bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic compression anastomosis with atypical anastomosis for anastomotic stenosis of the sigmoid colon: a case report
Authors: Kamada Teppei , Ohdaira Hironori , Hoshimoto Sojun , Narihiro Satoshi , Suzuki Norihiko , Marukuchi Rui , Takeuchi Hideyuki , Yoshida Masashi , Yamanouchi Eigoro , Suzuki Yutaka
Published: April 2020

Background

Magnetic compression anastomosis (MCA) is mainly applied in the gastrointestinal and biliary tracts through a nonsurgical procedure that can create an anastomosis similar to that obtained through surgery.

Magnets usually adsorb in the end-to-end direction (end-to-end anastomosis), exert a strong magnetic force and create an anastomosis according to the size of the magnets.

Regular endoscopic dilation is required to prevent restenosis when the anastomotic size is small.

We report a case in which MCA was successfully used to treat anastomotic stenosis of the sigmoid colon; the magnets adsorbed in the side-to-side direction rather than the end-to-end direction and generated a wide anastomosis in a short time that did not require endoscopic dilation.

Case presentation

An 81-year-old woman was admitted to our hospital to treat anastomotic stenosis of the sigmoid colon for closure of transverse colostomy. Two years prior, the Hartmann operation and drainage were performed at other hospitals due to perforated diverticulitis of the sigmoid colon. Obstruction of the sigmoid colostomy occurred, and a transverse colostomy was performed. One year after the first surgery, high anterior resection was performed, but anastomotic stenosis occurred, causing obstruction. MCA was planned because the patient had a history of multiple operations and was expected to have strong adhesions postoperatively. MCA was safely performed, but two magnets were accidently adsorbed in the side-to-side direction. The magnet position could not be changed. The two magnets were expected to move and adsorb in an end-to-end direction naturally due to bowel movements. The magnets that adsorbed in the side-to-side direction dropped from the anus 5 days after treatment, and the anastomosis was observed by colonoscopy. Three ileus tubes were placed from the transverse colostomy beyond the anastomosis to prevent restenosis. Colonoscopy showed that the anastomosis diameter was wider than expected at 14 days after treatment, and endoscopic dilation was not necessary. No complications were observed in this patient’s postoperative course. Finally, closure of the patient’s colostomy was successfully performed.

Conclusions

MCA with side-to-side anastomosis generated a wide anastomosis in a short time.
Neonatal diet impacts liver mitochondrial bioenergetics in piglets fed formula or human milk
Authors: Carvalho Eugenia , Adams Sean H. , Børsheim Elisabet , Blackburn Michael L. , Ono-Moore Kikumi D. , Cotter Matthew , Bowlin Anne K. , Yeruva Laxmi
Published: April 2020

Background

Neonatal diet impacts many physiological systems and can modify risk for developing metabolic disease and obesity later in life. Less well studied is the effect of postnatal diet (e.g., comparing human milk (HM) or milk formula (MF) feeding) on mitochondrial bioenergetics. Such effects may be most profound in splanchnic tissues that would have early exposure to diet-associated or gut microbe-derived factors.

Methods

To address this question, we measured ileal and liver mitochondrial bioenergetics phenotypes in male piglets fed with HM or MF from day 2 to day 21 age. Ileal and liver tissue were processed for mitochondrial respiration (substrate only [pyruvate, malate, glutamate], substrate + ADP, and proton “leak” post-oligomycin; measured by Oroboros methods), mitochondrial DNA (mtDNA) and metabolically-relevant gene expression analyses.

Results

No differences between the diet groups were observed in mitochondrial bioenergetics indices in ileal tissue. In contrast, ADP-dependent liver Complex I-linked OXPHOS capacity and Complex I + II-linked OXPHOS capacity were significantly higher in MF animals relative to HM fed piglets. Interestingly, p53, Trap1, and Pparβ transcript abundances were higher in MF-fed relative to HM-fed piglets in the liver. Mitochondrial DNA copy numbers (normalized to nuclear DNA) were similar within-tissue regardless of postnatal diet, and were ~ 2–3 times higher in liver vs. ileal tissue.

Conclusion

While mechanisms remain to be identified, the data indicate that neonatal diet can significantly impact liver mitochondrial bioenergetics phenotypes, even in the absence of a change in mtDNA abundance. Since permeabilized liver mitochondrial respiration was increased in MF piglets only in the presence of ADP, it suggests that formula feeding led to a higher ATP turnover. Specific mechanisms and signals involved with neonatal diet-associated differences in liver bioenergetics remain to be elucidated.
Urinary biomarker discovery in gliomas using mass spectrometry-based clinical proteomics
Authors: Wu Jianqiang , Zhang Jun , Wei Jing , Zhao Yuanli , Gao Youhe
Published: April 2020

Background

Gliomas are the most common primary malignant brain tumors and have a poor prognosis. Early detection of gliomas is crucial to improve patient outcomes. Urine accumulates systematic body changes and thus serves as an excellent early biomarker source.

Methods

At the biomarker discovery phase, we performed a self-controlled proteomics analysis by comparing urine samples collected from five glioma patients at the time of tumor diagnosis and after surgical removal of the tumor. At the biomarker validation phase, we further validated some promising proteins using parallel reaction monitoring (PRM)-based targeted proteomics in another cohort, including glioma, meningioma, and moyamoya disease patients as well as healthy controls.

