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PubMed2004

Liver transplantation in cirrhotic patients with small hepatocellular carcinoma: an analysis of pre-operative imaging, explant histology and prognostic histologic indicators.

BACKGROUND: In recent years, liver transplantation in patients with hepatocellular cancers and cirrhosis has been restricted to those with small cancers (<5 cm for solitary and <3 cm for multifocal HCC with <3 nodules). The selection of patients for liver transplantation is based on pre-operative imaging. The accuracy of imaging correlated with explant histology and the effect of tumour stage has not been evaluated in this selected population. METHODS: In this study, prospectively collected data for 30 patients who underwent orthotopic liver transplantation for cirrhosis complicated by small hepatocellular carcinoma (HCC) at a single centre have been reviewed with the aim of correlating radiological findings, explant histology and patient outcome. Patients who underwent orthotopic liver transplantation between 1995 and 1999 had plain and contrast-enhanced dual-phase spiral CT (DCT) scans of the liver. Patients suspected of having HCC on CT scan or due to elevated serum alpha-fetoprotein underwent iodized oil CT (IOCT). Following transplantation, the explanted liver was serially sectioned at 10-mm intervals and examined by a pathologist blinded to the results of imaging. Data collected prospectively on imaging and histology were compared with outcome data. The median period of follow-up was 1,139 days (range 690-1,955 days) after transplantation. All patients were followed up by clinical assessment, assessment of serum alpha-protein levels and imaging when indicated. RESULTS: All the patients transplanted fulfilled the selective criteria on the basis of imaging (solitary HCC <5 cm in diameter or multifocal HCC <3 cm in diameter with <3 nodules). Of the 30 patients transplanted, 46 HCCs were detected on explant histology with a median size of 24 mm (range 6-75 mm). Ten patients had multifocal disease (median number of lesions 2, range 2-4). No significant difference was observed between IOCT and DCT with regards to the sensitivity (67.4 vs. 68%) and specificity (78.97 vs. 88.6%) of detecting HCCs. IOCT had a positive predictive value of 78.9% as compared to 82.8% for DCT. IOCT had an overall sensitivity of 40% as compared to 30% for DCT in detecting multifocal disease (not significant). Histological assessment of the explanted livers showed that 8 patients had well-, 17 moderate and 5 poorly differentiated HCCs. Tumour size and the presence of multifocal disease did not influence survival in this study. Microvascular invasion was more common with larger tumours (from 38% with lesions less than 40 mm in diameter to 60% with lesions >40 mm in diameter; p < 0.01) and with moderately (29.4%) or poorly differentiated (60%) HCCs than well-differentiated HCC (12.5%) (p < 0.04 and 0.01 for well- vs. moderately and poorly differentiated HCC, respectively). Microvascular invasion on explant histology was associated with poor survival. Of the 17 transplant recipients without vascular invasion, 15 were alive at 1 and 2 years in comparison to 7 of 9 with microscopic vascular invasion (p < 0.01). Four patients died in the post-transplant period due to recurrent HCC. Overall survival [after excluding early post-transplant sepsis-induced deaths (n = 4)] at 1 year was 83.3%. CONCLUSIONS: Selective criteria for transplantation of HCC in cirrhosis are associated with a 1-year and 3-year survival rate of 73.3% (including early post-transplant sepsis-induced deaths). IOCT and DCT are similar in their ability to detect unifocal or multifocal HCC. Tumour size and number are not predictive of recurrence with these selective criteria, but microscopic vascular invasion is a bad prognostic factor.

Carcinoma, Hepatocellular↗
PubMed2003

Bone mineral density and lifetime physical activity in South African women.

