[Risk factors for development of hematotoxicity in elderly patients treated with Linezolid].

Objective: To analyze the clinical data, especially the occurrence of hematotoxicity, of hospitalized elderly patients who took Linezolid (LZD), and to further explore the related risk factors. Methods: Our study enrolled the elderly inpatients treated with linezolid at the Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2018 to September 2021. The hospital information system data were retrieved to retrospectively analyze the clinical characteristics of patients, particularly the clinical characteristics and related risk factors of patients who experienced hematotoxic reactions to LZD. Results: Of the 233 eligible cases included, 103 patients received empirical use of LZD (44.21%). The total effective rate was 76.39% (178/233). Among the 57 effective cases who received blood drug concentration monitoring, the trough concentration of LZD was high in 36.84 % (21/57) of elderly patients. Moreover, there were 15 patients with thrombocytopenia alone, 3 patients with decreased hemoglobin (HB) alone, and 3 patients with both thrombocytopenia and HB decrease. The patients who experienced hematotoxicity (developed a certain degree of hemoglobin decrease and/or thrombocytopenia) were more likely to be complicated with renal impairment (χ²=6.642, P=0.036), concomitantly using proton pump inhibitor (PPI) (χ²=4.566, P=0.033), and had a longer course of LZD treatment (P=0.041). There was no linear correlation between the trough concentration of LZD and glomerular filtration rate evaluated by Modification of Diet in Renal Disease Formula (eGFRMDRD) (R=0.226, P=0.136). Conclusions: The elderly patients, especially those with renal impairment, concomitant treatment with PPI, and a longer course of LZD treatment, exhibited a higher risk of hematotoxicity during LZD treatment. Hence, we should strengthen the protection of renal function, reduce drug interaction, and dynamically monitor the blood drug concentration of LZD to adjust its dose, thus implementing safer and more effective treatments.

Characterization of symptoms in irritable bowel syndrome with mixed bowel habit pattern.

BACKGROUND: Irritable bowel syndrome (IBS) with mixed bowel habits (IBS-M) is a heterogeneous subtype with varying symptoms of constipation and diarrhea, and has not been well characterized. We aimed to characterize gastrointestinal (GI) and non-GI symptoms in IBS-M patients from a US patient population, and to compare them with IBS with constipation (IBS-C) and diarrhea (IBS-D). METHODS: Subjects answering community advertisements and meeting Rome III criteria for IBS completed symptom questionnaires. KEY RESULTS: Of the initial 289 IBS patients identified, one third (n = 51, 32.5%) who met Rome III criteria for IBS-M endorsed having either loose stools or hard stools due to medication. These patients had more severe symptoms and longer duration of flares compared to the rest of the IBS-M group (p = 0.014, p = 0.005). Excluding IBS-M patients with medication-related extremes in stool form who could not be reclassified by medical history, 247 IBS patients were assessed. IBS-M was the most common (44.1%), followed by IBS-C (27.9%), IBS-D (26.3%), and IBS-U (unsubtyped, 1.6%). While IBS-M shared symptoms with both IBS-C and IBS-D, there were significant differences in the prevalence of bowel habit symptoms (p-value range: <0.001-0.002). IBS-M patients reported most bothersome symptoms that were more similar to IBS-D, with the most common being irregular bowel habits (27.5%), bloating (26.6%), and abdominal pain (20.2%). There were no differences in non-GI symptoms between subtypes. CONCLUSIONS & INFERENCES: IBS-M is a heterogeneous symptom group and thus requires that subclassification criteria be better defined. Use of laxative/antidiarrheal medications adds to the diagnostic complexity in a potentially more severe subset of IBS-M and should be assessed for accurate subclassification.

[Long-term prognosis after recovery from acute myocardial infarction].

754 cases of acute myocardial infarction survivors were followed up for 28 days to 14 years, the missing rate was 1.86%. The factors influencing long-term prognosis were analyzed. Single factor analysis revealed sex, occupation, age, amount of cigarette smoked, history of stroke, and COPD, complications of heart failure, and arrhythmia, stroke and COPD, heart rate higher than 110/min, lung rales, frequency of infarction, quit smoking after infarction exerted significant influence on over all and cardiac death rate. Multiple factors Cox model analysis revealed quit smoking, complications of stroke heart failure, arrhythmia and occupation were the independent predicting factors for over-all causes of death. Frequency of myocardial infarction, quit smoking, amount of cigarette smoked, occupation, stroke were the independent prognostic factors of cardiac death.

[Prognostic factors in the acute stage of myocardial infarction: analysis of 893 cases].

The prognostic factors in the acute stage of 893 myocardial infarction patients, admitted during a period from 1970 to 1986, were analysed. The overall mortality was 15.6%, including 14.4% cardiac death and 1.1% non-cardiac death. Single factor analysis indicated that age, sex, occupation, history of hypertension, chest pain during the episode, systolic blood pressure, heart rate and site of infarction at the time of admission, presence of complications such as cardiogenic shock, arrhythmias, stroke and monitoring in CCU or not were related to the overall mortality and cardiac death. Multiple factor logistic regression analysis indicated that for the overall mortality, the independent prognostic factors included presence of cardiogenic shock, heart rate and chest pain at the time of admission; for the cardiac death, the independent factors included age, occupation, history of hypertension, heart rate and chest pain at the time of admission, involvement of anterior wall and presence of cardiogenic shock and arrhythmias. Basing on the above findings we establish a risk factors predicting prognostic model of acute myocardial infarction in its acute stage.

Malleability of conditioned associations: path dependence.

Using conditioned suppression of barpressing to investigate the stability of a conditioned stimulus-unconditioned stimulus (CS-US) association, we gave water-deprived rats either a few pairings of the CS with a strong footshock US or many pairings with a weak footshock US so that barpress suppression in response to the CS was equated. Experiment 1 established training parameters that yielded this equivalence. Specifically, rapid acquisition to a preasymptotic level of responding with strong shock produced suppression comparable to the asymptotic level reached more slowly with weak shock. Experiment 2 showed that although equivalent performance was obtained from extensive conditioning with a weak shock or limited conditioning with strong shock, only extensive conditioning with weak shock resulted in retarded acquisition of an association between that same CS and a footshock level perceived as midway between the two initial training shock intensities as implied by asymptotic performance in Experiment 1. Experiment 3 demonstrated that the observed retardation in animals given many conditioning trials with weak shock was CS specific. Collectively, these findings indicate that the malleability of learned behavior is not simply a function of initial associative strength but is dependent on path during initial acquisition.