Results

Using label-free proteome quantitation (LFQ), we identified twenty-seven urinary proteins that were significantly changed after tumor resection, many of which have been previously associated with gliomas. The functions of these proteins were significantly enriched in the autophagy and angiogenesis, which are associated with glioma development. After targeted proteomics validation, we identified a biomarker panel (AACT, TSP4, MDHM, CALR, LEG1, and AHSG) with an area under the curve (AUC) value of 0.958 for the detection of gliomas. Interestingly, AACT, LEG1, and AHSG are also potential cerebrospinal fluid or blood biomarkers of gliomas.

Conclusions

Using LFQ and PRM proteome quantification, we identified candidate urinary protein biomarkers with the potential to detect gliomas. This study will also provide clues for future biomarker studies involving brain diseases.
Child development and nutritional status in 12–59 months of age in resource limited setting of Ethiopia
Authors: Workie Shimelash Bitew , Mekonen Tesfa , Mekonen Tefera Chane , Fekadu Wubalem
Published: April 2020

Background

Early years of life are period of maximal growth and development of human brain. Development of young child is influenced by biological endowment and health of child, nutritional status of child, relationships with primary caregivers, family, and support systems in the community. This study was aimed to assess childhood development in relation to their nutritional status.

Method

Community-based cross-sectional study was employed. Multi–stage systematic random sampling technique was used to select 626 children aged 12-59 months with mother/caregivers’ pairs in Wolaita district in 2015. Child development assessment was done using third edition of age and stage questionnaire. Height and weight were measured by trained data collectors then the WHO Anthro version 3.2.2 software was used to convert nutritional data indices. Data were entered into Epi-info version 3.3.5 and was exported and analyzed using STATA version 14. Correlation and multiple logistic regression were used.

Result

High risk of developmental problem in children were 19.0% with 95% CI (16.06%, 22.3%), and it is expressed as communication 5.8%, gross motor 6.1%, fine motor 4.0%, personal social 8.8%, and problem solving 4.1%. One-third (34.1%) of the study participants were stunted while 6.9% and 11.9% of them were wasted and underweight respectively. Weight-for-age (WAZ) and height-for-age positively correlated with all five domains of development, i.e., with communication, gross motor, fine motor, personal social, and problem solving (r = 0.1 − 0.23; p < 0.0001, and r = 0.131 − 0.249; p < 0.0001) respectively.

Conclusion and recommendation

Overall child development was directly related with nutritional status. So, available resources should be offered to decrease children undernutrition. Further assessment on childhood development of children is necessary
First COVID-19 infections in the Philippines: a case report
Authors: Edrada Edna M. , Lopez Edmundo B. , Villarama Jose Benito , Salva Villarama Eumelia P. , Dagoc Bren F. , Smith Chris , Sayo Ana Ria , Verona Jeffrey A. , Trifalgar-Arches Jamie , Lazaro Jezreel , Balinas Ellen Grace M. , Telan Elizabeth Freda O. , Roy Lynsil , Galon Myvie , Florida Carl Hill N. , Ukawa Tatsuya , Villanueva Annavi Marie G. , Saito Nobuo , Nepomuceno Jean Raphael , Ariyoshi Koya , Carlos Celia , Nicolasora Amalea Dulcene , Solante Rontgene M.
Published: April 2020

Background

The novel coronavirus (COVID-19) is responsible for more fatalities than the SARS coronavirus, despite being in the initial stage of a global pandemic. The first suspected case in the Philippines was investigated on January 22, 2020, and 633 suspected cases were reported as of March 1. We describe the clinical and epidemiological aspects of the first two confirmed COVID-19 cases in the Philippines, both admitted to the national infectious disease referral hospital in Manila.

Case presentation

Both patients were previously healthy Chinese nationals on vacation in the Philippines travelling as a couple during January 2020. Patient 1, a 39-year-old female, had symptoms of cough and sore throat and was admitted to San Lazaro Hospital in Manila on January 25. Physical examination was unremarkable.Influenza B, human coronavirus 229E,Staphylococcus aureusandKlebsiella pneumoniaewere detected by PCR on initial nasopharyngeal/oropharyngeal (NPS/OPS) swabs. On January 30, SARS-CoV-2 viral RNA was reported to be detected by PCR on the initial swabs and she was identified as the first confirmed COVID-19 case in the Philippines. Her symptoms resolved, and she was discharged. Patient 2, a 44-year-old male, had symptoms of fever, cough, and chills.Influenza BandStreptococcus pneumoniaewere detected by PCR on initial NPS/OPS swabs. He was treated for community-acquired pneumonia with intravenous antibiotics, but his condition deteriorated and he required intubation. On January 31, SARS-CoV-2 viral RNA was reported to be detected by PCR on the initial swabs, and he was identified as the 2nd confirmed COVID-19 infection in the Philippines. On February 1, the patient’s condition deteriorated, and following a cardiac arrest, it was not possible to revive him. He was thus confirmed as the first COVID-19 death outside of China.

Conclusions

This case report highlights several important clinical and public health issues. Despite both patients being young adults with no significant past medical history, they had very different clinical courses, illustrating how COVID-19 can present with a wide spectrum of disease. As of March 1, there have been three confirmed COVID-19 cases in the Philippines. Continued vigilance is required to identify new cases.
Welling-up of cerebrospinal fluid is a sign of remote supratentorial hemorrhage during microvascular decompression: a case report
Authors: Yakufujiang Maidinamu , Higuchi Yoshinori , Wakita Shogo , Horiguchi Kentaro , Ikegami Shiro , Iwadate Yasuo
Published: April 2020

Background

Subdural hematoma (SDH) at a remote operative site is uncommon following neurosurgical procedures. However, supratentorial SDH is one of the rare complications following microvascular decompression (MVD). We report a case of supratentorial SDH following MVD. The welling of cerebrospinal fluid (CSF) in the cerebellomedullary fissure was observed unexpectedly during the dissection. It is a signal case that can improve our understanding of the occurrence of such rare complications and of possible mechanisms.

