Χ2 For Linear Trend Research Articles

Predictors of Response to Cognitive Behavioral Therapy in Patients With Tinnitus

Clinical guidelines recommend cognitive behavioral therapy (CBT) as a treatment for tinnitus. However, patient response to CBT is variable, and currently, there are no known predictors of response to CBT treatment for tinnitus. To identify the clinical predictors of patient response to CBT for treatment of tinnitus. This was a secondary cohort analysis of a single-arm clinical study including adults with chronic bothersome tinnitus recruited from Washington University School of Medicine in St Louis (Missouri) from September 2019 to February 2023. Participants completed an 8-week group CBT program with a licensed clinical psychologist. Each week consisted of 2.5 hours of CBT, amounting to 20 hours of total CBT participation, primarily delivered through a virtual platform. Conjunctive consolidation was used to create a predictive classification system for response to CBT based on tinnitus bother and anxiety levels. Response to CBT was predefined as a 13-point or greater decrease in the Tinnitus Functional Index (TFI) survey score. The study sample included 88 adult patients (median [IQR] age, 59 [49-66] years; 47 [53%] females and 41 [47%] males) with chronic bothersome tinnitus, of whom 53 (60%) had at least 13-point decrease in TFI and were considered to be responders. In univariable and multivariable logistic regression analyses, high to moderate anxiety level and severe tinnitus bother were associated with treatment response (adjusted odds ratio: anxiety, 3.33; 95% CI, 0.90-12.30; tinnitus bother, 12.08; 95% CI, 1.48-98.35). The clinical stratification system showed good predictive and discriminative ability (χ2 for linear trend = 20.0; C statistic = 0.75; 95% CI, 0.65-0.85). The findings of this study show that assessment of bother and anxiety levels in patients with tinnitus may be useful for identifying those who are more likely to respond to CBT. Before incorporation into clinical practice, future research should externally validate this finding in a separate population.

Women’s Marital Surname Change by Bride’s Age and Jurisdiction of Residence: A Replication

Hyphenating or keeping premarital surname for all U.S. destination brides marrying in Hawai’i in 2010 was highly, positively correlated with a state-level women’s income measure (r = .78, p < .000) and the analogous statistic for men (r = .64, p < .000), by bride’s state of residence. The women’s measure, only, remained significant when both predictors were used, together, to predict retention/hyphenation (i.e., under regression of both predictors). The interaction of state Gini coefficient and the women’s income measure was positively predictive in a regression including the interaction components as predictors (adjusted-R2 = .66). None of several other predictors suggested by previous research or related to Gini index or income, testable using available, state-level data, were predictive (under regression) alongside the women’s income measure. The older the bride, from any jurisdiction, the more likely she is to hyphenate or keep her surname (χ2 for linear trend = 1754.65, p < .000). These analyses comprise a nearly direct replication of previous work, adding novel analyses. Taken together, the original and replicated study may show evidence consistent with a general practice of women taking into account local economic factors, in marital surname decision-making.

Mortality Among Confirmed Lassa Fever Cases During the 2015-2016 Outbreak in Nigeria.

To determine factors associated with mortality among confirmed Lassa fever cases. We reviewed line lists and clinical records of laboratory-confirmed cases of Lassa fever during the 2016 outbreak in Nigeria to determine factors associated with mortality. We activated an incident command system to coordinate response. We documented 47 cases, 28 of whom died (case fatality rate [CFR] = 59.6%; mean age 31.4 years; SD = ±18.4 years). The youngest and the oldest were the most likely to die, with 100% mortality in those aged 5 years or younger and those aged 55 years or older. Patients who commenced ribavirin were more likely to survive (odds ratio [OR] = 0.1; 95% confidence interval [CI] = 0.03, 0.50). Fatality rates went from 100% (wave 1) through 69% (wave 2) to 31% (wave 3; χ2 for linear trend: P < .01). Patients admitted to a health care center before incident command system activation were more likely to die (OR = 4.4; 95% CI = 1.1, 17.6). The only pregnant patient in the study died postpartum. Effective, coordinated response reduces mortality from public health events. Attention to vulnerable groups during disasters is essential. Public Health Implications. Activating an incident command system improves the outcome of disasters in resource-constrained settings.

