Significant Differences In Regard Research Articles

Effects of Apatite Cement Containing Atelocollagen on Attachment to and Proliferation and Differentiation of MC3T3-E1 Osteoblastic Cells.

To improve the osteoconductivity of apatite cement (AC) for reconstruction of bone defects after oral maxillofacial surgery, we previously fabricated AC containing atelocollagen (AC(ate)). In the present study, we examined the initial attachment, proliferation and differentiation of mouse osteoblastic cells (MC3T3-E1 cells) on the surface of conventional AC (c-AC), AC(ate) and a plastic cell dish. The number of osteoblastic cells showing initial attachment to AC(ate) was greater than those attached to c-AC and similar to the number attached to the plastic cell wells. We also found that osteoblastic cells were well spread and increased their number on AC(ate) in comparison with c-AC and the wells without specimens, while the amount of procollagen type I carboxy-terminal peptide (PIPC) produced in osteoblastic cells after three days on AC(ate) was greater as compared to the others. There was no significant difference in regard to alkaline phosphatase (ALP) activity and osteocalcin production by osteoblastic cells among the three surface types after three and six days. However, after 12 days, ALP activity and the produced osteocalcin were greater with AC(ate). In conclusion, AC(ate) may be a useful material with high osteoconductivity for reconstruction of bone defects after oral maxillofacial surgery.

Transcatheter Aortic Valve Implantation versus Surgical Aortic Valve Replacement: Meta-Analysis of Clinical Outcomes and Cost-Effectiveness.

Transcatheter aortic valve implantation (TAVI) has emerged as a feasible alternative treatment to conventional surgical aortic valve replacement (AVR) for high-risk patients with aortic stenosis. The present systematic review aimed to assess the comparative clinical and cost-effectiveness outcomes of TAVI versus AVR, and meta-analyse standardized clinical endpoints. An electronic search was conducted on 9 online databases to identify all relevant studies. Eligible studies had to report on either periprocedural mortality or incremental cost-effectiveness ratio (ICER) to be included for analysis. The systematic review identified 24 studies that reported on comparative clinical outcomes, including three randomized controlled trials and ten matched observational studies involving 7906 patients. Meta-analysis demonstrated no significant differences in regards to mortality, stroke, myocardial infarction or acute renal failure. Patients who underwent TAVI were more likely to experience major vascular complications or arrhythmias requiring permanent pacemaker insertion. Patients who underwent AVR were more likely to experience major bleeding. Eleven analyses from 7 economic studies reported on ICER. Six analyses defined TAVI to be low value, 2 analyses defined TAVI to be intermediate value, and three analyses defined TAVI to be high value. The present study demonstrated no significant differences in regards to mortality or stroke between the two therapeutic procedures. However, the cost-effectiveness and long-term efficacy of TAVI may require further investigation. Technological improvement and increased experience may broaden the clinical indication for TAVI for low-intermediate risk patients in the future.

Frequency of early warning score assessment and clinical deterioration in hospitalized patients: A randomized trial

AimTo explore whether early warning score (EWS) measurements at 8h intervals is associated with better outcomes than 12h intervals. We hypothesized that the proportion of patients that deteriorated to a higher EWS at 24h after hospital admission would be lower with 8h interval than with 12h interval. MethodThis was a pragmatic, ward-level randomized, non-blinded, controlled trial at an urban University hospital. During two six weeks periods acutely admitted surgical and medical patients, with an initial EWS of 0 or 1, were monitored either every 8th hour or every 12th hour. The primary outcome was clinical deterioration 24h post-admission, estimated by the proportion of patients with an EWS≥2 at 24h after the initial EWS on admission. ResultsOf 3185 patients screened for eligibility, 1346 patients were included to the trial. Forty-nine percent were allocated to the 8h group and 51% to the 12h group; of these, 23% and 20% had an elevated EWS≥2 at 24h, respectively (p=0.456), OR 1.17 (0.78–1.76); 3.4% and 2.2%, respectively had an EWS≥5 (p=0.391), and one patient in each group had an EWS≥7 at 24h (p=1.0). Multiple logistic regression analysis showed no significant interactions for the primary outcome and the predefined variables: age, gender, ward type, and inclusion period, with an adjusted OR 1.20 (0.79–1.82). There were no significant differences in regard to the secondary outcomes: cardiac arrests, ICU admissions, review by medical emergency team (MET), length of hospital stay, or elevated EWS at 48h. Thirty-day mortality was 1.1% vs. 1.8% (p=0.357) in the 8h group and the 12h-group, respectively (OR=0.60 (0.23–1.50), p=0.279). ConclusionWe found no significant reduction in the proportion of clinical deterioration with monitoring frequencies of 3 vs. 2 times daily among patients acutely admitted to a surgical or medical ward and an initial EWS of 0–1.

