AIM: To explore gastroenterologist perceptions towards and experience with faecal microbiota transplantation(FMT).METHODS: A questionnaire survey consisting of 17 questions was created to assess gastroenterologists...AIM: To explore gastroenterologist perceptions towards and experience with faecal microbiota transplantation(FMT).METHODS: A questionnaire survey consisting of 17 questions was created to assess gastroenterologists' attitude towards and experience with FMT. This was anonymously distributed in hard copy format amongst attendees at gastroenterology meetings in Australia between October 2013 and April 2014. Basic descriptive statistical analyses were performed.RESULTS: Fifty-two clinicians participated. Twenty one percent had previously referred patients for FMT,8% more than once. Ninety percent would refer patients with Clostridium difficile infection(CDI) for FMT if easily available,37% for ulcerative colitis,13% for Crohn's disease and 6% for irritable bowel syndrome. Six percent would not refer any indication,including recurrent CDI. Eighty-six percent would enroll patients in FMT clinical trials. Thirty-seven percent considered the optimal mode of FMT administration transcolonoscopic,17% nasoduodenal,13% enema and 8% oral capsule. The greatest concerns regarding FMT were: 42% lack of evidence,12% infection risk,10% non infectious adverse effects/lack of safety data,10% aesthetic,10% lack of efficacy,4% disease exacerbation,and 2% inappropriate use; 6% had no concerns. Seventy seven percent believed there is a lack of accessibility while 52% had an interest in learning how to provide FMT. Only 6% offered FMT at their institution.CONCLUSION: Despite general enthusiasm,most gastroenterologists have limited experience with,or access to,FMT. The greatest concerns were lack of supportive evidence and safety issues. However a significant proportion would refer indications other than CDI for FMT despite insufficient evidence. These data provide guidance on where education and training are required.展开更多
AIM To systematically review the literature on women with both diabetes in pregnancy(DIP) and depression during or after pregnancy. METHODS In this systematic literature review, PubM ed/MEDLINE and EMBASE were searche...AIM To systematically review the literature on women with both diabetes in pregnancy(DIP) and depression during or after pregnancy. METHODS In this systematic literature review, PubM ed/MEDLINE and EMBASE were searched(13 November 2015) using terms for diabetes(type 1, type 2, or gestational), depression, and pregnancy(no language or date restrictions). Publications that reported on women who had both DIP(any type) and depression or depressive symptoms before, during, or within one year after pregnancy were considered for inclusion. All study types were eligible for inclusion; conference abstracts, narrative reviews, nonclinical letters, editorials, and commentaries were excluded, unless they provided treatment guidance.RESULTS Of 1189 articles identified, 48 articles describing women with both DIP and depression were included(sample sizes 36 to > 32 million). Overall study quality was poor; most studies were observational, and only 12 studies(mostly retrospective database studies) required clinical depression diagnosis. The prevalence of concurrent DIP(any type) and depression in general populations of pregnant women ranged from 0% to 1.6%(median 0.61%; 12 studies). The prevalence of depression among women with gestational diabetes ranged from 4.1% to 80%(median 14.7%; 16 studies). Many studies examined whether DIP was a risk factor for depression or depression was a risk factor for DIP. However, there was no clear consensus for either relationship. Importantly, we found limited guidance on the management of women with both DIP and depression. CONCLUSION Given the increasing prevalence of diabetes and depression, high-quality research and specific guidance for management of pregnant women with both conditions are warranted.展开更多