Linear association between maternal age and need of medical interventions at delivery in primiparae: a cohort of 21,235 singleton births

Objectives: We sought to investigate the potential association between maternal age and the need for active obstetrical intervention intrapartum in primiparas.Study design: Observational study over 14 years (2001–2014) of all consecutive primiparous singleton births having delivered at the Centre Hospitalier Universitaire Hospitalier Sud Reunion’s maternity (French overseas department, Indian Ocean).Results: Of the 21,235 singleton primiparous births, there were three significant linear associations between maternal age from 12 years of age to 42 + (all χ2 for linear trend, p < .0001) (a) vaginal deliveries without any medical intervention, (b) rate of cesarean sections, and (c) rate of operative vaginal procedures. These three linear associations persisted when controlling for maternal obesity (±30 kg/m2), “heavy babies” (>3.5 kg), and ethnicity. Using maternal age remained significantly an independent risk factor (p < .0001), after controlling for the major confounders: maternal BMI, maternal height, birthweight ≥3500 g, p < .0001.Conclusions: Increasing maternal age has a linear association with vaginal deliveries without any medical intervention, rate of cesarean sections, and rate of operative vaginal procedures. These associations are independent of maternal BMI and maternal height. We currently do not have a specific explanation why younger women appear to be protected from requiring intrapartum obstetric intervention. Nevertheless, these strong facts deserve acknowledgement and further research.

Prevalence and Risk Factors of Hypertension in Hansposa VDC of Sunsari District, Nepal

Introduction: Hypertension is defined as a systolic blood pressure (SBP) of 140 millimeter of mercury (mm of Hg) or more and a diastolic blood pressure (DBP) of 90 mm of Hg or more, or taking antihypertensive medication. Hypertension causes an increased work load on the heart and can cause damage to the blood vessels. The public awareness about hypertension in the villages of Nepal is low and no studies have been conducted earlier to elaborate the risk factors and prevalence of Hypertension in Hansposa village of Nepal. The aim of this study was to identify the prevalence of Hypertension and the risk factors associated with it in this village.Methods: A cross sectional survey (study) was carried out from September 25, 2014 to October 25, 2014 in order to know the prevalence and risk factor(s) of hypertension among people of Hansposa Village Development Committee (VDC), Sunsari, Nepal. Data were collected from both sexes by asking demographic details, habits like alcohol intake, smoking, exercise and education and examination of blood pressure, weight and height. The association of hypertension with age, sex, education, tobacco, alcohol consumption and body mass index (BMI) were estimated according to WHO standard criteria.Results: On analysis, the prevalence of hypertension was 37 % [95% CI=31-42(M: 55.1%; F: 26.7%)]. The prevalence of tobacco, alcohol consumption, and overweight/obesity was 31.3% (including past and present), 36.1%, and 31.9% respectively. Further analysis showed that there is significant association between hypertension and age, sex, alcohol consumption and physical inactivity (P&lt;0.05) i.e. there is increasing trend in the prevalence of hypertension with increasing age [ χ2(chi square) for linear trend P = 0.000].Conclusion: There is high prevalence of hypertension among people of Hansposa VDC; especially isolated diastolic blood pressure and is associated with age, sex, alcohol consumption and physical inactivity.

Linear association between maternal age and spontaneous breech presentation in singleton pregnancies after 32 weeks gestation

Purpose: To investigate the association between maternal age and spontaneous breech presentation.Material and methods: Fifteen-year observational study over (2001–2015). All consecutive singleton births delivered at the Centre Hospitalier Universitaire Sud Reunion’s maternity. The only single exclusion criterion was uterine malformations (N = 123) women.Results: Of the 60,963 singleton births, there was a linear association (χ2 for linear trend, p< 0.0001) between maternal age and spontaneous breech presentation. Overall rate of breech presentation was 2.7% in deliveries over 32 weeks gestation, while it was 1.9% in women aged 15 to 19 years and 4.0% in women aged 45+, with a linear progression for each 5-year age category. This linearity remained significant controlling for early prematurity (<33 weeks) and severe fetal malformations (χ2 for linear trend = 64, p < 0.0001). Controlling in a multiple logistic regression model for other major risk factors gestational age, female sex, primiparity, maternal age remained significantly an independent risk factor, p < 0.0001.Conclusion: Maternal age (x) is an independent factor for breech presentation in singleton pregnancies after 32 weeks gestation with a linear association that may be approximated at y = 0.1x. (y: incidence, percent).

