Search

Background Biliary leaks and anastomotic strictures are common early anastomotic biliary complications (EABCs) following liver transplantation. However, there are no large multicentre studies investigating their clinical impact or risk factors. This study aimed to define the incidence, risk factors and impact of EABC. Methods The NHS registry on adult liver transplantation between 2006 and 2017 was reviewed retrospectively. Adjusted regression models were used to assess predictors of EABC, and their impact on outcomes. Results Analyses included 8304 liver transplant recipients. Patients with EABC (9·6 per cent) had prolonged hospitalization (23 versus 15 days; P, Early anastomotic biliary complications are common following liver transplantation. In this national registry analysis we show that these complications have a significant, independent, impact on graft loss and mortality following transplantation. We also identify a number of key risk factors for development of early anastomotic biliary complications.

Background Asthma is a highly prevalent chronic disease among Ontario children; however, the extent to which rural status and distance are associated with unplanned emergency department (ED) use by this population is largely unknown. Objective To explore the impact of rurality and geographical distance to primary and specialist care services on healthcare utilization by analyzing the use of unplanned ED services. Methods A population level retrospective cohort study of Ontario children ages 5–14 with newly diagnosed asthma was conducted using health administrative data from Institute for Clinical Evaluative Sciences (ICES). Adjusted logistic regression models were used to analyze the association between unplanned ED use with rural status and distance to general practitioner/family physician (GP/FP) and specialist healthcare services, while controlling for confounders. Results In total, 19,732 individuals met the inclusion criteria. Individuals who lived in rural locations (OR 2.00, 95% CI 1.64–2.44) and travelled >50 km to a GP/FP (OR 1.25, 95% CI 1.06–1.48) or specialist (OR 1.20, 95% CI 1.05–1.38) were more likely to utilize an ED. Conclusion Children with asthma utilize healthcare services differently based on rural status and distance to services. To ensure equitable access to care, there is a need to accommodate for these factors in the planning and provision of asthma healthcare services.

Previous Mendelian randomization (MR) studies on 25-hydroxyvitamin D (25(OH)D) and cancer have typically adopted a handful of variants and found no relationship between 25(OH)D and cancer; however, issues of horizontal pleiotropy cannot be reliably addressed. Using a larger set of variants associated with 25(OH)D (74 SNPs, up from 6 previously), we perform a unified MR analysis to re-evaluate the relationship between 25(OH)D and ten cancers. Our findings are broadly consistent with previous MR studies indicating no relationship, apart from ovarian cancers (OR 0.89; 95% C.I: 0.82 to 0.96 per 1 SD change in 25(OH)D concentration) and basal cell carcinoma (OR 1.16; 95% C.I.: 1.04 to 1.28). However, after adjustment for pigmentation related variables in a multivariable MR framework, the BCC findings were attenuated. Here we report that lower 25(OH)D is unlikely to be a causal risk factor for most cancers, with our study providing more precise confidence intervals than previously possible., Studies of the genetic association between vitamin D and cancer risk have typically been underpowered. Here the authors analyse this using Mendelian Randomisation with more than 70 vitamin D variants obtained from the UK Biobank and large-scale data from various consortia, confirming null associations between vitamin D and most cancers.

Restructuring of institutional long-term care was undertaken using predictions of future bed need with assumptions made on incidence rates of clients defined by type of disability, survival, and demographic changes. Recent substantial increase in the population rate of clients seeking placement across all degrees of disability, coincident with new facilities for those with modest disability, occurred. Consequently, more appropriate housing and supervised care beds, and more limited downsizing of nursing homes will be required.

The 96-hr LC50 of copper to Atlantic salmon parr in water taken from the Exploits River, Newfoundland, is about 125 μg/liter at a total hardness of 8–10 mg/liter CaCO3 and a total alkalinity of 4 mg/liter. However, the addition of spent sulphite liquor from a pulp mill allowed fish to survive more than 180 μg/liter Cu. Considering the variety of organic compounds which have now been shown to chelate dissolved copper, it is likely that a simple model for the prediction of copper toxicity in waters receiving mine effluent will prove impossible.

SUPPURATIVE arthritis remains a relatively frequent form of joint disease despite the introduction of antibacterial agents. Chartier et al 1 of the Mayo Clinic covered the period from 1939 to 1957 and reported 77 cases of suppurative arthritis. Ward et al 2 from the Massachusetts General Hospital concentrated on the ten-year period from 1954 to 1964, reporting a total of 24 cases. Our interest in suppurative arthritis began in January 1960, and from then until 1964 we have observed 42 cases of infectious arthritis at the three universityaffiliated hospitals in the Buffalo area. Case Material Cases of infectious arthritis due to gonococcus, meningococcus, fungi, or tuberculosis were excluded on the basis that these represented specific diseases. Also, cases of pyogenic joint infection from osteomyelitis, penetrating wounds, or by extension were excluded. These were considered different problems from ordinary septic arthritis because of the nature of the cause. As a result