Background Falls are the most frequently reported adverse events in inpatient settings. We conducted a retrospective case-control study of inpatient falls within aged care wards in a tertiary hospital to investigate t...Background Falls are the most frequently reported adverse events in inpatient settings. We conducted a retrospective case-control study of inpatient falls within aged care wards in a tertiary hospital to investigate the associated characteristics of elderly patients suffering from falls and fall-related characteristics. Methods Consecutive retrospective cross-sectional design spanned July 2006 to December 2008. Patient group： Information on all aged care inpatients who suffered from 1 or more falls was extracted from Incident Information Management System （IIMS）. Further details about the particular admission（s） were obtained from patients＇ medical records, e.g., patients＇ characteristics and circumstances surrounding the falls. Randomly selected aged care patients who did not suffer from a fall and who were discharged from the hospital in the same period served control group. Characteristics among patients with single fall and recurrent falls, as well as non-railers were compared. Results Of the 438 falls evaluated, 71.9% occurred in patients＇ room and 18.9% in patients＇ bathroom/toilet. The common activities were moving/transferring and taking shower/toileting, respectively, 70.3%, 12.1% while occurring falls; and time of falls had a high peak during 9：00-11：00 a.m. Many were unassisted while falling. The common contributing factors for fall were intrinsic factors. Patients with recurrent falls were more likely to have lower Mini-Mental State Examination （MMSE） score. Logistic regression analysis showed length of stay longer than five weeks, dementia and stroke were independent risk factors for recurrent falls; and living in hostel/nursing home preadmission, needing assistance with mobility, cognitive impairment, stroke, incontinence and arthritis/osteoporosis were independent risk factors for fall. Conclusions In an aged care ward, falls are independently associated with recurrent factors. Cognitive impairment/dementia was a strong risk factor for falls, and main causes leading to fall were intrinsic factors. For patients with cognitive impairment/dementia and behavioral disorder providing special and effective interventions is of paramount importance for reducing the incidence of fall in an aged care ward in hospital settings.展开更多
Objective:Photoselective vaporization of the prostate(PVP)is a widely performed surgical procedure for benign prostatic obstruction.This approach has become particular favoured for men on anti-platelet and anticoagula...Objective:Photoselective vaporization of the prostate(PVP)is a widely performed surgical procedure for benign prostatic obstruction.This approach has become particular favoured for men on anti-platelet and anticoagulation agents such as clopidogrel and warfarin but there is minimal published experience in the setting of novel oral anticoagulants(NOACs).This study was to examine the perioperative outcomes in men on NOACs undergoing PVP,with particular reference to perioperative morbidity.Methods:A retrospective analysis of PVP datasets was undertaken from three centres in Sydney(Australia),Toulouse(France)and Boston(USA).Subjects who had been treated whilst on NOACs without discontinuation or bridging were identified.Perioperative outcomes and treatment parameters were examined and morbidity recorded according to Clavien-Dindo(CD)classification.Results:There were a total of 20 subjects who had undergone PVP whilst NOACs had been continued during the perioperative period.The mean age was 776.5 years.The mean prostate volume,energy utilization and vaporisation time was 9456 mL,301211 kJ,and 3521 min respectively.The mean postoperative duration of catheterization and duration of hospitalization was 2.22.4 days and 2.42.4 days respectively.There was a single episode of urinary tract infection and four subjects required re-catheterisation for non-hematuric retentions.Conclusions:This study supports the safety of men on NOACs undergoing PVP.Whilst this study represents the largest experience of PVP in these men,larger studies are necessary to confirm the safety of PVP in this group of men undergoing BPH-related surgery.展开更多
High-risk human papillomavirus has been suggested as a risk factor for esophageal adenocarcinoma.Tumor human papillomavirus status has been reported to confer a favorable prognosis in esophageal adenocarcinoma.The siz...High-risk human papillomavirus has been suggested as a risk factor for esophageal adenocarcinoma.Tumor human papillomavirus status has been reported to confer a favorable prognosis in esophageal adenocarcinoma.The size of the primary tumor and degree of lymphatic spread determines the prognosis of esophageal carcinomas.Lymph node status has been found to be a predictor of recurrent disease as well as 5-year survival in esophageal malignancies.In human papillomavirus driven cancers,e.g.cervical,anogenital,head and neck cancers,associated lymph nodes with a high viral load suggest metastatic lymph node involvement.Thus,human papillomavirus could potentially be useful as a marker of micro-metastases.To date,there have been no reported studies regarding human papillomavirus involvement in lymph nodes of metastatic esophageal adenocarcinoma.This review highlights the importance of investigating human papillomavirus in lymph node metastasis of esophageal adenocarcinoma based on data derived from other human papillomavirus driven cancers.展开更多