Optimizing the prophylaxis of hospital-acquired deep vein thrombosis and pulmonary thromboembolism

To reduce the number of preventable hospital-acquired venous thromboembolic events (HA-VTE) and to improve the quality of VTE prophylaxis at multiprofile hospital. A comprehensive approach to preventing HA-VTE was developed, which involved the global trigger tool method to assess adverse events, as well as the computerized clinical decision support system (CDSS) to prevent HA-VTE on the basis of relevant clinical practice guidelines, and HA-VTE registry. A total of 50 patients (15 men, 35 women; their median age was 70.5 years) with HA-VTE were included in the HA-VTE registry in January 2014 to June 2015. Assessment of a trend in the prevalence of HA-VTE when introducing CDSS to prevent VTE showed its statistically significant decline in the total number of HA-VTE cases (χ2=7.325, df=1; p=0.0068) and in that of HA-VTE in surgical patients (χ2=7.266, df=1; p=0.0070). The statistical significance of χ2 for linear trend was not achieved for medical patients, which is probably due to the small sample size (χ2=2.764, df=1; p=0.0964). While introducing CDSS, there was a statistically significant reduction in the incidence of postoperative VTE from 8.76 to 4.17 cases per 1000 interventions (χ2=5.347, df=1; p=0.0208; the absolute values of HA-VTE and surgical interventions were used for the calculation). The proposed comprehensive approach can substantially increase the detection rate of HA-VTE and decrease its incidence rates. This requires a personified assessment of the risk of VTE and hemorrhage in all hospitalized patients on day 1 of their admission, timely initiation of recommended VTE prophylaxis, and dynamic assessment of the risk of VTE and hemorrhage for timely correction of the prophylaxis.

Barriers against split-dose bowel preparation for colonoscopy

ObjectiveAlthough split regimen is associated with higher adenoma detection and is recommended for elective colonoscopy, its adoption remains suboptimal. The identification of patient-related barriers may improve its implementation. Our aim...

Human Immunodeficiency Virus, Antiretroviral Therapy and Markers of Lymphatic Filariasis Infection: A Cross-sectional Study in Rural Northern Malawi.

BackgroundLymphatic filariasis (LF) and human immunodeficiency virus (HIV) are major public health problems. Individuals may be co-infected, raising the possibility of important interactions between these two pathogens with consequences for LF elimination through annual mass drug administration (MDA).Methodology and Principal FindingsWe analysed circulating filarial antigenaemia (CFA) by HIV infection status among adults in two sites in northern Malawi, a region endemic for both LF and HIV. Stored blood samples and data from two geographically separate studies were used: one a recruitment phase of a clinical trial of anti-filarial agent dosing regimens, and the other a whole population annual HIV sero-survey. In study one, 1,851 consecutive adult volunteers were screened for HIV and LF infection. CFA prevalence was 25.4% (43/169) in HIV-positive and 23.6% (351/1487) in HIV-negative participants (p=0.57). Geometric mean CFA concentrations were 859 and 1660 antigen units per ml of blood (Ag/ml) respectively, geometric mean ratio (GMR) 0.85, 95%CI 0.49-1.50. In 7,863 adults in study two, CFA prevalence was 20.9% (86/411) in HIV-positive and 24.0% (1789/7452) in HIV–negative participants (p=0.15). Geometric mean CFA concentrations were 630 and 839 Ag/ml respectively (GMR 0.75, 95%CI 0.60-0.94). In the HIV-positive group, antiretroviral therapy (ART) use was associated with a lower CFA prevalence, 12.7% (18/142) vs. 25.3% (67/265), (OR 0.43, 95%CI 0.24-0.76). Prevalence of CFA decreased with duration of ART use, 15.2% 0-1 year (n=59), 13.6% >1-2 years (n=44), 10.0% >2-3 years (n=30) and 0% >3-4 years treatment (n=9), p<0.01 χ2 for linear trend.Conclusions/SignificanceIn this large cross-sectional study of two distinct LF-exposed populations, there is no evidence that HIV infection has an impact on LF epidemiology that will interfere with LF control measures. A significant association of ART use with lower CFA prevalence merits further investigation to understand this apparent beneficial impact of ART.

