Early Postoperative Extubation is Associated with Shorter Hospitalization and Improved Short-Term Survival in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Background Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is associated with significant operative time, hospital resources, and morbidity. We examine factors associated with hospital length of stay (LOS) and early overall survival (OS) after CRS/HIPEC. Materials and Methods Patients who underwent CRS/HIPEC were evaluated for factors associated with LOS. Institutional learning curve influence was addressed by comparing early vs late cohorts. Variables with P < .200 after univariate analysis were considered for inclusion in multivariate linear regression modeling. Independent factors associated with OS were evaluated using the Kaplan-Meier method. Results Seventy patients underwent CRS/HIPEC (mean age 52.3 years, 64.3% female, and 68.6% Caucasian). Presence of any surgical complication was found in 26 (37.1%), 28 (40%) remained intubated postoperatively, and the mean Peritoneal Carcinomatosis Index (PCI) score was 14.4 ([Formula: see text]10.4). Mean intensive care unit and hospital LOS were 2.9 days ([Formula: see text]2.3) and 9.6 days ([Formula: see text]3.6), respectively. After adjusting for covariates, only shorter time to postoperative ambulation (regression coefficient .92, P = .001) and early extubation (regression coefficient −1.90, P = .018) were associated with decreased hospital LOS on multivariate analysis. Immediate postoperative extubation conferred an independent early survival benefit on Kaplan-Meier analysis (mean OS 714.8 vs 473.4 days, P = .010). There was no difference in hospital LOS or OS between early and late cohorts. Conclusion Early postoperative extubation and shorter time to ambulation are associated with decreased hospital LOS. Moreover, CRS/HIPEC patients extubated immediately postoperatively have an early survival benefit. Every effort should be made to achieve early postoperative extubation and mobilization in CRS/HIPEC patients.

Selection on early survival does not explain germination rate clines in Mimulus cardinalis (Phrymaceae)

Premise Many traits covary with environmental gradients to form phenotypic clines. While local adaptation to the environment can generate phenotypic clines, other nonadaptive processes may also. If local adaptation causes phenotypic clines, then the direction of genotypic selection on traits should shift from one end of the cline to the other. Traditionally genotypic selection on non-Gaussian traits like germination rate have been hampered because it is challenging to measure their genetic variance. Methods Here we used quantitative genetics and reciprocal transplants to test whether a previously discovered cline in germination rate showed additional signatures of adaptation in the scarlet monkeyflower (Mimulus cardinalis). We measured genotypic and population level covariation between germination rate and early survival, a component of fitness. We developed a novel discrete log-normal model to estimate genetic variance in germination rate. Results Contrary to our adaptive hypothesis, we found no evidence that genetic variation in germination rate contributed to variation in early survival. Across populations, southern populations in both gardens germinated earlier and survived more. Conclusions Southern populations have higher early survival but this is not caused by faster germination. This pattern is consistent with nonadaptive forces driving the phenotypic cline in germination rate, but future work will need to assess whether there is selection at other life stages. The statistical framework should help expand quantitative genetic analyses for other waiting-time traits.

The Value of Effective Lung Ventilation Area Ratio Based on CT Image Analysis Is a New Index to Predict the Shorter Outcome of Anti-melanoma Differentiation-Associated Protein 5 Positive Dermatomyositis Associated Interstitial Lung Disease: A Single-Center Retrospective Study

Background: Anti-melanoma differentiation-associated protein 5 (MDA5) positive dermatomyositis (MDA5+DM) patients have poor outcomes due to rapidly progressive interstitial lung disease (ILD). The accurate assessment of lung involvement is an urgent focus of research.Methods: A computer-aided lung interstitial image analysis technology has been developed, and a quantitative indicator named effective lung ventilation area ratio (ELVAR) that calculates the proportion of the area outside the lung interstitium in lung tissue has been established. 55 newly diagnosed MDA5+DM patients and 46 healthy individuals, matched for age and gender, were enrolled in this study. MDA5+DM patients were classified into early death group or early survival group according to their survival state within 3 months after diagnosis. Clinical characteristics, laboratory and immunological test results, lung involvement (including ELVAR value) and treatment were compared between early death group and early survival group to determine an index that can predict prognoses of patients with MDA5+DM.Results: There were significant differences between early death MDA5+DM patients and early survival MDA5+DM patients about 12 indices including age of onset, CRP, ferritin, albumin, and pulmonary involvement including severity of type I respiratory failure at diagnosis, P/F ratio, oxygen supplementation, values of ELVAR, FVC, and DLCO. The results of ROC analysis and correlation analysis showed the value of ELVAR had good diagnostic value and widely correlation with many clinical characteristics. Univariate analysis and Multivariate analysis showed four factors including age of onset, ferritin, value of ELVAR, and oxygen supplementation &gt;4 L/min significantly value for poor prognosis in MDA5+DM patients. A cutoff value of 0.835 about ELVAR had good predictive power for mortality within 3 months in 54.2% of MDA5+DM patients.Conclusion: The value of ELVAR derived from computed tomography image analysis is a new index that can predict poor outcomes in MDA5+DM patients with rapidly progressive interstitial lung disease.

