Perioperative risk factors affecting hospital stay and hospital costs in open heart surgery for patients > or = 65 years old

OBJECTIVE: Demographic changes, associated with increased demands for open heart surgery in the elderly, place increased burden on financial resources. To evaluate perioperative risk factors affecting incidence of hospital events and estimation of hospital charges, 2577 patients > or = 65 years (range 65-91), operated on from January 1991 to December 1994, were compared with a concurrent cohort of 2642 younger patients. METHODS: Statistical analysis, by surgical procedure, focused on hospital mortality, key postoperative complications affecting length of hospital stay and hospital charges. RESULTS: Overall hospital mortality was 4.7%, 3.5% in younger patients versus 6.1% in the older group (P < 0.01). Mortality was significantly lower in patients less than 65 years undergoing coronary artery bypass grafting (3% versus 5%, P < 0.01) and valve replacement (4% versus 9%, P = 0.01). Significant risk factors for hospital death in the elderly: diabetes (P < 0.01), hypertension (P < 0.01), myocardial infarction (P < 0.01) and congestive heart failure (P < 0.01). Significant postoperative events, more common in older patients, included prolonged ventilation (P < 0.01), congestive heart failure (P < 0.01), infection (P < 0.01), cerebrovascular accident (P < 0.01), and intra aortic balloon pump (P < 0.01). Incremental risk factors for morbidity in the elderly were: higher New York Heart Association class, congestive heart failure, emergent operation, and female gender. Mean length of hospital stay for the < 65 group was 15.3 versus > 19.5 days for the > 65 group (P < 0.01). Length of stay over 18 days positively correlated with increased morbidity in both age groups. For patients > or = 65 years of age, the average hospital charge for open heart surgery was 172% higher for patients with a length of stay greater than 18 days compared with 165% for patients less than 65 years of age. CONCLUSIONS: Higher operative mortality and longer length of stay in elderly patients, resulting in increased health care costs, was associated with more co-morbidities. These results suggest interventions designed to reduce congestive heart failure and other co-morbidities may improve patient's recovery and reduce costs.     

分数Vasicek利率下创新重置期权定价

假定股票价格过程服从分数跳-扩散过程,利率满足分数Vasicek利率模型,利用分数跳-扩散过程理论以及保险精算方法,讨论了创新重置期权的定价问题,获得了创新重置看涨期权定价公式,推广了关于创新重置期权定价的相关结果.     

Differences in microbial activity of digesta from three sections of the porcine large intestine according to in vitro fermentation of carbohydrate‐rich substrates

To determine whether faecal microorganisms can represent the entire large intestinal population, samples from caecum, mid‐colon and rectum of three adult pigs were used for the in vitro fermentation of fructo‐oligosaccharide (FOS), potato starch, wheat bran and oat hulls. The cumulative gas production technique measured fermentation kinetics and end‐products such as total gas, NH₃ and volatile fatty acids (VFA). There were significant differences in the fermentability of substrates, in terms of both kinetics and end‐products. More relevant to this study, there were also differences between pigs in respect of total gas production, the rate of gas production (R_M) and VFA production. For large intestine sections, there were more VFA from mid‐colon and rectal inocula compared with that from the caecum (p < 0.0001). Total gas, R_M and NH₃ were highest for rectal, intermediate for mid‐colon and lowest for caecal inocula (p < 0.0001). It was concluded that, while faecal sampling might overestimate caecal fermentation, its use is valid for in vitro assessment of large intestinal fermentation. However, differences between pigs indicate that a mix of samples from several animals remains important. Copyright © 2004 Society of Chemical Industry     

带双参数四次Said-Ball曲线的扩展

为了使曲线易于实现光滑拼接,同时具有对应于相同控制顶点的不同形状,定义了具有凸包性、对称性、形状可调性等基本性质的新曲线.文中分析了基函数及曲线的性质和2个形状参数的几何意义,给出了2条Said-Ball型曲线的G0,G1,G2连续拼接条件.类似构造了局部形状可调的组合曲面.数值实例说明了所给方法的正确性和有效性.     

Novel antitumor 2-cyanoaziridine-1-carboxamides

A set of 20 2-cyanoaziridine-1-carboxamides was synthesized from 2-cyanoaziridine and appropriate isocyanates. These compounds were active against a variety of solid and hematological tumor cells in culture, including strains resistant to doxorubicin and mitoxantrone. Their potencies in these assays correlated with the lipophilicity of substituents. The N-phenyl derivative was more potent and equally effective to imexon, a cyclized 2-cyanoaziridine-1-carboxamide of clinical interest, against cloned fresh human tumors.     

The material basis for reduced mechanical properties in oim mice bones

Osteogenesis imperfecta (OI), a heritable disease caused by molecular defects in type I collagen, is characterized by skeletal deformities and brittle bones. The heterozygous and homozygous oim mice (oim/+ and oim/oim) exhibit mild and severe OI phenotypes, respectively, serving as controlled animal models of this disease. In the current study, bone geometry, mechanics, and material properties of 1-year-old mice were evaluated to determine factors that influence the severity of phenotype in OI. The oim/oim mice exhibited significantly smaller body size, femur length, and moment of area compared with oim/+ and wild-type (+/+) controls. The oim/oim femur mechanical properties of failure torque and stiffness were 40% and 30%, respectively, of the +/+ values, and 53% and 36% of the oim/+ values. Collagen content was reduced by 20% in the oim/oim compared with +/+ bone and tended to be intermediate to these values for the oim/+. Mineral content was not significantly different between the oim/oim and +/+ bones. However, the oim/oim ash content was significantly reduced compared with that of the oim/+. Mineral carbonate content was reduced by 23% in the oim/oim bone compared with controls. Mineral crystallinity was reduced in the oim/oim and oim/+ bone compared with controls. Overall, for the majority of parameters examined (geometrical, mechanical, and material), the oim/+ values were intermediate to those of the oim/oim and +/+, a finding that parallels the phenotypes of the mice. This provides evidence that specific material properties, such as mineral crystallinity and collagen content, are indicative and possibly predictive of bone fragility in this mouse model, and by analogy in human OI.     

HIV seroprevalence amongst pregnant women in northeastern Zaire

Heparin co-factor II is in addition to antithrombin III another heparin dependent thrombin inhibitor. This glycoprotein blocks thrombin action not only in haemostasis but also in its other effects. Congenital deficiency of heparin co-factor II was found equally frequently among asymptomatic subjects and patients with thrombotic complications. Although its deficiency probably is not a serious risk factor of thromboembolic disease, it can promote its development in a significant way. The authors describe the case of a child with thrombotic complications and a congenital deficiency of heparin co-factor II.