Case presentation

A 54-year-old woman was diagnosed with left hemifacial spasm (HFS) and had been receiving botulinum toxin injections since 10 years before surgery. CSF welling-up in the cerebellopontine cistern was noticed by the surgeon during the arachnoid dissection. MVD was performed completely. A thin supratentorial SDH was found on the right side (contralateral) on immediate postoperative computed tomography (CT). The SDH was asymptomatic, and the size of hematoma did not increase in follow-up CT scans after surgery. During the follow-up period, she was relieved of HFS. CSF welling-up can be considered the time of initiation of the hemorrhage.

Conclusion

Limited case reports of supratentorial SDH following MVD have been published, and none of them have reported time of initiation of the hemorrhage. The phenomenon of abnormal CSF welling-up in the cistern could be a sign of remote supratentorial hemorrhage.
Adsorption performance of coated bentonite via graphene oxide
Authors: Shaarawy H H , Hussein H S , Kader E Abdel , Hussien Nabila H , Hawash S I
Published: April 2020

Background

The nano-adsorbents present considerable decontamination potential due to their unique characteristics. This study aimed to investigate the adsorption efficiency and capacity of synthesized nano graphene oxide coated layer over Egyptian clays (bentonite, kaolinite and feldspar) as substrate. The experimental work involves nano graphene oxide coating using acid dehydration via sulfuric acid in presence of different percentage of sugar (fine powder from 1 to 7%), followed by thermal activation to improve the adsorption capacity of natural clay that is locally available in Egypt. Several operating parameters were studied to prepare the superior adsorbent (type of substrate, sulfuric acid concentration, sugar concentration and contact time).

Results

The optimum preparation conditions of nano graphene oxide coated bentonite (NGOCB) adsorbent were bentonite substrate 1 kg, sulfuric acid concentration 1.5 kg/kg clay, sugar fine powder 50 g/kg clay, water 3000 ml/kg clay, and stirring time of 30 min at 100 °C. The morphology characterization showed that the deposited graphene oxide layer is in the nano form (6 to 33 nm). Sets of experiments were conducted to evaluate the adsorption performance of synthesized NGOCB for removal of methylene blue (MB) dye from aqueous solutions. Effect of initial dye concentration, contact time, pH and temperature on the adsorption capacity of the modified adsorbent were studied. The capacity of the prepared nano graphene oxide coated bentonite adsorbent was 1000 mg/g.

Conclusions

The removal efficiency of nano graphene coated clay reached to 99.9% that indicates the Egyptian bentonite could be employed as a low-cost absorbent for dye removal.
Engaging Patients in Precision Oncology: Development and Usability of a Web-Based Patient-Facing Genomic Sequencing Report
Authors: Solomon Ilana B. , McGraw Sarah , Shen Jenny , Albayrak Adem , Alterovitz Gil , Davies Melanie , Del Vecchio Fitz Catherine , Freedman Rachel A. , Lopez Lisa N. , Sholl Lynette M. , Van Allen Eliezer , Mortimer Joanne , Fakih Marwan , Pal Sumanta , Reckamp Karen L. , Yuan Yuan , Gray Stacy W.
Published: April 2020

PURPOSE

Evidence-based somatic and germline sequencing has transformed cancer care and improves patient outcomes. However, patients’ low genetic literacy and misunderstanding of their own genomic results poses a threat to the realization of precision oncology. To optimize patient genomic comprehension, we developed a Web-based, patient-directed, genomic sequencing education and return-of-results tool, HOPE-Genomics.

METHODS

The HOPE-Genomics prototype included somatic and germline sequencing results, embedded multimedia genomic education, and interactive features (eg, request for genetic counseling). Between January and April 2018, we elicited feedback on tool usability and comprehensiveness through participant surveys, 4 focus groups of patients with cancer and their family members, and 3 provider focus groups (comprising 8 patients, 5 family members, and 19 providers).

RESULTS

We identified themes in patient/family tool-related responses, including the desire to view a patient-friendly report, a desire to receive multiple types of genomic information (eg, prognostic and uncertain), high acceptability of report content, and interest in tool-enabled access to genetic counseling. Major themes from the clinician focus groups included believing the tool could help patients formulate questions and facilitate patients’ communication of results to family members. However, there were diverse responses from all participants in terms of tool implementation (ie, timing and nature of report release). Some participants preferred report release before meeting with the provider, and others preferred it during the appointment. Additionally, some clinicians were concerned about providing prognostic and treatment information through the tool.

CONCLUSION

There was high acceptability and interest from patients, family members, and providers in a patient-directed genomics report. Future work will determine whether direct-to-patient reporting of genomic results improves patient knowledge, care engagement, and compliance with genomically guided interventions.
Hypermethylated RASSF1A as Circulating Tumor DNA Marker for Disease Monitoring in Neuroblastoma
Authors: van Zogchel Lieke M. J. , van Wezel Esther M. , van Wijk Jalenka , Stutterheim Janine , Bruins Wassilis S. C. , Zappeij-Kannegieter Lily , Slager Tirza J. E. , Schumacher-Kuckelkorn Roswitha , Verly Iedan R. N. , van der Schoot C. Ellen , Tytgat Godelieve A. M.
Published: April 2020

PURPOSE

Circulating tumor DNA (ctDNA) has been used for disease monitoring in several types of cancer. The aim of our study was to investigate whether ctDNA can be used for response monitoring in neuroblastoma.

