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Aim: This study seeks to identify patient socioeconomic factors that may be associated with no-shows to our academic urology clinics. Subject and methods: This was a retrospective analysis of patient attendance to appointments scheduled at the main urology clinics of our academic center between April 2018 and April 2019. Attendance to scheduled appointments was computed and analyzed with respect to patients’ demographics and socioeconomic status, along with clinic site, type of provider scheduled with, and reason for visit. Chi-square test and simple and multiple logistic regression were performed in order to determine the relationship between patient no-show rates and the variables for appointment characteristics. Results: The cohort of patients at highest risk for no-show was associated with those who were uninsured (OR = 30.00, 95% CI: 23.73-–7.92; p< 0.0001) and from our county’s urban sector (OR = 1.96, 95% CI:1.63–2.37; p< 0.0001), in which the population reported a household income of 30% below poverty level and was only one-third high-school educated. Conclusion: Further studies of this at-risk population who are likeliest to miss their urology clinic appointment may appropriately address these patients’ needs and thus curtail the number of no-shows to future outpatient appointments.

Dermoid cysts are the most common germ cell tumours encountered in the reproductive age group. The coexistence of dermoid cysts with other histological types within the ovary is rare. An uncommon combination of mature cystic teratoma with mucinous cystadenoma is being presented here. The challenges in managing these tumours arise from their large size, making cystectomy while preserving the normal ovary a daunting task. Preoperative identification of separate components and thorough discussion with the histopathologist play a crucial role in effective management. The presence of malignant components and the diagnosis of the most aggressive component guide the direction of the management protocol. Our case highlights the positive outcome of fertility-sparing surgery in the context of bilateral ovarian masses.

Objective: To assess the link between very early erythromycin exposure and pyloric stenosis in young infants. Design: Retrospective cohort study. Participants and Methods: Medicaid or TennCare (Tennessee's program for Medicaid enrollees and uninsured individuals) births in Tennessee from 1985 to 1997. Cases of infants with a hospital discharge diagnosis of pyloric stenosis and an associated surgical procedure code were used. Erythromycin exposure and other antibiotic exposure between 3 and 90 days of life were identified from prescription files. Main Outcome Measures: Hospital discharge diagnosis of pyloric stenosis, and an associated surgical procedure code. Results: Of 933 239 births in Tennessee during the study period, 314029 were enrolled in Medicaid. Among these infants, 804 (2.6/1000 infants) met the criteria for pyloric stenosis. Very early exposure to erythromycin (between 3 and 13 days of life) was associated with a nearly 8-fold increased risk of pyloric stenosis (adjusted incident rate ratio, 7.88; 95% confidence interval, 1.97-31.57). No increased risk of pyloric stenosis was seen in infants exposed to erythromycin after 13 days of life or in infants exposed to antibiotics other than erythromycin. Conclusions: The significant increase in pyloric stenosis in children with very early exposure to erythromycin is consistent with reports of other investigators. The risks and benefits of erythromycin should be weighed carefully prior to initiating such therapy in young infants.

Background: Many lung transplant programs employ lengthy regimens of IV ganciclovir therapy to prevent disease due to cytomegalovirus (CMV). In 1994, we introduced a regimen of delayed ganciclovir prophylaxis for [...]

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Study objectives: Black smokers have been reported to have higher serum cotinine levels than do white smokers, and have higher rates of most smoking-related diseases, despite smoking fewer cigarettes per [...]

