Risk-free Group Research Articles

Açık kalp cerrahisi geçiren 80 yaş üstü hastalarda Geriatrik Nutrisyonel Risk İndeksinin mortalite oranını tahmin edebilme gücü

Purpose: This retrospective study aimed to determine the predictive power of the geriatric nutritional risk index, calculated using the preoperative albumin value of patients over 80 years old who underwent open-heart surgery, in relation to the postoperative mortality rate.
 Materials and Methods: A total of 22 patients (13 males, 9 females; mean age: 82.1±2.4 years; range, 80-88 years) who underwent open elective heart surgery for coronary bypass and heart valve replacement between July 2019 and September 2022 were retrospectively analyzed using the geriatric nutritional risk index. Based on this index, two distinct groups were formed. Values 98 and below were considered risky, and values 99 and above were considered risk-free. There were 6 patients in the risk group. The other 16 patients were in the risk-free group. All patient groups were compared on the basis of surgical procedures, age, gender, body mass index (kg/m2), diabetes, hypertension, atrial fibrillation, smoking, and operative characteristics.
 Results: In the study, 6 risky (27.3%) and 16 risk-free (%72.7) patients were examined according to the geriatric nutritional risk index and the mortality rate was found to be high (%66.7) in the risky group. The patients in the risk group had lower body mass index and albumin values (25.0±1.8 and 30.1±2.4) compared with the risk-free group (28.1±2.4 and 36.7±3.1). In addition, the mean extubation values were high (11.2±4.2). No significant difference was found between the other parameters and the presence of risk.
 Conclusion: Before undergoing open heart surgery, the Geriatric Nutritional Risk Index can strongly predict postoperative mortality rates.

Clinical study on new risk assessment and prediction system for early osteonecrosis of the femoral head

To establish a risk assessment and prediction system for early osteonecrosis of the femoral head (ONFH) in order to predict the collapse risk. The risk assessment system for early necrosis and collapse of femoral head was established based on the combination of Steinberg stage, ABC typing and the proportion of the proximal sclerotic rim. Firstly, Steinberg stage system was applied. ABC typing was applied to predict risk in stage I, type C was risk free, type B was low risk, type A and type BC were medium risk, type A-C and type AB were high risk. The classification of proximal sclerotic rim was first applied when the Steinberg stage was Ⅱ-Ⅲ, and type 2 was expected to be low risk. If the classification of proximal sclerotic rimwas type 1, then the ABC typing was applied, type C was risk-free, type B was low risk, type A and type BC were medium risk, type A-C and type AB were high risk. According to this prediction system, the collapse risk of femoral head in 188 cases(301 hips) were predicted by retrospective analysis. All the hips were enrolled at the out-patient department of orthopedic in Guang'anmen Hospital attached to China Academy of Chinese Medical Science. The consistency of the prediction results of three doctors and one doctor at different times were evaluated. Among them, 136 cases were male, 52 were female. 75 cases were single hip, 113 were double hip. The age of the patients wa 19 to 64(42.61±12.07) years. The natural course of disease was 0.33 to 5.00(3.62±1.93) years. 206 hips in 301 hips had collapsed, with a collapse rate of 68.44%. In the risk-free group, none hip had collapsed, with a collapse rate of 0%. In the low-risk group, 9 hip in 91 hips had collapsed, with a collapse rate of 9.89%. In the medium-risk group, 12 hip in 19 hips had collapsed, with a collapse rate of 63.16%. And in the high risk group, 185 hips in 190 hips had collapsed, with a collapse rate of 97.37%. They were significantly differences in their collapse rate (P=0.00) in the following order:high-risk group> medium-risk > low-risk group > risk-free group. The prediction value of the system was high (AUC=0.95, P=0.00). The results predicted by different doctors were consistent (ICC=0.94, P=0.00), and the results predicted by the same doctor at two different times were consistent (Kappa coefficient =0.90, P=0.00). The risk assessment and prediction system for early ONFH selects different methods to predict the risk of collapse according to the imaging characteristics of different stages, which is combines with the comprehensive assessment of multiple risk factors. The system is applicable to a wide range, simple operation and convenient for clinical application.

Long-term prognosis of women with Brugada syndrome and electrophysiological study

