Factors associated with hospitalisations of patients with chronic heart failure approaching the end of life: A systematic review.

BACKGROUND: Heart failure has high mortality and is linked to substantial burden for patients, carers and health care systems. Patients with chronic heart failure frequently experience recurrent hospitalisations peaking at the end of life, but most prefer to avoid hospital. The drivers of hospitalisations are not well understood. AIM: We aimed to synthesise the evidence on factors associated with all-cause and heart failure hospitalisations of patients with advanced chronic heart failure. DESIGN: Systematic review of studies quantitatively evaluating factors associated with all-cause or heart failure hospitalisations in adult patients with advanced chronic heart failure. DATA SOURCES: Five electronic databases were searched from inception to September 2020. Additionally, searches for grey literature, citation searching and hand-searching were performed. We assessed the quality of individual studies using the QualSyst tool. Strength of evidence was determined weighing number, quality and consistency of studies. Findings are reported narratively as pooling was not deemed feasible. RESULTS: In 54 articles, 68 individual, illness-level, service-level and environmental factors were identified. We found high/moderate strength evidence for specialist palliative or hospice care being associated with reduced risk of all-cause and heart failure hospitalisations, respectively. Based on high strength evidence, we further identified black/non-white ethnicity as a risk factor for all-cause hospitalisations. CONCLUSION: Efforts to integrate hospice and specialist palliative services into care may reduce avoidable hospitalisations in advanced heart failure. Inequalities in end-of-life care in terms of race/ethnicity should be addressed. Further research should investigate the causality of the relationships identified here.

Early-onset anemia after kidney transplantation is an independent factor for graft loss: a multicenter, observational cohort study.

BACKGROUND: The association of anemia with outcomes after renal transplantation (RT) is unclear. METHODS: We performed a retrospective study that included patients who received a RT in Spain in 2007. We collected data on anemia (hemoglobin [Hb] <11 g/dL and/or erythropoietic agents and/or transfusion in the previous month) as well as transplantation and clinical data during follow-up. We used multivariate Cox models to predict graft and patient survival. RESULTS: We included 639 patients; 7.2% lost their graft and 6.3% died. The prevalence of anemia was 84% at 7 days, 77% at 1 month, 41% at 2 months, 16% at 12 months, 14% at 24 months, and 18% at 36 months. After adjusting by glomerular filtration rate (hazard ratio [95% confidence interval], 0.96 [0.93-0.98]), low Hb levels at 1 month remained as an independent predictor of graft loss (hazard ratio for each 1 g/dL increase, 0.72 [0.54-0.96]) along with a maximum panel-reactive antibody of more than 10% (3.80 [1.73-8.36]), a donor with stroke (3.30 [1.31-8.28]), and one or more acute rejection episode (13.89 [4.78-40.37]). Tacrolimus use was a protective factor (0.24 [0.11-0.50]). CONCLUSIONS: Low Hb levels in the early posttransplantation period (1 month) seem to be an independent prognostic factor for graft loss, but not for mortality, in Spanish RT patients regardless of graft function, recipient and donor characteristics, unfavorable events within the first month, and immunosuppression.

Effects of environmental factors on edible oil quality of organically grown Camelina sativa.

The aim of the present study was to evaluate the potential for the production of edible oil from organically grown camelina ( Camelina sativa L. Crantz), focusing on the influence of environmental factors on nutritional quality parameters. Field experiments with precrop barley were conducted in Norway in the growing seasons 2007, 2008, and 2009. Trials were fully randomized with two levels of nitrogen (N) fertilization, 0 and 120 kg total N ha(-1), and two levels of sulfur (S) fertilization, 0 and 20 kg total S ha(-1). Weather conditions, that is, temperature and precipitation, were recorded. Additional experiments were performed in the years 2008 and 2009 to evaluate the effects of replacing precrop barley with precrop pea. Seed oil content was measured by near-infrared transmittance, and crude oil compositions of fatty acids, phytosterols, tocopherols, and phospholipids were analyzed by chromatography and mass spectrometry. Results showed significant seasonal variations in seed oil content and oil composition of fatty acids, tocopherols, phytosterols, and phospholipids that to a great extent could be explained by the variations in weather conditions. Furthermore, significant effects of N fertilization were observed. Seed oil content decreased at the highest level of N fertilization, whereas the oil concentrations of α-linolenic acid (18:3n-3), erucic acid (22:1n-9), tocopherols, and campesterol increased. Pea compared to barley as precrop also increased the 18:3n-3 content of oil. S fertilization had little impact on oil composition, but an increase in tocopherols and a decrease in brassicasterol were observed. In conclusion, organically grown camelina seems to be well suited for the production of edible oil. Variations in nutritional quality parameters were generally small, but significantly influenced by season and fertilization.