Background. In the search for tumor-related antigens with survival-predictive value, previous studies have yielded varied conclusions regarding the expression of one such antigen, the transferrin receptor in lung cancer. The goal of this study was to define the frequency of expression of transferrin receptor in lung cancer specimens and gather preliminary data regarding the prognostic value of this tumor-related antigen. Methods. Tissue immunoreactivity was studied with a murine monoclonal antibody to transferrin receptor in patients with nonsmall cell lung cancer who underwent surgical resection at the Medical Center Hospital of Vermont during the period from January, 1988, to May, 1991. Results. The study group consisted of 32 patients (21 males and 11 females) with an average follow-up length of 27 months (standard deviation of 16 months). There were 17 patients with adenocarcinoma, 14 with squamous cell carcinoma, and 1 with large cell carcinoma. At the end of data accumulation, a total of 16 deaths had been recorded (8 with squamous cell, 8 with adenocarcinoma). Normal lung tissue did not stain for transferrin receptor; however, 13 of 17 (76%) adenocarcinomas, 13 of 14 (93%) squamous cell carcinomas, and the 1 large cell carcinoma stained positively for transferrin receptor. Staining for transferrin receptor was graded according to pattern and intensity and categorized as absent-weak or strong. Survival analysis was performed to evaluate patient outcome based on a variety of clinical and experimentally determined characteristics. Groups based on N-status (N0 vs. N1 + N2, P = 0.08), stage (Stage 1 vs. Stage 2 +3, P = 0.13), age (younger than 60 vs. 60 years or older, P = 0.09), and transferrin receptor staining (absent-weak vs. strong, P = 0.14) achieved nearly significant differences in survival. Further analysis of the differences in survival for groupings based on transferrin receptor staining found that these differences in survival reached significance for patients with larger tumors (T2 or T3, P = 0.02). Conclusions. Transferrin receptor is expressed in the majority of lung cancers and the presence of transferrin receptor in nonsmall cell lung cancers may be an indicator of poorer prognosis in certain groups of patients. Cancer 1995; 76:20-5. Key words: carcinoma, nonsmall cell lung, antigens, neoplasm, receptors, transferrin, survival analysis.

Objective: Compare rates of initial extubation success in preterm infants extubated to NIPPV or NI-NAVA. Study design: In this pilot study, we randomized 30 mechanically ventilated preterm infants at the time of initial elective extubation to NI-NAVA or NIPPV in a 1:1 assignment. Primary study outcome was initial extubation success. Results: Rates of continuous extubation for 120 h were 92% in the NI-NAVA group and 69% in the NIPPV group (12/13 vs. 9/13, respectively, p= 0.14). Infants extubated to NI-NAVA remained extubated longer (median 18 vs. 4 days, p= 0.02) and experienced lower peak inspiratory pressures (PIP) than infants managed with NIPPV throughout the first 3 days after extubation. Survival analysis through 14 days post extubation showed a sustained difference in the primary study outcome until 12 days post extubation. Conclusions: Our study is the first to suggest that a strategy of extubating preterm infants to NI-NAVA may be more successful.

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Clostridioides difficileis the most common cause of healthcare-associated infection and gastroenteritis-associated death in the USA. Adherence to guideline recommendations for treatment of severe C. difficileinfection (CDI) is associated with improved clinical success and reduced mortality. The purpose of this study was to determine whether implementation of a pharmacist-led antimicrobial stewardship program (ASP) CDI initiative improved adherence to CDI treatment guidelines and clinical outcomes. This was a single-center, retrospective, quasi-experimental study evaluating patients with CDI before and after implementation of an ASP initiative involving prospective audit and feedback in which guideline-driven treatment recommendations were communicated to treatment teams and documented in the electronic health record via pharmacy progress notes for all patients diagnosed with CDI. The primary endpoint was the proportion of patients treated with guideline adherent definitive regimens within 72?hours of CDI diagnosis. Secondary objectives were to evaluate the impact on clinical outcomes, including length of stay (LOS), infection-related LOS, 30-day readmission rates, and all-cause, in-hospital mortality. A total of 233 patients were evaluated. The proportion of patients on guideline adherent definitive CDI treatment regimen within 72?hours of diagnosis was significantly higher in the post-interventional group (pre: 42% vs post: 58%, p=0.02). No differences were observed in clinical outcomes or proportions of patients receiving laxatives, promotility agents, or proton pump inhibitors within 72?hours of diagnosis. Our findings demonstrate that a pharmacist-led stewardship initiative improved adherence to evidence-based practice guidelines for CDI treatment.

Healthcare associated (HA) sepsis is associated with increased resource utilization and mortality compared with community acquired (CA) sepsis. The purpose of this study was to identify independent predictors of in-hospital mortality from HA-sepsis.