Factors Influencing on Awareness Levels of Medical Service in Ambulatory Surgery Patients in A Tertiary Health Care

This study was performed to identify the factors influencing on awareness levels of medical service in ambulatory surgery patients in a tertiary health care in Korea. Data were surveyed using interview and questionnaires by 166 outpatients who visited a general hospital which was located in Chungnam area from January 13 to February 26, 2015. General characteristics and factors related to awareness levels of medical service were analyzed with descriptive statistics by frequency and percentage. factors related to awareness levels according to general characteristics were measured by t or ANOVA. Factors Influencing on ambulatory surgery outpatients were performed by multiple regression analysis. The results of this study are as follows. Firstly, for the subject’s gender, male with 51.2% revealed higher rate than female with 48.8%. Secondly, for religion, the proportion of christianity(28.3%) was a higher rate than the proportion(20.5%) of buddihism. Thirdly, in the factor related to awareness levels of Received(November 16, 2015), Review request(November 17, 2015), Review Result(1st: December 04, 2015, 2nd: December 30, 2015) Accepted(January 08, 2016), Published(January 31, 2016) 32588, Dept. of Medical Information, Kongju National University. 56 Gongjudaehak-ro, Gongju-si, Chungnam, Korea email : leesr@kongju.ac.kr Factors Influencing on Awareness Levels of Medical Service in Ambulatory Surgery Patients in A Tertiary Health Care Copyright c 2016 HSST 110 medical service, outpatients who had an experience with hospitalizing, there was significant difference in regard to the reliability of medical service(t=0.584, p<.05). Fourthly, multiple regression analysis revealed that their age and education affected the perception of ambulatory surgery (p<.05). In conclusion, in order to increase the rate of ambulatory surgery, it is necessary to give information about the advantages of ambulatory surgery and preoperative education.

الاتجاه نحو الإرشاد الإلکترونی لدى عینة من العاملین على رعایة الموهوبین والموهوبات بالإدارة العامة للتربیة والتعلیم بمحافظة جدة ( دراســــة مقـــارنـــة ) Attitude Towards Use Electronic Counseling in a Sample of workers care of Gifted in the Directorate General of Education in Jeddah (Comparative Study)

هدفت الدراسة الحالية إلى التعرف على اتجاه العاملين على رعاية الموهوبين والموهوبات نحو الإرشاد الإلکتروني, وکذلک الفروق بين متوسطات درجات اتجاه عينة الدراسة نحو الإرشاد الإلکتروني تبعا لمتغير الجنس- سنوات الخبرة – المسمى الوظيفي, ولتحقق من هذا الهدف البحث اتبعت الباحثة المنهج الوصفي المقارن. وتکونت عينة الدراسة من (100) موظف من العاملين على رعاية الموهوبين والموهوبات بالإدارة العامة للتربية والتعليم بمحافظة جده والمتمثلة في مديري إداراتي الموهوبين والموهوبات–معلمي الرعاية – مشرفي الموهوبين والموهوبات – منسقي المرحلة الابتدائية بمدارس التعليم العام بمحافظة جدة. قامت الباحثة ببناء استبانه تضمنت (43) عبارة موزعة على ثلاث أبعاد وهي (الاتجاه نحو أهمية الإرشاد الإلکتروني – الاتجاه نحو المرشد الإلکتروني – الاتجاه نحو خدمات الإرشاد الإلکتروني). وقد خلصت الدراسة إلى مجموعة من النتائج أهمها: 1- جميع أبعاد الاتجاه نحو الإرشاد الإلکتروني سجلت درجات مرتفعة جدا لدى عينة الدراسة, وجاء ترتيب هذه الأبعاد من المرتفع إلى الأقل ارتفاعا کما يلي(الاتجاه نحو أهمية الإرشاد الالکتروني, الاتجاه نحو المرشد الإلکتروني, الاتجاه نحو خدمات الإرشاد الإلکتروني) فيما سجلت أيضا درجة مرتفعة جدا في الدرجة الکلية للاستبيان. 2- عدم وجود فروق دالة إحصائيا في درجات المجموعات للأبعاد والدرجة الکلية للاتجاه نحو الإرشاد الإلکتروني تبعا (الجنس- سنوات الخبرة). 3- وجود فروق دالة إحصائيا في درجات المجموعات للأبعاد والدرجة الکلية لاستبيان الاتجاه نحو الإرشاد الإلکتروني تبعا لنوع الوظيفة لصالح مدير إدارة الموهوبين. This study aimed to identify the attitude of the staff who are in charge of Male and Female Talented Welfare toward Electronic Counseling, as well as the Differences between the scores averages of the study sample attitude toward Electronic Counseling depending on the variable (sex - years of experience - Job Title) . The researcher followed the comparative descriptive method to check out the study goal . The Study Sample Consisted of (100 Employees Working on Male and Female Talented Welfare at the General Administration of Education in Jeddah represented in the Directors of Male and Female Talented Departments of in Jeddah – the care Teachers - the Supervisors of Male and Female Talented - the Coordinators of the Elementary grade at public schools in Jeddah . The researcher built a Questionnaire included (43)Phrases distributed in three dimensions, namely,( the attitude toward the importance of Electronic Counseling - the attitude Toward Electronic Counseling- the attitude Toward Electronic Counseling Services Of most important results the study concluded to: All dimensions attitude toward Electronic Counseling recorded highly scores in the study sample, the order of these dimensions came from high to less high, as follows ( the attitude toward the importance of Electronic Counseling, the attitude toward Electronic counselor, the attitude toward Electronic Counseling services), respectively, while the attitude toward electronic counseling also recorded very high score in the questionnaire total scores. Lack of significant differences in the scores of the groups of the dimensions and the total score of the attitude toward electronic counseling according to (sex - years of experience). The presence of significant differences in regard to the scores of groups of dimensions and the total score for the questionnaire of the attitude toward Electronic counseling depending on the type of job in favor of the Director of the Male Talented Department.