Ragweed pollen collected along high-traffic roads shows a higher allergenicity than pollen sampled in vegetated areas.

BACKGROUND: Pollutants may affect pollen allergenicity and thus the prevalence of allergies. Although a few studies are available in literature, the connection between pollution and the allergenic potential of pollen has yet to be clearly defined. The objective of this study was to evaluate the effect of traffic-related pollution on the allergenicity of ragweed (Ambrosia artemisiifolia L.) pollen through a field-based experiment. METHODS: Mature pollen grains were collected from ragweed plants grown along main roadsides and in vegetated areas of Po river plain. The percentage of sub-pollen particle-releasing grains (SPPGs) was evaluated immediately after sampling by microscope and image analysis. Immunochemistry and LC-MS/MS were applied to assess the whole allergenicity and the allergen pattern characterizing the different pollen samples. RESULTS: No statistical difference was detected in the percentage of SPPGs among pollen samples. Specifically, after hydration, the mean percentage was very low (<4%) in all the samples, regardless of the site of origin. On the contrary, pollen collected along high-traffic roads showed a higher whole allergenicity than pollen from low-traffic roads and vegetated areas which showed a reactivity similar to that of the commercial pollen 'Allergon', used as a standard. The detected higher allergenicity levels were attributed to both quantitative and qualitative differences in allergen pattern. CONCLUSION: Our findings show that pollen collected at different sites contains different amount and number of allergens and suggest that traffic-related pollution enhances ragweed pollen allergenicity, which may contribute to the increasing prevalence of ragweed allergy in Lombardy plain.

A comparative study of melting and non-melting flesh peach cultivars reveals that during fruit ripening endo-polygalacturonase (endo-PG) is mainly involved in pericarp textural changes, not in firmness reduction.

Peach softening is usually attributed to the dismantling of the cell wall in which endo-polygalacturonase (endo-PG)-catalysed depolymerization of pectins plays a central role. In this study, the hypothesis that the function of endo-PG is critical for achieving a melting flesh fruit texture but not for reducing fruit firmness was tested by comparing pericarp morphology and endo-PG expression and localization in melting (MF) and non-melting flesh (NMF) fruit at successive stages of ripening. MF Bolero, Springbelle, and Springcrest, and NMF Oro-A and Jonia cultivars were analysed. Both MF and NMF fruit were left to ripen on the tree and reached a firmness of <10 Newtons (N). The image analysis of pericarp tissues revealed that during softening the loss of cell turgidity was a process common to mesocarp cells of all MF and NMF fruit and was clearly visible in peaches with a firmness of less than ∼20 N. In contrast, the loss of cell adhesion was a feature exclusively observed in ripe MF fruit pericarp. In this ripe fruit, large numbers of endo-PG isoforms were highly expressed and the enzyme localization corresponded to the middle lamella. As a consequence, wide apoplastic spaces characterized the pericarp of ripe MF peaches. In contrast, no loss of cell adhesion was observed in any NMF fruit or in unripe MF peaches. Accordingly, no endo-PG was detected in unripe NMF fruit, whereas few and poorly expressed enzyme isoforms were revealed in ripe NMF and in unripe MF peaches. In this fruit, the poorly expressed endo-PG localized mainly in vesicles within the cytoplasm and inner primary cell wall. On the whole the results suggested that endo-PG function was needed to achieve melting flesh texture, which was characterized by wide apoplastic spaces and partially deflated mesocarp cells. Conversely, endo-PG activity had no critical influence on the reduction of fruit firmness given the capacity of NMF peaches to soften, reaching values of 5-10 N. As in tomato, the change of symplast/apoplast water status seems to be the main process through which peach fruit regulates its firmness.