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New primary cancers can occur in patients with a previous cancer. Among the risk factors, therapies such as chemotherapy, radiotherapy, and hormonal therapy have been associated with the development of neoplasms. Second cancers most commonly develop 5–10 years after the initial tumor. We observe the implications of cancer-related therapy in the development of a new tumor. We looked at 602 patients who had their first cancer diagnosed in 2011 and calculated the number of different primary cancers between 2011 and 2016 for each patient. Twenty-four patients had a second cancer within 5 years from the first diagnosis and there were no patients with a third cancer. There was no statically significant difference in the rates of second cancers after exposure to chemotherapy, radiotherapy, hormonal therapy, or any combination of these (p=0.738). Of the second cancers reported after 2011, renal, uterine, cervical, and lung cancers were the most frequently reported. Additionally, there was no statically significant difference among the rates of second cancers in men versus women (p=0.467), as well as among whites versus blacks (p=0.318). We conclude that while new primaries can occur after one cancer, there was no increased risk after exposure to different cancer-related therapies. With increased focus on the primary disease, there is a higher likelihood of missing another primary lesion. This is important as the practical implications of managing multiple primaries are rarely discussed.

To cope up with the Big Data explosion, the Nth Order Binary Encoding (NOBE) algorithm with the Split-protocol has been proposed. In the earlier papers, the application Split-protocol for security, reliability, availability, HPC have been demonstrated and implemented encoding. This technology will significantly reduce the network traffic, improve the transmission rate and augment the capacity for data storage. In addition to data compression, improving the privacy and security is an inherent benefit of the proposed method. It is possible to encode the data recursively up to N times and use a unique combination of NOBE's parameters to generate encryption keys for additional security and privacy for data on the flight or at a station. This paper describes the design and a preliminary demonstration of (NOBE) algorithm, serving as a foundation for application implementers. It also reports the outcomes of computable studies concerning the performance of the underlying implementation.

Supplemental Digital Content is Available in the Text.This is a two-part study evaluating the efficacies of various vitreomacular traction treatments: (1) intravitreal injection of expansile gas (pneumatic vitreolysis), (2) intravitreal injection of ocriplasmin, and (3) pars plana vitrectomy. The results suggest pneumatic vitreolysis may be as effective or superior to intravitreal injection of ocriplasmin for vitreomacular traction release.

This study proposed to validate a prediction model and risk-stratification tool of 2-year mortality rates of individuals in the general population suitable for office practice use. A risk indicator (R) derived from data in the literature was based on only 6 variables: to calculate R for an individual, starting with 0, for each year of age above 60, add 0.14; for a male, add 0.9; for diabetes mellitus, add 0.7; for albuminuria >30 mg/g of creatinine, add 0.7; for stage =3 chronic kidney disease (CKD), add 0.9; for cardiovascular disease (CVD), add 1.4; or for both CKD and CVD, add 1.7. We developed a univariate logistic regression model predicting 2-year individual mortality rates. The National Health and Nutrition Examination Survey (NHANES) data set (1999–2004 with deaths through 2006) was used as the target for validation. These 12,515 subjects had a mean age of 48.9±18.1 years, 48% males, 9.5% diabetes, 11.7% albuminuria, 6.8% CVD, 5.4% CKD, and 2.8% both CKD and CVD. Using the risk indicator R alone to predict mortality demonstrated good performance with area under the receiver operating characteristic (ROC) curve of 0.84. Dividing subjects into low-risk (R=0–1.0), low intermediate risk (R>1.0–3.0), high intermediate risk (R>3.0–5.0) or high-risk (R>5.0) categories predicted 2-year mortality rates of 0.52%, 1.44%, 5.19% and 15.24%, respectively, by the prediction model compared with actual mortality rates of 0.29%, 2.48%, 5.13% and 13.40%, respectively. We have validated a model of risk stratification using easily identified clinical characteristics to predict 2-year mortality rates of individuals in the general population. The model demonstrated performance adequate for its potential use for clinical practice and research decisions.

To determine the lesion characterization capability by low dose CT for localized lung lesions in comparison with standard dose CT.

•We planned to confirm the efficiency of low dose CT protocol at 50mAs as a routine protocol.•We examined the difference in the diagnostic result between the low dose CT images and standard dose CT image protocol.•Fundamental chest CT abnormal findings including both lung and soft tissue abnormality were recorded and compared between two protocols.•The difference in the diagnostic result of a reader from the other two readers is not greater in low dose CT images.•The result of present study supported the use of routine low dose CT protocol.