Initial experience with radical antegrade modular pancreatosplenectomy in a single institution.

PurposeRadical antegrade modular pancreatosplenectomy (RAMPS) is expected to be favorable for obtaining the negative tangential margin with oncologic feasibility through the horizontal dissection in a right-to-left fashion for radical lymph node dissections.MethodsFrom January 2007 to February 2015, a total of 30 RAMPS and 19 conventional distal pancreatectomy (DP) cases were enrolled. The demographics, perioperative and survival outcomes were compared according to the type of surgery.ResultsThe mean operative time, blood loss and length of hospital stay were similar between 2 groups. Morbidities were reported in 14 cases of RAMPS (46.7%) and 8 cases of DP (42.1%) (P = 0.777). The rate of negative tangential margin (96.2%) and the number of harvested lymph nodes (mean ± standard deviation, 21.5 ± 8.3) were significantly higher in RAMPS group (P = 0.011, P = 0.003, respectively). In terms of survival outcomes, there was no significant difference in regard to the overall 3-year disease-free survival (DFS; 30.4% in RAMPS vs. 35.0% in DP, P = 0.354) or overall survival (OS; 29.9% vs. 29.4%, P = 0.429) between the 2 groups. After exclusion of cases with nodal invasion, however, the RAMPS group had a longer DFS than the DP group (55.6% vs. 27.3%, P = 0.048) although OS was similar without significant difference (42.4% vs. 27.3%, P = 0.197).ConclusionRAMPS is a safe and oncologically feasible procedure in left-sided pancreatic cancer by obtaining a successful negative tangential margin and radical lymph node dissection. The authors suggest it could also be useful for local control, especially for the limited left-sided pancreatic cancer without nodal invasion.

Need for Mechanical Ventilation in Pediatric Scald Burns: Why it Happens and Why it Matters.

Scald burns are the most common thermal injury among children. A small subset of pediatric scald burns are complicated by the need for mechanical ventilation (MV). Studies suggest that 4 to 5% of pediatric scald burns will require MV, and these patients tend to be younger with larger burns. Identifying why pediatric patients with scald burns require MV has remained unclear, and few studies have sought to elucidate possible mechanisms. After institutional review board approval, a retrospective review of all pediatric patients with scald burns admitted to the Burn Center between 2010 and 2013 was conducted. Variables collected included age, sex, weight, height, race, ethnicity, socioeconomic status or type of insurance, hospital length of stay, burn size and location, Department of Child and Family Services (DCFS) involvement, time to intubation from admission, reason for intubation, need for MV, duration of MV, need for operative intervention, 24-hour and 48-hour total fluid intake and urine output, glucose levels, infectious complications, comorbidities, and mortality. Patients who required MV were then compared with those who did not require MV to identify statistically significant differences between groups. The MV patients (n = 6) and nonventilated patients (n = 339) did not show significant differences in regards to gender, body mass index, ethnicity, and type of insurance; however, MV patients were younger and had larger burns. The mean age of MV patients was 8.2 + 5.0 months compared with 40.7 + 45.2 months for non-MV (P = .002). The mean percentage of TBSA burn in MV patients was 17.3 + 9.0% compared with 4.5 + 3.9% for non-MV (P < .001). Burn location was significant, and 66.6% of MV patients had burns on the face or neck compared with 23.6% of non-MV (P = .015). MV patients were more likely to have been victims of child abuse, as DCFS was involved in 67% of MV patients vs. 28% of non-MV patients (P = .036). Fifty percent of patients requiring MV had either a preceding upper respiratory infection, diagnosis of asthma, or congenital defects, compared with 6% of non-MV patients (P = .004). MV patients received more fluids for 48 hours compared with non-MV patients (2275.7 vs. 1332.3 ml, P = .013) and had a higher 48-hour urine output (2.34 vs. 1.34 ml/kg/hr, P = .013). Pediatric scald burns that require MV have an increased mortality risk and length of stay. MV patients were younger with larger burns. They received more fluids than non-MV patients, and child abuse, asthma, and stress hyperglycemia within the first 72 hours of injury were common among MV patients. Importantly, burn size and previous history of asthma were found to be independent predictors of the need for MV.