Exposure to cadmium-contaminated soils increases allergenicity of Poa annua L. pollen.

BACKGROUND: Pollution is considered as one main cause for the increase of allergic diseases. Air pollutants may cause and worsen airway diseases and are probably able to make pollen allergens more aggressive. Previous studies looked at traffic-related air pollution, but no data about the effects of polluted soils on pollen allergens are available. We aimed to assess the effects of plant exposure to cadmium-contaminated soil on allergenicity of the annual blue grass, Poa annua L, pollen. METHODS: Poa plants were grown in soil contaminated or not contaminated (control) with cadmium. At flowering, mature pollen was analyzed by microscopy, to calculate the percentage of pollen grains releasing cytoplasmic granules, and by proteomic techniques to analyze allergen proteins. Allergens were identified by sera from grass pollen-allergic patients and by mass spectrometry. RESULTS: Pollen from Cd-exposed plants released a higher amount of allergenic proteins than control plants. Moreover, Cd-exposed pollen released allergens-containing cytoplasmic grains much more promptly than control pollen. Group 1 and 5 allergens, the major grass pollen allergens, were detected both in control and Cd-exposed extracts. These were the only allergens reacting with patient's sera in control pollen, whereas additional proteins strengthening the signal in the gel region reacting with patient's sera were present in Cd-exposed pollen. These included a pectinesterase, a lipase, a nuclease, and a secretory peroxydase. Moreover, a PR3 class I chitinase-like protein was also immunodetected in exposed plants. CONCLUSION: Pollen content of plants grown in Cd-contaminated soils is more easily released in the environment and also shows an increased propensity to bind specific IgE.

Localization of stilbene synthase in Vitis vinifera L. during berry development.

The localization of stilbene synthase (STS) (EC 2.3.1.95) in grape berry (Vitis vinifera L.) was investigated during fruit development. The berries were collected at 2, 4, 7, 11, and 15 weeks postflowering from the cultivar Nebbiolo during the 2005 and 2006 growing seasons. High-performance liquid chromatography analysis showed that berries accumulated cis- and trans-isomers of resveratrol mainly in the exocarp throughout fruit development. Immunodetection of STS protein was performed on berry extracts and sections with an antibody specifically developed against recombinant grape STS1. In agreement with resveratrol presence, STS was found in berry exocarp tissues during all stages of fruit development. The labeled epidermal cells were few and were randomly distributed, whereas nearly all the outer hypodermis cells were STS-positive. The STS signal decreased gradually from exocarp to mesocarp, where the protein was detected only occasionally. At the subcellular level, STS was found predominantly within vesicles (of varying size), along the plasma membrane and in the cell wall, suggesting protein secretion in the apoplast compartment. Despite the differences in fruit size and structure, the STS localization was the same before and after veraison, the relatively short developmental period during which the firm green berries begin to soften and change color. Nevertheless, the amount of protein detected in both exocarp and mesocarp decreased significantly in ripe berries, in agreement with the lower resveratrol content measured in the same tissues. The location of STS in exocarp cell wall is consistent with its role in synthesizing defense compounds and supports the hypothesis that a differential localization of phenylpropanoid biosynthetic machinery regulates the deposition of specific secondary products at different action sites within cells.

Fibrosing mediastinitis: successful stenting of the pulmonary artery.

Fibrosing mediastinitis is a rare benign condition, which can cause compression of the pulmonary or systemic vessels, tracheobronchial tree, coronary arteries or esophagus, leading to disabling clinical symptoms and even death. The case of a 26-year-old woman who presented with dyspnea is described. She was found to have 80% stenosis of the right pulmonary artery secondary to fibrosing mediastinitis. The stenosis was managed successfully with an endovascular Palmaz-Schatz stent, and the patient remains symptom-free 10 years later.

Long stay patients in a psychiatric hospital in Lagos, Nigeria.