Primed neutrophils that are capable of releasing matrix metalloproteinases (MMPs) into the circulation are thought to play a significant role in the pathophysiology of acute respiratory distress syndrome (ARDS). We hypothesized that direct measurement of plasma MMP-9 activity may be a predictor of incipient tissue damage and subsequent lung injury, which was investigated in both an animal model of ARDS and a small cohort of 38 critically ill human patients. In a mouse model of ARDS involving instillation of intratracheal lipopolysaccharide (LPS) to induce lung inflammation, we measured neutrophil-mediated inflammation, along with MMP-9 activity in the airways and lung tissue and MMP-9 expression in the plasma. Neutrophil recruitment, inflammation, and MMP-9 activity in the airways and lung tissue increased throughout the 72 h after LPS instillation, whereas plasma MMP-9 expression was greatest at 12 to 24 h after LPS instillation. The results suggest that the peak in plasma MMP-9 activity may precede the peak of neutrophil inflammation in the airways and lung tissue in the setting of ARDS. Based on this animal study, a retrospective observational cohort study involving 38 patients admitted to a surgical intensive care unit at a tertiary care university hospital with acute respiratory failure requiring intubation and mechanical ventilation was conducted. Plasma samples were collected daily, and MMP-9 activity was compared with lung function as determined by the PaO2FiO2ratio. In patients who developed ARDS, a notable increase in plasma MMP-9 activity on a particular day correlated with a decrease in the PaO2FiO2ratio on the following day (r= −0.503, P< 0.006). Taken together, these results suggest that plasma MMP-9 activity changes, as a surrogate for primed neutrophils may have predictive value for the development of ARDS in a selected subset of critically ill patients.

To study the association between periodontal disease (PD) and age-related macular degeneration (AMD).

Circulating plasmacytoid dendritic cells (PDC) decrease in human immunodeficiency virus (HIV) infection, either from loss or redistribution to lymph nodes (LN). Limited animal and human studies variably showed increased or decreased nodal PDC. CD123 immunostaining was performed on 28 archived LN biopsies (20 reactive) from 25 HIV patients. PDC clustering was graded (1: none; 2: rare small; 3: medium-sized, loose; and 4: large tight clusters) and correlated with HIV-lymphadenitis stage, blood CD4 counts, time since HIV diagnosis, and treatment duration. Increased PDC clustering was seen with decreasing CD4 counts (P=0.001), shorter treatment duration (P=0.0268), and advancing HIV-lymphadenitis stage (P=0.06). No correlation with time since HIV diagnosis was noted. To our knowledge, this is the first human study assessing relationship of nodal PDC in HIV to CD4 counts, treatment duration, and lymphadenitis pattern. Our findings suggest that PDC redistribute to LN with advancing immunodeficiency and stage of HIV infection.

Cardiac arrest occurs in >400 000 patients in the United States per year, and mortality rates vary across the country. Whether variations in cardiac arrest outcome are the result of differences in hospital or patient characteristics remains understudied. We tested whether hospital-independent factors would account for the difference in outcome between 2 geographically distinct hospitals.

Immunoreactive signal for the desmosomal protein plakoglobin (-catenin) is reduced at cardiac intercalated disks in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC), a highly arrhythmogenic condition caused by mutations in genes encoding desmosomal proteins. Previously, we observed a false-positive case in which plakoglobin signal was reduced in a patient initially believed to have ARVC but who actually had cardiac sarcoidosis. Sarcoidosis can masquerade clinically as ARVC but has not been previously associated with altered desmosomal proteins.

