bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors and pregnancy outcomes associated with retinopathy in patients presenting with severe preeclampsia
Authors: Ye Lei , Shi Meng-dan , Zhang Yan-ping , Zhang Jia-shuo , Zhu Cai-rong , Zhou Rong
Published: March 2020

The visual system was reported to be affected in over half of patients with preeclampsia (PE), though fundus examination was performed only among patients complaining of visual symptoms. Delayed diagnosis and treatment of PE-related retinopathy may lead to permanent visual impairment. Therefore, we hypothesize that some clinical or laboratory parameters could predict severity of retinal damage.

The aim of the study was to explore the risk factors for retinopathy in severe preeclampsia (sPE) and investigate pregnancy outcomes with different degrees of retinopathy.

This retrospective cohort study included women with sPE who underwent ophthalmoscopy and delivered after admission to West China Second University Hospital, between June 2013 and December 2016. Clinical and laboratory characteristics were retrieved from medical records. Patients confirmed with retinopathy were followed up with telephones. Multiple logistic regression analysis was performed to identify risk factors of PE-related retinopathy.

Five hundred thirty-four patients were included, of which 17.6% having stage-1/2 retinopathy, 14.6% having stage-3/4 retinopathy, and 67.8% having normal retina. Compared with patients without retinopathy, patients with stage 3/4 retinopathy were more likely to have preterm-birth and low-birth-weight babies. Significant risk factors for stage 3/4 retinopathy in sPE included severe hypertension (odds ratio [OR] 2.24, 95% confidence interval [CI]: 1.10–4.56), elevated white blood cell (WBC) counts (OR 1.88, 95% CI: 1.05–3.35), decreased platelet counts (OR 2.12, 95% CI: 1.07–4.48), lactate dehydrogenase (LDH) concentration of >800 IU/L (OR 2.31, 95% CI: 1.05–5.06), low hemoglobin (HGB) concentrations of <110 g/L (OR 3.73, 95% CI: 1.21–11.47), 24-hour proteinuria of 2 to 5 g (OR 6.39, 95% CI: 2.84–14.39), and >5 g (OR 8.66, 95% CI: 3.67–20.44).

This study confirms the association between retinopathy and preterm-birth and low-birth weight in sPE. The risk factors for severe PE-related retinopathy, including severe hypertension, platelet and WBC count, HGB and LDH concentration, and proteinuria, are associated with the development of retinopathy. Routine and repeated fundus examination is recommended for maternal monitoring in sPE.
Insights into the role of tumor abnormal protein in early diagnosis of cancer
Authors: Li Lu-Xi , Zhang Bin , Gong Rui-Zhi
Published: March 2020

The aim of this study was to evaluate the clinical use of tumor abnormal protein (TAP) in the diagnosis of different cancers.

Totally 394 patients were divided into 4 groups, namely 100 healthy volunteers, 167 patients with cancer, 20 subjects with precancerous lesions, and 107 subjects with benign lesions. TAP was detected in 4 groups of research subjects using a TAP testing kit and examination system. We correlated TAP levels with a wide variety of clinical indicators as well as established cancer markers, including alpha fetoprotein (AFP) and carbohydrate antigen 19-9 (CA19-9). Besides, the changes of TAP level in 51 patients with liver cancer before and after surgery, and overall survival of patients with high or low TAP expression in pancreatic, gallbladder, bile duct, and liver cancers were analyzed.

Statistically significant difference was observed in the TAP-positive ratio among subjects with cancer (79.6%) and precancerous lesions (45.0%) compared to the healthy volunteers (4.0%). TAP expression in different cancers was characterized by high sensitivity (79.64%), specificity (89.87%), positive and negative predictive value (85.25% and 85.71%), overall compliance rate (85.53%) but low omission and mistake diagnostic rate (20.36% and 10.13%), Youden index (0.6951). In addition, there was no significant difference among patients with different types of cancer (χ
2 = 2.886, P = .410), and TAP expression was shown to be correlated with AFP in liver cancer (P = .034) but not with CA19-9 in pancreatic cancer (P = .241). Moreover, the overall survival of patients with low expression of TAP in pancreatic, gallbladder, bile duct, and liver cancers were significantly higher than of patients with high expression of TAP. Compared with the preoperative patients with cancer, TAP levels decreased dramatically among postoperative subjects (P < .001).