BACKGROUND： Gender differences have been reported in some common mental disorders. However, few studies have monitored gender differences in individuals with delirium. OBJECTIVE： To explore gender differences in cha...BACKGROUND： Gender differences have been reported in some common mental disorders. However, few studies have monitored gender differences in individuals with delirium. OBJECTIVE： To explore gender differences in challenging behaviors, management and outcomes in age-matched elderly patients with delirium.DESIGN, TIME AND SETTING： A retrospective cohort study was performed in the Bankstown-Lidcombe Hospital, Sydney, Australia, from October 2008 to April 2009. METHODS： Patients, aged 65-90 years, diagnosed with delirium according to the International Classification of Diseases （ICD）-10 in the Psychogeriatric Unit of Bankstown Lidcombe Hospital from January 2002 to October 2008 were reviewed. All the patients were measured according to the Confusion Assessment Method upon admission. Those who developed delirium during hospitalization were excluded.MAIN OUTCOME MEASURES： Cause of delirium, wandering, aggression, duration of delirium, physical restraint, use of antipsychotic medicine, recovery from delirium, discharge back home, length of stay, one-to-one nursing care, falls and absconding rate.RESULTS： The 131 age-matched delirious patients comprised 54 males and 77 females. The behavioral disorders of wandering [odds ration （OR） = 2.612, 95% confidence interval （CI） = 1.26 -5.413, P = 0.009] and aggression （OR = 2.243, 95% CI = 1.028 - 4.891, P= 0.04） were more frequent in males than in females. More males received one-to-one nursing care （OR = 4.114, 95% CI = 1.355 - 12.491, P = 0.008）, were more likely to receive antipsychotic medications （OR = 2.24, 95% CI = 1.095-4.583, P = 0.021） and more likely to be physically restrained （OR = 2.07, 95% CI = 1.02-1.02, P = 0.043） compared with female patients. All absconding patients （3/131, 2.3%） were male. In addition, male patients displayed a greater falling rate compared with females （OR = 4.57, 95% CI= 1.519-13.722, P = 0.004）.CONCLUSION： There are gender differences in challenging behaviors, management and outcomes in elderly delirious patients. Males with delirium display more challenging behaviors that require physical restraint and pharmacological management including wandering and aggression; males also abscond and have a higher rate of falls compared with female patients.展开更多
The accumulation and aggregation of alpha-synuclein(α-syn)in several tissue including the brain is a major pathological hallmark in Parkinson’s disease(PD).In this study,we show that α-syn can be taken up by primar...The accumulation and aggregation of alpha-synuclein(α-syn)in several tissue including the brain is a major pathological hallmark in Parkinson’s disease(PD).In this study,we show that α-syn can be taken up by primary human cortical neurons,astrocytes and skin-derived fibroblasts in vitro.Our findings that brain and peripheral cells exposed to α-syn can lead to impaired mitochondrial function,leading to cellular degeneration and cell death,provides additional evidence for the involvement of mitochondrial dysfunction as a mechanism of toxicity of α-syn in human cells.展开更多
Background：Percutaneous endoscopic gastrostomy （PEG） feeding is widely used in stroke patients suffering from persistent dysphagia;however,predicting the risks and benefits of PEG insertion in the individual patien...Background：Percutaneous endoscopic gastrostomy （PEG） feeding is widely used in stroke patients suffering from persistent dysphagia;however,predicting the risks and benefits of PEG insertion in the individual patient is difficult.The aim of our study was to investigate if candidate risk factors could predict short-term mortality risk in poststroke patients who had PEG tube insertion for persistent dysphagia.Methods：This was a retrospective study of 3504 consecutive stroke patients admitted to two metropolitan hospitals during the period January 2005 to December 2013 and who also underwent PEG insertion for feeding due to persistent dysphagia.Results：A total of 102 patients were included in the study.There were 22 deaths in 6 months