We investigated the relation between lifetime physical activity and bone mineral density (BMD) in South African women using data collected in a case-control study of breast cancer in relation to BMD. Subjects (n = 144) were of black African or mixed ancestral origin, and <60 years of age (mean age 42.6 +/- 8.9 years). Cases had newly diagnosed breast cancer (n = 62) and controls were referred for conditions unrelated to BMD or breast cancer (n = 82). Physical activity data consisting of household, occupational and leisure-time activity, and activity for transport, were collected via questionnaire at 4 life stages (epochs), viz. 14-21, 22-34, 35-50, and 50+ years of age. Total energy (MET hrs) and peak strain scores were calculated. Lumbar spine and total proximal femur BMD were measured using dual-energy x-ray absorptiometry. BMD measures were similar between groups, therefore data were combined. BMD measures were unrelated to total lifetime physical activity. However, the major determinants of total proximal femur BMD included age, transport activity including walking and bicycling between the ages of 14 and 21 years, and current weight (adjusted r2 = 0.33, P < 0.0001). The major determinants of lumbar spine BMD included age, household energy expenditure between the ages of 14 and 21 years, and current weight (adjusted r2 = 0.23, P < 0.0001). Total peak bone strain score for activities between 14-21 years of age was also significantly correlated with lumbar spine BMD ( r = 0.18, P < 0.05). Intraclass correlation coefficients to assess tracking of activity through epochs 1, 2, and 3 were high for total energy expenditure (0.96; 95%CI: 0.94-0.97), household (0.98; 95%CI: 0.97-0.99) and occupational activity (0.78; 95%CI: 0.71-0.84) and activity for transport (0.92; 95%CI: 0.89-0.94). These data suggest that walking or activities resulting in impact loading at a young age are associated with higher BMD in later years. In addition, our findings suggest tracking of physical activity over time.

Absorptiometry, Photon↗
PubMed2001

Risk factors for osteoporosis related to their outcome: fractures.

The aim of the study was to determine to what extent easy obtainable bone mineral density (BMD)-related risk factors are associated with the occurrence of fractures and to what extent changes in these determinants during a patient's lifetime are relevant. A cross-sectional population-based study was carried out on 4725 postmenopausal women, 50-80 years of age, registered with 23 general practitioners (GPs). The women were questioned and examined. BMD of the lumbar spine was measured using dual-energy X-ray absorptiometry (QDR-1000, Hologic). We analyzed the total population as well as a random sample of 1155 women for whom additional data were collected on recalled weight at age 20-30 years and on self-reported height. Body mass index (BMI) was estimated in two ways: (2) objective BMI [= measured weight/(measured height)2]; (2) recalled BMI [= recalled body weight at age 20-30/(self-reported height)2]. Fractures (dependent variable) were categorized as: (1) fractures sustained during the patient's lifetime; (2) fractures after the age of 50 years; (3) fractures that had occurred during the 5 years before BMD measurement took place. Multivariate stepwise backward and forward logistic regression analyses, using fractures as the dependent variable, were performed with all discrete and non-discrete variables (divided into quartiles). The relationship between the presence of osteoporosis and the presence of fractures was related to the changes in BMI (recalled BMI versus objective BMI). More advanced age, positive family history of fractures and BMD had a positive association with the presence of fractures. Low recalled BMI was a statistically significant predictor of 'fractures during the patient's lifetime' and of 'fractures after the age of 50'. Hysterectomy was associated with a higher prevalence of 'fractures during the patient's lifetime'. Perimenopausal complaints in the history seemed to be associated with a lower prevalence of 'fractures after the age of 50'. Moderate (and heavy) occupational exercise in the past were associated with the presence of fractures 'after the age of 50' and 'fractures during the past 5 years'. Sporting activities in the past showed a slightly positive relationship with the presence of 'fractures during the patient's lifetime' and 'fractures after the age of 50'. Bivariate analysis revealed that current smokers had not sustained significantly more fractures than current nonsmokers, but within the subgroup of current smokers, the prevalence of fractures was significantly higher among those women who had smoked for more than 35 years. Smoking was statistically significantly associated with early menopause. Early menopause was not statistically significantly related to the presence of osteoporosis but appeared to be statistically significantly associated with the prevalence of fractures in the age categories over 65 years. The absolute risks of sustaining one or more fractures ranged from 3% to 44%. Women in the lowest quartile of recalled and objective BMI were often osteoporotic (40%). In this category, women with normal BMD had a statistically significant lower fracture risk than osteoporotic women. Women with a possibly decreased BMI were most often osteoporotic and had sustained more 'fractures during the past 5 years' than expected. Women who had (probably) always been obese were less often osteoporotic and had a much lower fracture risk. It is concluded that decreased BMI is associated with a higher risk of developing fractures at an older age. Prevention of fractures should include fall prevention. In addition, in lean women treatment of low BMD is important.