A male predominance in Brugada syndrome (BrS) has been widely reported, but scarce information on female patients with BrS is available. The purpose of this study was to investigate the clinical characteristics and long-term prognosis of women with BrS. A multicenter retrospective study of patients diagnosed with BrS and previous electrophysiological study (EPS) was performed. Among 770 patients, 177 (23%) were female. At presentation, 150 (84.7%) were asymptomatic. Females presented less frequently with a type 1 electrocardiographic pattern (30.5% vs 55.0%; P <.001), had a higher rate of family history of sudden cardiac death (49.7% vs 29.8%; P <.001), and had less sustained ventricular arrhythmias (VAs) on EPS (8.5% vs 15.1%; P = .009). Genetic testing was performed in 79 females (45% of the sample) and was positive in 34 (19%). An implantable cardioverter-defibrillator was inserted in 48 females (27.1%). During mean (± SD) follow-up of 122.17 ± 57.28 months, 5 females (2.8%) experienced a cardiovascular event compared to 42 males (7.1%; P = .04). On multivariable analysis, a positive genetic test (18.71; 95% confidence interval [CI] 1.82-192.53; P = .01) and atrial fibrillation (odds ratio 21.12; 95% CI 1.27-350.85; P = .03) were predictive of arrhythmic events, whereas VAs on EPS (neither with 1 or 2 extrastimuli nor 3 extrastimuli) were not. Women with BrS represent a minor fraction among patients with BrS, and although their rate of events is low, they do not constitute a risk-free group. Neither clinical risk factors nor EPS predicts future arrhythmic events. Only atrial fibrillation and positive genetic test were identified as risk factors for future arrhythmic events.

Nominal risk analysis of the blue light from LED luminaires in indoor lighting design

It is a common opinion that LEDs emit a very high amount of energy in the blue range, which could be potentially harmful to our visual tissues. This study focuses on the LED lamps used for interior lighting and was carried out base don the parameters of 15 LED lights collected by inspectors from the Consumer Council of Castilla la Mancha, Spain. The samples were acquired at random from various commercial establishments. The luminaires acquired in collaboration with the public administration can be placed in any workplace or home. The following is a study of the nominal risk of blue light. The results show that these LED luminaires comply with relevant regulations, and none of them pose a risk to the retina because they all belong to the risk-free group.

Joint model for bivariate zero-inflated recurrent event data with terminal events

Bivariate recurrent event data are observed when subjects are at risk of experiencing two different type of recurrent events. In this paper, our interest is to suggest statistical model when there is a substantial portion of subjects not experiencing recurrent events but having a terminal event. In a context of recurrent event data, zero events can be related with either the risk free group or a terminal event. For simultaneously reflecting both a zero inflation and a terminal event in a context of bivariate recurrent event data, a joint model is implemented with bivariate frailty effects. Simulation studies are performed to evaluate the suggested models. Infection data from AML (acute myeloid leukemia) patients are analyzed as an application.

Investigating demographic, socioeconomic, and obsteric risk factors of term intrauterine stillbirth cases

Objective: To establish the prevalence, etiology, demographic, socioeconomic, and obstetric risks factors of intrauterine fetal deaths among term pregnancies with no risk factors. Our study is the first to investigate term stillbirth risk factors in such a large population. Material and Methods: A total of 96 cases of stillbirth between 37th and 42nd weeks with no risk factors out of 90,557 births conducted in 2011-2015 were investigated retrospectively. Eighty patients that had stillbirth in our clinic were chosen as the study cases and 80 others that had risk-free live birth at the weeks of 37-42 chosen randomly accepted as the control group. Variables such as age of mothers, gravidas, parities, level of education of mothers, time since the previous pregnancy, BMIs, weight gained during pregnancy, gestational week, birth weights of infants, systolic and diastolic blood pressures, hemoglobin values, blood glucose levels, white blood cell counts, smoking history, follow-ups at the hospital, gender of babies, and seasonal distribution of stillbirths were evaluated. Results: The stillbirth rate was found as 14 per million and stillbirth in risk-free population at 37-42 weeks was 1.05 per mill. BMI, hemoglobin levels, and systolic blood pressures of mothers were significantly higher in stillbirths. Any statistically significant difference in mean maternal age, gravida/parity, education level, weight gained during pregnancy, smoking and fetal gender distribution was not established between the groups Conclusion: Term stillbirths in the risk-free group may be correlated with advanced gestational week, increased BMI, systolic blood pressure, and hemoglobin levels of the mother also insufficient antenatal follow-up.

Nutritional risk screening in patients at the gastroenterology department

Objective To study the incidence of risk of malnutrition , nutritional support rate , and the relationship between nutrition risk scores and nutrition indicators .Methods A total of 139 patients were investigated by nutrition risk screening 2002 （ NRS2002 ） .The relationships between NRS 2002 scores and nutrition indicators were analyzed .Results The incidence of risk of malnutrition （ NRS≥3 ） and nutritional support rate were 48%.37.5%patients had nutritional support .The pre-albumin was （142.56 ±68.23） mg/L in nutritional risk group, that was less than the risk-free group with （208.45 ±59.65）mg/L, the difference was statistically significant （t=23.95,P〈0.05）.The results of nutritional risk assessment and the pre-albumin, albumin, hemoglobin was negatively correlated （r=-0.882, -0.713,-0.689, respectively;P〈0.05）. Conclusions Screening for new patients is helpful to learn the nutritional status of the patients .The method is easy to operate.NRS2002 has many advantages and should be widely used to predict the nutrition risks of digestive patients . Key words: Nutritional support; Nutritional risk screening; Gastroenterology department