after insertion of PEG tubes and 20 deaths of those occurred within 3 months post PEG.Those who survived beyond 6 months showed significantly lower mean age （75.9 ± 9.0 years vs.83.0 ± 4.9 years,P 〈 0.001）,a lower mean American Society of Anesthesia （ASA） score （3.04 ± 0.63 vs.3.64 ± 0.58,P 〈 0.001） compared to nonsurvivors.In multiple Logistic,age （P =0.004,odds ratio [OR] =1.144;95% confidence interval [CI]：1.044-1.255）;ASA （P =0.002,OR =5.065;95% CI：1.815-14.133） and albumin level pre-PEG insertion （P =0.033,OR =0.869;95% CI：0.764-0.988）were the independent determinants of mortality respectively.Conclusions：We propose that age,ASA score and albumin level pre-PEG insertion to be included as factors to assist in the selection of patients who are likely to survive more than 3 months post PEG insertion.展开更多
基金Supported by The Clinical trial(Clinical Trials.gov Identifier:NCT01896635)this study was performed in conjunction with has received funding from the Broad Medical Research Program at CCFAthe GESA IBD Clinical Research Grant
文摘AIM: To explore gastroenterologist perceptions towards and experience with faecal microbiota transplantation(FMT).METHODS: A questionnaire survey consisting of 17 questions was created to assess gastroenterologists' attitude towards and experience with FMT. This was anonymously distributed in hard copy format amongst attendees at gastroenterology meetings in Australia between October 2013 and April 2014. Basic descriptive statistical analyses were performed.RESULTS: Fifty-two clinicians participated. Twenty one percent had previously referred patients for FMT,8% more than once. Ninety percent would refer patients with Clostridium difficile infection(CDI) for FMT if easily available,37% for ulcerative colitis,13% for Crohn's disease and 6% for irritable bowel syndrome. Six percent would not refer any indication,including recurrent CDI. Eighty-six percent would enroll patients in FMT clinical trials. Thirty-seven percent considered the optimal mode of FMT administration transcolonoscopic,17% nasoduodenal,13% enema and 8% oral capsule. The greatest concerns regarding FMT were: 42% lack of evidence,12% infection risk,10% non infectious adverse effects/lack of safety data,10% aesthetic,10% lack of efficacy,4% disease exacerbation,and 2% inappropriate use; 6% had no concerns. Seventy seven percent believed there is a lack of accessibility while 52% had an interest in learning how to provide FMT. Only 6% offered FMT at their institution.CONCLUSION: Despite general enthusiasm,most gastroenterologists have limited experience with,or access to,FMT. The greatest concerns were lack of supportive evidence and safety issues. However a significant proportion would refer indications other than CDI for FMT despite insufficient evidence. These data provide guidance on where education and training are required.
文摘AIM To systematically review the literature on women with both diabetes in pregnancy(DIP) and depression during or after pregnancy. METHODS In this systematic literature review, PubM ed/MEDLINE and EMBASE were searched(13 November 2015) using terms for diabetes(type 1, type 2, or gestational), depression, and pregnancy(no language or date restrictions). Publications that reported on women who had both DIP(any type) and depression or depressive symptoms before, during, or within one year after pregnancy were considered for inclusion. All study types were eligible for inclusion; conference abstracts, narrative reviews, nonclinical letters, editorials, and commentaries were excluded, unless they provided treatment guidance.RESULTS Of 1189 articles identified, 48 articles describing women with both DIP and depression were included(sample sizes 36 to > 32 million). Overall study quality was poor; most studies were observational, and only 12 studies(mostly retrospective database studies) required clinical depression diagnosis. The prevalence of concurrent DIP(any type) and depression in general populations of pregnant women ranged from 0% to 1.6%(median 0.61%; 12 studies). The prevalence of depression among women with gestational diabetes ranged from 4.1% to 80%(median 14.7%; 16 studies). Many studies examined whether DIP was a risk factor for depression or depression was a risk factor for DIP. However, there was no clear consensus for either relationship. Importantly, we found limited guidance on the management of women with both DIP and depression. CONCLUSION Given the increasing prevalence of diabetes and depression, high-quality research and specific guidance for management of pregnant women with both conditions are warranted.