Absorptiometry, Photon↗
PubMed2006

Classification of dopamine, serotonin, and dual antagonists by decision trees.

Dopamine antagonists (DA), serotonin antagonists (SA), and serotonin-dopamine dual antagonists (Dual) are being used as antipsychotics. A lot of dopamine and serotonin antagonists reveal non-selective binding affinity against these two receptors because the antagonists share structurally common features originated from conserved residues of binding site of the aminergic receptor family. Therefore, classification of dopamine and serotonin antagonists into their own receptors can be useful in the designing of selective antagonist for individual therapy of antipsychotic disorders. Data set containing 1135 dopamine antagonists (D2, D3, and D4), 1251 serotonin antagonists (5-HT1A, 5-HT2A, and 5-HT2C), and 386 serotonin-dopamine dual antagonists was collected from the MDDR database. Cerius2 descriptors were employed to develop a classification model for the 2772 compounds with antipsychotic activity. LDA (linear discriminant analysis), SIMCA (soft independent modeling of class analogy), RP (recursive partitioning), and ANN (artificial neural network) algorithms successfully classified the active class of each compound at the average 73.6% and predicted at the average 69.8%. The decision trees from RP, the best model, were generated to identify and interpret those descriptors that discriminate the active classes more easily. These classification models could be used as a virtual screening tool to predict the active class of new candidates.

Algorithms↗
PubMed1999

National Health Interview Survey: research for the 1995-2004 redesign.

OBJECTIVES: This report presents a major portion of the research carried out for the 1995-2004 redesign of the National Health Interview Survey. The primary focus of the 1995-2004 NHIS redesign research was to explore sample design options to improve the reliability of NHIS statistics for racial, ethnic, economic, and geographic domains. Another objective was to assess the integration of the sample designs of the NCHS surveys of health care providers and NHIS. METHODS: A number of research tasks were carried out by Westat, Inc., to explore the feasibility and cost of various sample design options for the 1995-2004 National Health Interview Survey redesign. This report provides a detailed description of the research that was carried out. RESULTS: The research results presented in this report were the primary basis for assessing the technical soundness and costs for a number of design alternatives. The first option, called the alpha option, was developed under the assumption of a 50-percent data collection budget increase. The second option, called the beta option, was developed under the assumption of no change in the data collection budget. The beta option was the design implemented in 1995. Other important research items described in this report include oversampling methods for minority populations and dual-frame sampling methods. The research results in this report also led to additional research, primarily in the area of survey integration. A more detailed description of the 1995-2004 NHIS design will appear in a forthcoming NCHS Series 2 report titled Design and Estimation for the 1995-2004 National Health Interview Survey.

Adolescent↗
PubMed1996

Learning shortcuts to success. Africa.

The exchange of experiences and lessons has been a feature of JOICFP's IP in Africa since the project's earliest days, particularly at the local level. At the end of 1995, this exchange system was expanded to the regional level with the swap of study teams between Zambia and Tanzania. Five personnel from Tanzania visited Zambia from October 14 to 28 and four IP personnel from Zambia visited Tanzania from November 4 to 18. For both teams the experience was one of learning and provided insights into different approaches to such areas as logistics, operational strategy, service delivery, organization setup, administration, income-generation and sustainability, data collection, analysis and reporting and cost-effectiveness. The Tanzanian team was impressed with the effective use of the health advisory committees at the village level in Zambia to reach local people. The steering committee structure ends at the ward level and not the village level in Tanzania. They also noted the strong involvement of men in the project and the dual existence of clubs for men and women. In one of the villages visited, the team joined an IP Open Day attended by over 5000. The study visit to Tanzania was also effective for the Zambian team, which was impressed with the IP system for the collection and analysis of CYP/CPR data. The members noted the close UMATI-government collaboration and joining of forces for FP service delivery. Tanzania's success with systematic CBD/CBS deployment was another impressive feature for the Zambians.

