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Neurohormonal therapy, which includes beta-blockers and angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (ACEi/ARBs), is the cornerstone of heart failure with reduced ejection fraction (HFrEF) treatment. While neurohormonal therapies have demonstrated efficacy in randomized clinical trials, older patients, which now comprise the majority of HFrEF patients, were underrepresented in those original trials. This study aimed to determine the association between short- (30 day) and long-term (1year) mortality and the use of neurohormonal therapy in HFrEF patients, across the age spectrum.

This is a population-based, retrospective, cohort study between January 2008 and December 2015. We used 100% Medicare Parts A and B and a random 40% sample of Part D to create a cohort of 295,494 fee-for-service beneficiaries with at least one hospitalization for HFrEF between 2008 and 2015. All analyses were performed between May 2019 and July 2020.

We used Part D data to determine exposure to beta-blocker and ACEi and ARB therapy.

We found that in 295,494 patients admitted for HFrEF between 2008 and 2015, the average age was 80 years, 54% were female and 17% were non-white. The baseline mortality rate was higher among those aged ≥85, but the mortality benefits of neurohormonal therapy were preserved across the age spectrum. Among those ≥85 years old, the hazard ratio for death within 30 days was 0.59 (95% confidence interval [CI] 0.56-0.62; p < 0.001) for beta-blockers and 0.47 (95% CI 0.44-0.49; p < 0.001) for ACEi/ARBs. The hazard ratio for death within 1year was 0.37-0.56 (95% CI 0.35-0.58; p < 0.001) for beta-blockers and 0.38-0.53 (95% CI 0.37-0.55; p < 0.001) for ACEi/ARB.

At a population level, neurohormonal therapy was associated with lower short- and long-term mortality across the age spectrum.

At a population level, neurohormonal therapy was associated with lower short- and long-term mortality across the age spectrum.

To determine the effect of a probiotic supplement containing native Lactobacillus acidophilus (L. acidophilus) and Bifidobacterium animalis lactis (B. lactis) on 24-hour urine oxalate in recurrent calcium stone formers with hyperoxaluria. Moreover, the in-vitro oxalate degradation capacity and the intestinal colonization of consumed probiotics were evaluated.

The oxalate degrading activity of L.acidophilus and B.lactis were evaluated in-vitro. selleck chemical The presence of oxalyl-CoA decarboxylase (oxc) gene in the probiotic species was assessed. One hundred patients were randomized to receive the probiotic supplement or placebo for four weeks. The 24-hour urine oxalate and the colonization of consumed probiotics were assessed after weeks four and eight.

Although the oxc gene was present in both species, only L.acidophilus had a good oxalate degrading activity, in-vitro. Thirty-four patients from the probiotic and thirty patients from the placebo group finished the study. The urine oxalate changes were not significantly different between groups (57.21 ± 11.71 to 49.44 ± 18.14 mg/day for probiotic, and 56.43 ± 9.89 to 50.47 ± 18.04 mg/day for placebo) (P=.776). The probiotic consumption had no significant effect on urine oxalate, both in univariable (P=.771) and multivariable analyses (P =.490). The consumed probiotics were not detected in the stool samples of most participants.

Our results showed that the consumption of a probiotic supplement containing L.acidophilus and B. lactis did not affect urine oxalate. The results may be due to a lack of bacterial colonization in the intestine.

Our results showed that the consumption of a probiotic supplement containing L. acidophilus and B. lactis did not affect urine oxalate. The results may be due to a lack of bacterial colonization in the intestine.

To explore the risk factors and predictive factors of systemic inflammatory response syndrome (SIRS) after flexible ureteroscopy (fURS) for upper urinary tract stones.

Patients experienced fURS from January 2014 to September 2019 were retrospectively analyzed, which were divided into the SIRS group and non-SIRS group. Clinical data of all patients, including gender, age, American society of anesthesia score, diabetes, etc., were collected. Univariate and multivariate logistic regression was used to determine the independent risk factors for SIRS after fURS, and the receiver operating characteristic (ROC) curve was drawn to verify the validity of results. In addition, patients from October 2019 to January 2020 were prospectively collected to verify the results.

A total of 369 patients were retrospectively included. Univariate analysis showed significant differences in postoperative stone residuals (P = 0.039), preoperative neutrophil/ lymphocyte ratio (NLR) (P < 0.001), and lymphocyte/monocyte ratio (LMR) (P = 0.001) between two groups. Further, preoperative NLR and postoperative stone residuals were independent according to multivariate logistic regression analysis. The optimal cut-off value of preoperative NLR by ROC curve was 2.61, and the area under ROC curve was 77.9%. Prospective analysis based on 53 patients showed that the incidence of SIRS in patients with NLR > 2.61 was significantly higher than that in other patients. (RR = 4.932, P = 0.040).

Preoperative NLR can be used as a predictive factor for SIRS in patients with fURS according to our study. It may provide an evidence for clinicians to make preoperative decisions or medical plans.

Preoperative NLR can be used as a predictive factor for SIRS in patients with fURS according to our study. It may provide an evidence for clinicians to make preoperative decisions or medical plans.

To assess the prognostic effect of blood urea nitrogen to serum albumin ratio in patients with Fournier’s gangrene (FG) in a referral center in order to reduce the mortality of FG patients.

Patients with FG were admitted and enrolled consecutively in this study from March 2008 to April 2020. Statistical analysis was done to evaluate the differences between the two groups and to identify the best cutoff value to predict mortality and the need for intensive care.

Of all 114 patients, 46 patients (40.35%) died in the course of hospitalization and 40 entered the study. No variable manifested a notable difference except for the BUN to albumin ratio, which was significantly different (P-value = 0.045). The ratio of BUN to albumin was not associated with any other variables and was independently a predictor of death in FG patients.

The ratio of BUN to albumin was significantly different among deceased and survived patients with FG. Therefore, more studies with a larger sample size are still needed to access this parameter properly.