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BACKGROUND:Dysglycemia is frequently observed in patients with sepsis. However, the relationship between dysglycemia and outcome is inconsistent. We evaluate the clinical characteristics, glycemic abnormalities, and the relationship between the initial glucose level and mortality in patients with sepsis. METHODS:This is a retrospective sub-analysis of a multicenter, prospective cohort study. Adult patients with severe sepsis (Sepsis-2) were divided into groups based on blood glucose categories (

Over the past 15 years, and despite many difficulties, significant progress has been made to advance child and adolescent tuberculosis (TB) care. Despite increasing availability of safe and effective treatment and prevention options, TB remains a global health priority as a major cause of child and adolescent morbidity and mortality—over one and a half million children and adolescents develop TB each year. A history of the global public health perspective on child and adolescent TB is followed by 12 narratives detailing challenges and progress in 19 TB endemic low and middle-income countries. Overarching challenges include: under-detection and under-reporting of child and adolescent TB; poor implementation and reporting of contact investigation and TB preventive treatment services; the need for health systems strengthening to deliver effective, decentralized services; and lack of integration between TB programs and child health services. The COVID-19 pandemic has had a significant negative impact on case detection and treatment outcomes. Child and adolescent TB working groups can address country-specific challenges to close the policy–practice gaps by developing and supporting decentral ized models of care, strengthening clinical and laboratory diagnosis, including of multidrug-resistant TB, providing recommended options for treatment of disease and infection, and forging strong collaborations across relevant health sectors.

Abstract Background Sepsis is a leading cause of death and long-term disability in developed countries. A comprehensive report on the incidence, clinical characteristics, and evolving management of sepsis is important. Thus, this study aimed to evaluate the characteristics, management, and outcomes of patients with severe sepsis in Japan. Methods This is a cohort study of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis, and Trauma (FORECAST) study, which was a multicenter, prospective cohort study conducted at 59 intensive care units (ICUs) from January 2016 to March 2017. We included adult patients with severe sepsis based on the sepsis-2 criteria. Results In total, 1184 patients (median age 73 years, interquartile range (IQR) 64–81) with severe sepsis were admitted to the ICU during the study period. The most common comorbidity was diabetes mellitus (23%). Moreover, approximately 63% of patients had septic shock. The median Sepsis-related Organ Failure Assessment (SOFA) score was 9 (IQR 6–11). The most common site of infection was the lung (31%). Approximately 54% of the participants had positive blood cultures. The compliance rates for the entire 3-h bundle, measurement of central venous pressure, and assessment of central venous oxygen saturation were 64%, 26%, and 7%, respectively. A multilevel logistic regression model showed that closed ICUs and non-university hospitals were more compliant with the entire 3-h bundle. The in-hospital mortality rate of patients with severe sepsis was 23% (21–26%). Older age, multiple comorbidities, suspected site of infection, and increasing SOFA scores correlated with in-hospital mortality, based on the generalized estimating equation model. The length of hospital stay was 24 (12–46) days. Approximately 37% of the patients were discharged home after recovery. Conclusion Our prospective study showed that sepsis management in Japan was characterized by a high compliance rate for the 3-h bundle and low compliance rate for central venous catheter measurements. The in-hospital mortality rate in Japan was comparable to that of other developed countries. Only one third of the patients were discharged home, considering the aging population with multiple comorbidities in the ICUs in Japan. Trial registration UMIN-CTR, UMIN000019742. Registered on 16 November 2015.

O ensino da Geometria a nível mundial esteve em constantes mudanças, as quais influíram na forma de ensinar neste ramo da Matemática. Esta disciplina na escola angolana, constitui um esboço essencial para a organização do currículum matemático, e como linha directriz, aparece no ensino da Matemática do primário até o nível médio, quer dizer, este ensino passa por várias etapas da intuitiva até a racional. Este critério de organização está bastante generalizado no mundo e responde às características psicológicas pelas que transita da infância até sua adolescência. Pode-se constatar por distintas vias como: observação a aulas, provas de ingresso ao Educação Superior, provas parciais e exames finais; bem como pela experiência dos autores no processo de ensino-aprendizagem da disciplina, onde foi possível identificar dificuldades na apropriação do conteúdo geométrico e uma falta de relação interdisciplinária. Este trabalho aborda a relação interdisciplinária entre as disciplinas de Geometria Superior e Geometria Diferencial que se lecionam no curso de Licenciatura em Ciências da Educação, opção Matemática no Instituto Superior de Ciências da Educação. O mesmo pode contribuir a obter uma melhor motivação para a disciplina e por onde obter uma melhor assimilação dos conteúdos geométricos.