In summary, TAP might hold promise in serving as universal indicator for the diagnosis of different cancers.
Serum ammonia levels on admission for predicting sepsis patient mortality at D28 in the emergency department
Authors: Zhao Jie , He Yarong , Xu Ping , Liu Junzhao , Ye Sheng , Cao Yu
Published: March 2020

We assessed the predictive value of serum ammonia level on admission for the 28-day mortality of patients with sepsis.

We retrospectively included septic patients admitted to the emergency department of West China Hospital, Sichuan University and The Fourth People's Hospital of Zigong city from June 2017 to May 2018. Patients were divided into 2 groups according to 28-day survival. Comparisons of serum ammonia level and sequential organ failure assessment (SOFA) score were made between 2 groups. Multivariate logistic regression models were employed to determine independent risk factors affecting 28-day mortality rate, and receiver operating characteristic (ROC) curve was also used to evaluate the efficacy of risk factors.

Total of 316 patients were included into the study, 221 survived to 28 days and 95 were died before 28 days. The 28-day mortality rate was 30.06%. Multivariate logistic regression analyses revealed that the ammonia level, C reactive protein, SOFA score, and the leukocyte were independent risk factors for the 28-day mortality rate. In predicting the 28-day mortality rate, the SOFA score presented an area under the ROC curve (AUC) of 0.815, and the ammonia levels presented the AUC of 0.813.

The ammonia level, C reactive protein, SOFA score, and the leukocyte are independent risk factors for 28-day mortality rate in septic patients. Moreover, the serum ammonia and SOFA score have similar predictive values. The serum ammonia level is also a suitable early indicator for prognostic evaluation of patients with sepsis as well.
Effects of recombinant human brain natriuretic peptide in patients with acute myocardial infarction undergoing percutaneous coronary intervention
Authors: Ning Cheng , Zheng Yawei , Li Jie , Liu Ming , Fang Zhuyuan
Published: March 2020

Objective:

To systematically review the effect of recombinant human brain natriuretic peptide (rhBNP) on the cardiac function in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).

Methods:

PubMed, Web of Science, the Cochrane Library, Chinese Biomedical Database (CBD), and China National Knowledge Infrastructure (CNKI) were electronically searched to collect randomized controlled trials (RCTs) of traditional exercise for patients with AMI undergoing PCI from the beginning of the database inception to January 2019. Two reviewers independently screened the literature, extracted data, and evaluated the quality of included studies. Then, meta-analysis was performed using the RevMan 5.3 software.

Results:

A total of 16 RCTs and 1551 patients were included. The results of the meta-analysis showed that, compared with the control-treated patients, rhBNP-treated patients with AMI had an increased left ventricular ejection fraction (LVEF) of 3.34% ([MD = 3.34, 95% CI (0.39,6.29), P = .03]) 1 week postoperatively, 6.22% ([MD = 6.22, 95% CI (4.15,8.28), P < .00001]) 4 weeks postoperatively, 7.34% ([mean difference (MD) = 7.34, 95% CI (4.52, 10.16), P < .00001]) 12 weeks postoperatively, and 5.32% ([MD = 5.32, 95% CI (3.05, 7.59), P < .00001]) 24 weeks postoperatively. Moreover, the heart failure (HF) recurrence of rhBNP-treated patients with AMI 12 weeks postoperatively was 0.24 times that of the control-treated patients ([risk ratio (RR) = 0.24, 95% CI (0.06, 0.92), P = .04]), and the difference was statistically significant. At the same time, rhBNP-treated patients had decreased N-terminal pro-brain natriuretic peptide (NT-proBNP) (24 hours, 48 hours, 72 hours) and aldosterone (Ald) (24 hours, 72 hours, 168 hours) levels in comparison with the control-treated patients.

Conclusion:

Current evidence shows that the application of rhBNP presents a greater clinical benefit to patients with AMI undergoing PCI. Due to the methodological bias in the included studies and small sample size, more high-quality studies are required to verify the study findings.

Systematic Review Registration Number:

PROSPERO (CRD42019126727)
Chondromyxoid fibroma of the temporal bone
Authors: Liu Tao , Yao Jing , Li Xiaoyu , Qi Xinmeng , Zhao Pengyun , Tan Zhiqiao , Wang Jie , Li Yongxin
Published: March 2020

Rationale:

Chondromyxoid fibroma (CMF) is a rare form of benign bone tumor and easily misdiagnosed as fibrosarcoma. Hence, to explore the clinical manifestations, diagnostic tests, and therapeutic procedures for temporal bone cartilage myxoid fibroma, it is important to optimize patient treatment and avoid overtreatment. Previous research has discussed cases of CMF, but this paper presents a systematic, complete, and comprehensive introduction of this disease based on this case and related literature.

