accurate and specific predictor of objective response to treatment in locally advanced and advanced NSCLC. No significant financial relationships to disclose.

Methylenetetrahy-drofolate Reductase Gene Polymorphism in Patients Receiving Hemodialysis

Methylenetetrahydrofolate Reductase (MTHFR) is key enzyme in metabolism of homocysteine. Homozygotes for mutation (TT genotype) have hyperhomocysteinemia, risk factor for atherosclerosis development. The aim of the study was to find out distribution of genotype frequencies of C677T MTHFR among patients on maintenance hemodialysis. Possible association of alleles and genotypes of C677T polymorphism of the MTHFR gene with age of onset, duration of dialysis and cause of kidney failure was studied also. Cross-sectional study includes 80 patients from Clinic of Hemodialysis KUCS in Sarajevo. In order to perform genotyping, isolated DNA was analyzed by RFLP-PCR and gel-electrophoresis. From total of 80 patients, 42.5% (n=24) were female, 57.5% (n=46) were male, mean age 54.59+/-1.78 years and duration of dialysis 79.92+/-6.32 months. Genotype distribution was: CC 51.2% (n=41), CT 37.5% (n=30) and TT 11.2% (n=9). Patients with wild-type genotype have longer duration of dialysis in month (87.1 +/- 63.93) comparing to TT genotype patients (67.06 +/- 39.3), with no statistical significance. T allele frequency was significantly higher in group of vascular and congenital cause of kidney failure (Pearson X2 =6.049, P<0.05) comparing to inflammation etiology group. Genotype distribution results are within the results other studies in Europe. Obtained results indicate that C677T polymorphism is not associated with onset, duration and cause of kidney failure in our hemodialysis population. There is an association of T allele of the MTHFR gene and vascular and congenital cause kidney failure.