Epidemiological Trends of GI Cancers in Patients Visiting a Tertiary Care Hospital in Chandigarh, North India.

Cancer has become an epidemic disease. Nearly ten million new cancer cases are diagnosed annually in the world and out of these about half are from the developing world. To appropriately plan for treatment, management and prevention of the disease, it becomes necessary to study the trends about morbidity caused by cancers. Data for patients diagnosed with any form of gastrointestinal (GI) cancers was extracted from records maintained in the outpatient department registers of the Oncology Department of Government Medical College and Hospital in Chandigarh from 1999 to 2012. Trends were analysed for different categories of GI cancers for the period of 12 years. In present study GI cancers accounted for 23 % of all registered cases (n-9603) of carcinomas. Males predominated for all GI cancers except in the gall bladder. Gastrointestinal cancers as a proportion of total cancers increased from 21% in 1999 to 25.9% in 2012 with a significant increasing trend in our series (χ2 for linear trend=9.36, p<0.003). Cancers of the tonsil, oral cavity and pharynx taken together showed an increasing trend over the years (χ2 for trend=55.2, p<0.001) whereas cancers of the lower GI (χ2=19.6, p<0.0001) and gall bladder (χ2=19.5, p<0.0001) showed a declining trend in our series. GI cancers form a significant proportion of all cancers reporting to our data. In depth studies to ascertain the reasons for the changing trends are required to design intervention programs. Further information is necessary from cancer registries and from the hospital records of oncology departments.

Impact of Malnutrition and Measles Mortality on Underfives All-Cause Mortality in Gweru City, Zimbabwe, in 1960-89

A study was carried out to determine secular changes in all-cause mortality rates for children aged < 5 years in 1960-1989 and their association with measles and malnutrition mortality rates in the same age group in the same period in city of Gweru, Zimbabwe. The study utilized under-fives mortality data from births and deaths registration office and measles and malnutrition surveillance data obtained from Gweru city’s public health department. Data was analysed in SPSS version 20 for windows and linear regression analysis was used to determine whether measles and malnutrition mortality rates were independent predictors of all-cause underfives mortality rates. It was found that in 1960-1989 underfives mortality rates from all causes were 10.2-63.7/1000 live births (median: 28.7, Q1 = 16.2, Q3 = 42.6) and these rates significantly and linearly declined in this period (χ2 for linear trend=165.74, p < 0.001). Measles mortality rates among underfives significantly and linearly declined (χ2 for linear trend = 812.49, p<0.001) while malnutrition mortality rates in the same age group also significantly and linearly declined (X2 for linear trend = 2411.54, p<0.001) in underfives in 1960-1989. Linear regression analysis indicated that malnutrition mortality rates (Regression Coefficient = 0.072, 95% CI = 0.039 - 0.104, p < 0.001) and measles mortality rates (Regression Coefficient = 0.029, 95% CI = 0.006-0.052, p=0.02) were independent predictors of all-cause underfives mortality rates with an adjusted coefficient of determination of 70.5% (Adjusted R2 = 0.7048) with malnutrition mortality rates uniquely explaining 21% of the variance in all-cause mortality (semipartial correlation squared = 0.21) while measles mortality rates uniquely explained 7% of the variance in all-cause mortality rates (semipartial correlation squared =0.068). It was concluded that decline in malnutrition and measles mortality rates among underfives significantly contributed to decline in all-cause underfives mortality rates in 1960-89 in Gweru city, Zimbabwe. On account of these findings, it is critical that efforts directed at controlling malnutrition and measles be intensified in areas and populations of similar settings.

Mortality trends from 2003 to 2009 among adolescents and young adults in rural Western Kenya using a health and demographic surveillance system.