文摘Background Falls are the most frequently reported adverse events in inpatient settings. We conducted a retrospective case-control study of inpatient falls within aged care wards in a tertiary hospital to investigate the associated characteristics of elderly patients suffering from falls and fall-related characteristics. Methods Consecutive retrospective cross-sectional design spanned July 2006 to December 2008. Patient group： Information on all aged care inpatients who suffered from 1 or more falls was extracted from Incident Information Management System （IIMS）. Further details about the particular admission（s） were obtained from patients＇ medical records, e.g., patients＇ characteristics and circumstances surrounding the falls. Randomly selected aged care patients who did not suffer from a fall and who were discharged from the hospital in the same period served control group. Characteristics among patients with single fall and recurrent falls, as well as non-railers were compared. Results Of the 438 falls evaluated, 71.9% occurred in patients＇ room and 18.9% in patients＇ bathroom/toilet. The common activities were moving/transferring and taking shower/toileting, respectively, 70.3%, 12.1% while occurring falls; and time of falls had a high peak during 9：00-11：00 a.m. Many were unassisted while falling. The common contributing factors for fall were intrinsic factors. Patients with recurrent falls were more likely to have lower Mini-Mental State Examination （MMSE） score. Logistic regression analysis showed length of stay longer than five weeks, dementia and stroke were independent risk factors for recurrent falls; and living in hostel/nursing home preadmission, needing assistance with mobility, cognitive impairment, stroke, incontinence and arthritis/osteoporosis were independent risk factors for fall. Conclusions In an aged care ward, falls are independently associated with recurrent factors. Cognitive impairment/dementia was a strong risk factor for falls, and main causes leading to fall were intrinsic factors. For patients with cognitive impairment/dementia and behavioral disorder providing special and effective interventions is of paramount importance for reducing the incidence of fall in an aged care ward in hospital settings.
文摘Objective:Photoselective vaporization of the prostate(PVP)is a widely performed surgical procedure for benign prostatic obstruction.This approach has become particular favoured for men on anti-platelet and anticoagulation agents such as clopidogrel and warfarin but there is minimal published experience in the setting of novel oral anticoagulants(NOACs).This study was to examine the perioperative outcomes in men on NOACs undergoing PVP,with particular reference to perioperative morbidity.Methods:A retrospective analysis of PVP datasets was undertaken from three centres in Sydney(Australia),Toulouse(France)and Boston(USA).Subjects who had been treated whilst on NOACs without discontinuation or bridging were identified.Perioperative outcomes and treatment parameters were examined and morbidity recorded according to Clavien-Dindo(CD)classification.Results:There were a total of 20 subjects who had undergone PVP whilst NOACs had been continued during the perioperative period.The mean age was 776.5 years.The mean prostate volume,energy utilization and vaporisation time was 9456 mL,301211 kJ,and 3521 min respectively.The mean postoperative duration of catheterization and duration of hospitalization was 2.22.4 days and 2.42.4 days respectively.There was a single episode of urinary tract infection and four subjects required re-catheterisation for non-hematuric retentions.Conclusions:This study supports the safety of men on NOACs undergoing PVP.Whilst this study represents the largest experience of PVP in these men,larger studies are necessary to confirm the safety of PVP in this group of men undergoing BPH-related surgery.
文摘High-risk human papillomavirus has been suggested as a risk factor for esophageal adenocarcinoma.Tumor human papillomavirus status has been reported to confer a favorable prognosis in esophageal adenocarcinoma.The size of the primary tumor and degree of lymphatic spread determines the prognosis of esophageal carcinomas.Lymph node status has been found to be a predictor of recurrent disease as well as 5-year survival in esophageal malignancies.In human papillomavirus driven cancers,e.g.cervical,anogenital,head and neck cancers,associated lymph nodes with a high viral load suggest metastatic lymph node involvement.Thus,human papillomavirus could potentially be useful as a marker of micro-metastases.To date,there have been no reported studies regarding human papillomavirus involvement in lymph nodes of metastatic esophageal adenocarcinoma.This review highlights the importance of investigating human papillomavirus in lymph node metastasis of esophageal adenocarcinoma based on data derived from other human papillomavirus driven cancers.