OBJECTIVE: In the face of recently introduced government health reform and the dwindling number of available beds for acutely ill patients, a cross sectional study was carried out on long-stay patients at the 100 years old psychiatric hospital Yaba, Lagos, Nigeria with a view to discharging most of them. METHOD: Necessary consent was obtained from the Hospital Research and Ethical Committee. All the long-stay patients were evaluated with a specially designed proforma to elicit socio-demographic, clinical and long-stay variables. Further more, each of them had clinical assessment to make diagnosis in accordance with ICD - 10 and finally, the subjects were also assessed with the Brief Psychiatric Rating Scale (BPRS). RESULTS: Fifty-one (51) subjects; that is, occupying 10.7% of the hospital functional beds fulfilled the criteria of long-stay. They included 36 (70.6%) males and 15(24.4%) females. The mean age was 47.3 inverted exclamation markA16.5 years with age range of 18-92 years. The average length of stay was 11.4 inverted exclamation markA15.0 years and range of 0.5 to 57 years; with significant gender difference (males higher than females) (t =3.51, p<0.02). The vast majority of the subjects were diagnosed with schizophrenia (84.3%), followed by mental retardation with seizure disorder (5.9%). One-third (33.3%) of the subjects had co-morbid physical pathologies most especially epilepsies, hypertension, Koch inverted exclamation mark s disease, HIV/AIDS. Despite being on high doses of antipsychotics (conventional and/or atypical) the majority of the subjects (86.3%) exhibited poor mental state with BPRS scores of inverted exclamation markY10. The mean BPRS score was 23.6 inverted exclamation markA22.0 and range of 4-56 with a significant gender difference (t = 3.66, p< 0.02). CONCLUSION: These patients would continue to require long-stay hospitalization despite been a burden to the study center; or, in the alternative provision of mid Cway facilities for their rehabilitation.

Long stay patients in a psychiatric hospital in Lagos, Nigeria

Objective: In the face of recently introduced government health reform and the dwindling number of available beds for acutely ill patients, a cross sectional study was carried out on long-stay patients at the 100 years old psychiatric hospital Yaba, Lagos, Nigeria with a view to discharging most of them. Method: Necessary consent was obtained from the Hospital Research and Ethical Committee. All the long-stay patients were evaluated with a specially designed proforma to elicit socio-demographic, clinical and long-stay variables. Further more, each of them had clinical assessment to make diagnosis in accordance with ICD - 10 and finally, the subjects were also assessed with the Brief Psychiatric Rating Scale (BPRS). Results: Fifty-one (51) subjects; that is, occupying 10.7% of the hospital functional beds fulfilled the criteria of long-stay. They included 36 (70.6%) males and 15(24.4%) females. The mean age was 47.3±16.5 years with age range of 18-92 years. The average length of stay was 11.4±15.0 years and range of 0.5 to 57 years; with significant gender difference (males higher than females) (t =3.51, p<0.02). The vast majority of the subjects were diagnosed with schizophrenia (84.3%), followed by mental retardation with seizure disorder (5.9%). One-third (33.3%) of the subjects had co-morbid physical pathologies most especially epilepsies, hypertension, Koch/'s disease, HIV/AIDS. Despite being on high doses of antipsychotics (conventional and/or atypical) the majority of the subjects (86.3%) exhibited poor mental state with BPRS scores of ≥10. The mean BPRS score was 23.6±22.0 and range of 4-56 with a significant gender difference (t = 3.66, p< 0.02). Conclusion: These patients would continue to require long-stay hospitalization despite been a burden to the study center; or, in the alternative provision of mid­way facilities for their rehabilitation

Air quality biomonitoring: assessment of air pollution genotoxicity in the Province of Novara (North Italy) by using Trifolium repens L. and molecular markers.