Africa↗
PubMed1999

Total body water data for white adults 18 to 64 years of age: the Fels Longitudinal Study.

BACKGROUND: Total body water (TBW) volume is reported to decrease with age, but much of the published data are 20 to almost 50 years old and are cross-sectional. Proper interpretation of clinical levels of TBW and trends with age necessitates the availability of current longitudinal data from healthy individuals. METHODS: Mixed longitudinal data for TBW of 274 white men and 292 white women (18 to 64 years of age) in the Fels Longitudinal Study were collected on a regular schedule over a recent eight-year period. The concentration of deuterium was measured by deuterium nuclear magnetic resonance spectroscopy. Body composition estimates were made with dual-energy x-ray absorptiometry, and random effect models were used to determine the patterns of change over time with and without covariates. RESULTS: The mean TBW data for the Fels men are either similar to or approximately 2 to as much as 6 liters greater than that reported by most other investigators 20 to 50 years ago. For Fels women, the mean TBW ranges from approximately 2 to as much as 5 liters less than that reported previously. These comparisons with much earlier studies reflect cohort effects and the secular changes in overall body size that have occurred during the past 60 to 70 years. These findings are reinforced by the fact that some early data sets included individuals born almost 140 years ago. After adjusting for the covariate effects of total body fat (TBF) and fat-free mass (FFM) with age, there were no significant age or age-squared effects on TBW in the men. In the women, after adjusting for the covariate associations of TBF and FFM with age, there was a small, but significant, negative linear association of TBW with age. In the men and women, the mean ratio of TBW to weight declined with age as a function of an increase in body fatness and more so for the men than the women. CONCLUSION: The findings from these mixed longitudinal data indicate that TBW volume, on average, maintains a reasonable degree of stability in men and women through a large portion of adulthood. These TBW data are recommended as current reference data for healthy adults.

Adipose Tissue↗
PubMed1993

Amplitude and frequency measures of surface electromyography during dual task elbow torque production.

Studies of motor unit recruitment thresholds have demonstrated the existence of task-specific motor units within the muscles controlling the elbow. Two degree-of-freedom (df) task specificity was investigated at higher levels of elbow torque using the amplitude and frequency characteristics of surface electromyography (EMG). Flexion and supination torque data were collected together with EMG from electrode pairs on the brachioradialis (BRAD), biceps brachii short head, and medial and lateral aspects of biceps brachii long head, while subjects (n = 14) performed the following four combinations of isometric tasks: (1) maximum voluntary contraction (MVC) flexion (F) and (2) MVC supination (S), each with a targeted torque of zero in the second df; (3) MVC flexion with targeted MVC supination (FS); and (4) MVC supination with targeted MVC flexion (SF). Median power frequency (MEDF) and root mean square (RMS) amplitude under steady-state torque conditions were calculated and analyzed using ANCOVA models with planned contrasts (alpha = 0.05). A significant main effect for task was found in RMS, but not in MEDF. Contrasts showed a significant increase in RMS response in the dual MVC tasks (FS and SF) over the single MVC tasks of F and S. The lack of frequency changes with alterations in RMS data indicates that the underlying recruitment/rate coding scheme in use for dual-df tasks may be different than in single-df tasks, and provides possible support for the notion of motor unit task groups. Task-by-site interactions were found for both MEDF and RMS, and illustrated that the three biceps sites differed from BRAD in their responses to the F versus S tasks.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Analysis of polyacrylamide gels for trace metals using diffusive gradients in thin films and laser ablation inductively coupled plasma mass spectrometry.