文摘BACKGROUND： Gender differences have been reported in some common mental disorders. However, few studies have monitored gender differences in individuals with delirium. OBJECTIVE： To explore gender differences in challenging behaviors, management and outcomes in age-matched elderly patients with delirium.DESIGN, TIME AND SETTING： A retrospective cohort study was performed in the Bankstown-Lidcombe Hospital, Sydney, Australia, from October 2008 to April 2009. METHODS： Patients, aged 65-90 years, diagnosed with delirium according to the International Classification of Diseases （ICD）-10 in the Psychogeriatric Unit of Bankstown Lidcombe Hospital from January 2002 to October 2008 were reviewed. All the patients were measured according to the Confusion Assessment Method upon admission. Those who developed delirium during hospitalization were excluded.MAIN OUTCOME MEASURES： Cause of delirium, wandering, aggression, duration of delirium, physical restraint, use of antipsychotic medicine, recovery from delirium, discharge back home, length of stay, one-to-one nursing care, falls and absconding rate.RESULTS： The 131 age-matched delirious patients comprised 54 males and 77 females. The behavioral disorders of wandering [odds ration （OR） = 2.612, 95% confidence interval （CI） = 1.26 -5.413, P = 0.009] and aggression （OR = 2.243, 95% CI = 1.028 - 4.891, P= 0.04） were more frequent in males than in females. More males received one-to-one nursing care （OR = 4.114, 95% CI = 1.355 - 12.491, P = 0.008）, were more likely to receive antipsychotic medications （OR = 2.24, 95% CI = 1.095-4.583, P = 0.021） and more likely to be physically restrained （OR = 2.07, 95% CI = 1.02-1.02, P = 0.043） compared with female patients. All absconding patients （3/131, 2.3%） were male. In addition, male patients displayed a greater falling rate compared with females （OR = 4.57, 95% CI= 1.519-13.722, P = 0.004）.CONCLUSION： There are gender differences in challenging behaviors, management and outcomes in elderly delirious patients. Males with delirium display more challenging behaviors that require physical restraint and pharmacological management including wandering and aggression; males also abscond and have a higher rate of falls compared with female patients.
基金This work was supported by the UNSW Faculty of Medicine Research Grant to Dr Nady BraidyDr Nady Braidy is also the recipient of an Alzheimer’s Australia Viertel Foundation and the National Health and Medical Research Council Early Career Research Fellowship at the University of New South Wales.This work has been also supported by the Alzheimer’s Association(grant#IIRG-08–89545)the Rebecca Cooper foundation(Australia).
文摘The accumulation and aggregation of alpha-synuclein(α-syn)in several tissue including the brain is a major pathological hallmark in Parkinson’s disease(PD).In this study,we show that α-syn can be taken up by primary human cortical neurons,astrocytes and skin-derived fibroblasts in vitro.Our findings that brain and peripheral cells exposed to α-syn can lead to impaired mitochondrial function,leading to cellular degeneration and cell death,provides additional evidence for the involvement of mitochondrial dysfunction as a mechanism of toxicity of α-syn in human cells.
文摘Background：Percutaneous endoscopic gastrostomy （PEG） feeding is widely used in stroke patients suffering from persistent dysphagia;however,predicting the risks and benefits of PEG insertion in the individual patient is difficult.The aim of our study was to investigate if candidate risk factors could predict short-term mortality risk in poststroke patients who had PEG tube insertion for persistent dysphagia.Methods：This was a retrospective study of 3504 consecutive stroke patients admitted to two metropolitan hospitals during the period January 2005 to December 2013 and who also underwent PEG insertion for feeding due to persistent dysphagia.Results：A total of 102 patients were included in the study.There were 22 deaths in 6 months after insertion of PEG tubes and 20 deaths of those occurred within 3 months post PEG.Those who survived beyond 6 months showed significantly lower mean age （75.9 ± 9.0 years vs.83.0 ± 4.9 years,P 〈 0.001）,a lower mean American Society of Anesthesia （ASA） score （3.04 ± 0.63 vs.3.64 ± 0.58,P 〈 0.001） compared to nonsurvivors.In multiple Logistic,age （P =0.004,odds ratio [OR] =1.144;95% confidence interval [CI]：1.044-1.255）;ASA （P =0.002,OR =5.065;95% CI：1.815-14.133） and albumin level pre-PEG insertion （P =0.033,OR =0.869;95% CI：0.764-0.988）were the independent determinants of mortality respectively.Conclusions：We propose that age,ASA score and albumin level pre-PEG insertion to be included as factors to assist in the selection of patients who are likely to survive more than 3 months post PEG insertion.