Patient concerns:

A 52-year-old male patient presented with pain in his right ear for 2 years and hearing loss in his right ear with tinnitus for 1 year. The patient had a history of hypertension for 9 years and it was well-controlled.

Diagnosis:

A computed tomography (CT) scan of the temporal bone showed an expansive growth on the right temporal bone plate and tympanic plate, presenting as a cloud-like ground glass opaque shadow involving the temporom and ibular joint, middle skull base, and small auditory bones. A magnetic resonance imaging (MRI) of the temporal bone showed a large and irregular soft tissue mass shadow on the right temporal bone plate. The right temporal bone plate was occupied by the lesion, consistent with a bone origin. From the results of the imaging examination of the patient, a lesion occupying the temporal bone in the right ear and mastoiditis in the right middle ear was initially diagnosed.

Interventions:

Right ear temporal bone tumor resection and abdominal fat extraction were conducted.

Outcomes:

Postoperative pathological results demonstrated myxoid fibroma of the temporal bone cartilage. No recurrence or severe complications were observed in 8 months of follow-up.

Lessons:

A finding of myxoid fibroma of the temporal bone cartilage is rare in the clinic. The growth of such tumors is slow. The temporal bone CT and inner ear MRI were helpful in diagnosis. Surgery was the principal treatment.
Machine-learning prediction of self-care activity by grip strengths of both hands in poststroke hemiplegia
Authors: Suzuki Makoto , Sugimura Seiichiro , Suzuki Takako , Sasaki Shotaro , Abe Naoto , Tokito Takahide , Hamaguchi Toyohiro
Published: March 2020

To investigate the relationships between grip strengths and self-care activities in stroke patients using a non-linear support vector machine (SVM).

Overall, 177 inpatients with poststroke hemiparesis were enrolled. Their grip strengths were measured using the Jamar dynamometer on the first day of rehabilitation training. Self-care activities were assessed by therapists using Functional Independence Measure (FIM), including items for eating, grooming, dressing the upper body, dressing the lower body, and bathing at the time of discharge. When each FIM item score was ≥6 points, the subject was considered independent. One thousand bootstrap grip strength datasets for each independence and dependence in self-care activities were generated from the actual grip strength. Thereafter, we randomly assigned the total bootstrap datasets to 90% training and 10% testing datasets and inputted the bootstrap training data into a non-linear SVM. After training, we used the SVM algorithm to predict a testing dataset for cross-validation. This validation procedure was repeated 10 times.

The SVM with grip strengths more accurately predicted independence or dependence in self-care activities than the chance level (mean ± standard deviation of accuracy rate: eating, 0.71 ± 0.04, P < .0001; grooming, 0.77 ± 0.03, P < .0001; upper-body dressing, 0.75 ± 0.03, P < .0001; lower-body dressing, 0.72 ± 0.05, P < .0001; bathing, 0.68 ± 0.03, P < .0001).

Non-linear SVM based on grip strengths can prospectively predict self-care activities.
Clinical course of non-small cell lung cancer patients with dry pleural dissemination
Authors: Kim Woojung , Park In Kyu , Park Samina , Kang Chang Hyun , Kim Young Tae
Published: March 2020

We investigated the prognosis of patients with dry pleural dissemination (DPD) of non-small cell lung cancer (NSCLC) and the risk factors of developing to malignant pleural effusion (MPE).

We retrospectively reviewed 104 patients with NSCLC and DPD, confirmed surgically from 1996 to 2016. Incidence rate and risk factors of MPE were analyzed statistically. The prognosis of NSCLC patients with MPE was evaluated using the Kaplan–Meier method.

The most common histologic type was adenocarcinoma in 95 (91.3%) patients. The median follow-up duration was 65.5 months and the median survival time was 37.7 months. MPE developed in 51 (49%) patients, and the median effusion-free interval was 41.9 months. The median survival time of the patients with and without MPE was not different (41.3 vs 31.7 months, P = .16). No predictive factors for the development of MPE were identified. Fifteen (14.4%) patients underwent invasive procedures for the management of MPE.

