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alliative rehabilitation.Patient preferences and the patient experience should continue to shape service design.There is a need to ensure physical activity advice is consistent throughout healthcare settings and not fragmented between primary, secondary and tertiary care.This article argues for the usefulness of deploying a trans lens to examine the diaries of Anne Lister (1791-1840). The author contends that a trans reading may expand possibilities for critical analysis of Lister's gender practices within the context of early-nineteenth-century white, upper-class Halifax society, in addition to existing labels such as "lesbian" and "queer." Examples to illustrate these possibilities are drawn from Lister's reading habits, facilitated by some initial quantitative analysis of Lister's own indexing practices. The article concludes that Lister structures their literary life to enable them to trans certain gender practices, and to fashion a livable gendered existence amidst the competing pressures of class, nationhood, financial security, self-determination, and sexual desire.

Patients with persistent nephrotic-range proteinuria have a high risk of kidney dysfunction and cardiovascular events. Recently, the maintenance of proteinuria remission has been demonstrated to reduce the risk of kidney endpoint. However, the effect of remission duration on cardiovascular outcomes remains unclear.

This study enrolled 982 patients with primary nephrotic syndrome who had achieved clinical remission. Remission duration was defined as the maintenance time (months) of the first remission. Arteriosclerotic cardiovascular disease (ASCVD) and kidney dysfunction (ESKD or eGFR reduction >50%) were the endpoints. Survival curves, Cox regression models, restricted cubic spline analysis were used and the cutoff time points were determined.

During the 38.3 months of follow-up, 161 (16.4%) patients developed ASCVD (51.3 per 1000 patient-years) and 52 (5.3%) patients developed kidney dysfunction (15.3 per 1000 patient-years). Multivariate analysis showed that remission duration was an independently protective factor to ASCVD, in which each one-year extension associated with a 15% reduction of the risk (HR, 0.854; 95% CI, 0.776 ∼ 0.940,

= .001). The initial time point was seven months for remission to present the protective effect to ASCVD and the maximum time point was 36 months. Remission duration was also an independently protective factor to kidney dysfunction. This effect was shown from the beginning of remission and reached the maximum at 26 months.

The maintenance of proteinuria remission was crucial for the improvement of cardiovascular and kidney outcomes in nephrotic syndrome patients.

The maintenance of proteinuria remission was crucial for the improvement of cardiovascular and kidney outcomes in nephrotic syndrome patients.Introduction Benign esophageal tumors are uncommon; most are detected by chance upon endoscopy. Lymphoid polyps, like those of the small and large intestine, have not been reported to occur in the esophagus. We describe an esophageal benign lymphoid polyp. Case Report A 7.5-year-old girl was referred with dysphagia. Upper endoscopy demonstrated and removed a single small pedunculated polyp in the upper third of the esophagus. The polyp consisted of two hyperplastic lymphoid aggregates in the lamina propria covered by stratified non-keratinizing squamous epithelium. Discussion Esophageal polyps may be produced by hyperplastic lymphoid tissue and may be a cause of dysphagia.

Following the results of the PlaNeT-2 randomized controlled trial showing decreased morbidity and mortality in neonates transfused at a threshold of 25 versus 50 × 10

platelets/L, a protocol supporting restrictive platelet transfusions was established in 2019 at the Sainte-Justine Hospital neonatal intensive care unit (NICU). This study aimed to (1) determine the impact of a local restrictive transfusion protocol on the number of platelet transfusions and donor exposure; (2) compare platelet-transfusion determinants and justifications before and after its implementation.

Prospective observational cohort chart-review study comparing all neonates consecutively admitted to the NICU during two 5-months periods 2013 (before; N= 401) versus 2021 (after; N= 402). Possible determinants were assessed via logistic regressions and justifications via a questionnaire.

Mean (± standard deviation) gestational age and birth weight were 34.9± 4.2 weeks and 2.5± 1.0kg, respectively. In 2021, 5.0% were platelet-transfused versus 9.2% in 2013 (p= .027). Platelet transfusions decreased from a mean of 2.6± 1.7 in 2013 to 1.4± 0.7 in 2021 (p= .045). Adherence to protocol thresholds was of 70%. After protocol implementation, no infant received ≥4 platelet transfusions nor was exposed to ≥4 donors, compared to 29.7% and 21.6%, respectively, in 2013. Platelet transfusion justifications and determinants remained similar, except for severe intraventricular hemorrhage being an additional determinant in 2021.

Restrictive local transfusion thresholds in a NICU decreased the proportion of platelet-transfused neonates by 46% and reduced donor exposure in transfused patients.