Maternal stress effects on infant development in wild Verreaux's sifaka (Propithecus verreauxi)

Maternal effects mediated by nutrients or specific endocrine states of the mother can affect infant development. Specifically, pre- and postnatal maternal stress associated with elevated glucocorticoid (GC) output is known to influence the phenotype of the offspring, including their physical and behavioral development. These developmental processes, however, remain relatively poorly studied in wild vertebrates, including primates with their relatively slow life histories. Here, we investigated the effects of maternal stress, assessed by fecal glucocorticoid output, on infant development in wild Verreaux’s sifakas (Propithecus verreauxi), a group-living Malagasy primate. In a first step, we investigated factors predicting maternal fecal glucocorticoid metabolite (fGCM) concentrations, how they impact infants’ physical and behavioral development during the first 6 months of postnatal life as well as early survival during the first 1.5 years of postnatal life. We collected fecal samples of mothers for hormone assays and behavioral data of 12 infants from two birth cohorts, for which we also assessed growth rates. Maternal fGCM concentrations were higher during the late prenatal but lower during the postnatal period compared to the early/mid prenatal period and were higher during periods of low rainfall. Infants of mothers with higher prenatal fGCM concentrations exhibited faster growth rates and were more explorative in terms of independent foraging and play. Infants of mothers with high pre- and postnatal fGCM concentrations were carried less and spent more time in nipple contact. Time mothers spent carrying infants predicted infant survival: infants that were more carried had lower survival, suggesting that they were likely in poorer condition and had to be cared for longer. Thus, the physical and behavioral development of these young primates were impacted by variation in maternal fGCM concentrations during the first 6 months of their lives, presumably as an adaptive response to living in a highly seasonal, but unpredictable environment. Significance statement The early development of infants can be impacted by variation in maternal condition. These maternal effects can be mediated by maternal stress (glucocorticoid hormones) and are known to have downstream consequences for behavior, physiology, survival, and reproductive success well into adulthood. However, the direction of the effects of maternal physiological GC output on offspring development is highly variable, even within the same species. We contribute comparative data on maternal stress effects on infant development in a Critically Endangered primate from Madagascar. We describe variation in maternal glucocorticoid output as a function of ecological and reproductive factors and show that patterns of infant growth, behavioral development, and early survival are predicted by maternal glucocorticoids. Our study demonstrates how mothers can influence offspring fitness in response to challenging environmental conditions.

The survival rates and risk factors of implants in the early stage: a retrospective study

Background Few large-sample studies in China have focused on the early survival of dental implants. The present study aimed to report the early survival rates of implants and determine the related influencing factors. Methods All patients receiving dental implants at our institution between 2006 and 2017 were included. The endpoint of the study was early survival rates of implants, according to gender, age, maxilla/mandible, dental position, bone augmentation, bone augmentation category, immediate implant, submerged implant category, implant diameter, implant length, implant torque, and other related factors. Initially, SPSS22.0 was used for statistical analysis. The Chi-square test was used to screen all factors, and those with p < 0.05 were further introduced into a multiple logistic regression model to illustrate the risk factors for early survival rates of implants. Results In this study, we included 1078 cases (601 males and 477 females) with 2053 implants. After implantation, 1974 implants were retained, and the early survival rate was 96.15%. Patients aged 30–60 years (OR 2.392), with Class I bone quality (OR 3.689), bone augmentation (OR 1.742), immediate implantation (OR 3.509), and implant length < 10 mm (OR 2.972), were said to possess risk factors conducive to early survival rates. Conclusions The early survival rate of implants in our cohort exceeded 96%, with risk factors including age, tooth position, bone quality, implant length, bone augmentation surgery, and immediate implantation. When the above factors coexist, implant placement should be treated carefully.