Abstract Background The pathophysiological mechanisms of acute coagulopathy of trauma-shock (ACOTS) are reported to include activated protein C-mediated suppression of thrombin generation via the proteolytic inactivation of activated Factor V (FVa) and FVIIIa; an increased fibrinolysis via neutralization of plasminogen activator inhibitor-1 (PAI-1) by activated protein C. The aims of this study are to review the evidences for the role of activated protein C in thrombin generation and fibrinolysis and to validate the diagnosis of ACOTS based on the activated protein C dynamics. Methods We conducted systematic literature search (2007–2017) using PubMed, the Cochrane Database of Systematic Reviews (CDSR), and the Cochrane Central Register of Controlled Trials (CENTRAL). Clinical studies on trauma that measured activated protein C or the circulating levels of activated protein C-related coagulation and fibrinolysis markers were included in our study. Results Out of 7613 studies, 17 clinical studies met the inclusion criteria. The levels of activated protein C in ACOTS were inconsistently decreased, showed no change, or were increased in comparison to the control groups. Irrespective of the activated protein C levels, thrombin generation was always preserved or highly elevated. There was no report on the activated protein C-mediated neutralization of PAI-1 with increased fibrinolysis. No included studies used unified diagnostic criteria to diagnose ACOTS and those studies also used different terms to refer to the condition known as ACOTS. Conclusions None of the studies showed direct cause and effect relationships between activated protein C and the suppression of coagulation and increased fibrinolysis. No definitive diagnostic criteria or unified terminology have been established for ACOTS based on the activated protein C dynamics.

Background: The “Physical Activity Reference for Health Promotion 2013” provides “fit” reference values for cardiorespiratory fitness (CRF) for good health. The importance of achieving a fit CRF level for several years on the subsequent prevention of type 2 diabetes mellitus (T2DM) remains to be clarified. Methods: This cohort study was conducted in 2,235 nondiabetic males aged 21 to 59 years, enrolled in April 1986 through March 1987. We calculated the ratio of the area under the curve (AUCratio) for actual measured values and the AUC for the reference values of CRF in each individual during an 8-year measurement period before the baseline. According to whether they met a fit CRF level or not, participants were categorized into groups based on the AUCratio (FitAUC or UnfitAUC) and initial CRF (Fitinitial or Unfitinitial), respectively. T2DM was evaluated on health checkups until March 2010. Results: During the follow-up period, 400 men developed T2DM. After adjustment for confounders, as compared with those in the FitAUC group, the hazard ratio (HR) for those in the UnfitAUC group was 1.33 (95% confidence interval [CI], 1.06–1.65). A combined analysis with the categories of initial value and AUCratio showed that, compared with the Fitinitial and FitAUC group, the HRs of Fitinitial and UnfitAUC, Unfitinitial and FitAUC, and Unfitinitial and UnfitAUC groups were 1.41 (95% CI, 0.99–2.00), 1.18 (95% CI, 0.81–1.70), and 1.40 (95% CI, 1.08–1.83), respectively. Conclusion: Achievement of a fit CRF level established in the Japan physical activity guideline for several years was associated with lower subsequent risk of T2DM.

Background: We sought to examine the association between cardiorespiratory fitness (CRF) and incidence of type 2 diabetes considering the follow-up period in a cohort of Japanese men with a maximum follow-up period of 23 years. Methods: This study enrolled 7,804 male workers free of diabetes in 1986. CRF was measured using a cycle ergometer, and maximal oxygen uptake was estimated. During 1986–2009, participants were followed for development of type 2 diabetes, which was diagnosed using fasting blood tests, self-administered questionnaires, or oral glucose tolerance tests after urinary tests from annual health checkups. Hazard ratios for the incidence of type 2 diabetes were estimated using Cox proportional hazards models. Results: During the follow-up period, 1,047 men developed type 2 diabetes. In analyses by follow-up periods (1986–1993, 1994–2001, and 2002–2009), there was an inverse dose-response relationship between CRF and the development of type 2 diabetes for all three follow-up periods (P for trend 0.019, 20 years among men.

Abstract Background The relationship between the combination of physical activity (PA) and body mass index (BMI) with low back pain (LBP) is unclear. The present study offers a cross-sectional assessment of how combinations of PA and BMI are related to LBP in Japanese men. Methods Participants were 4022 Japanese men (mean age = 47) who underwent regular clinical examinations. PA was measured using a uniaxial accelerometer and divided into tertiles (PAhigh, PAmiddle, PAlow). A self-administered questionnaire was used to report on persistent LBP experience, drinking and smoking habits, and any existing lifestyle diseases. After covariance adjustment, a logistic regression model was used to assess how combinations of PA and BMI are related to persistent LBP. Results 428 of the participants had persistent LBP. A clear negative dose-response relationship was found between PA levels and persistent LBP (P for linearity = 0.012). Regarding BMI, odd ratios were shown to be higher in the overweight/obese category (BMI ≥ 25 kg/m2) than for the normal weight category (BMI

The stability of the relative order of cardiorespiratory fitness (CRF) during adulthood has not been sufficiently investigated. This study investigated the tracking of CRF over a 7-year follow-up period in Japanese male adults aged 18-53 years. A total of 3,718 male workers who underwent three submaximal exercise tests (a first test and again 3 and 7 years later for a second and third test) were included. CRF was defined as the maximal oxygen uptake estimated from a submaximal exercise test using a cycle ergometer. Spearman correlation coefficients for CRF in the first and second tests, the second and third tests and the first and third tests were 0.61, 0.62 and 0.54, respectively. A moderate kappa coefficient, indicating the degree of agreement for quartiles, was obtained for all follow-up periods (kappa coefficient = 0.43-0.53). The changes in quartiles for all three time measurements indicated that approximately 70% of participants had stable (participants in the same quartile for all three measurements) or moderately stable (participants who exhibited changes varying by one quartile from the initial quartile) CRF levels. These findings showed moderate CRF tracking during adulthood over a period of up to 7 years.