A simple method for the analysis of polyacrylamide diffusive gradients in thin film (DGT) gels by laser ablation inductively coupled plasma mass spectrometry (LA-ICPMS), employing a novel use of (115)In internal standardization, has been developed. This method allows the determination of Co, Ni, Cu, Zn, Cd, and Pb concentrations (at the DGT filter face) or fluxes in sediments at a spatial resolution of 100 microm. Single-layered gels, using an optimized laser defocus of 4000 microm at 400 mJ power, showed high precision (generally approximately 10%) and a linear response during solution deployment. Of the elements Sc, In, Ba, La, Ce, and Tb, Ba most closely tracked variations in laser energy and showed the highest analytical precision but could not be used as an internal standard due to its elevated presence in natural sediments. Therefore, internal standardization, necessary to normalize data collected on different days, was carried out using (115)In contained within a second layer of backing gel and dried along with the analyte layer as a dual-gel disk. This multilayered gel standard required a laser defocus setting of 1000 microm and a laser power of approximately 800 mJ. Analytical precision for a 64-spot ablation grid at 100-microm spacing was approximately 10%. Verification of this method was carried out on DGT sediment probes deployed in Priest Pot (English Lake District). Results obtained by conventional slicing techniques and aqueous elution agreed with laser ablation results when the different sampling areas were considered. The elution results varied by a factor of <2, whereas the laser ablation technique showed a variability of approximately 4, indicating localized elevated concentrations of Co. This higher resolution LA-ICPMS method could ultimately lead to an improved understanding of the geochemical processes responsible for metal uptake and release in sediments.

Acrylic Resins↗
PubMed2002

Regulation and function of LEFTY-A/EBAF in the human endometrium. mRNA expression during the menstrual cycle, control by progesterone, and effect on matrix metalloprotineases.

The human endometrium is a unique tissue that is periodically shed during menstruation. Although overall triggered by ovarian steroids withdrawal, menstrual induction of matrix metalloproteinases (MMPs) and resulting tissue breakdown are focal responses, pointing to additional local modulators. LEFTY-A, a novel member of the transforming growth factor-beta family identified originally as an endometrial bleeding-associated factor (EBAF), is a candidate for this local control. We measured LEFTY-A and beta-ACTIN mRNA concentration during the menstrual cycle in vivo and found that their ratio was dramatically ( approximately 100-fold) increased at the perimenstrual phase. A similar increase was seen when proliferative explants were cultured for 24 h in the absence of ovarian steroids; this was followed by spontaneous production of proMMP-1, -3, and -9. Both responses were inhibited by progesterone. Moreover, addition of recombinant LEFTY-A to proliferative explants was sufficient to stimulate the expression of proMMP-3 and -7; this response was also blocked by ovarian steroids. Collectively, these data indicate that LEFTY-A may provide a crucial signal for endometrial breakdown and bleeding by triggering expression of several MMPs. Progesterone appears to exert a dual block, upstream by inhibiting LEFTY-A expression and downstream by suppressing its stimulatory effect on MMPs.

Actins↗
PubMed2004

Upgrade of single chamber pacemakers with transvenous leads to dual chamber pacemakers in pediatric and young adult patients.

Children with single chamber pacemakers, in adolescence and young adulthood, may be upgraded to dual chamber systems, but there are no published data about indications, timing, and complications. Upgrading was attempted in 18 patients with transvenous pacing leads. A retrospective analysis of all collected data was performed. At initial pacemaker implantation (mean +/- SD, 9.3 +/- 4.1 years), the pacing mode was VVIR (n = 13 patients) and AAI/AAIR (n = 5 patients). After 72 +/- 41 months of follow-up, at the age of 15.5 +/- 5.2 years, upgrade was undertaken because of the patient's age at elective generator replacement (n = 3 patients), ventricular dysfunction (n = 7), syncope/presyncope (n = 3) in patients with VVIR pacing, atrioventricular block (n = 2), and/or drug refractory supraventricular tachyarrhythmias (n = 4) in patients with atrial pacing. In comparison with single chamber pacemaker implantations, the average procedural time and the average fluoroscopy time were not significantly longer. All suitable preexisting leads were incorporated in the new pacing system. Leads were inserted via the ipsilateral subclavian vein in 16 patients. Venous occlusion was found in two patients: in the first the procedure was not performed; in the second, the contralateral vein was used and the old lead was abandoned. There were no procedural complications. During a follow-up of 14 +/- 11 months, ventricular dysfunction worsened in five of seven patients; other patients benefitted symptomatically. In conclusion, pacemaker upgrade is technically challenging but feasible and safe and may be beneficial for some patients.