METHODS

One hundred forty-nine plasma samples from 56 patients were analyzed by quantitative polymerase chain reaction (qPCR) for total cell free DNA (cfDNA; albumin and β-actin) and ctDNA (hypermethylated RASSF1A). ctDNA results were compared with mRNA-based minimal residual disease (qPCR) in bone marrow (BM) and blood and clinical patient characteristics.

RESULTS

ctDNA was detected at diagnosis in all patients with high-risk and stage M neuroblastoma and in 3 of 7 patients with localized disease. The levels of ctDNA were highest at diagnosis, decreased during induction therapy, and not detected before or after autologous stem-cell transplantation. At relapse, the amount of ctDNA was comparable to levels at diagnosis. There was an association between ctDNA and blood or BM mRNA, with concordant results when tumor burden was high or no tumor was detected. The discrepancies indicated either low-level BM infiltration (ctDNA negative/mRNA positive) or primary tumor/soft tissue lesions with no BM involvement (ctDNA positive/mRNA negative).

CONCLUSION

ctDNA can be used for monitoring disease in patients with neuroblastoma. In high-risk patients and all patients with stage M at diagnosis, ctDNA is present. Our data indicate that at low tumor load, testing of both ctDNA and mRNA increases the sensitivity of molecular disease monitoring. It is likely that ctDNA can originate from both primary tumor and metastases and may be of special interest for disease monitoring in patients who experience relapse in other organs than BM.
Tumor-Infiltrating Neutrophils Predict Poor Survival of Non-Functional Pancreatic Neuroendocrine Tumor
Authors: Zhang Wu-Hu , Wang Wen-Quan , Gao He-Li , Xu Shuai-Shuai , Li Shuo , Li Tian-Jiao , Han Xuan , Xu Hua-Xiang , Li Hao , Jiang Wang , Ye Long-Yun , Lin Xuan , Wu Chun-Tao , Yu Xian-Jun , Liu Liang
Published: April 2020

Objective

This study retrospectively characterized the immune infiltrating profile in nonfunctional pancreatic neuroendocrine tumors (NF-PanNETs).

Methods

Tumor tissues from the 109-patient Fudan cohort and a 73-patient external validation set were evaluated by immunohistochemistry for 9 immune cell types: tumor-infiltrating neutrophils (TINs), tumor-associated macrophages (TAMs), CD11c+ dendritic cells, anti-NCR1+ natural killer (NK) cells, CD4+ and CD8+ T cells, CD45RO+ memory T cells, FOXP3+ regulatory T cells (Tregs), and CD20+ B cells.

Results

TINs were primarily distributed in the intratumoral area, dendritic cells and NK cells were scattered evenly in intratumoral and stromal areas, and Tregs were rarely detected. The remaining 5 cell types were primarily present in peritumoral stroma. Total TINs (P < .001) and TAMs (P = .002) increased as NF-PanNET grade rose. Kaplan-Meier analyses showed that high intratumoral TINs, total TAMs, and stromal CD4+ T-cell infiltration correlated with shorter recurrence-free survival (RFS, P = .010, P = .027, and P = .035, respectively) and overall survival (OS, P = .017, P = .029, and P = .045, respectively). Additionally, high intratumoral CD8+ T cell infiltration correlated with prolonged RFS (P = .039). Multivariate Cox regression demonstrated that intratumoral TINs, World Health Organization (WHO) classification, and eighth edition of the American Joint Committee on Cancer tumor-node-metastasis staging system (AJCC8th TNM) were independent factors for RFS (P = .043, P = .023, and P = .029, respectively), whereas intratumoral TINs and WHO classification were independent factors for OS (P = .010 and P = .007, respectively). Furthermore, the combination of TINs, WHO classification, and AJCC8th TNM remarkably improved prognostic accuracy for RFS. These results have been verified in the external validation set.

Conclusion

Intratumoral TINs are an independent and unfavorable predictor of postoperative NF-PanNETs. A combination of TINs, WHO classification, and AJCC8th TNM could improve prognostic accuracy for RFS.
Prediction of an Acute Hypotensive Episode During an ICU Hospitalization With a Super Learner Machine-Learning Algorithm
Authors: Cherifa Ményssa , Blet Alice , Chambaz Antoine , Gayat Etienne , Resche-Rigon Matthieu , Pirracchio Romain
Published: April 2020

BACKGROUND:

Acute hypotensive episodes (AHE), defined as a drop in the mean arterial pressure (MAP) <65 mm Hg lasting at least 5 consecutive minutes, are among the most critical events in the intensive care unit (ICU). They are known to be associated with adverse outcome in critically ill patients. AHE prediction is of prime interest because it could allow for treatment adjustment to predict or shorten AHE.

METHODS:

The Super Learner (SL) algorithm is an ensemble machine-learning algorithm that we specifically trained to predict an AHE 10 minutes in advance. Potential predictors included age, sex, type of care unit, severity scores, and time-evolving characteristics such as mechanical ventilation, vasopressors, or sedation medication as well as features extracted from physiological signals: heart rate, pulse oximetry, and arterial blood pressure. The algorithm was trained on the Medical Information Mart for Intensive Care dataset (MIMIC II) database. Internal validation was based on the area under the receiver operating characteristic curve (AUROC) and the Brier score (BS). External validation was performed using an external dataset from Lariboisière hospital, Paris, France.