The majority of breast cancers that occur in BRCA1mutation carriers (BRCA1carriers) are estrogen receptor-negative (ER-). Therefore, it has been suggested that ER negativity is intrinsic to BRCA1cancers and reflects the cell of origin of these tumors. However, approximately 20% of breast cancers that develop in BRCA1carriers are ER-positive (ER+); these cancers are more likely to develop as BRCA1carriers age, suggesting that they may be incidental and unrelated to BRCA1deficiency. The purpose of this study was to compare the prevalence of loss of heterozygosity due to loss of wild type (wt) BRCA1in ER+ and ER- breast cancers that have occurred in BRCA1carriers and to determine whether age at diagnosis or any pathologic features or biomarkers predict for loss of wt BRCA1in these breast cancers. Relative amounts of mutated and wt BRCA1DNA were measured by quantitative polymerase chain reaction performed on laser capture microdissected cancer cells from 42 ER+ and 35 ER- invasive breast cancers that developed in BRCA1carriers. BRCA1gene methylation was determined on all cancers in which sufficient DNA was available. Immunostains for cytokeratins (CK) 5/6, 14, 8 and 18, epidermal growth factor receptor and p53 were performed on paraffin sections from tissue microarrays containing these cancers. Loss of wt BRCA1was equally frequent in ER+ and ER- BRCA1-associated cancers (81.0% vs 88.6%, respectively; P= 0.53). One of nine cancers tested that retained wt BRCA1demonstrated BRCA1gene methylation. Age at diagnosis was not significantly different between first invasive ER+ BRCA1breast cancers with and without loss of wt BRCA1(mean age 45.2 years vs 50.1 years, respectively; P= 0.51). ER+ BRCA1cancers that retained wt BRCA1were significantly more likely than those that lost wt BRCA1to have a low mitotic rate (odds ratio (OR), 5.16; 95% CI, 1.91 to ∞). BRCA1cancers with loss of wt BRCA1were more likely to express basal cytokeratins CK 5/6 or 14 (OR 4.7; 95% CI, 1.85 to ∞). We found no difference in the prevalence of loss of wt BRCA1between ER+ and ER- invasive BRCA1-associated breast cancers. Our findings suggest that many of the newer therapies for BRCA1breast cancers designed to exploit the BRCA1deficiency in these cancers may also be effective in ER+ cancers that develop in this population.

Despite a growing literature on patient satisfaction in breast reconstruction, few studies have compared perforator flaps with the more commonly practiced methods. The authors compared four reconstructive techniques and identified factors influencing patient satisfaction.

To determine whether angiotensin-converting enzyme (ACE) inhibitors and other antihypertensives are associated with risk of pneumonia.

Many incisional techniques have been described for access to the craniofacial skeleton for traumatic fracture repair, including subciliary, subtarsal, and transconjunctival approaches. Each is associated with a distinct set of complications. The goal of the authors' study was to examine lower lid malposition associated with these incisional approaches at the authors' institution and in the literature.

There are few blood biomarkers predictive of mortality in adult respiratory distress syndrome (ARDS), and none that currently serve as therapeutic targets. Here, we ask whether a circulating protein angiopoietin 2 (Ang2) correlates with severity of lung injury and mortality in a surgical intensive care unit cohort with acute lung injury (ALI)/ARDS. Tie 2 is a tyrosine kinase receptor expressed on endothelial cells. One ligand, angiopoietin 1, phosphorylates Tie 2 and stabilizes adult vasculature. An alternate ligand, Ang2, serves as a context-dependent antagonist and disrupts barrier function. Previously, our laboratory detected high circulating Ang2 levels in septic patients and a correlation with low Pao2/Fio2. In this study, daily plasma was collected in 63 surgical intensive care unit patients. Eighteen patients met clinical criteria for ALI or ARDS. The median Ang2 at admission in patients who never developed ALI/ARDS was 3.7 ng/mL (interquartile range IQR, 5.6; n = 45). The Ang2 on the day a patient met criteria for ALI/ARDS was 5.3 ng/mL (IQR, 6.7) for survivors (n = 11) and 19.8 ng/mL (IQR, 19.2) for nonsurvivors (n = 7; P= 0.004). To explore the mechanism of high Ang 2 leading to increased permeability, plasma from patients with ALI was applied to cultured lung endothelial cells and found to disrupt normal junctional architecture. This effect can be rescued with the Tie 2 agonist angiopoietin 1. A patient's convalescent (low Ang2) plasma did not disrupt junctional architecture. Although further studies with larger sample sizes will be needed to confirm these results, high Ang2 in critically ill patients with ALI/ARDS is associated with a poor outcome. These data, coupled with our cell culture experiments, suggest that antagonism of Ang2 may provide a future novel therapeutic target for ARDS.

The detection of lymphoma cells in cerebrospinal fluid (CSF) as a means to diagnose lymphomatous meningitis is problematic due to its low sensitivity. We hypothesize that matrix metalloproteases (MMPs) would be important in lymphomatous meningitis because lymphoma cells may produce MMPs for brain invasion and angiogenesis.

Group B streptococcal infections remain an important cause of morbidity and mortality in newborns.