This document discusses the association between plasma venetoclax (VEN) trough levels and serum C-reactive protein (CRP) levels in patients with acute myeloid leukemia (AML) who are treated with VEN plus azacitidine (AZA). The study found that inflammation, indicated by elevated CRP levels, is frequently observed in AML patients during induction therapy and can affect VEN levels. The VEN trough levels were significantly higher in patients with moderate and severe inflammation compared to those with no or mild inflammation. The study suggests that monitoring plasma trough VEN levels may be useful for ensuring the safety of AML patients undergoing VEN + AZA treatment. However, further research is needed to determine the optimal therapeutic range of VEN and its relationship with adverse events. [Extracted from the article]

Abstract Background No single anticoagulant has been proven effective for sepsis-associated disseminated intravascular coagulation (DIC). Thus, the concomitant use of antithrombin concentrate and recombinant thrombomodulin has been conceived. This observational study was conducted to investigate the efficacy and safety of this combination therapy. Methods A total of 510 septic DIC patients who received antithrombin substitution were retrospectively analyzed. Among them, 228 were treated with antithrombin and recombinant thrombomodulin (combination therapy) and the rest were treated with antithrombin alone (monotherapy). Propensity score matching created 129 matched pairs, and 28-day all-cause mortality, DIC scores, the sequential organ failure assessment (SOFA) scores, and the incidence of bleeding were compared. Results A log-rank test revealed a significant association between combination therapy and a lower 28-day mortality rate (hazard ratio 0.49, 95% confidence interval 0.29–0.82, P = 0.006) in the matched pairs. The DIC scores and the SOFA scores in the combination therapy group were significantly lower than those in the monotherapy group on Day 4 and Day 7. The incidence of bleeding did not differ between the groups (2.11 vs. 2.31%, P = 1.000). Conclusions The current study demonstrated the potential benefit of adding recombinant thrombomodulin to antithrombin. The co-administration of these two anticoagulants was associated with reduced mortality among patients with sepsis-induced DIC without increasing the risk of bleeding.

Abstract Background This study aimed to develop and cross-validate prediction equations for estimating appendicular skeletal muscle mass (ASM) and to examine the relationship between sarcopenia defined by the prediction equations and risk factors for cardiovascular diseases (CVD) or osteoporosis in Japanese men and women. Methods Subjects were healthy men and women aged 20–90 years, who were randomly allocated to the following two groups: the development group (D group; 257 men, 913 women) and the cross-validation group (V group; 119 men, 112 women). To develop prediction equations, stepwise multiple regression analyses were performed on data obtained from the D group, using ASM measured by dual-energy X-ray absorptiometry (DXA) as a dependent variable and five easily obtainable measures (age, height, weight, waist circumference, and handgrip strength) as independent variables. Results When the prediction equations for ASM estimation were applied to the V group, a significant correlation was found between DXA-measured ASM and predicted ASM in both men and women (R 2 = 0.81 and R 2 = 0.72). Our prediction equations had higher R 2 values compared to previously developed equations (R 2 = 0.75–0.59 and R 2 = 0.69–0.40) in both men and women. Moreover, sarcopenia defined by predicted ASM was related to risk factors for osteoporosis and CVD, as well as sarcopenia defined by DXA-measured ASM. Conclusions In this study, novel prediction equations were developed and cross-validated in Japanese men and women. Our analyses validated the clinical significance of these prediction equations and showed that previously reported equations were not applicable in a Japanese population.

We investigated the associations between the DRD2/ANKK1 genotype (rs1800497, C > T) and both physical activity (PA) level and exercise habit. A total of 648 Japanese men and women aged 26 – 82 years were included in this cross-sectional study. The PA level was evaluated using a triaxial accelerometer. Exercise habits in the past year and in the period from childhood to adolescence were assessed using a questionnaire. There were no significant differences in PA level or exercise habit in the past year among the DRD2/ANKK1 genotypes. On the other hand, there was a significant association between the DRD2/ANKK1 genotype and exercise habit in the period from childhood to adolescence. Regular exercisers (Ex) showed a lower proportion of the CC genotype than non-exercisers (Non-Ex) (P < 0.05). Logistic regression analysis for exercise habit in the period from childhood to adolescence, controlling for gender and age in an additive genetic model, indicated significant associations with increased likelihood of exercisers (Ex) carrying the T allele, OR = 1.38 (95% CI: 1.06 – 1.80, P < 0.05). In conclusion, it was suggested that the DRD2/ANKK1 genotype is associated with exercise habit in the period from childhood to adolescence, but not current PA and exercise habit in the past year.