BackgroundTargeted global efforts to improve survival of young adults need information on mortality trends; contributions from health and demographic surveillance system (HDSS) are required.Methods and FindingsThis study aimed to explore changing trends in deaths among adolescents (15–19 years) and young adults (20–24 years), using census and verbal autopsy data in rural western Kenya using a HDSS. Mid-year population estimates were used to generate all-cause mortality rates per 100,000 population by age and gender, by communicable (CD) and non-communicable disease (NCD) causes. Linear trends from 2003 to 2009 were examined. In 2003, all-cause mortality rates of adolescents and young adults were 403 and 1,613 per 100,000 population, respectively, among females; and 217 and 716 per 100,000, respectively, among males. CD mortality rates among females and males 15–24 years were 500 and 191 per 100,000 (relative risk [RR] 2.6; 95% confidence intervals [CI] 1.7–4.0; p<0.001). NCD mortality rates in same aged females and males were similar (141 and 128 per 100,000, respectively; p = 0.76). By 2009, young adult female all-cause mortality rates fell 53% (χ2 for linear trend 30.4; p<0.001) and 61.5% among adolescent females (χ2 for linear trend 11.9; p<0.001). No significant CD mortality reductions occurred among males or for NCD mortality in either gender. By 2009, all-cause, CD, and NCD mortality rates were not significantly different between males and females, and among males, injuries equalled HIV as the top cause of death.ConclusionsThis study found significant reductions in adolescent and young adult female mortality rates, evidencing the effects of targeted public health programmes, however, all-cause and CD mortality rates among females remain alarmingly high. These data underscore the need to strengthen programmes and target strategies to reach both males and females, and to promote NCD as well as CD initiatives to reduce the mortality burden amongst both gender.

Incidence of Serious Injuries Due to Physical Abuse in the United States: 1997 to 2009

Although US child protective services data showed a 55% decrease in the national incidence of substantiated physical abuse from 1992 to 2009, no study has tracked the occurrence of serious injuries due to physical abuse. This study examined changes in the incidence of serious injuries due to physical abuse in hospitalized children from 1997 to 2009. The Kids' Inpatient Database, a sample of discharges from hospitals in the United States, includes International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and external cause of injury codes; it was prepared every 3 years from 1997 to 2009. Cases of serious physical abuse (eg, abusive head injury) were identified by using injury codes (800-959) and codes for abuse (995.50, 0.54, 0.55, and 0.59), selected assault codes (E960-966, 968), or perpetrator of abuse (E967). The weighted number of hospitalizations due to serious physical abuse was used to calculate the national incidence, and χ(2) for linear trend compared over time the incidence for children <18 years and <1 year of age. The incidence per 100,000 children <18 years of age increased 4.9%: 6.1 (95% confidence interval = 5.4-6.8) for 1997, 6.0 (5.2-6.7) for 2000, 6.0 (5.3-6.7) for 2003, 6.1 (5.3-6.8) for 2006, and 6.4 (5.7-7.2) for 2009 (P < .01). The incidence for children <1 year of age increased 10.9% (P < .05). Over 12 years, when substantiated physical abuse was declining, there was a small increase in the incidence of serious physical abuse in children <18 and <1 year of age.

Associated Factors for Falls, Recurrent Falls, and Injurious Falls in Aged Men Living in Taiwan Veterans Homes

The information exploring the falls, recurrent falls, and injurious falls simultaneously in a large scale of aged people was limited. This study investigated the prevalence and frequency of falls and identified the associated factors of fall among aged Chinese men. A cross-sectional study was carried out in four veteran homes in eastern Taiwan from 2009 to 2010. The investigated sample consisted of 940 elderly men. A questionnaire was used for collecting demographic background, comorbid medical conditions, and fall characteristics. Depression status was evaluated by the Geriatric Depression Scale-Short Form. The prevalence of fall and recurrent falls were 17.2 % and 6.9%, respectively. The injury rate after falls was 51.9%.The advanced age [odds ratio (OR): 1.04; confidence interval (CI): 1.01–1.07), depression status (OR: 1.05; CI: 1.01–1.10), stroke (OR: 2.16; CI: 1.18–3.96), gouty arthritis (OR: 1.96; CI: 1.36–2.81), and cataract (OR: 1.48; CI: 1.03–2.15) were independent variables associated with falls. We also found that the greater the number of variables, the higher the risk of falling (χ2 for linear trend = 31.98, d.f.= 4, p < 0.001). Furthermore, depression was the only independent variable for predicting recurrent falls (OR: 1.22; CI: 1.12–1.32). However, no variable was found to be capable of predicting injurious falls. This study demonstrated that the advanced age, depression status, stroke, gouty arthritis, and cataract are independent variables for predicting falls; depression is the only clinical factor capable of predicting the recurrent falls. These variables were potential targets for effective prevention of falls.