Treatment Choice of Decitabine Versus Conventional Chemotherapy for the Treatment of Elderly Patients with Newly Diagnosed Acute Myeloid Leukemia

Background: The European Medicines Agency Committee for Medical Products for Human Use and the Korean Food and Drug Administration approved decitabine as the first-line treatment for elderly patients with acute myeloid leukemia (AML) in 2012 and 2013, respectively. However, there are limited data supporting treatment choice of decitabine versus conventional chemotherapy for the treatment of elderly patients with newly diagnosed AML.Methods & Materials: We retrospectively reviewed medical records of patients with age between 65 and 75 who were diagnosed with AML except acute promyelocytic leukemia between Nov, 2004 and June, 2015 at Severance hospital, Seoul, Korea. Patients who were treated with decitabine or conventional chemotherapy as the first-line therapy for remission induction were studied. Patients who had received hypomethylating agents before diagnosing AML were excluded. Progression free-survival was assessed from the date of documentation of complete response (CR) or CR with incomplete blood count recovery (CRi) to the date of disease progression or death in patients achieving CR or CRi.Results: A total of 58 patients were studied. 16 and 42 patients were treated with decitabine and conventional chemotherapy (39 cytarabine with idarubicin; 3 fludarabine, cytarabine, and attenuated dose idarubicin), respectively, and compared in this study. The baseline characteristics of patient groups treated with decitabine or conventional chemotherapy were not significantly different in regard of gender (male; 62.5% vs. 50.0%; P = 0.557), performance status (median 1.0 vs. 1.0; P = 0.888), bone marrow blast percentage (median 55.5% vs. 69.1%; P = 0.162) and Charlson comorbidity score (median 0.0 vs. 0.0; P = 0.657). Age were older in decitabine-treated group than in group treated with conventional chemotherapy (median age 72 vs. 68; P < 0.001). Patients who were treated with conventional chemotherapy had poor cytogenetic risk more frequently than those who were treated with decitabine (45.0% vs. 13.3%; P = 0.040). CR or CRi were achieved in 42.9% of evaluable patients with decitabine therapy and 61.9% of evaluable patients with conventional chemotherapy (P = 0.232). The median overall survival (OS) (302 days in decitabine group; 95% CI: 269-335 vs. 286 days in conventional chemotherapy group; 95% CI: 130-441; P = 0.262) and progression free-survival (PFS) (284 days in decitabine group; 95% CI: 80-488 vs. 128 days in conventional chemotherapy group; 95% CI: 33-223; P = 0.572) were not significantly different between two groups. When performing subgroup analysis with patient groups having intermediate risk of cytogenetics (n = 10 in decitabine group, 20 in conventional chemotherapy group), there was no significant difference in regard of median OS (302 days in decitabine group; 95% CI: 276-328 vs. 486 days in conventional chemotherapy group; 95% CI: 190-782 days; P = 0.900) and PFS (284 days in decitabine group; 95% CI: 73-495 vs. 191 days in conventional chemotherapy group; 95% CI: 0-509; P = 0.698). Although there was no survival difference, overall hospitalization rates were lower in decitabine-treated patients when compared with conventional chemotherapy-treated patients (16.4% vs. 40.8%; P = 0.001).Conclusions: First-linedecitabine therapy was not inferior to conventional chemotherapy in regard of response rate, OS, and PFS in elderly patients with AML despite older age in our study. In addition, decitabine therapy induced fewer hospitalizations than conventional chemotherapy. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Analysis of Prognostic Factors and Outcome of Patients with Newly Diagnosed Diffuse Large B-Cell Lymphoma of the Gastrointestinal Tract