The present study describes the in vivo detection and imaging of tumour-associated MMP-7 (matrix metalloproteinase-7 or matrilysin) activity using a novel polymer-based fluorogenic substrate PB-M7vis, which serves as a selective ‘proteolytic beacon’ (PB) for this metalloproteinase. PB-M7vis is built on a PAMAM (polyamido amino) dendrimer core of 14.2 kDa, covalently coupled with an Fl (fluorescein)-labelled peptide Fl(AHX)RPLALWRS(AHX)C (where AHX stands for aminohexanoic acid) and with TMR (tetramethylrhodamine). PB-M7vis is efficiently and selectively cleaved by MMP-7 with a kcat/Km value of 1.9×105 M−1·s−1 as measured by the rate of increase in Fl fluorescence (up to 17-fold for the cleavage of an optimized PB-M7vis) with minimal change in the TMR fluorescence. The Km value for PB-M7vis is approx. 0.5 µM, which is approx. two orders of magnitude lower when compared with that for an analogous soluble peptide, indicating efficient interaction of MMP-7 with the synthetic polymeric substrate. With MMP-2 or -3, the kcat/Km value for PB-M7vis is approx. 56- or 13-fold lower respectively, when compared with MMP-7. In PB-M7vis, Fl(AHX)RPLALWRS(AHX)C is a selective optical sensor of MMP-7 activity and TMR serves to detect both the uncleaved and cleaved reagents. Each of these can be visualized as subcutaneous fluorescent phantoms in a mouse and optically discriminated based on the ratio of green/red (Fl/TMR) fluorescence. The in vivo specificity of PB-M7vis was tested in a mouse xenograft model. Intravenous administration of PB-M7vis gave significantly enhanced Fl fluorescence from MMP-7-positive tumours, but not from control tumours (P<0.0001), both originally derived from SW480 human colon cancer cells. Prior systemic treatment of the tumour-bearing mice with an MMP inhibitor BB-94 {[4-(N-hydroxyamino)-2R-isobutyl-3S-(thienylthiomethyl)-succinyl]-l-phenylalanine-N-methylamide}, markedly decreased the Fl fluorescence over the MMP-7-positive tumour by approx. 60%. Thus PB-M7vis functions as a PB for in vivo detection of MMP-7 activity that serves to light this optical beacon and is, therefore, a selective in vivo optical molecular imaging contrast reagent.

2×Kcontingency tables having both ordinal and nominal categories are often encountered in various types of studies. Such data are referred to as ‘mixed’ categorical data in this article. To apply a method for ordered categorical data one has to discard the nominal categories, and to apply a method for nominal categories one has to discard the ordering information inherent in the ordered categories. Therefore, investigators often either discard observations in nominal categories or discard the ordering of the categories before analysing such data. Some information will be lost in both approaches. A method for analysing data in 2×K‘mixed’ tables is proposed in this paper which can be considered as an extension of well known methods for nominal and ordered categories. The proposed method utilizes observations in the nominal categories as well as the ordering information. If all the categories were ordered then the proposed method reduces to the trend test, and if all the categories were nominal then the proposed method reduced to Pearson's chi‐square test. Copyright © 2002 John Wiley & Sons, Ltd.

Similar to the circadian rhythm of core body temperature, hot flashes have been found to exhibit a circadian rhythm in healthy, naturally postmenopausal women, with a peak in frequency at 1825 h. However, to date, no studies have evaluated whether this same pattern is found among breast cancer survivors reporting hot flashes.

We evaluated the relationship between the ratio of free-to-total prostate specific antigen (PSA) and prostate pathology, including grade, stage and tumor volume, among patients with prostate cancer who underwent radical prostatectomy.

Epidemiological studies have reported strong association between sleep loss and hypertension with unknown mechanisms. This study investigated macrovascular and microcirculation changes and inflammatory markers during repetitive sleep restriction. Sex differences were also explored. Forty-five participants completed a 22-day in-hospital protocol. Participants were assigned to, (1) eight-hour sleep per night (control), or (2) sleep restriction (SR) condition: participants slept from 0300 to 0700 h for three nights followed by a recovery night of 8-h sleep, repeated four times. Macrocirculation assessed by flow mediated dilation (FMD) and microcirculation reactivity tests were performed at baseline, last day of each experimental block and during recovery at the end. Cell adhesion molecules and inflammatory marker levels were measured in blood samples. No duration of deprivation (SR block) by condition interaction effects were found for FMD, microcirculation, norepinephrine, cell adhesion molecules, IL-6 or IL-8. However, when men and women were analyzed separately, there was a statistical trend (p= 0.08) for increased IL-6 across SR blocks in women, but not in men. Interestingly, men showed a significant progressive (dose dependent) increase in skin vasodilatation (p= 0.02). A novel and unexpected finding was that during the recovery period, men that had been exposed to repeated SR blocks had elevated IL-8 and decreased norepinephrine. Macrocirculation, microcirculation, cell adhesion molecules, and markers of inflammation appeared to be resistant to this model of short-term repetitive exposures to the blocks of shortened sleep in healthy sleepers. However, men and women responded differently, with women showing mild inflammatory response and men showing more vascular system sensitivity to the repetitive SR.

