Clinical outcomes for the obese hospital inpatient: An observational study.

OBJECTIVES: The prevalence of obesity presents a burden for Australian health care. The aim of this study was to determine whether severely obese hospital inpatients have worse outcomes. METHODS: This is an observational cohort study, using data from all adult patients admitted to hospital for all elective and emergency admissions of patients aged over 18 years to two large Australian urban hospitals. We measured their length of stay, intensive care unit admission rate, intensive care unit length of stay, mortality and readmission rates within 28 days of discharge and compared these outcomes in the severely obese and non-severely obese subjects using t-test or chi-square test as appropriate. RESULTS: Between February 2008 and February 2012, 120,872 were admitted to hospital 193,800 times; 2701 patients were identified as severely obese (2.23%) and 118,171 patients were non-severely obese. If admitted as an emergency, severely obese patients have worse outcomes and consume more resources than other patients. These outcomes are still worse, but less so, if the obese patient is admitted as an elective patient suggesting that anticipation of any obesity-specific problems can have a beneficial effect. CONCLUSION: Upon admission or discharge of severely obese hospital inpatients, health care plans should be even more carefully laid than usual to reduce the risk of readmission.

Subtle genetic population structure in Pacific halibut Hippoglossus stenolepis.

Pacific halibut Hippoglossus stenolepis from 10 sampling locations throughout their range were investigated for signs of population structure. Two genetic data sets were created: (1) all individuals (n = 828) at few anonymous microsatellite markers (number of loci = 16); (2) fewer individuals (n = 435) genotyped at anonymous as well as expressed sequence-tag linked microsatellites (number of loci = 61). A combination of multidimensional scaling plots, discriminant analysis of principal components and pairwise differentiation estimates suggested that samples from the Aleutian Islands, particularly the western Aleutian Islands, were genetically distinct from samples collected in other regions. In addition, outlier analyses found that two markers linked to expressed sequence tags may be under directional selection and could explain the differentiation among samples. These results confirm findings from previous research and suggest that population structure may exist within a current management unit (i.e. International Pacific Halibut Commission Regulatory Area 4B).

Barriers and strategies for taking medicines in adult patients with renal transplantation.

Adherence to the immunosuppressant medications is important for the proper function a renal graft, but there are factors that make this difficult. This study describes strategies and barriers to adequate intake of these medicines based upon 177 surveys in renal transplant patients. Medication adherence was reported to be high (84%), but there were barriers to taking medications (64.95%): the most common were that the pharmacy did not work medicines (28.81%), changes in medication or dose (24.29%), failure to remember (9.6%), and lack of time (6.78%). The most common strategies for taking medications were: the use of cell phone alarms (15.25%) or alarm clocks (9.04%), schedules (5.65%), drug-related meals (5.08%), drug use book (2.26%), and visibility on the table (2.26%). Proper understanding of the barriers to medication adherence and strategies used by recipients may help physicians more adequately educate patients, thereby reducing the risk of rejection related to nonadherence and suggest, specific interventions for improvement.

Effect of surfactant and oil additions in the biodegradation of hexane and toluene vapours in batch tests.

The biological treatment of gaseous emissions of hydrophobic volatile organic compounds (VOCs) results in low rates of elimination partially because of the low solubility of VOCs in water. Recently, the use of two-phase partition bioreactors (TPPBs) was proposed to increase the bioavailability and consequently the elimination capacities of this kind of VOC. In the present study, TPPBs operating in a batch feed mode were tested for biodegradation of hexane and toluene vapours with a microbial consortium. The results obtained were compared with single-phase systems (control experiments). The liquid phase used was silicone oil (organic phase) with the surfactant Pluronic F-68. Experiments were named F1 and F2 for one and two phases, respectively, and F(1S) and F(2S) when the surfactant was included. The maximum specific rates (S(rates)) of hydrocarbon consumption for hexane and toluene were 539 and 773 mg(hydrocarbon)/(g(protein) x h), respectively. For both substrates, the systems that showed the highest S(rates) of hydrocarbon consumption were F2 and F(2S). In experiment F(1S) the surfactant Pluronic F-68 increased the solubility of hydrocarbons in the liquid phase, but did not increase the S(rates). The maximum percentages of mineralization were 51% and 72% for hexane and toluene, respectively. The results showed that simultaneous addition of silicone oil and surfactant favours the mineralization, but not the rate ofbiodegradation, of toluene and hexane vapours.

Rapid evolution of a sexual reproduction gene in centric diatoms of the genus Thalassiosira.

Sexual reproduction is commonly assumed to occur in the vast majority of diatoms due to the intimate association of this process with cell size control. Surprisingly, however, little is known about the impact of sexual events on diatom population dynamics. The Sig1 gene is strongly upregulated during sexual reproduction in the centric diatom Thalassiosira weissflogii and has been hypothesized to encode a protein involved in gamete recognition. In the present study, degenerate PCR primers were designed and used to amplify a portion of Sig1 from three closely related species in the cosmopolitan genus Thalassiosira, Thalassiosira oceanica, Thalassiosira guillardii, and Thalassiosira pseudonana. Identification of Sig1 in these three additional species facilitated development of this gene as a molecular marker for diatom sexual events. Examination of the new sequences indicated that multiple copies of Sig1 are probably present in the genome. Moreover, compared to the housekeeping gene beta-tubulin, the Sig1 genes of isolates of T. weissflogii collected from different regions of the Atlantic and Pacific oceans displayed high levels of divergence. The Sig1 genes of the four closely related Thalassiosira species also displayed high levels of sequence divergence compared to the levels observed with a second gene, Fcp, probably explaining why Sig1 could not be amplified from more distantly related species. The high levels of sequence divergence both within and between species suggest that Sig1 is rapidly evolving in a manner reminiscent of the manner observed in other genes that encode gamete recognition proteins. A simple model is presented for Sig1 evolution and the implications of such a rapidly evolving sexual reproduction gene for diatom speciation and population dynamics.