Introduction: The gastrointestinal tract is one of the extranodal sites more frequently involved in patients with diffuse large B-cell lymphoma (DLBCL). However, DLBCL with gastrointestinal involvement represents a very heterogeneous disease encompassing various biological entities. Therefore, optimal therapeutic strategies still remain a matter of debate.Methods: Patients with newly diagnosed DLBCL and gastrointestinal involvement treated at the University Hospital of Heidelberg, Germany, between January 2000 and December 2011 were included in this analysis. Medical charts were retrospectively reviewed in regard to clinical characteristics, treatment and outcome. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The impact of variables on PFS and OS was evaluated by univariate log-rank tests as well as by multivariate Cox regression.Results: 82 patients were identified, 47 were male, 35 female. Median age was 60.5 years [range 19-86 years]. The site of gastrointestinal involvement was stomach in 37 patients (45%), duodenum in 4 (5%), small intestine in 19 (23%), colon in 8 (10%) and multiple gastrointestinal sites in 14 (17%). According to the international prognostic index (IPI) 24 patients (29%) were low risk (IPI 0-1), 27 (33%) intermediate risk (IPI 2-3), and 13 (16%) high risk (IPI 4-5); 18 patients had no evaluable IPI score. 5-year PFS was 65%, 5-year OS was 79%. There was no significant difference in regard to survival between the different sites of gastrointestinal involvement both in uni- and multivariate analysis. While neither age, sex, stage, and IPI score had a significant impact on survival in multivariate analysis, presence of B-symptoms was significantly associated with inferior PFS (p=.02) yet not with OS.In regard to therapy, 66 patients (80%) were treated with a rituximab containing regimen. The chemotherapy backbone consisted of CHOP or a comparable regimen in 57 patients (70%), 21 (26%) received a more aggressive regimen (in our cohort mainly CHOP with additional etoposide (CHOEP)); four elderly patients underwent palliative treatment. Consolidative radiotherapy to the site of extranodal involvement was applied in 22 patients (27%). The addition of rituximab did not show a significant impact in regard to survival both in uni- and multivariate analysis. However, escalation of chemotherapy from CHOP to a more aggressive regimen had a significant positive impact on PFS (p=.004) and OS (p=.04) in univariate analysis; in multivariate analysis, it was significantly associated with prolonged PFS (p=.03) and showed a trend towards prolonged OS (p=.09). Patients receiving CHOEP had an excellent outcome with 5-year PFS 90% and 5-year OS 100%. While consolidative radiotherapy did not have an impact in univariate analysis, there was a trend towards beneficial impact on PFS (p=.09) and OS (p=.06) in multivariate analysis.Conclusions: In our cohort of patients with newly diagnosed DLBCL and gastrointestinal involvement presence of B-symptoms was significantly associated with inferior PFS. Regarding treatment modalities, escalation of chemotherapy to a more aggressive regimen than CHOP as well as consolidative radiotherapy seem to be potentially beneficial therapeutic strategies. DisclosuresWitzens-Harig:Pfizer: Honoraria, Research Funding; Roche: Honoraria.

Evaluation of Rivaroxaban and Dalteparin in Cancer Associated Thrombosis

Introduction: Venous thromboembolism (VTE) in the form of deep venous thrombosis (DVT) or pulmonary embolism (PE) is a complication of malignancy. Several studies have demonstrated the superiority of dalteparin (Fragmin®), a low molecular weight heparin (LMWH), in comparison to oral vitamin K antagonists in preventing VTE recurrence in the setting of active cancer. LMWH is the preferred treatment of cancer associated thrombosis. However, the cost of LMWH can be prohibitive and the need for daily subcutaneous injections can decrease patients' quality of life. While rivaroxaban (Xarelto®), a Factor Xa inhibitor, has been approved for the treatment and secondary prevention of DVT and PE, there is limited data regarding its use in cancer patients. The objective of our study is to determine the efficacy and safety of rivaroxaban compared to dalteparin in cancer associated thrombosis.Methods: This is a retrospective chart review of cancer patients greater than age 18 treated at H. Lee Moffitt Cancer Center between May 3, 2010 and June 30, 2015 on anticoagulation with rivaroxaban or dalteparin. Patients were excluded if the length of anticoagulant therapy was < 30 days, anticoagulant therapy was initiated > 6 months after VTE diagnosis, the indication for treatment was not DVT/PE, if patients had contraindications to either LMWH or rivaroxaban, or patients were not on treatment doses of therapy. Out of 459 patients identified, 226 patients (107 in the rivaroxaban group, and 119 in the dalteparin group) were eligible for analysis based on our exclusion criteria. Efficacy was determined by the incidence of recurrent VTE, such as recurrent DVT, new fatal or non-fatal PE within 30 days. The secondary endpoint of the study was to determine the safety of rivaroxaban compared to dalteparin in cancer patients for the treatment of VTE. Safety was determined by the incidence and severity of bleeding. Major bleeding was defined as clinically overt if it was associated with a fall in hemoglobin of 2 g/dL or more, required transfusions of ≥ 2 units of packed red blood cells, involved retroperitoneal, intracranial, or critical site bleeding, or if it contributed to death. Minor bleeding was defined as overt bleeding not meeting the criteria for major bleeding but associated with medical intervention, unscheduled contact with a physician, interruption or discontinuation of anticoagulation treatment, or associated with any other discomfort such as pain or impairment of activities of daily life. Descriptive statistical analyses were utilized. Chi square analysis and t- test were performed to compare categorical and continuous variables. All data was analyzed using SPSS version 21.0 statistical software.Results: Rivaroxaban had a similar rate of DVT and PE failure with 1 event versus 2 with dalteparin (p = 0.625). The rivaroxaban group had 0 major and 8 minor bleeds compared to 3 major and 8 minor bleeds in the dalteparin group with p values of 0.09 and 0.86 respectively. Comorbidities and risk factors for thrombosis were similar in both groups as summarized in Table 1.TableRivaroxaban vs. Dalteparin: No Significant Differences in the Efficacy and Safety Profile in Cancer Associated ThrombosisRivaroxabanN = 107DalteparinN =119P valueDVT Failure within 30 days1 (0.93%)2 (1.68%)0.625PE Failure within 30 days1 (0.93%)1 (0.84%)0.94Major Bleeding0 (0 %)3 (2.5%)0.09Minor Bleeding8 (7.5%)8 (6.7%)0.864Median Age (Yrs)61650.93MaleFemale58 (54.2%) 49 (45.8%)60 (50.4%) 59 (49.6%)0.596Active Cancer96 (86.5%)111 (93.2%)0.350Surgery within 30 Days14 (13.1%)13 (10.9%)0.684Hypertension58 (54.2%)61 (51.3%)0.69Diabetes14 (13.1%)14 (11.8%)0.84Coronary Artery Disease6 (5.61%)11 (9.2%)0.326History of Previous DVT12 (11.2%)5 (4.2%)0.074BMI >3039 (36.4%)48 (40.3%)0.585Creatinine Clearance (Cr Cl) 30 - 50 Cr Cl 50 - 707 (6.5%) 100 (93.3%)7 (5.9%) 112 (94.1%)0.837Conclusions: Our study evaluated the safety and efficacy of rivaroxaban compared to dalteparin in patients with predominantly active cancer treated at a large comprehensive cancer center and found rivaroxaban to be comparable to dalteparin in this cohort. There were no significant differences in regards to recurrent VTE or major/minor bleeding with patients on rivaroxaban or dalteparin in our cohort of patients. Large randomized trials evaluating the efficacy and safety of rivaroxaban in the oncology population are needed to further validate our findings. DisclosuresNo relevant conflicts of interest to declare.