Adolescent↗
PubMed2006

Do guidelines matter? Implementation of the ACG and AGA osteoporosis screening guidelines in inflammatory bowel disease (IBD) patients who meet the guidelines' criteria.

OBJECTIVE: The American College of Gastroenterology (ACG) and American Gastroenterology Association (AGA) have both recently issued guidelines (the "Guidelines") regarding the diagnosis and management of osteoporosis in patients with inflammatory bowel disease (IBD). The objective of this study was to determine the yield of implementing the Guidelines' recommendations in a prospective cohort of IBD patients and identify the prevalence of bone loss, risk factors, and potential influence on management. METHODS: One hundred consecutive IBD patients who fulfilled the Guidelines' criteria underwent dual energy X-ray absorptiometry scanning (DEXA) scanning of the lumbar vertebrae and bilateral hips. Demographic data, risk factor information, and changes in therapy based on screening were collected and analyzed. RESULTS: Indications for screening were history of prolonged past or concurrent steroid use (92%), postmenopausal status (7%), and history of low trauma fracture (7%). Forty-four percent of patients had osteopenia of either the lumbar spine or the hips, 12% had osteoporosis of either the spine or hips, and 44% had normal bone density. In a univariate analysis, factors predicting a greater likelihood of osteoporosis (but not osteopenia) were a diagnosis of Crohn's disease (vs. ulcerative colitis), low body mass index in women, and postmenopausal status. Specific therapies based on DEXA findings were initiated in 69% of patients: oral calcium and vitamin D supplementation in 69% and an oral bisphoshphonate in 20%. CONCLUSIONS: Implementation of the Guidelines led to the detection of osteopenia or osteoporosis and initiation of specific therapies in a majority of patients who met the Guidelines' criteria for DEXA screening.

Absorptiometry, Photon↗
PubMed2026

Graph neural network-based risk stratification of prostate cancer using gene expression and SHAP interpretability.

Accurate risk stratification is essential for guiding treatment decisions and preventing over treatment of prostate cancer, which remains one of the most prevalent cancers among adult men. While the Gleason score, obtained from prostate biopsies, is routinely used to assess tumor aggressiveness, the biopsy procedure carries risks such as pain, infection, and, in some cases, serious complications such as sepsis. In this study, we proposed an artificial intelligence-based framework that integrates mRNA expression profiles with functional interaction networks to classify prostate cancer patients into low-, medium-, and high-risk groups defined by Gleason scores. The pipeline comprised five steps: (1) data collection from The Cancer Genome Atlas (TCGA), (2) preprocessing of gene expression data, (3) two-stage feature selection to identify informative biomarkers, (4) risk classification using a dual-branch graph neural network (GNN) that combines gene-gene interaction graphs with sample-level expression features, and (5) model interpretation using SHAP to quantify feature contributions. Differentially expressed genes were identified in the High (ASPN, GMNN, PEBP4, C2, KNCK17), Medium (C2, IGSF1, ASPN, CDKN3, AMH), and Low (TNMD, VWA5B2, ST6GALNAC5, CYP3A5, PHGR1) risk groups, underscoring the molecular heterogeneity of disease progression. On an independent held-out test set, the model achieved AUCs of 0.86, 0.88, and 0.95 for the low-, medium-, and high-risk groups, respectively, with an overall accuracy of 80%. These results suggest that combining GNN-based modeling with explainable AI can capture both global and local molecular patterns relevant to tumor aggressiveness. However, as the model was developed and evaluated solely on the TCGA cohort, the findings should be regarded as exploratory, and external validation will be required to establish generalizability. Within these limitations, the proposed framework highlights the potential of molecular profiling and graph-based deep learning to support more precise, potentially less invasive, risk assessment and individualized treatment planning in prostate cancer.