RESULTS:

Among 1151 patients included, 826 (72%) patients had at least 1 AHE during their ICU stay. Using 1 single random period per patient, the SL algorithm with Haar wavelets transform preprocessing was associated with an AUROC of 0.929 (95% confidence interval [CI], 0.899–0.958) and a BS of 0.08. Using all available periods for each patient, SL with Haar wavelets transform preprocessing was associated with an AUROC of 0.890 (95% CI, 0.886–0.895) and a BS of 0.11. In the external validation cohort, the AUROC reached 0.884 (95% CI, 0.775–0.993) with 1 random period per patient and 0.889 (0.768–1) with all available periods and BSs <0.1.

CONCLUSIONS:

The SL algorithm exhibits good performance for the prediction of an AHE 10 minutes ahead of time. It allows an efficient, robust, and rapid evaluation of the risk of hypotension that opens the way to routine use.
Intraoperative Electronic Alerts Improve Compliance With National Quality Program Measure for Perioperative Temperature Management
Authors: Lakha Sameer , Levin Matthew A. , Leibowitz Andrew B. , Lin Hung-Mo , Gal Jonathan S.
Published: April 2020

BACKGROUND:

Reimbursement for anesthesia services has been shifting from a fee-for-service model to a value-based model that ties payment to quality metrics. The Centers for Medicare & Medicaid Service’s (CMS) value-based payment program includes a quality measure for perioperative temperature management (Measure #424, Perioperative Temperature Management). Compliance may impose new challenges in clinical practice, data collection, and reporting. We investigated the impact of an electronic decision-support tool on adherence to this emerging standard.

METHODS:

In this retrospective observational study, perioperative temperature data were collected from cases eligible for reporting this measure to CMS from a single academic medical center before and after the implementation of an electronic decision-support tool that prompted temperature measurement and maintenance of normothermia. Proportions of measure compliance were assessed using segmented regression analysis. Proportions of intraoperative temperature measurement were also assessed, and multivariable logistic regression was performed to assess the association between patient and surgical factors and measure compliance.

RESULTS:

A total of 24,755 cases eligible for reporting in 2017 were assessed, and 25,274 cases from 2016 were included as an extended baseline. Segmented time-series regression did not show a significant baseline trend in measure compliance. Introduction of the alerts was associated with an increase in overall compliance from 84.4% (95% confidence interval [CI], 83.6%–85.2%) to 92.4% (91.4%–93.4%), and an increase in intraoperative compliance from 26.8% (25.8%–27.8%) to 71.0% (69.6%–72.4%). The association between the alerts and overall compliance was also present on multivariable analysis.

CONCLUSIONS:

Implementation of an intraoperative decision-support tool was associated with statistically significant improvement in the maintenance of normothermia in cases eligible for reporting to CMS. This led to improved compliance with Measure #424 and suggests that electronic alerts can help practices improve their performance and payment bonus eligibility.
Forecasting a Crisis: Machine-Learning Models Predict Occurrence of Intraoperative Bradycardia Associated With Hypotension
Authors: Solomon Stuart C. , Saxena Rajeev C. , Neradilek Moni B. , Hau Vickie , Fong Christine T. , Lang John D. , Posner Karen L. , Nair Bala G.
Published: April 2020

BACKGROUND:

Predictive analytics systems may improve perioperative care by enhancing preparation for, recognition of, and response to high-risk clinical events. Bradycardia is a fairly common and unpredictable clinical event with many causes; it may be benign or become associated with hypotension requiring aggressive treatment. Our aim was to build models to predict the occurrence of clinically significant intraoperative bradycardia at 3 time points during an operative course by utilizing available preoperative electronic medical record and intraoperative anesthesia information management system data.

METHODS:

The analyzed data include 62,182 scheduled noncardiac procedures performed at the University of Washington Medical Center between 2012 and 2017. The clinical event was defined as severe bradycardia (heart rate <50 beats per minute) followed by hypotension (mean arterial pressure <55 mm Hg) within a 10-minute window. We developed models to predict the presence of at least 1 event following 3 time points: induction of anesthesia (TP1), start of the procedure (TP2), and 30 minutes after the start of the procedure (TP3). Predictor variables were based on data available before each time point and included preoperative patient and procedure data (TP1), followed by intraoperative minute-to-minute patient monitor, ventilator, intravenous fluid, infusion, and bolus medication data (TP2 and TP3). Machine-learning and logistic regression models were developed, and their predictive abilities were evaluated using the area under the ROC curve (AUC). The contribution of the input variables to the models were evaluated.

RESULTS:

The number of events was 3498 (5.6%) after TP1, 2404 (3.9%) after TP2, and 1066 (1.7%) after TP3. Heart rate was the strongest predictor for events after TP1. Occurrence of a previous event, mean heart rate, and mean pulse rates before TP2 were the strongest predictor for events after TP2. Occurrence of a previous event, mean heart rate, mean pulse rates before TP2 (and their interaction), and 15-minute slopes in heart rate and blood pressure before TP2 were the strongest predictors for events after TP3. The best performing machine-learning models including all cases produced an AUC of 0.81 (TP1), 0.87 (TP2), and 0.89 (TP3) with positive predictive values of 0.30, 0.29, and 0.15 at 95% specificity, respectively.