Parental feeding practices in Turkish children with autism spectrum disorder: Factorial validation of the Feeding Strategies Questionnaire

ABSTRACTThe Feeding Strategies Questionnaire (FSQ) has not previously been validated either in a Turkish sample or on children with autism spectrum disorder (ASD). In the present study, the factorial validity and reliability of the Turkish version of the FSQ were examined in order to use the assessment of the parental feeding practices on children with ASD. Further, the parental feeding strategies and their possible associations with various child demographic variables (i.e., children’s age groups, gender, severity, comorbidity, and body mass index [BMI]) were investigated. The present study suggests that the FSQ shows a good internal consistency, adequate split-half reliability, and acceptable factorial validity, which confirms that the FSQ can be used to assess the feeding strategies of parents and their children with ASD in a Turkish sample. The FSQ and factors scores were calculated as a moderate level. There were no significant differences in regard to FSQ by age group, gender, severity of disability, or comorbidity. BMI scores indicate the risk of overweight for a sample of Turkish children with ASD. There was a just significant and negative correlation between the coercive interactions factor of FSQ and BMI average score, which may be interpreted that when BMI score reduces, parents tend to be in coercive feeding style.

A Quasiclassical Study of the F((2)P) + CHD3 (ν1 = 0,1) Reactive System on an Accurate Potential Energy Surface.

Quasiclassical trajectories (QCT) have been employed to elucidate the effect of exciting the C-H bond in F + CHD3 collisions. The calculations were performed on a new potential energy surface that accurately describes the van der Waals complexes in the entrance channel of the reaction. It was found that exciting the C-H bond significantly enhances the yield of HF + CD3, whereas it has a minor effect on the production of DF + CHD2. Therefore, the net effect is that the total reactivity increases upon excitation. This result strongly contradicts recent experimental findings. Significant differences in regard to the yield of each product channel were also found between QCT results calculated with the new surface and those obtained with the surface previously developed by Czakó et al. This shows that relatively small variations in the topography of the entrance channel can result in huge discrepancies in the predicted DF/HF branching ratio. However, in regard to other attributes of the reaction, the agreement between QCT results computed with different surfaces, and between them and experimental results, is good. For the F + CHD3 → HF + CD3 reaction, at a collisional energy of 9.0 kcal/mol, experiments and QCT calculations agree, indicating that the extra energy deposited in the C-H bond is channelled into the HF product. In addition, the angular distribution of CD3 is backward oriented and is not sensitive to the excitation of the C-H bond.