Prostatic Neoplasms↗
PubMedDate not supplied

Self-help group meeting attendance among clients with dual diagnoses.

This study explores factors associated with self-help group meeting attendance in the aftercare of 81 clients with dual diagnoses of severe mental illness and chemical dependency following their discharge from an inpatient chemical dependency treatment program. It also explores the association between self-help group meeting attendance and treatment outcomes. Data were collected from patient records and results of the Addiction Severity Index (ASI) administered as part of an earlier experiment that evaluated the effectiveness of the treatment program. Collaterals also provided follow-up information. Of thirteen variables examined, only two were associated with increased self-help group meeting attendance: having more years of education and having a major substance problem that did not include alcohol. No association was found between self-help group meeting attendance and treatment outcome regarding psychiatric problem severity or five other domains of the ASI. A moderate association was found indicating that more self-help group meeting attendance was related to improvements in the legal problems domain of the ASI. Implications are discussed for future research and for improving self-help group meeting attendance and its influence on treatment outcomes for individuals with dual diagnoses.

Adolescent↗
PubMed1995

Early complications of permanent pacemaker implantation: no difference between dual and single chamber systems.

OBJECTIVE: To evaluate the incidence of intraoperative and early postoperative complications (up to two months after implant) of endocardial permanent pacemaker insertion in all patients under-going a first implant at a referral centre. METHODS: Prospective evaluation of all endocardial pacemaker implantation procedures performed from April 1992 to January 1994 carried out by completion of standard audit form at implant. Patients' demographic data, medical history, details of pacemaker hardware used, and any complications were noted. Follow up information was also collected prospectively onto standard forms at pacemaker outpatient clinic. SETTING: United Kingdom tertiary referral cardiothoracic centre. PATIENTS: 1088 consecutive patients underwent implantation of their first endocardial permanent pacemaker from April 1992 to January 1994. Implant and follow up data were available for 1059 (97.3%) patients at analysis. The median (range) age was 77 years (16-99); 51.2 % were male. RESULTS: Dual chamber units were implanted in 54.1% of patients, single chamber atrial in 5.2%, and ventricular in 40.7%. A temporary pacing lead was present at implant in 22.9% of patients. Most (93.6%) implants were performed via the subclavian vein. Immediate complications were rare: eight (0.8%) patients developed pneumothorax requiring medical treatment and 11 (1.0%) an insignificant pneumothorax. There was no significant difference in the pneumothorax rate for dual chamber (DDD) compared with single chamber systems. Arterial puncture without sequelae was documented in 2.7% of attempts at subclavian vein cannulation. A total of 35 patients (3.3%) required reoperation; the reoperation rate for dual chamber (3.5%) was similar to that for single chamber (3.1%) systems. Electrode displacement (n = 15, 1.4%) was the most common reason for reoperation. Atrial lead displacement (n = 10, 1.6% of atrial leads) was significantly more common than ventricular lead displacement (n = 5, 0.5% of ventricular leads, P = 0.047). There was no difference in electrode displacement rates for dual (1.6%) compared with single (1.2%) chamber systems. Pacemaker pocket infection led to reoperation in 10 patients (six dual, four single chamber, P = not significant) and was significantly more common in patients who had a temporary pacing lead in place at implant (2.9%) than in those who did not (0.4%, P = 0.0014). Five patients (0.5%) required reoperation for generator erosion (two dual, three single chamber, P = not significant). and a further five for drainage of haematoma or a serous fluid collection (three dual, two single chamber, P = not significant). Complications that did not require reoperation were also rare. Undersensing occurred in 10 patients (0.9%). Atrial undersensing (n = 8) was significantly more common than ventricular undersensing (n = 2, P = 0.017). All patients were successfully treated by reprogramming of sensitivity. Superficial wound infection was treated successfully with antibiotics in nine patients (six dual, three single chamber, P = not significant). Three patients with DDD generators developed sustained atrial fibrillation: two required reprogramming to VVI mode and one required cardioversion. CONCLUSIONS: Permanent pacing in a large tertiary referral centre with experienced operators carries a low risk. Infection rates are low, < 1% overall but significantly higher in patients who undergo temporary pacing before implantation. Lead displacement and undersensing are more likely to occur with atrial than ventricular leads. The overall complication rate for dual chamber pacing, however, is no higher than for single chamber pacing.