Almost half of all patients with NSCLC and DPD experienced MPE, and 14.4% patients developed symptomatic MPE requiring invasive procedures. MPE in DPD did not affect the survival in NSCLC patients.
Ascitic calprotectin for the diagnosis of spontaneous bacterial peritonitis: a systematic review and meta-analysis
Authors: Dibas Mahmoud , Rajab Ahmad Mamoun , Zaghloul Mohamed Saddik , Atiah Mohammad J. , Aljundi Saadi , Amir Ahmed , Saquib Nazmus
Published: March 2020

Calprotectin is a promising diagnostic biomarker for spontaneous bacterial peritonitis (SBP) among cirrhotic patients, but published studies report a wide variation of its diagnostic accuracy. We systematically searched six databases for eligible studies (i.e., all original studies that reported ascitic calprotectin as a diagnostic marker for SBP in cirrhotic patients), and assessed their quality with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We calculated the pooled sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), and diagnostic odds ratio (DOR) using the bivariate mixed-effect model. We constructed the summary receiver operating characteristic and determined the area under the curve (AUC). We registered the study protocol in PROSPERO (CRD42019125476). Our search retrieved 102 studies, of which 10 were included in the analysis. The overall risk of bias of these studies ranged from low to moderate. There was no heterogeneity from the threshold effect (Spearman correlation coefficient = 0.100, P value = 0.770). The pooled estimates [95% confidence intervals (CIs)] for ascitic calprotectin were as follows: sensitivity 0.91 (95% CI: 0.88–0.94), specificity 0.87 (95% CI: 0.68–0.96), PLR 7.18 (95% CI: 2.52–20.43), NLR 0.10 (95% CI: 0.07–0.15), DOR 71.91 (95% CI: 19.42–266.34), and AUC 0.92 (95% CI: 0.90–0.94). The sensitivity analysis did not detect outliers, and the model had a robust goodness of fit. There was no significant publication bias detected (Deeks test of asymmetry, P value = 0.79). Ascitic calprotectin is a promising diagnostic biomarker for SBP in cirrhotic patients.
Implementation and Early Evaluation of a Quantitative Electroencephalography Program for Seizure Detection in the PICU*
Authors: Rowberry Tracey , Kanthimathinathan Hari Krishnan , George Fay , Notghi Lesley , Gupta Rajat , Bill Peter , Wassmer Evangeline , Duncan Heather P. , Morris Kevin P. , Scholefield Barnaby R.
Published: March 2020

Objectives:

To describe implementation and early evaluation of using quantitative electroencephalography for electrographic seizure detection by PICU clinician staff.

Design:

Prospective observational study of electrographic seizure detection by PICU clinicians in patients monitored with quantitative electroencephalography. Quantitative electroencephalography program implementation included a continuous education and training package. Continuous quantitative electroencephalography monitoring consisted of two-channel amplitude-integrated electroencephalography, color density spectral array, and raw-electroencephalography.

Setting:

PICU.

Patients:

Children less than 18 years old admitted to the PICU during the 14-month study period and deemed at risk of electrographic seizure.

Interventions:

None.

Measurements and Main Results:

Real time electrographic seizure detection by a PICU team was analyzed for diagnostic accuracy and promptness, against electrographic seizure identification by a trained neurophysiologist, retrospectively reading the same quantitative electroencephalography and blinded to patient details. One-hundred one of 1,510 consecutive admissions (6.7%) during the study period underwent quantitative electroencephalography monitoring. Status epilepticus (35%) and suspected hypoxic-ischemic injury (32%) were the most common indications for quantitative electroencephalography. Electrographic seizure was diagnosed by the neurophysiologist in 12% (n = 12) of the cohort. PICU clinicians correctly diagnosed all 12 patients (100% sensitivity and negative predictive value). An additional eleven patients had a false-positive diagnosis of electrographic seizure (false-positive rate = 52% [31–73%]) leading to a specificity of 88% (79–94%). Median time to detect seizures was 25 minutes (5–218 min). Delayed recognition of electrographic seizure (> 1 hr from onset) occurred in five patients (5/12, 42%).