Yield and yield components of minituber potato under direct cultivation and transplanting

This research was performed to study the effect of direct planting and transplanting of potato minituber on its yield and yield components. The experiment was designed as a randomized complete blocks with nine treatments and three replications. Treatments were one direct and eight indirect planting. In order to prepare the nursery, two types of pots (peat and nylon) and four types of substrates including sand + peat moss (1:1), sand + Kimiya organic fertilizer (1:1), sand + vermicompost (1:1) and sand + farm soil (1:1) were used. Results showed that there was significant difference in regard to mean yield per plant, mean wet weight of tuber, number of tubers smaller and greater than 80 g, percent dry weight of tuber, biologic yield, starch percentage and nitrate content of tubers. The highest mean tuber yield per plant, number of tubers greater than 80 gr and biologic yield belonged to plants in nylon pots with substrate of sand + Kimiya organic fertilizer. The highest percentage of starch and tuber dry matter belonged to plants in peat pots with substrate of sand + soil. The highest mean wet weight of tubers belonged to nylon pots with substrate of sand + peat moss. The highest number of tubers lower than 80 g and the highest nitrate content was obtained by direct planting. The sand+ Kimiya organic fertilizer, which provides the necessary elements for plant growth, with more yield and number of marketable tubers, could be the best substrate as compared to other substrates used in this experiment.

Pediatric orthopaedic infection season: An analysis of the seasonal variation of pediatric osteomyelitis and septic arthritis

Some studies have suggested seasonal variations in pediatric orthopaedic infection. We sought to determine if there is seasonal variation in septic arthritis and/or osteomyeltis. We performed a query of a single pediatric hospital's database, iden- tifying all patients diagnosed with septic arthritis and/or osteomyelitis, age 0 through 18, from 1994 through 2010. The institution is located in a temperate climate with definite seasonal variations. Our query yielded 735 pyogenic arthritis and 104 unspecified infective arthritis diagnoses for a total of 839 combined septic arthritis cases. The query yielded 318 acute osteomyelitis, 227 chronic osteomyelitis, and 1114 unspecified osteomyelitis diagnoses for a total of 1659 combined osteomyelitis cases. We identified statistically significant differences in regard to region of body involvement, gender, age, and incidence over time. There was no statistically significant difference with regard to month or at the time of presentation. There does not appear to be a seasonal variation in the incidence of septic arthritis or osteomyelitis in the pediatric population. This would not support the perception of an infection season in pediatric orthopedics. In addition, there is a stable incidence of septic arthritis and an increasing incidence of osteomyelitis noted at our institution over the last 17 years.

Trombocitopenia en gestantes con pre-eclampsia severa y eclampsia

OBJETIVOS: Determinar la incidencia de trombocitopenia en gestantes con pre-eclampsia severa y eclampsia y su distribución de acuerdo a edad materna, edad gestacional y paridad. DISEÑO: Estudio de tipo básico, descriptivo, prospectivo, realizado en el Hospital Regional Docente de Trujillo entre el 1ro de abril al 1o de diciembre de 1995. Trujillo entre el 1ro de abril al 1ro de diciembre de 1995. PACIENTES: 45 gestantes con diagnóstico de pre-eclampsia severa y/o eclampsia, con edades gestacionales ³ 28 semanas de amenorrea. RESULTADOS: La incidencia de trombocitopenia encontrada fue del 48, 8% y su distribución de acuerdo, a edad materna, edad gestacional y paridad no presentó variaciones estadísticamente significativas. CONCLUSION: La trombocitopenia se encuentra en casi la mitad de pacientes que presentan H.I.E.

Prevalence of molecular subtypes of invasive breast cancer: A retrospective study

BackgroundClassification of breast cancers into different molecular subtypes using immunohistochemistry as a surrogate tool to DNA microarray technology has been identified. Aim of this study was to find the precise prevalence of molecular subtypes of invasive breast carcinoma using immunohistochemistry and to correlate it with histological and clinical prognostic factors. MethodsA descriptive study design wherein 56 breast carcinoma cases diagnosed between May 2012 and Apr 2014 were reviewed and molecular subtyped using relevant immunohistochemical markers. Age, histological type, tumor size, tumor grade, lymphovascular emboli (LVE), nodal status and basal marker expressions were analyzed for all cases. Correlations between molecular subtypes and clinico-pathological characteristics were evaluated statistically. ResultsIn our study group, average age of patients was 50.5 years and most of patients were diagnosed in stage II (54%). Luminal A subtype was most prevalent 34%, followed by Basal like/Triple negative subtype 25%. Luminal B and Her2/neu subtypes had same prevalence i.e. 18% each and Breast Tissue like/Unclassified subtype/Penta Negative subtype was 5%. All cases demonstrated positivity for the luminal cytokeratins 8/18. Histological grade and ER negative status showed strong correlations with basal markers. ConclusionOn the basis of hormone receptor, Her2 neu, EGFR and CK 5/6 expressions, breast carcinoma cases were classified into five distinct molecular subtypes which show significant differences in regards to morphological features, prognostic markers and there by predicting possible clinical outcome.

Emotional Availability and Touch in Deaf and Hearing Dyads.

