The relationship between smoking cessation, concurrent weight gain, and stroke events is not yet understood. Thus, we examined the association between smoking cessation and subsequent stroke risk and ...whether the association was modified by concurrent weight gain.
In 2017, we analyzed data from 109,498 postmenopausal US women enrolled in the Women's Health Initiative from 1993 to 1998. Women with a history of cancer or cardiovascular disease events were excluded. The median length of follow-up time was 14.01 years. Variables of primary focus were smoking cessation, weight change, and clinically confirmed incident cases of hemorrhagic and ischemic stroke. Hazard ratios were estimated for stroke incidences (all, ischemic, and hemorrhagic) associated with smoking cessation using Cox regression. The exposure-outcome relationship of smoking cessation and risk of stroke was evaluated for effect modification by weight change.
Recent quitters between baseline and year 3 had a significantly lower risk for all stroke and ischemic stroke, but not hemorrhagic stroke, when compared to the reference group of continuing smokers. In the multivariable-adjusted model for ischemic stroke, the hazard ratio for recent quitters was 0.66 (95% CI: 0.46, 0.95). In the model for hemorrhagic stroke, the hazard ratio for recent quitters was 0.76 (95% CI: 0.36, 1.61). The association between recent quitting and stroke risk was not significantly modified by weight change.
Smoking cessation was associated with a significant reduction in stroke risk. The benefit of smoking cessation on the risk of stroke was not attenuated by concurrent weight gain.
•Smoking cessation significantly reduced all stroke risk.•Smoking cessation significantly reduced ischemic stroke risk.•Smoking cessation was not significantly associated with hemorrhagic stroke risk.•Smoking cessation was associated with weight gain.•Weight gain did not attenuate the benefit of smoking cessation on stroke risk.
Background:
In spring 2021, the infection prevention and control department at a pediatric academic medical center identified 3 oncology patients with concern for invasive
Rhizopus
spp infections. An ...in-depth investigation was conducted, but a common source of the fungus was not identified. In August 2021, an additional oncology patient with concern for invasive
Rhizopus
spp was identified, resulting in an extended investigation for possible sources of fungus.
Methods:
A multidisciplinary work group was assembled. The CDC Targeted Environmental Investigation Checklist for Outbreaks of Invasive Infections Caused by Environmental Fungi was used as a framework for conducting the investigation. Stakeholders were engaged throughout the process, including the hematology–oncology service, hospital leadership, environmental services, patient safety and quality, and facilities and engineering. The investigation included hospital incident command system (HICS) activation; visual inspection of patient rooms and common spaces; heating, ventilation, and air conditioning (HVAC) review; environmental sampling (surfaces, linen, and air); chart review; and process mapping.
Results:
By early October 2021, 2 environmental samples grew isolates (each at 1 CFU/m
3
) of the same species of
Rhizopus
as one of the affected patients. One sample was from a patient room, and the other from an outdoor garden space. No source of indoor amplification of
Rhizopus
was identified. The investigation revealed several opportunities for improvement: annual room maintenance schedules, use of gardens and outdoor spaces by at-risk patients, linen storage, construction and/or infection control risk assessment (ICRA) processes, and appliances used by families (eg, washing machines and refrigerators). Work streams were established to address each of these areas.
Conclusions:
No definite source was identified for the 4 invasive
Rhizopus
spp infections. This extensive investigation highlighted multiple opportunities for improvement; the changes implemented may prevent future invasive fungal infections in high-risk pediatric patients.
Funding:
None
Disclosures:
None
•Quality improvement project was initiated at a large, academic freestanding children's hospital for inpatients with an indwelling urinary catheter.•An audit tool based on Kamishibai, a Japanese form ...of storytelling, was developed based on CDC CAUTI prevention recommendations.•Hospital-wide urinary catheter K-card rounding facilitated standardized data collection, discussion of reliability, and real-time feedback to nurses.
We instituted Kamishibai (K-card rounding) with the goals of improving indwelling urinary catheter maintenance bundle reliability and decreasing catheter-associated urinary tract infection (CAUTI) rates.
In a free-standing children's hospital, we undertook a hospital-wide quality improvement project from January 2019 to June 2021 after developing a K-card based on our urinary catheter maintenance bundle. Auditors used K-cards to ask standardized questions during weekly rounds. Bundle reliability and CAUTI rates were analyzed prospectively.
During the study period, 826 K-card audits were performed for 657 unique patients. While overall maintenance bundle reliability remained stable at 84%, there was a statistically significant improvement in reliability to the bundle element “medical discussion of need for the urinary catheter” from 88% to 94% (P = .01). The hospital-wide CAUTI rate significantly decreased (incidence rate ratio, 0.38; 95% CI, 0.15-0.93; P = .04).
Hospital-wide urinary catheter K-card rounding facilitated standardized data collection, discussion of reliability and real-time feedback to nurses. Maintenance bundle reliability remained stable after implementation, accompanied by a significant decrease in the CAUTI rate.