Conclusions:

Early evaluation of quantitative electroencephalography program to detect electrographic seizure by PICU clinicians suggested good sensitivity for electrographic seizure detection. However, the high false-positive rate is a challenge. Ongoing work is needed to reduce the false positive diagnoses and avoid electrographic seizure detection delays. A comprehensive training program and regular refresher updates for clinical staff are key components of the program.
Hospital-Associated Venous Thromboembolism in a Pediatric Cardiac ICU: A Multivariable Predictive Algorithm to Identify Children at High Risk
Authors: Kerris Elizabeth W. J. , Sharron Matthew , Zurakowski David , Staffa Steven J. , Yurasek Greg , Diab Yaser
Published: March 2020

Objectives:

Critically ill children with cardiac disease are at significant risk for hospital-associated venous thromboembolism, which is associated with increased morbidity, hospital length of stay, and cost. Currently, there are no widely accepted guidelines for prevention of hospital-associated venous thromboembolism in pediatrics. We aimed to develop a predictive algorithm for identifying critically ill children with cardiac disease who are at increased risk for hospital-associated venous thromboembolism as a first step to reducing hospital-associated venous thromboembolism in this population.

Design:

This is a prospective observational single-center study.

Setting:

Tertiary care referral children’s hospital cardiac ICU.

Patients:

Children less than or equal to18 years old admitted to the cardiac ICU who developed a hospital-associated venous thromboembolism from December 2013 to June 2017 were included. Odds ratios and 95% CIs are reported for multivariable predictors.

Measurements and Main Results:

A total of 2,204 separate cardiac ICU encounters were evaluated with 56 hospital-associated venous thromboembolisms identified in 52 unique patients, yielding an overall prevalence of 25 hospital-associated venous thromboembolism per 1,000 cardiac ICU encounters. We were able to create a predictive algorithm with good internal validity that performs well at predicting hospital-associated venous thromboembolism. The presence of a central venous catheter (odds ratio, 4.76; 95% CI, 2.0–11.1), sepsis (odds ratio, 3.5; 95% CI, 1.5–8.0), single ventricle disease (odds ratio, 2.2; 95% CI, 1.2–3.9), and extracorporeal membrane oxygenation support (odds ratio, 2.7; 95% CI, 1.2–5.7) were independent risk factors for hospital-associated venous thromboembolism. Encounters with hospital-associated venous thromboembolism were associated with a higher rate of stroke (17% vs 1.2%; p < 0.001).

Conclusions:

We developed a multivariable predictive algorithm to help identify children who may be at high risk of hospital-associated venous thromboembolism in the pediatric cardiac ICU.
Implementation of an Evidence-Based Guideline of Enteral Nutrition for Infants With Congenital Heart Disease: A Controlled Before-and-After Study*
Authors: Gu Ying , Hu Yan , Zhang Huiwen , Fu Weijia , Yang Yuxia , Latour Jos M.
Published: March 2020

Objectives:

To describe the implementation process of a nutrition risk screening and assessment guideline for infants with congenital heart disease and to assess the impact of nurses’ behavior and the effect on infants’ outcomes.

Design:

A controlled before-and-after implementation study. The three dimensions of the integrated-Promoting Action on Research Implementation in Health Services framework were used to assess barriers and promoting factors.

Setting:

Cardiac center at Children’s Hospital of Fudan University, Shanghai, China.

Patients:

Infants with congenital heart disease (n = 142) and nurses (n = 100).

Interventions:

Implementation of an evidenced-based nutrition risk screening and assessment guideline.

Measurements and Main Results:

Implementation processes were assessed on nurses’ knowledge, attitude, behavior, and compliance of the guideline. Infants’ clinical outcomes were evaluated before-and-after the implementation. Knowledge, attitude, and behavior of nurses about nutrition risk screening and assessment increased significantly after implementing the guideline. Nurses’ compliance with the recommendations for nutritional risk screening improved significantly on three criteria; assessment of nutritional status stability (p < 0.001), assessment of nutritional status deterioration (p = 0.003), and nutritional assessment among infants with moderate risk and above (p < 0.001). The nurses’ compliance with the recommendations for nutrition assessment improved significantly in eight of the 10 criteria (p < 0.001). The proportion of infants receiving comprehensive nutrition assessment when they were first screened with moderate or high nutritional risk were higher in the intervention group (24.3% vs 83.3%; p < 0.001). The accuracy rates of nutrition risk screening were higher in the intervention group (52.9% vs 81.9%; p < 0.001).