CONCLUSIONS:

We developed models to predict unstable bradycardia leveraging preoperative and real-time intraoperative data. Our study demonstrates how predictive models may be utilized to predict clinical events across multiple time intervals, with a future goal of developing real-time, intraoperative, decision support.
Predicting Deep Hypnotic State From Sleep Brain Rhythms Using Deep Learning: A Data-Repurposing Approach
Authors: Belur Nagaraj Sunil , Ramaswamy Sowmya M. , Weerink Maud A. S. , Struys Michel M. R. F.
Published: April 2020

BACKGROUND:

Brain monitors tracking quantitative brain activities from electroencephalogram (EEG) to predict hypnotic levels have been proposed as a labor-saving alternative to behavioral assessments. Expensive clinical trials are required to validate any newly developed processed EEG monitor for every drug and combinations of drugs due to drug-specific EEG patterns. There is a need for an alternative, efficient, and economical method.

METHODS:

Using deep learning algorithms, we developed a novel data-repurposing framework to predict hypnotic levels from sleep brain rhythms. We used an online large sleep data set (5723 clinical EEGs) for training the deep learning algorithm and a clinical trial hypnotic data set (30 EEGs) for testing during dexmedetomidine infusion. Model performance was evaluated using accuracy and the area under the receiver operator characteristic curve (AUC).

RESULTS:

The deep learning model (a combination of a convolutional neural network and long short-term memory units) trained on sleep EEG predicted deep hypnotic level with an accuracy (95% confidence interval [CI]) = 81 (79.2–88.3)%, AUC (95% CI) = 0.89 (0.82–0.94) using dexmedetomidine as a prototype drug. We also demonstrate that EEG patterns during dexmedetomidine-induced deep hypnotic level are homologous to nonrapid eye movement stage 3 EEG sleep.

CONCLUSIONS:

We propose a novel method to develop hypnotic level monitors using large sleep EEG data, deep learning, and a data-repurposing approach, and for optimizing such a system for monitoring any given individual. We provide a novel data-repurposing framework to predict hypnosis levels using sleep EEG, eliminating the need for new clinical trials to develop hypnosis level monitors.
ETHYLENE INSENSITIVE 3 suppresses plants de novo root regeneration from leaf explants and mediates age-regulated regeneration decline
Authors: Li Hong , Yao Lulu , Sun Lili , Zhu Ziqiang
Published: April 2020

Powerful regeneration ability enables plants survival when plants are wounded. For example, adventitious roots can regenerate from the cutting site in detached Arabidopsis thaliana leaf explants even in the absence of any exogenous plant hormone treatment. This process is known as de novo root regeneration (DNRR). Although the developmental program underlying DNRR is revealed, the precise regulatory mechanisms during DNRR are not completely understood. Here, we show that ethylene treatment or genetic activation of transcription factor ETHYLENE INSENSITIVE 3 (EIN3) strongly suppresses DNRR rates, while a mutant lacking EIN3 and its homolog EIL1 (ein3 eil1) displays a higher DNRR capacity. Previous reports have shown that the sequential induction of WUSCHEL RELATED HOMEOBOX 11 (WOX11)/WOX12 and WOX5/WOX7 expression is required for the establishment of DNRR. We found that EIN3 directly targets WOX11 and WOX5 promoter regions to suppress their transcription. Furthermore, older plants show enhanced EIN3 activity, and repressed expression of WOX11 and WOX5. Taken together, these results illustrate that plant aging at least partially takes advantage of EIN3 as a negative regulator to suppress DNRR through inhibiting the activation of WOX genes.
Limits to Sustained Energy Intake XXXI: Effect of Graded Levels of Dietary Fat on Lactation Performance in Swiss Mice
Authors: Huang Yi , Mendoza Jazmin Osorio , Hambly Catherine , Li Baoguo , Jin Zengguang , Li Li , Madizi Moshen , Hu Sumei , Speakman John R.
Published: April 2020

The heat dissipation limit theory predicts lactating female mice consuming diets with lower specific dynamic action (SDA) should have enhanced lactation performance. Dietary fat has lower SDA than other macronutrients. Here we tested the effects of graded dietary fat levels on lactating Swiss mice. We fed females five diets varying in fat content from 8.3 to 66.6%. Offspring of mothers fed diets of 41.7% fat and above were heavier and fatter at weaning compared to those of 8.3% and 25% fat diets. Mice on dietary fat contents of 41.7% and above had greater metabolizable energy intake at peak lactation (8.3%: 229.4±39.6, 25%: 278.8±25.8, 41.7%: 359.6±51.5, 58.3%: 353.7±43.6, 66.6%: 346±44.7 kJ day−1), lower daily energy expenditure (8.3%: 128.5±16, 25%: 131.6±8.4, 41.7%: 124.4±10.8, 58.3%: 115.1±10.5, 66.6%: 111.2±11.5 kJ day−1) and thus delivered more milk energy to their offspring (8.3%: 100.8±27.3, 25%: 147.2±25.1, 41.7%: 225.1±49.6, 58.3%: 238.6±40.1, 66.6%: 234.8±41.1 kJ day−1). Milk fat content (%) was unrelated to dietary fat content, indicating females on higher fat diets (> 41.7%) produced more rather than richer milk. Mothers consuming diets with 41.7% fat or above enhanced their lactation performance compared to those on 25% or less, probably by diverting dietary fat directly into the milk, thereby avoiding the costs of lipogenesis. At dietary fat contents above 41.7% they were either unable to transfer more dietary fat to the milk, or they chose not to do so, potentially because of a lack of benefit to the offspring that were increasingly fatter as maternal dietary fat increased.
Androgenic modulation of extraordinary muscle speed creates a performance trade-off with endurance
Authors: Tobiansky Daniel J. , Miles Meredith C. , Goller Franz , Fuxjager Matthew J.
Published: April 2020