Implementation of hospital-wide urinary catheter K-card rounding was associated with reduction in CAUTI rates. The project demonstrated likelihood of reproducibility with support of a multidisciplinary team.
Background/aims: Microdialysis technique, for the in vivo estimation of endogenous and exogenous substances in tissues, is gaining increasing use in human experimentation. The cutaneous microdialysis ...technique has interesting applications in several fields, including the study of skin inflammation and percutaneous absorption. One of the aspects of cutaneous microdialysis which needs clarification is the influence on results of the exact position of the microdialysis probe in the dermis.
Methods: In a total material of 67 histamine experiments, probe depth has been measured by the ultrasound technique. In 24 uniform experiments, histamine values at 10‐min intervals after probe insertion and prior to other provocation have been analyzed in relation to probe depth.
Results: The mean probe depth was 1.1 mm (range 0.8‐1.9 mm). In regression analysis of histamine values in 10‐min intervals up to 90 min after probe insertion in relation to probe depth, the histamine values were found to be independent of probe depth. This may be due to rapid local diffusion of histamine, together with axon reflex mediated histamine release. Further analysis revealed no correlation between histamine results and the subject's age, sex or presence of atopy.
Conclusion: The present results indicate that the exact placement of the microdialysis probe into the dermis is not too critical in experiments where histamine is to be studied. It must be pointed out that the same may not necessarily be true of other inflammatory mediators: for each new target substance and application, the influence of probe placement needs to be considered.
Intersexual signals that reveal developmental or mating status in females have evolved repeatedly in many animal lineages. Such signals have functions in sexual conflict over mating and can therefore ...influence sexually antagonistic coevolution. However, we know little about how female signal development modifies male mating harassment and thereby sexual conflict. Here, we combine phylogenetic comparative analyses of a color polymorphic damselfly genus (
) with behavioral experiments in one target species to investigate the evolutionary origin and current adaptive function of a developmental female color signal. Many
species have multiple female color morphs, which include a male-colored morph (male mimics) and one or two female morphs that differ markedly from males (heterochrome females). In
, males and male-mimicking females express a blue abdominal patch throughout postemergence life. Using phenotypic manipulations, we show that the developmental expression of this signaling trait in heterochrome females reduces premating harassment prior to sexual maturity. Across species this signal evolved repeatedly, but in heterochrome females its origin is contingent on the signal expressed by co-occurring male-mimicking females. Our results suggest that the co-option of a male-like trait to a novel female antiharassment function plays a key role in sexual conflict driven by premating interactions.
Conflicts of interests between males and females over reproduction is a universal feature of sexually reproducing organisms and has driven the evolution of intersexual mimicry, mating behaviours and ...reproductive polymorphisms. Here, we show how temperature drives pre‐reproductive selection in a female colour polymorphic insect that is subject to strong sexual conflict. These species have three female colour morphs, one of which is a male mimic. This polymorphism is maintained by frequency‐dependent sexual conflict caused by male mating harassment. The frequency of female morphs varies geographically, with higher frequency of the male mimic at higher latitudes. We show that differential temperature sensitivity of the female morphs and faster sexual maturation of the male mimic increases the frequency of this morph in the north. These results suggest that sexual conflict during the adult stage is shaped by abiotic factors and frequency‐independent pre‐reproductive selection that operate earlier during ontogeny of these female morphs.
To determine whether adding shear-wave (SW) elastographic features could improve accuracy of ultrasonographic (US) assessment of breast masses.
From September 2008 to September 2010, 958 women ...consented to repeat standard breast US supplemented by quantitative SW elastographic examination in this prospective multicenter institutional review board-approved, HIPAA-compliant protocol. B-mode Breast Imaging Reporting and Data System (BI-RADS) features and assessments were recorded. SW elastographic evaluation (mean, maximum, and minimum elasticity of stiffest portion of mass and surrounding tissue; lesion-to-fat elasticity ratio; ratio of SW elastographic-to-B-mode lesion diameter or area; SW elastographic lesion shape and homogeneity) was performed. Qualitative color SW elastographic stiffness was assessed independently. Nine hundred thirty-nine masses were analyzable; 102 BI-RADS category 2 masses were assumed to be benign; reference standard was available for 837 category 3 or higher lesions. Considering BI-RADS category 4a or higher as test positive for malignancy, effect of SW elastographic features on area under the receiver operating characteristic curve (AUC), sensitivity, and specificity after reclassifying category 3 and 4a masses was determined.