Restrictive local transfusion thresholds in a NICU decreased the proportion of platelet-transfused neonates by 46% and reduced donor exposure in transfused patients.The complex etiopathology of retained placenta (RP) and hazards associated with it has made it crucial for researchers and clinical veterinarians to study pathogenesis, early-warning diagnosis, and treatment. This study aimed to screen the potential prognostic markers of RP in dairy cows using plasma metabolomics coupled with clinical laboratory indicators. Blood samples were collected from 260 dairy cows at 21, 14, 7, and 0 days before parturition and 7, 14, and 21 days after parturition. Consequently, 10 healthy cows and 10 cows with RP with similar parity, body condition score, and age were included in the study. The changes in clinical laboratory indicators of the enrolled cows from 21 before parturition to 21 days after parturition were assessed. After initial overview of the multivariate statistical data using PCA analysis, the data were subjected to orthogonal partial least-squares discriminant analysis. Compared with cows with RP at 7 days before parturition, the levels of endothelin and 6-keto-prostaglandin F1α were increased in healthy cows, while the level of estradiol and progesterone decreased. Adenine dinucleotide phosphate, hypoxanthine, guanine dinucleotide phosphate, inosine monophosphate, and L-arginine were revealed as potential prognostic markers of cows with RP at 7 days before parturition involved in the regulation of taste transduction, purine and glutathione metabolism, and autophagy. The best period for the early-warning diagnosis of RP in dairy cows is 7 days before parturition, and purine metabolism and autophagy may play a vital role in the occurrence and development of RP in dairy cows.Infection with both Hepatitis B (HBV) and D (HDV) virus causes more severe liver damage than HBV alone. Superinfections among chronic HBV infected cohorts often lead to HDV persistence with rapid progression to cirrhosis, necessitating continuous surveillance to determine their prevalence and relative contribution to liver pathology. A cross-sectional study among hospital outpatients in Ekiti and Osunstates was conducted using random sampling technique. Blood samples were collected from 410 participants and tested for HBV serological markers. All samples positive for HBsAg samples were tested for Hepatitis D virus antigen (HDAg), serum anti-HDV IgM, and serum anti-HDV IgG using enzyme-linked immunosorbent assay kits. Selleck MAPK inhibitor The prevalence of HBV infection among the 410 samples was 12.4% (CI 9.5-15.9). Past HBV exposure was detected in 120 (29.2%), while 147(35.8%) were susceptible to HBV infection. Among the HBsAg positive individuals, 9.8% were hepatitis D antigen (HDAg) positive, while 3.9% and 1.9% were positive for IgG anti-HDV and IgM anti-HDV, respectively. Risk factors associated with HBV infections in this study were multiple sexual partners and sharing of sharp objects. Our investigation has verified the endemicity of HBV in Nigeria and revealed that HBV- HDV co-infection is highly prevalent in south-west Nigeria.

This study aimed to explore the prognostic value of the lymphocyte (LYM)-to-white blood cell (WBC) ratio (LWR) in patients with decompensated liver cirrhosis (DLC).

This study was conducted by recruiting 214 patients with DLC with different aetiologies (development cohort). Receiver operating characteristic (ROC) curve analyses were used to assess the predictive accuracy of the LWR, and Youden's index was used to determine the optimal cut-off values of the LWR based on the ROC curve. Next, patients were divided into high- and low-LWR groups according to the cut-off values. Multivariate logistic analyses were performed to determine the independent predictors for the 1-, 3- and 6-month mortality. Restricted cubic spline (RCS) was used to determine and visualize the association between LWR and the risk of death. We verified the predictive ability of LWR in the validation cohort of 139 patients.

In the development cohort, there were 16 (7.5%), 22 (10.3%) and 30 patients (14.0%) who died at 1, 3 and 6months,in patients with decompensated liver cirrhosis (DLC).Decreased LWR is an independent factor for adverse outcomes in patients with DLC.

Our findings indicate that a lower LWR is an independent factor for unfavourable outcomes and may serve as a potential novel prognostic predictor in patients with DLC.KEY MESSAGESThis study is the first report on the prognostic value of the lymphocyte (LYM)-to-white blood cell (WBC) ratio (LWR) in patients with decompensated liver cirrhosis (DLC).Decreased LWR is an independent factor for adverse outcomes in patients with DLC.Fertility rates in Nigeria are declining at such a modest rate, that if more proactive measures are not employed to reduce fertility, the nation may double its population before long. We empirically examined fertility behaviour as derivatives of specific subgroup social norms, and the variations in the factors responsible for different fertility behaviours, using the 2018 Nigeria Demographic and Health Survey. Descriptive bivariate, and multinomial logistic regression analyses were used to predict the contribution of demographic and sociocultural factors contributing to the fertility level, and findings were reported as odds ratios. Results revealed that age, religion and level of education are the most significant predictors of fertility level, with remarkable differences in birth rate across subgroups, whereas North-West Nigeria had the highest fertility level. Furthermore, marriage had a significantly negative effect on high fertility among North-Western women, whereas higher education significantly increased high fertility among North-Eastern women. In conclusion, subgroup social norms fertility behaviour is responsible for the persistent fertility differential outcome in Nigeria. Thus, the paper strongly advocates the need to intensify community-led, norm-based solution and not a universal approach in addressing fertility control in Nigeria.