Hepatitis C virus (HCV)-specific CD8 T-cells in HCV-seronegative individuals: Frequency and T-cell receptor repertoire (TCR)

Memory CD8 T-cells cross-reactive with a heterologous virus have shown to provide either protective immunity and/or immune pathology. In humans, proliferation of cross-reactive CD8 memory T-cells has been implicated in infectious mononucleosis (IM) and subfulminant acute HCV-infection. Since each individual has its own private immune repertoire, the frequency of memory T cells polyspecific to HCV can vary and the specificity is determined by the CDR3 of the TCR. This study aimed to determine the frequency and TCR of HCV-specific CD8 T-cells in HCV-seronegative individuals with different risk profiles for HCV transmission. 60 HCV-seronegative HLA-A2+ individuals were studied (14 risk free, 19 unknown blood donors, 15 sexual partners of HCV patients, 7 health care worker, 5 iv drug user). HCV-NS3(1073)-specific T-cell lines were generated. Response was defined based on proliferation by CFSE and tetramer frequency. TCR-analysis of tetramer-sorted cells was performed by RT-PCR with Vb-specific primer and subcloning/sequencing of CDR3. TCR of HCV-seronegative responder was compared with TCR used in acute HCV-infection. In 18/60 individuals, HCV-NS3(1073)-specific cells proliferated and variable frequencies (0,4–76%) of tetramer+ cells were documented independent from the risk group. TCR-analysis of the highly responding individual (risk free group) showed usage of only TCR-Vb6.2 (oligoclonal response). Interestingly, the CDR3 of the dominant clone (Vb6.2-QEAGAP-Jb2.2) revealed the presence of similar amino acids found in patients with acute HCV-infection (Vb6.2-LxGxP-Jb 2.7, Vb6.2-ExAxG-Jb 2.3). The TCR of low responding individuals were more diverse. Our study confirmed that HCV-NS3(1073)-specific CD8 T-cells exist in HCV-seronegative individuals. The variability between individuals is consistent with the concept of private specificity. The pattern of TCR usage was also reminiscent to previously identified cross-reactive responses in mouse models or during IM.

The Efficacy of the Intima-media Thickness (IMT) to Predict Cardiovascular Disease in Vasculogenic Erectile Dysfunction Patients

Purpose: Erectile dysfunction (ED) is associated and might be one of the first signs of cardiovascular disease (CVD). We aimed to assess whether men with vasculogenic ED have an increased risk of CVD by evaluating the relationship between erectile function and the intima-media thickness (IMT) of the common carotid arteries. Materials and Methods: A total of 40 men were divided into 4 groups according to their erectile function as evaluated by the International Index of Erectile Function (IIEF)-15 and the presence of vascular risk factors (VRF). The risk free (RF) group (n=10) included men with ED and no evidence of VRF, the low-risk (LR) group (n=10) included the vasculogenic ED subjects who were overweight or dyslipidemic, and high-risk (HR) group (n=10) consisted of ED subjects with hypertension or diabetes. An age-matched healthy group without ED served as the control (n=10). Blood pressure, height, weight, the lipid profile and the IMT of the carotid arteries were evaluated. Results: The control group and the vasculogenic ED groups showed significant differences in the IIEF scores and IMT (p<0.05). Spearman's test of the entire subjects revealed a significant correlation between the severity of ED and IMT (p<0.01), which was not present in the control group (p=0.523). However, a significant correlation of the severity of ED and IMT was found in the groups with ED (p<0.05). In addition, the evaluated parameters of the control group and the RF group revealed no significant difference except for the IIEF scores. Conclusions: Our results suggest that ED might be a prodrome of cardiovascular diseases. Thus, screening on cardiovascular risk factors and taking preventive measures are considered in ED patients, especially if the ED is severe. (Korean J Urol 2006;47:859-865) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Starlings’ preferences for predictable and unpredictable delays to food

Risk-sensitive foraging theory is based on the premise that unpredictable runs of good or bad luck can cause a variable food source to differ in fitness value from a fixed food source yielding the same average rate of gain but no unpredictability. Thus, risk-sensitive predictions are dependent on the food intake from variable sources being not only variable but also unpredictable or ‘risky’ in outcome. This study tested whether unpredictability is a component of the value that foraging starlings,Sturnus vulgarisattribute to food sources that are variable in the delay to obtain food. Two groups of birds chose between a fixed and a variable delay option; the variable option was unpredictable in the risky group and predictable in the risk-free group in the overall rate of intake it yielded. In both groups the fixed option was adjusted by titration to quantify the magnitude of preference for predictable and unpredictable variance. On negative energy budgets both groups were significantly risk-prone, with the risky group being significantly more risk-prone than the risk-free group. Switching the birds to positive budgets by doubling the size of each food reward had no significant effect on preference, and similar trends to those found with negative budgets were observed. These results are not readily explained by risk-sensitive foraging theory, but may be explained by the algorithm used by the birds to attribute value to average expected rewards.