Background.Rural women are less likely to receive screening mammography at recommended intervals. This study evaluated efforts to promote screening mammography among women in rural communities through community education interventions and low-cost mobile mammography van services.

While it is well established that slow-wave sleep electroencephalography (EEG) rebounds following sleep deprivation, very little research has investigated autonomic nervous system recovery. We examined heart rate variability (HRV) and cardiovagal baroreflex sensitivity (BRS) during four blocks of repetitive sleep restriction and sequential nights of recovery sleep. Twenty-one healthy participants completed the 22-day in-hospital protocol. Following three nights of 8-hr sleep, they were assigned to a repetitive sleep restriction condition. Participants had two additional 8-hr recovery sleep periods at the end of the protocol. Sleep EEG, HRV, and BRS were compared for the baseline, the four blocks of sleep restriction, and the second (R2) and third (R3) nocturnal recovery sleep periods following the last sleep restriction block. Within the first hour of each sleep period, vagal activation, as indexed by increase in high frequency (HF; HRV spectrum analysis), showed a rapid increase, reaching its 24-hr peak. HF was more pronounced (rebound) in R2 than during baseline (p < 0.001). The BRS increased within the first hour of sleep and was higher across all sleep restriction blocks and recovery nights (p = 0.039). Rebound rapid eye movement sleep was observed during both R2 and R3 (p = 0.004), whereas slow-wave sleep did not differ between baseline and recovery nights (p > 0.05). Our results indicate that the restoration of autonomic homeostasis requires a time course that includes at least three nights, following an exposure to multiple nights of sleep curtailed to about half the normal nightly amount.

ObjectiveTo determine if earlier administration of epinephrine (adrenaline) in patients with non-shockable cardiac arrest rhythms is associated with increased return of spontaneous circulation, survival, and neurologically intact survival.DesignPost hoc analysis of prospectively collected data in a large multicenter registry of in-hospital cardiac arrests (Get With The Guidelines-Resuscitation).SettingWe utilized the Get With The Guidelines-Resuscitation database (formerly National Registry of Cardiopulmonary Resuscitation, NRCPR). The database is sponsored by the American Heart Association (AHA) and contains prospective data from 570 American hospitals collected from 1 January 2000 to 19 November 2009.Participants119 978 adults from 570 hospitals who had a cardiac arrest in hospital with asystole (55%) or pulseless electrical activity (45%) as the initial rhythm. Of these, 83 490 arrests were excluded because they took place in the emergency department, intensive care unit, or surgical or other specialty unit, 10 775 patients were excluded because of missing or incomplete data, 524 patients were excluded because they had a repeat cardiac arrest, and 85 patients were excluded as they received vasopressin before the first dose of epinephrine. The main study population therefore comprised 25 095 patients. The mean age was 72, and 57% were men.Main outcome measuresThe primary outcome was survival to hospital discharge. Secondary outcomes included sustained return of spontaneous circulation, 24 hour survival, and survival with favorable neurologic status at hospital discharge.Results25 095 adults had in-hospital cardiac arrest with non-shockable rhythms. Median time to administration of the first dose of epinephrine was 3 minutes (interquartile range 1-5 minutes). There was a stepwise decrease in survival with increasing interval of time to epinephrine (analyzed by three minute intervals): adjusted odds ratio 1.0 for 1-3 minutes (reference group); 0.91 (95% confidence interval 0.82 to 1.00; P=0.055) for 4-6 minutes; 0.74 (0.63 to 0.88; P<0.001) for 7-9 minutes; and 0.63 (0.52 to 0.76; P<0.001) for >9 minutes. A similar stepwise effect was observed across all outcome variables.ConclusionsIn patients with non-shockable cardiac arrest in hospital, earlier administration of epinephrine is associated with a higher probability of return of spontaneous circulation, survival in hospital, and neurologically intact survival.