In recent years , increasing attention has been given to the development of deaf children, though few studies have included Deaf parents. The present study examined emotional availability (EA) and functions of touch used by Deaf or hearing parents with hearing or deaf infants during free play. Sixty dyads representing four hearing status groups were observed when the infants were 18 months old. Comparisons among all four groups revealed significant differences in regard to parental sensitivity and child responsiveness, with hearing mothers with deaf infants tending to score lowest in the various subcategories of EA. Significant differences were also found for attentional touch and total touch, with deaf mothers of deaf or hearing infants using both types of touch more than hearing mothers of deaf or hearing infants. The importance of support and interventions for hearing mothers with deaf infants is discussed.

The Effect of Metformin Use on Left Ventricular Ejection Fraction and Mortality Post-Myocardial Infarction.

Animal studies showed that the use of metformin after myocardial infarction (MI) resulted in a protective effect on cardiac myocytes. In this study, we examined the effect of metformin in patients with diabetes mellitus (DM) on left ventricular ejection fraction (LVEF) and post-MI mortality. We reviewed charts of patients with MI admitted to the UAMS medical center. Baseline characteristics and 12-month follow up data were collected. Patients were classified into three groups: Control group- no DM (n = 464), Metformin group- DM + MI (n = 88) and No-Metformin group- DM + MI (n = 168). First, we compared Metformin and No-Metformin groups to the Control group. Second, we performed propensity-score matching in patients with DM, and compared Metformin to No-Metformin groups. All-cause 30-day and 12-month mortality was significantly higher in the No-Metformin group compared to controls (13.5 vs 9.3% p = 0.03 at 30 days, 23.7 vs 15.9 % p = 0.03 at 12 months). However, all-cause 30-day and 12-month mortality were similar in the Controls and Metformin group (9.3 vs 6.8 % p = 0.93 at 30 days, 15.9 vs 11.4 % p = 0.97 at 12 months). Mean LVEF on presentation (45 % in the three groups) and at follow up (47.84, 46.38 and 43.62 % in Control, Metformin, and No-Metformin groups, respectively) were not statistically different. There were no significant differences in regard to re-hospitalization, re-intervention, new stroke, CHF development, new MI, or identifiable arrhythmias. Metformin was an independent predictor of lower 30-day and 12-month all-cause mortality in patients with DM (HR 0.25, p = 0.02 and HR 0.32, p = 0.01, respectively). In the matched analysis, 30-day all-cause mortality was significantly higher in the No-Metformin compared to the Metformin group (21.1 vs 8.8 %, p = 0.05). However the difference in 12-month all-cause mortality did not reach statistical significance (24.6 vs 15.8 %, p = 0.15). This proof-of-concept study shows that use of metformin in patients with DM is associated with lower 30-day all-cause mortality and tendency for a lower 12-month all-cause mortality following MI without discernible improvement in LVEF.

Which one helps tourists most? Perspectives of international tourists using different navigation aids

This study aims to examine wayfinding efficiency and behaviors of international tourists when using a mobile navigation aid, as compared with a paper map and local directional signs. Moreover, it intends to explore the extent to which spatial knowledge acquisition varies among those three groups. A total of 86 subjects participated in this study, and completed two wayfinding tasks, starting from a Mass Rapid Transit train station and arriving at two attraction sites, by using assigned wayfinding navigation aids. The results showed significant differences in wayfinding efficiency and level of feeling lost among participants using different navigation aids. The participants who used an English paper map spent the shortest time in wayfinding for both tasks. The participants who used a 3G-based mobile navigation aid gave the highest score to ‘feeling lost all the time,’ as compared with the two other groups. However, the participants using different navigation aids exhibited no significant differences in regard to their wayfinding anxiety and difficulties. According to the sketch maps drawn by the participants, those who used the local signs for wayfinding provided more detailed information/landmarks, and their walking routes were more accurate than those of the two other groups.

PPV susceptibility of commonly used peach rootstock-scion combinations.

Sharka disease is one of the most devastating plant epidemics of Prunus species, caused by plum pox virus (PPV). The viral infection affects the fruits by weight-loss and degradation of quality properties. Breeding of resistant rootstocks and cultivars is one of the most effective disease control methods. PPV determines the peach production all over the world. On the world'sfruit production list peach is in the sixth, in the Mediterranean region in the fourth place. In this study new data were shown about PPV susceptibility of commonly used rootstock-scion combinations from Hungary. Reverse transcription PCR (RT-PCR) analysis was conducted on the samples from acommercial orchard; the results were evaluated by chi-square test and binary logistic regression. Four rootstock ('GF677', 'PeMa', 'Cadaman' and almond seedlings) and three scion cultivars (Prunus persicae 'Michelini', 'Babygold 6' and 'Cresthaven') were included in this experiment. The rootstocks did not show any significant differences in regard to the resistance of the virus infection (40-50%), but in case of scions, strong significant relations were observed. In case of the combinations there were results in both directions; tolerant and susceptible combinations were observed as well.