Saundersmunck2147

Identifying preoperative risk factors in older patients becomes more important to reduce adverse functional outcome. This study investigated the association between preoperative medication use and functional decline in elderly cardiac surgery patients and compared polypharmacy as a preoperative screening tool to a clinical frailty assessment.

This sub-study of the Anaesthesia Geriatric Evaluation study included 518 patients aged ≥70 years undergoing elective cardiac surgery. The primary outcome was functional decline, defined as a worse health-related quality of life or disability 1 year after surgery. The association between polypharmacy (i.e. ≥5 prescriptions and <10 prescriptions) or excessive polypharmacy (i.e. ≥10 prescriptions) and functional decline was investigated using multivariable Poisson regression. Discrimination, calibration and reclassification indices were used to compare preoperative screening tools for patient selection.

Functional decline was reported in 284 patients (55%) and preadverse outcome after cardiac surgery.Previous studies have investigated influencing factors of early discontinuation of breastfeeding, but few studies have developed an easy-to-use tool to identify risk of breastfeeding cessation at 6 months after birth. This research team aimed to develop and validate an exclusive breastfeeding duration risk nomogram in Chinese mothers. A longitudinal cohort survey was conducted. Data were collected from 394 postpartum women in three hospitals in Hubei Province, China from December 2017 to December 2018. The LASSO regression model was used to screen for optimized factors in an exclusive breastfeeding duration model. Multivariable logistic regression was applied to construct a prediction model. Discrimination and calibration were assessed using a C-index and calibration curve, and internal validity was established using bootstrapping validation. Factors integrated in the prediction risk nomogram were monthly household income (odds ratio [OR] = 1.31, 95% confidence interval [CI] [0.95, 1.80]), experiences of breastfeeding (OR = 1.23, 95% CI [0.92, 1.63]), attitude (OR = 1.72, 95% CI [0.94, 3.16]), self-efficacy (OR = 2.45, 95% CI [1.40, 4.29]), perceived insufficient milk supply (OR = 0.12, 95% CI [0.06, 0.25]) and postpartum depression (OR = 0.06, 95% CI [0.02, 0.17]). The model displayed good discrimination with a C-index of 0.87 (95% CI [0.84, 0.91]) and good calibration. The C-index interval validation was confirmed to be 0.86. This study resulted in the development of a novel nomogram with good accuracy to aid healthcare professionals in assessing the probability of a mother discontinuing exclusive breastfeeding at the breast before 6 months.

The effect of diet type on sustainable environment is known. It is important to understand the adaptation of individuals with high ecological footprint awareness to the Mediterranean type diet, especially under the assumption that the Mediterranean diet will reduce the ecological footprint. In the study, it is aimed to examine the relationship between the level of adherence to the Mediterranean diet and Ecological Footprint awareness of adults.

The sample of the study consisted of 395 individuals with a mean age of 26.2 ± 8.7 years 293 females (74.2%) and 102 males (25.8%). As the Mediterranean Diet Adherence Scale (MDAS) score of individuals increased, the Ecological Footprint Awareness Scale score also increased. Similarly, a positive correlation was found between the participants' MDAS score and the awareness of food (r=0.157; P=0.002), energy (r=0.133; P=0.008), waste (r=0.149; P=0.003) and water consumption (r=0.101; P=0.045), which are sub-factors of the Ecological Footprint Awareness Scale.

As fa of food-environmental impact on different samples. © 2021 Society of Chemical Industry.

Ustekinumab is increasingly used in pregnant women with inflammatory bowel disease (IBD). Existing safety data are reassuring, but the stability of ustekinumab levels in pregnancy, degree of transfer to the infant and time to infant clearance are unknown.

In this prospective observational study, ustekinumab-exposed women with IBD had trough levels measured in each trimester of pregnancy and at delivery. Infant ustekinumab levels were measured at delivery and ongoing until clearance was achieved. Trough ustekinumab level stability in individuals across pregnancy was compared by Skillings-Mack test. Spearman coefficients were used to correlate maternal and infant delivery levels, and median time to infant ustekinumab clearance was defined.

19 pregnant women receiving ustekinumab were included. There was no difference in ustekinumab levels across pregnancy in those with two or more representative trough levels (P=0.83, n=11). Infant delivery ustekinumab levels were higher than maternal levels, with a median infantmaternal ratio of 1.79 (IQR 1.26-3.1). There was a positive correlation between maternal and infant delivery ustekinumab levels (r=0.75, P=0.001) and an inverse correlation between the number of days from final antenatal dose and delivery infant ustekinumab level (r=-0.65, P=0.006). Median time of infant ustekinumab clearance was 9 (range 6-19) weeks (n=9).

Ustekinumab drug levels appear stable in pregnancy, with a delivery infantmaternal ratio similar to that of anti-TNFs. Infant ustekinumab clearance was complete by 20weeks post-partum, however, infants exposed in utero should avoid live vaccination before 12months of age until further clearance data are obtained.

Ustekinumab drug levels appear stable in pregnancy, with a delivery infantmaternal ratio similar to that of anti-TNFs. Infant ustekinumab clearance was complete by 20 weeks post-partum, however, infants exposed in utero should avoid live vaccination before 12 months of age until further clearance data are obtained.

To analyse prenatal work-up, associated anomalies and postnatal outcomes of foetuses with cerebral lateral ventricular width 9-9.9mm.