Median participant age was 50 years; 289 of 939 (30.8%) masses were malignant (median mass size, 12 mm). B-mode BI-RADS AUC was 0.950; eight of 303 (2.6%) BI-RADS category 3 masses, 18 of 193 (9.3%) category 4a lesions, 41 of 97 (42%) category 4b lesions, 42 of 57 (74%) category 4c lesions, and 180 of 187 (96.3%) category 5 lesions were malignant. By using visual color stiffness to selectively upgrade category 3 and lack of stiffness to downgrade category 4a masses, specificity improved from 61.1% (397 of 650) to 78.5% (510 of 650) (P<.001); AUC increased to 0.962 (P=.005). Oval shape on SW elastographic images and quantitative maximum elasticity of 80 kPa (5.2 m/sec) or less improved specificity (69.4% 451 of 650 and 77.4% 503 of 650, P<.001 for both), without significant improvement in sensitivity or AUC.
Adding SW elastographic features to BI-RADS feature analysis improved specificity of breast US mass assessment without loss of sensitivity.
Pleiotropy (multiple phenotypic effects of single genes) and epistasis (gene interaction) have key roles in the development of complex phenotypes, especially in polymorphic taxa. The development of ...discrete and heritable phenotypic polymorphisms often emerges from major-effect genes that interact with other loci and have pleiotropic effects on multiple traits. We quantified gene expression changes during ontogenetic color development in a polymorphic insect (damselfly: Ischnura elegans), with three heritable female morphs, one being a male mimic. This female color polymorphism is maintained by male mating harassment and sexual conflict. Using transcriptome sequencing and de novo assembly, we demonstrate that all three morphs downregulate gene expression during early color development. The morphs become increasingly differentiated during sexual maturation and when developing adult coloration. These different ontogenetic trajectories arise because the male-mimic shows accelerated (heterochronic) development, compared to the other female morphs. Many loci with regulatory functions in reproductive development are differentially regulated in the male-mimic, including upstream and downstream regulators of ecdysone signaling and transcription factors potentially influencing sexual differentiation. Our results suggest that long-term sexual conflict does not only maintain this polymorphism, but has also modulated the evolution of gene expression profiles during color development of these sympatric female morphs.
Five novel bismuth carboxylate coordination polymers were synthesized from biphenyl-3,4′,5-tricarboxylic acid (H3BPT) and 1,1′:4′,1′′terphenyl-3,3′′,5,5′′-tetracarboxylic acid (H4TPTC). One of the ...phases, Bi(BPT)·2MeOH (denoted SU-100, as synthesized), is the first example, to the best of our knowledge, of a reversibly flexible bismuth-based metal–organic framework. The material exhibits continuous changes to its unit cell parameters and pore shape depending on the solvent it is immersed in and the dryness of the sample. Typically, in breathing carboxylate-based MOFs, flexibility occurs through tilting of the organic linkers without significantly altering the coordination environment around the cation. In contrast to this, the continuous breathing mechanism in SU-100 involves significant changes to bond angles within the Bi2O12 inorganic building unit (IBU). The flexibility of the IBU of SU-100 reflects the nondiscrete coordination geometry of the bismuth cation. A disproportionate increase in the solvent accessible void volume was observed when compared to the expansion of the unit cell volume of SU-100. Additionally, activated SU-100 (SU-100-HT) exhibits a large increase in unit cell volume, yet has the smallest void volume of all the studied samples.
Objective To establish the safety and efficacy of endovascular repair of thoracoabdominal aortic aneurysms. Methods Between May 2004 and February 2006, patients with thoracoabdominal aneurysms ...considered high risk for conventional surgery were enrolled in a prospective trial to evaluate a novel endovascular grafting system. Devices were custom designed for each patient using high-resolution computed tomography. Patient data included mortality, morbidity, procedural details, and surrogate end points for endovascular repair. These were collected at hospital discharge and at 1, 6, and 12 months. Results Seventy-three patients underwent endovascular repair of thoracoabdominal aortic aneurysms for type I, II, or III (n = 28), or for type IV (n = 45) thoracoabdominal aneurysms. Mean aneurysm size was 7.1 cm (range 4.5–11.3 cm). General anesthesia was used in 47% of patients and regional anesthesia in 53%. There were no conversions to open surgery nor ruptures post-treatment. Technical success was achieved in 93% of patients (68/73). Thirty-day mortality was 5.5% (4/73). Major perioperative complications occurred in 11 (14%) patients and included paraplegia (2.7%, 2/73), new onset of dialysis (1.4%, 1/73), prolonged ventilator support (6.8%, 5/73), myocardial infarction (5.5%, 4/73), and minor hemorrhagic stroke (1.4%; 1/72). A majority of patients had no complications. Mean length of stay was 8.6 days. At follow-up, 6 deaths had occurred. There were no instances of stent migration nor aneurysmal growth. Conclusions Endovascular repair of aortic aneurysms involving the visceral segment in nonsurgical candidates is feasible. Known complications of repair are not eliminated, but morbidity and mortality appeared low relative to the high-risk population studied. Further refinement of device design, delivery technique, and patient selection is ongoing. Assessment of durability will require longer follow-up.
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