Aplastic anemia: A common hematological abnormality among peripheral pancytopenia

Background:Aplastic anemia is a well-recognized form of marrow failure. The incidence of aplastic anemia is subjected to wide variation. Most cases are acquired and immune-mediated but there are also inherited forms.Aim:The study was conducted to assess the magnitude of the problem, morphological changes and determinants of aplastic anemia in North Bengal.Materials and Methods:A cross-sectional study had been conducted for a period of one year among 5 to 70 years age group. Initially complete blood count followed by bone marrow examination was done for diagnosis.Results:Out of 48 cases, 38 (79.17%) had hypocellular diagnosed as aplastic anemia, 5 (10.42%) each had normocellular and hypercellular bone marrow. Histopathology shows that 30 (78.95%) cases had increased iron stores in bone marrow and 8 (21.05%) cases had decreased iron stores. Subjects less than 20 years of age mostly (31.58%) suffered from non-severe disease in contrast to subjects in higher age groups who had severe or very severe disease, though the trend was not significantly different (χ2 for linear trend 0.171, P > 0.05).Conclusion:The study shows aplastic anemia is a common hematological abnormality among peripheral pancytopenia in North Bengal region where males were affected more than females.

Maternal age, ethnicity and gestational diabetes mellitus

Backgroundin Australia, and globally, rates for gestational diabetes mellitus (GDM) have risen dramatically in recent decades. This is of concern as GDM is associated with adverse pregnancy outcomes and additional health-care costs. Factors linked to increasing incidence include older maternal age and non-Caucasian ethnicity. However, as yet, there is no clear consensus on the magnitude of effect associated with these factors in combination. This study therefore investigated the effect of maternal age and country/region of birth on GDM incidence. Methodsall women who gave birth in Victoria, Australia in 2005 and 2006 (n=133,359) were included in this population-based cross-sectional study. Stratified cross-tabulations were conducted to examine the incidence of GDM by maternal age group and country/region of birth. Primiparous women were further analysed separately from parous women. The proportion of women with GDM was reported, along with the χ2 for linear trend. Findingswhilst women born outside Australia constituted just 24.6% of women giving birth during the study period, they accounted for 41.4% of GDM cases. The highest GDM incidence was seen among Asian women at 11.5%, compared with Australian born women at 3.7%. There was strong evidence that women born in all regions except North America were increasingly likely to develop GDM in pregnancies at older ages (p<0.001).On examining age related GDM trends by maternal region of birth, higher rates were seen across all regions studied but were most marked among women born in Asia and the Middle East. Conclusionsolder maternal age and non-Australian birth increased a woman's risk of developing GDM and this increase was most evident among Asian women. As GDM is associated with adverse maternal and infant outcomes, it is important to explore ways of preventing GDM, and to put in place strategies to effectively manage GDM during pregnancy and to reduce the later risk of developing type 2 diabetes. Pregnancy presents midwives with a unique opportunity to provide education and to encourage dietary and behavioural modifications as women have repeated contact with the health system during this time.

Statins Are Associated With a Reduced Risk of Gastric Cancer: A Population-Based Case–Control Study

Experimental studies have shown that statins have potential protective effects against cancer. The aim of this study was to investigate whether the use of statins was associated with gastric cancer risk. We conducted a population-based case-control study in Taiwan. Data were retrospectively collected from the Taiwan National health Insurance Research Database. Cases consisted of all patients who were aged ≥50 years and had a first-time diagnosis of gastric cancer for the period between 2005 and 2008. The controls were matched to cases by age, sex, and index date. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by using multiple logistic regression. We examined 337 gastric cancer cases and 1,348 controls. We found that ever-use of any statin was associated with a significant decrease in gastric cancer risk (OR=0.68, 95% CI=0.49-0.95). Compared with no use of statins, the adjusted ORs were 0.90 (95% CI=0.60-1.36) for the group having been prescribed statins with cumulative defined daily doses (DDDs) <134.25 and 0.49 (95% CI=0.30-0.79) for the group with cumulative statin use of ≥134.25 DDDs. Also, there was a significant trend toward decreasing gastric cancer risk with increasing cumulative dose (χ(2) for linear trend=7.42, P=0.006). The results of this study are the first to suggest that statins may reduce the risk of gastric cancer.