Performance trade-offs can dramatically alter an organism's evolutionary trajectory by making certain phenotypic outcomes unattainable. Understanding how these trade-offs arise from an animal's design is therefore an important goal of biology. To explore this topic, we study how androgenic hormones, which regulate skeletal muscle function, influence performance trade-offs relevant to different components of complex reproductive behaviour. We conduct this work in golden-collared manakins (Manacus vitellinus), a Neotropical bird in which males court females by rapidly snapping their wings together above their back. Androgens help mediate the snap displays by radically increasing the twitch speed of a dorsal wing muscle [scapulohumeralis caudalis (SH)], which actuates the bird's wing-snap. Through hormone manipulations and in situ muscle recordings, we test how these positive effects on SH speed influence trade-offs with endurance. Indeed, this trait impacts the display by shaping signal length. We find that androgen-dependent increases in SH speed incur a cost to endurance, particularly when this muscle performs at its functional limits. Moreover, when behavioural data are overlaid on our muscle recordings, displaying animals appear to balance display speed with fatigue-induced muscle fusion (physiological tetanus) to generate the fastest possible signal while maintaining an appropriate signal duration. Our results point to androgenic hormone action as a functional trigger of trade-offs in sexual performance—they enhance one element of a courtship display, but in doing so, impede another.
Sports Participation Fee Policies in US High Schools: A National Survey of Athletic Directors
Authors: Eyler Amy A. , Valko Cheryl A. , Curoe Katherine , Ramadas Ramya
Published: April 2020

Purpose

Because of budget constraints, many school districts are reducing or eliminating sports programs. An alternative trend is to maintain programs but charge fees for student participation in sports. Fees may discourage participation and unfairly burden students unable to pay. The purpose of this study was to explore sports participation fee policies in US high schools among a national sample of athletic directors.

Methods

We developed a survey and sent it online or through postal service to a national sample of athletic directors (N = 3342) from a randomized list of US school districts. Descriptive statistics and multilevel regression models were computed comparing respondents from districts with and without policies, and those with and without fee waivers.

Results

We received 991 responses (response rate of 30%). Almost 40% (39.9%) reported participation fees for interscholastic sports, and 26% reported the likelihood of a policy within 5 yr. These policies varied; 32% charged fees per season, 26% per year, and 42% by sport. The average amount was $120. Most (78%) had waiver provisions. Lower-income districts had significantly lower odds of charging fees than higher-income districts, and when they did, they were less likely to have waivers.

Conclusion

Overall, respondents from districts with fee polices had significantly different perceptions of policies compared with no policy respondents. High schools are implementing a wide variety of sports participation fee policies, and majority of those with policies provide waivers for students unable to pay. There were significant differences by district income level. Further exploration on the extent to which these policies are influencing sports participation, especially among lower-income students, is needed.
The clinical utility of imaging methods used to measure hypoxia in cervical cancer
Authors: Waller Joseph , Onderdonk Benjamin , Flood Ann , Swartz Harold , Shah Jaffer , Shah Asghar , Aydogan Bulent , Halpern Howard , Hasan Yasmin
Published: April 2020

While it is well-established that hypoxia is a major factor that affects clinical outcomes in cervical cancer, widespread usage of clinically available methods to detect and evaluate hypoxia during the course of treatment have not been established. This review compares these methods, summarizes their strengths and weaknesses, and assesses the pathways for their useful employment to alter clinical practice. We conducted a search on PubMed for literature pertaining to imaging hypoxic cervical cancer, and implemented keywords related to oxygen measurement tools to improve the relevance of the search results.

Oxygenation level-dependent applications of MRI have demonstrated hypoxia-induced radioresistance, and changes in cervix tumor oxygenation from hyperoxic therapy.

The hypoxic areas within tumors can be indirectly identified in dynamic contrast-enhanced images, where they generally display low signal enhancement, and diffusion-weighted images, which demonstrates areas of restricted diffusion (which correlates with hypoxia). Positron emmision tomography, used independently and with other imaging modalities, has demonstrated utility in imaging hypoxia through tracers specific for low oxygen levels, like Cu-ATSM tracers and nitroimidazoles. Detecting hypoxia in the tumors of patients diagnosed with cervical cancer via medical imaging and non-imaging tools like electron paramagnetic resonance oximetry can be utilized clinically, such as for guiding radiation and post-treatment surveillance, for a more personalized approach to treatment. The merits of these methods warrant further investigation via comparative effectiveness research and large clinical trials into their clinical applications.
Transanal irrigation with Peristeen in neurogenic bowel dysfunction: audit of impact on symptoms and quality of life
Authors: McCarthy Sandra , Wallwork Sandra , Soni Bakulesh M
Published: April 2020

Background:

Spinal cord injury often results in neurogenic bowel dysfunction (NBD). NBD is associated with constipation and faecal incontinence, as well as loss of sensation, faecal loading and faecal leakage, and it has a severe impact on healthcare resources and patient quality of life. NBD is treated conservatively with medication, suppositories, physiotherapy, digital rectal stimulation and digital removal of faeces. Conservative options are not always effective and long-term may lead to haemorrhoids, rectal bleeding, mucosal prolapse and faecal soiling. The National Institute for Health and Care Excellence recommends the use of the Peristeen transanal irrigation system, which instills lukewarm water into the colon via a balloon catheter to stimulate regular and complete bowel movements.