This retrospective, observational, case-control study included 121 foetuses with initial presentation of isolated cerebral lateral ventricular width 9-9.9mm detected during routine ultrasound scans, 21-24weeks' gestation, in a tertiary referral centre, January 2001-December 2018. Controls included 123 foetuses with lateral ventricular width <9mm measured under the same parameters. Clinical characteristics, obstetrical history, ultrasound findings, prenatal work-up and pregnancy outcomes were collected from medical records. Information about postnatal functional and neurodevelopmental sequelae were obtained from telephone-based questionnaires.

The study group had more males (82/116 (70.6%) versus 65/123 (52.8%), p=0.004), more prenatal testing, including brain magnetic resonance imaging (28/116 (24.1%) versus 0/123 (0%), p<0.001), echocardiography (46/116 (39.7%) versus 15/123 (12.2%), p<0.001) and targeted anomaly scans (102/116 (87.9%) versus 1/123 (0.008%), p<0.001). Long-term follow-up did not reveal more neurodevelopmental sequelae compared to controls. Gender-based analysis found more males with ventricular dilatation 9-9.9mm treated for developmental delay compared to females with similar findings (15/82 (18.2%) versus 1/34 (2.9%), p=0.010).

Foetuses with 9-9.9mm cerebral lateral ventricular width versus <9mm underwent more prenatal testing but had similar rates of neurodevelopmental sequelae.

Foetuses with 9-9.9 mm cerebral lateral ventricular width versus less then 9 mm underwent more prenatal testing but had similar rates of neurodevelopmental sequelae.

Epidemiological studies have shown inconsistent incidence rates (IRs) for inflammatory bowel disease (IBD).

To assess the incidence and temporal trends of IBD in Sweden.

Nationwide cohort study based on diagnostic codes for IBD and biopsy reports registered through the ESPRESSO cohort in 1990-2014. Age-specific and age-standardised IRs and cumulative incidence were calculated.

Overall, we identified 65908 cases of incident IBD ulcerative colitis (UC, n=38261, 58%), Crohn's disease (CD, n=18577, 28%) and IBD-U (n=9070, 14%). During 1990-2014, the overall IRs per 100000 person-years were 29.0 (95% CI 27.3-30.7) for IBD, 16.9 (15.9-17.9) for UC, and 8.1 (7.7-8.6) for CD. For IBD-U, the IR was 5.2 (4.9-5.6) in 2002-2014. The annual incidence of IBD, UC and CD increased by approximately 7% per year between 1990 and 2001 (P<0.001) and then decreased by 1%-2% per year from 2002 onwards (P<0.001). selleck kinase inhibitor IRs for IBD, UC and IBD-U were higher in males while the IR for CD was higher in females. The lifetime risk of IBD was about 2.5% for both sexes.

In Sweden, the incidence of IBD in all subtypes increased in 1990-2001 but has since declined. One in 40 individuals is expected to be diagnosed with IBD during their lifetime.

In Sweden, the incidence of IBD in all subtypes increased in 1990-2001 but has since declined. One in 40 individuals is expected to be diagnosed with IBD during their lifetime.We assessed the impact on periprocedural myocardial injury of a ticagrelor loading dose given 6 hours.

Studies on symptom clusters among cancer patients have been conducted intensively. However, the concept seems not to be well defined, hindering its utilization in clinical practice.

The aim of this paper is to reconceptualize symptom cluster and discuss areas of future research.

A cluster of symptoms should not be viewed as simply as a group of symptoms appearing together. It should be clinically relevant, and symptom members should be interactive or have a mutual etiology. A cluster is declared as stable if its "quality" or "nature" is remained instead of merely having the same number of symptoms. Importantly, each symptom cluster should have a sentinel symptom. The sentinel symptom could be the one that predicts the presence of the cluster or could be the one that significantly interacts with other symptoms. The search for symptom clusters, which are common among various patient groups, might be helpful in some aspects. However, to better understand them, symptom clusters should be examined in specific populations.

The nature of the relationship between symptom members, clinical relevance, sentinel symptom, stability, and prevalence are important features of a symptom cluster. More explorations into these properties by future studies are suggested.

The nature of the relationship between symptom members, clinical relevance, sentinel symptom, stability, and prevalence are important features of a symptom cluster. More explorations into these properties by future studies are suggested.Temperate perennials require exposure to chilling temperatures to resume growth in the following spring. Growth and dormancy cycles are controlled by complex genetic regulatory networks and are governed by epigenetic mechanisms, but the specific genes and mechanisms remain poorly understood. To understand how seasonal changes and chilling regulate dormancy and growth in the woody perennial vine kiwifruit (Ac, Actinidia chinensis), a transcriptome study of kiwifruit buds in the field and controlled conditions was performed. A MADS-box gene with homology to Arabidopsis FLOWERING LOCUS C (FLC) was identified and characterized. Elevated expression of AcFLC-like (AcFLCL) was detected during bud dormancy and chilling. A long noncoding (lnc) antisense transcript with an expression pattern opposite to AcFLCL and shorter sense noncoding RNAs were identified. Chilling induced an increase in trimethylation of lysine-4 of histone H3 (H3K4me3) in the 5' end of the gene, indicating multiple layers of epigenetic regulation in response to cold.