An audit of rubella IgG antibody status in antenatal women in a NHS Trust over 5 years (2005–2009)

Rubella, a vaccine-preventable infection. This study examined the antibody status of 11 987 pregnant women during 2005-2009. Results showed a non-significant decrease in those with antibody levels of <4·0 IU/ml from 29/2312 (1·3%) in 2005 to 21/2447 (0·9%) in 2009 (χ² for linear trend=0·279, P=0·56) but a significant increase in those with levels of <10 IU/ml from 88/2312 (3·8%) in 2005 to 124/2447 (5·1%) in 2009 (χ² for linear trend=10·27, P=0·001). In women born before 1983 (pre-pubertal vaccination) the proportion of first pregnancies with titres <4 IU was 1·1% (21/2002) compared to 3·4% (69/2022) in those born after 1983 (χ²=25·176, P<0·0001) and 2·2% (44/2002) for titres <10 IU compared to 14·0% (282/2022) for those born after 1983 (χ²=171·43, P<0·0001). The potential impact of the increase is difficult to determine, requiring further monitoring. This paper discusses the effect of changing immunization programmes on rubella susceptibility in pregnant women.

Microvascular dysfunction in hepatic ischemia–reperfusion injury in pigs

Although hepatic ischemia–reperfusion (I/R) injury has been investigated for more than two decades, histopathological documentation is limited. As a result, three pig livers with I/R injury and three control livers were injected with colored media, cut into 14 segments, and examined by light microscopy together with microscopic map making. In livers with I/R injury, lobules were identified as being occluded or unoccluded. The proportion of the occluded lobules increased in a caudocephalic fashion, while that of the unoccluded lobules decreased (χ2 for linear trend, P<0.0001). Especially in the occluded lobules, swollen hepatic plates displayed various forms of cellular distortion. Collapsed sinusoids containing leukocyte aggregation and shrunken central veins were observed together with reduced caliber of the contiguous sublobular veins. Portal vein constriction with loosening of the surrounding stroma suggestive of edema and hepatic artery dilation were also seen. Isolated arterioles and transintimal vasal outlets of the hepatic vein's vasa venarum were dilated and frequently observed. In conclusion, I/R injury affected the liver parenchyma, the microvasculature, and its surrounding stroma. The heterogeneous distribution of occluded and unoccluded lobules is suggested due to the difference of vascular structure in various liver segments. The constrictive/obstructive changes in the portosinusoidal–hepatic vascular profile suggest a definite increase in resistance at presinusoidal, sinusoidal, and proximal postsinusoidal levels, resulting in an expansion of the arterial shunt circulation.

Multilocus Variable-Number Tandem-Repeat Analysis and Plasmid Profiling To Study the Occurrence of bla CMY-2 within a Pulsed-Field Gel Electrophoresis-Defined Clade of Salmonella enterica Serovar Typhimurium

Salmonella enterica serovar Typhimurium circulating in food animal populations and carrying resistance to antimicrobial agents represents a human health risk. Recently, a new clade of S. Typhimurium, WA-TYP035/187, was reported in cattle and humans in the Pacific Northwest, United States of America. The objective of this study was to describe a possible mechanism of acquisition of expanded-spectrum cephalosporin resistance in this clade. Ceftazidime resistance increased steadily among WA-TYP035/187 isolates, from 0% (0/2) in 1999 to 77.8% (28/36) in 2006 (chi2 for linear trend, P value of <0.001). Among 112 bovine-source and 18 human-source isolates, 49 (43.8%) and 12 (66.7%) were resistant to ceftazidime, respectively. Multiple-locus variable-number tandem-repeat analysis (MLVA) and plasmid profiling suggested that resistance was acquired by multiple independent genetic events within the WA-TYP035/187 clade. Given the lack of an obvious reservoir in species other than cattle and a parallel rise in ceftiofur resistance in the bovine-specific serovar Salmonella enterica serovar Dublin in the same time frame and region, selection pressure due to the use of the expanded-spectrum cephalosporin drug ceftiofur in cattle is a likely factor driving the increasing cephalosporin resistance of WA-TYP035/187.