An in vivo comparison between a visible light-cured bonding system and a chemically cured bonding system.

Direct bonding of brackets has become a routine procedure in clinical orthodontics. Many techniques and materials are currently advocated and used, the most recent being light-cured composites. Advantages of the light-cured systems are their relative ease of use, improved bracket placement, and more rapid set of the composite. For a new system to be clinically viable, it must possess properties that are at least as reliable as existing systems. The purpose of this longitudinal clinical study was to evaluate and compare the rate of success and/or failure between a visible light-cured bonding material (Sequence) and a chemically cured bonding material (System 1+), using both systems in every patient. Contralateral quadrants were bonded with each system respectively. A total of 32 patients were followed for a mean period of 11 months (range of 3 to 21 months), with a total of 531 brackets bonded, 265 with visible light-cured and 266 with chemically cured resins. Failures for each system were recorded and failure rates calculated. The failure rate of the visible light-cured composite was 11.3% and that of the chemically cured composite was 12%. A Chi-squared (chi2) test did not reveal any statistically significant differences between the failure rates of the two systems, (chi2 = 0.014, df-1, P > 0.9).

De novo duplication of 17p [dup(17)(p12----p11.2)]: report of an additional case with confirmation of the cytogenetic, phenotypic, and developmental aspects.

We describe an apparent de novo duplication of bands 17p11.2 and p12. A comparison of the manifestations of a previously reported case with a similar karyotype [Magenis et al., Am J Med Genet 24:415-420 (1986)] and of our own case seems to indicate a characteristic pattern which includes prenatal and postnatal growth retardation, facial changes, club feet, and mild developmental deficits. The prominent facial changes are a relatively triangular face, downslanted palpebral fissures, malocclusion, and abnormal ears. In addition, this condition appears to be milder than other duplications of the short arm of chromosome 17, namely trisomy 17p and dup(17)(p11.2----cen).

[The electron microscopic findings of helicoid bacteria lining the mucosa of the cecum in guinea pigs]. / Elektronno-mikroskopicheskie nakhodki spiralevidnykh bakterii, vystilaiushchikh slizistuiu slepoi kishki morskikh svinok.

This study has revealed that helical bacteria inhabiting the mucous membrane of the cecum of guinea pigs are localized in the parietal zone of the epithelium and can be detected as biological film consisting of many microcolonies. Helical bacteria are attached to the epithelium by insertion of one of the ends of an eukaryotic cell into the space between microvilli without damaging epithelial cells and their microvilli. Helical bacteria have been found to use the "anchor" type of attachment to the epithelium, which ensures the stability of their high population level in the biotope. These microorganisms appear on the mucous membrane of the epithelium, starting from day 15 of the life of guinea pigs. At the period of the transition of suckling guinea pigs to independent nourishment the population of helical bacteria is partially suppressed due to the appearance of bacillary and filamentous forms of bacteria, but later, after the adaptation of the animals to their diet, helical bacteria become normal resident microflora which forms biofilm covering large areas of the mucous membrane and the entrances of crypts of Lieberkühn.

[The surgical treatment of aneurysms of the ascending aorta with associated aortic insufficiency. Total replacement with reimplantation of the coronary arteries]. / Tratamiento quirúrgico de los aneurismas de aorta ascendente con insuficiencia aórtica asociada. Reemplazo completo con reimplantación de coronarias.

We reviewed our experience with replacement of the ascending aorta and aortic valve with a composite graft and reimplantation of coronary arteries to the tube graft during 8 years interval from April, 1982, to April 1990. 24 patients underwent repair, the mean age was 49.83 years. Annuloaortic ectasia was the most common indication (58.33%), followed by aortic dissection (acute or chronic). Emergency operation was carried out in nine patients with aortic dissection (37.5%) and elective in 15. The mean duration of cardiopulmonary bypass was 118 +/- 4 minutes and of aortic clamping 83.85 +/- 2 minutes. Hospital mortality was 4.17%, reoperation for hemorrhage was 12.5% and perioperative morbidity for other causes was 34.7%. There were one late death. 20 patients were follow-up with a total of 638 patients-months (two patients excluded with insufficient follow-up and one late death). At last follow-up 14 patients were in functional class I. Eight year actuarial survival for the 24 patients was 91%. We believe that replacement of the ascending aorta and aortic valve with a composite graft and coronary arteries reimplantation to the tube graft is more than one satisfactory alternative to supracoronary graft replacement and aortic valve replacement. It offers the advantage of excluding all abnormal aortic tissue, eliminating the risk for later development of complications in the non excluded disease aorta. It supposes the method of choice for patients with anuloaortic-ectasia, aneurysms of the sinuses of Valsalva with aortic insufficiency, and aortic dissection with proximal affectation of coronary arteries and aortic valve.