Adolescent↗
PubMed2006

Health care utilization among Medicare-Medicaid dual eligibles: a count data analysis.

BACKGROUND: Medicare-Medicaid dual eligibles are the beneficiaries of both Medicare and Medicaid. Dual eligibles satisfy the eligibility conditions for Medicare benefit. Dual eligibles also qualify for Medicaid because they are aged, blind, or disabled and meet the income and asset requirements for receiving Supplement Security Income (SSI) assistance. The objective of this study is to explore the relationship between dual eligibility and health care utilization among Medicare beneficiaries. METHODS: The household component of the nationally representative Medical Expenditure Panel Survey (MEPS) 1996-2000 is used for the analysis. Total 8,262 Medicare beneficiaries are selected from the MEPS data. The Medicare beneficiary sample includes individuals who are covered by Medicare and do not have private health insurance during a given year. Zero-inflated negative binomial (ZINB) regression model is used to analyse the count data regarding health care utilization: office-based physician visits, hospital inpatient nights, agency-sponsored home health provider days, and total dental visits. RESULTS: Dual eligibility is positively correlated with the likelihood of using hospital inpatient care and agency-sponsored home health services and the frequency of agency-sponsored home health days. Frequency of dental visits is inversely associated with dual eligibility. With respect to racial differences, dually eligible Afro-Americans use more office-based physician and dental services than white duals. Asian duals use more home health services than white duals at the 5% statistical significance level. The dual eligibility programs seem particularly beneficial to Afro-American duals. CONCLUSION: Dual eligibility has varied impact on health care utilization across service types. More utilization of home healthcare among dual eligibles appears to be the result of delayed realization of their unmet healthcare needs under the traditional Medicare-only program rather than the result of overutilization in response to the expanded benefits of the dual eligibility program. The dual eligibility program is particularly beneficial to Asian and Afro-American duals in association with the provision of home healthcare and dental benefits.

Aged↗
PubMed1993

Localization of IBF as a D-2 dopamine receptor imaging agent in nonhuman primates.

Preliminary study of iodine-123 labeled IBF, (S)-5-iodo-7-N-[(1-ethyl-2-pyrrolidinyl)methyl] carboxamido-2, 3-dihydrobenzofuran, has demonstrated the potential of using this agent to evaluate the status of the CNS D-2 dopamine receptor in humans. To further characterize this ligand and evaluate single-photon emission tomography (SPET) quantitation, a detailed biodistribution study in monkeys (Macaca fascicularis) with 123I- and 125I-IBF was performed. The dual tracer was simultaneously injected for in vivo imaging, bio-distribution, and ex vivo autoradiography in the same monkey. After the injection, SPET data (10 min/frame x 15) were collected with a triple-head gamma camera. Dynamic imaging data indicated that IBF localized in basal ganglia (BG) with a half life of 90-120 min. Other regions, i.e., cerebellum (CB) and cortex (CX), showed very low uptake. At 2.2 h after the injection, the monkey was sacrificed. Organ distribution data indicated that, as expected, there was a significant uptake in basal ganglia (0.029% ID/g), and the BG/CB and BG/CX ratios were 17.8 and 14.2 respectively. Lower ratios were obtained from SPET image analysis (BG/CB = 3.5 at 2.5 h). The eye uptake was observed with SPET, but was only quantified on autoradiograms with significant uptake (0.017% ID/g). Autoradiography of the eye demonstrated that predominant uptake was localized in the ciliary body and the choroid. The selective retention and high BG/CB ratio of 123I-IBF make it a useful agent for in vivo D-2 dopamine receptor imaging with SPET.

Animals↗