Mixed air pollutants are considered a major cause of DNA damage in living species. In this study Trifolium repens L. cv Regal was used as a bioindicator to assess the genotoxicity of air stressors in the Italian province of Novara. Two on-site biomonitoring experiments were performed during the spring and autumn of 2004. Test plants were exposed at 19 monitoring sites distributed homogeneously throughout the province, and each experiment lasted for a period of 6 weeks. Genotoxicity was evaluated with Amplified Fragment Length Polymorphism (AFLP) molecular markers. The results show the predominantly rural central-west region of the Novara Province to have the worst air quality with regard to genotoxicity. Analyses of geomorphology, land use and climatic factors suggest that the compromised air quality in the region could be attributed to wind strength and direction, transporting pollution from vehicular traffic on the A4 highway and from the urban/industrialized centres of Novara and Vercelli. Plant growth, changes in plant photochemical efficiency and the presence of ozone related leaf injuries were also measured to better interpret the results of genotoxicity. Statistical analyses show that although climatic factors such as light intensity and temperature influence plant growth, they do not contribute to atmospheric stressor-induced DNA damage. Further analyses indicated that, as expected, a mixture of genotoxic and non-genotoxic pollutants coexist in the Novara Province troposphere, and that the elevated ozone concentrations experienced during the study may have contributed to the DNA damage in the tested plants by enhancing genotoxicity via interaction with other air stressors.

Calcific shoulder tendinitis: treatment with modified US-guided fine-needle technique.

PURPOSE: To evaluate clinical response to treatment of calcified tendinitis of the shoulder by using a modified percutaneous ultrasonography (US)-guided fine-needle technique. MATERIALS AND METHODS: Thirty shoulders of 30 consecutive patients (23 women, seven men; mean age, 47.4 years) with chronic shoulder pain (average duration, 43.1 months) refractory to medical treatment were treated percutaneously by using a fine needle and US guidance. Patients were prospectively evaluated by using a shoulder pain and disability index consisting of 13 items and divided into two subcategories: pain and disability. The patient completed the questionnaire before the procedure and during the follow-up visit approximately 1 month later. A diagnostic US examination was also performed at that time. RESULTS: There was a statistically significant improvement in the shoulder pain and disability index total score (27.0%) and the pain (30.5%) and disability (23.9%) scores. According to the index, these results indicate a significant clinical response. CONCLUSION: This modified US-guided fine-needle technique for calcified tendinitis of the shoulder appears to be an effective therapy and was less aggressive than previously described percutaneous techniques.

Arterial embolotherapy for upper gastrointestinal hemorrhage: outcome assessment.

PURPOSE: To identify predictors of clinical outcome after arterial embolotherapy for upper gastrointestinal (UGI) hemorrhage. MATERIALS AND METHODS: Seventy-five consecutive patients (mean age, 62.5 y) underwent arterial embolization for acute UGI hemorrhage. Bleeding was detected at endoscopy and angiography in 22 patients, at endoscopy alone in 29 patients, and at angiography alone in 24 patients. As such, embolization was directed by angiography in 46 patients (61.3%) and by endoscopy (referred to as "blind" embolization) in 29 patients (38.7%). The embolic agents used were metallic coils, polyvinyl alcohol particles (size range, 355-710 microm), gelatin sponge, and tissue adhesive. Predictors of bleeding recurrence and mortality were analyzed with logistic regression and Cox models, respectively. RESULTS: The technical success rate of embolization was 98.7%. Primary clinical success was achieved in 57 patients (76%). Secondary clinical success occurred in five additional patients (82.5%) after repeat embolization. There were four (5.3%) complications: two cases of self-resolving duodenal ischemia, one hepatic infarct, and one inguinal hematoma. The periprocedural mortality rate was 34.6% (26 of 75), mostly related to underlying illness. Early recurrence of bleeding (within 30 days of embolization) was associated with coagulation disorders (international normalized ratio >1.5, partial thromboplastin time >45 seconds, or platelet count <80,000/microL; odds ratio, 19.46; P = .001) and with the use of coils as the only embolic agent (odds ratio, 7.73; P = .01). Cirrhosis and cancer shortened the overall survival of patients after embolic therapy. The mean patient follow-up time was 34.5 months. CONCLUSION: Arterial embolotherapy for UGI hemorrhage is safe, effective, and durable. Coagulopathy and the use of coils as the only embolic agent were associated with a higher risk of early bleeding recurrence.