Aim:

To assess the impact of transanal irrigation with Peristeen on the symptoms and treatments of NBD, as well as patient quality of life and satisfaction, in a regional spinal injury centre.

Method:

Patients were asked to complete an adapted NBD assessment at consultation when they were prescribed Peristeen and at 8-week follow up. Answers to 10 questions on symptoms and treatment were individually weighted to provide a bowel dysfunction score, excluding two Likert-type questions on quality of life.

Results:

Patient numbers undergoing digital evacuations once or more a week decreased by more than 50%, and medication use decreased slightly. Patients reported a decrease in the following symptoms: peri-anal skin problems (9%); uneasiness, sweating or headaches (20%); uncontrollable flatus (27%); rectal bleeding (30%); faecal soiling (37%) and involuntary defecation (46%). Mean total bowel dysfunction score decreased by 11.6 from 20.4 to 8.8, and those with dysfunction categorised as severe decreased by 64% from 80% to 16%. Average negative emotional wellbeing improved from 4.0 to 1.2, and mean satisfaction increased from 3.2 to 7.3.

Conclusion:

According to the study findings, Peristeen is observed to improve quality of life in spinal NBD, and it is effective at reducing both associated symptoms and the need for digital rectal stimulation and digital removal of faeces.
A new normal for health visiting
Authors: Forbes Lisa
Published: April 2020

In this time of focus on public health, what role will community based workers play? How will we carry on our professional duties in a time of social distancing?
QASEE: A Potential Learning Model to Improve the Critical Thinking Skills of Pre-service Teachers with Different Academic Abilities
Authors: Saputri Wulandari , Corebima Aloysius D. , Susilo Herawati , Suwono Hadi
Published: April 2020

Research on critical thinking skills has been frequently carried out, but it has not shown maximum results. This problem is exacerbated by the differences in pre-service teachers’ academic abilities. A new learning model that can improve pre-service teachers’ critical thinking skills and reduce the gap in critical thinking skills among the upper, middle, and lower academic ability pre-service teachers is needed. This research aims at exploring the potential of the QASEE learning model on the critical thinking skills of different academic ability. This quasi-experimental research involved 107 pre-service teachers of Universitas Islam Negeri Raden Fatah, Indonesia. The research classes were divided into three classes, namely the QASEE class (experimental class), the RQA class (positive control class), and the conventional class (negative control class). Each class was further divided into upper, middle, and lower academic categories. The data were collected using an essay test supported by a critical thinking skill rubric. The data were analyzed by using ANCOVA and followed by LSD test. The research results show that the QASEE (Questioning, Answering, Sharing, Extending, and Evaluating) learning model can improve and equalize the critical thinking skills of pre-service teachers with various academic levels. Thus, the QASEE learning model can be used as a new reference to improve pre-service teachers’ critical thinking skills, especially the lower academic ability.
Design and Validation of Mathematical Literacy Instruments for Assessment for Learning in Indonesia
Authors: Suciati Suciati , Munadi Sudji , Sugiman Sugiman , Febriyanti Wiwin Dwi Ratna
Published: April 2020

This study aims to design mathematical literacy instruments that have evidence of content and construct validity and are reliable for use as an Assessment for Learning. The research involved eight experts as instrument validators and 273 eighth-grade students of junior high school in Yogyakarta Province. The results showed that the ten mathematical literacy items developed had the V Aiken coefficient index calculated from 0.781 to 0.906 (> 0.75). The results of adequacy testing of samples with KMO and Bartlett show Chi-Square in the Bartlett test of 608,608, the p-value <0.05 and KMO value of 0.781 (> 0.5). The results of testing of the measurement model with Confirmatory Factor Analysis (CFA) produce a Root Mean Square Error of Approach (RMSEA) value of 0.049 (≤ 0.08), chi-s Square of 33.92 (<2df), the p-value of 0.05004 (≥ 0.05). Nine out of the ten items developed had t-value> 1.96, Standardized Loading Factor (SLF) was greater than the critical limit (> 0.3), and Construct Reliability (CR) of 0.78 (> 0.7). It can be concluded that the developed mathematical literacy instrument can measure what must be measured and nine items significantly reflect the construct or latent variable, as well as the level of consistency of a good score.
Where Exactly for Enhance Critical and Creative Thinking: The Use of Problem Posing or Contextual Learning
Authors: Toheri Toheri , Winarso Widodo , Haqq Arif Abdul
Published: April 2020

Learning models that can improve critical thinking, skills collaborate, communicate, and creative thinking are needed in the 21st-century education era. Critical and creative thinking are the two essential competencies of the four skills required in the 21st century. However, both are still difficult to achieve well by students due to a lack of thinking skills during mathematics learning. This study was conducted to determine the model of learning that is appropriate to develop students' critical and creative thinking skills. The study used three-class samples from eighth grade. The first class is given the problem-posing lesson; the second class is given contextual learning and third class as a control class. The results of the study indicate that improving students' critical and creative thinking skills are included in the moderate category for types using contextual learning and problem-posing. Also, it is found that contextual learning is more effective for improving critical thinking skills when compared with learning problem posing and expository learning. Meanwhile, learning problem posing is more useful to enhance creative thinking skills compared with contextual and expository learning.