Conclusions:

Using the integrated-Promoting Action on Research Implementation in Health Services framework contributed to a successful implementation of the nutrition guideline. The nurses’ knowledge, attitude, and behavior toward the nutrition guideline were positive resulting in a significantly higher nutrition assessments in infants with moderate or high nutritional risk.
Risk Factors for Electronic Prescription Errors in Pediatric Intensive Care Patients
Authors: Kadmon Gili , Shifrin Michal , Pinchover Michal , Nahum Elhanan
Published: March 2020

Objectives:

To assess risk factors for electronic prescription errors in a PICU.

Design:

A database of electronic prescriptions issued by a computerized physician order entry with clinical decision support system was analyzed to identify risk factors for prescription errors.

Measurements and Main Results:

Of 6,250 prescriptions, 101 were associated with errors (1.6%). The error rate was twice as high in patients older than 12 years than in patients children 6–12 and 0–6 years old (2.4% vs 1.3% and 1.2%, respectively, p < 0.05). Compared with patients without errors, patients with errors had a significantly higher score on the Pediatric Index of Mortality 2 (–3.7 vs –4.5; p = 0.05), longer PICU stay (6 vs 3.1 d; p < 0.0001), and higher number of prescriptions per patient (40.8 vs. 15.7; p < 0.0001). In addition, patients with errors were more likely to have a neurologic main admission diagnosis (p = 0.008) and less likely to have a cardiologic diagnosis (p = 0.03) than patients without errors.

Conclusions:

Our findings suggest that older patient age and greater disease severity are risk factors for electronic prescription errors.
Profile of Fluid Exposure and Recognition of Fluid Overload in Critically Ill Children
Authors: Al-Lawati Zahraa H. , Sur Moushumi , Kennedy Curtis E. , Akcan Arikan Ayse
Published: March 2020

Objectives:

Fluid overload is common in the PICU and has been associated with increased morbidity and mortality. It remains unclear whether fluid overload is a surrogate marker for severity of illness and need for increased support, an iatrogenic modifiable risk factor, or a sign of oliguria. The proportions of various fluid intake contributing to fluid overload and its recognition have not been adequately examined. We aimed to: 1) describe the types and amounts of fluid exposure in the PICU and 2) identify the clinicians’ recognition of fluid overload.

Setting:

Noncardiac PICU in a quaternary care hospital.

Patients:

Pediatric patients admitted for more than 24 hours.

Design:

Prospective observational study over 28 days.

Interventions:

Data were collected on the amount and type of fluid exposure—resuscitative boluses, blood products, enteral intake, parenteral nutrition (total parenteral nutrition), or modifiable fluids (IV fluids and medications) indexed to the patients’ admission body surface area on days 1 and 3. Charts of patients admitted for 3 days who developed 15% fluid overload were reviewed to assess clinicians’ recognition of fluid overload.

Measurements and Main Results:

One hundred two patients were included. Day 1 median fluid exposure was 2,318 mL/m2 (1,831–3,037 mL/m2; 1,646 mL/m2 [1,296–2,086 mL/m2] modifiable fluids). Forty-seven patients (46%) received fluid boluses, and 16 (16%) received blood products. Day 3 median fluid exposure was 2,233 mL/m2 (1,904–2,556 mL/m2; 750 mL/m2 [375–1,816 mL/m2] modifiable fluids). Of the 54 patients, one patient (1.9%) received a fluid bolus and two (3.7%) received blood products. In our cohort, 47 of 54 (87%) had fluid exposure greater than 1,600 mL/m2 on day 3. Fluid overload was not recognized by the clinicians in 30% of the patients who developed more than 15% fluid overload.

Conclusions:

Although resuscitation fluids contributed more to fluid exposure on day 1 compared with day 3, fluid exposure frequently exceeded maintenance requirements on day 3. Fluid overload was not always recognized by PICU practitioners. Further studies to correlate modifiable fluid exposure to fluid overload and explore modifiable practice improvement opportunities are needed.
Development of a New Tool for Better Social Recognition of Cancer Information and Support Activities Under the National Cancer Control Policy in Japan
Authors: Takayama Tomoko , Yamaki Chikako , Hayakawa Masayo , Higashi Takahiro , Toh Yasushi , Wakao Fumihiko
Published: March 2020

Under the recent trend of an increasing number of cancer survivors, there is a need to devise measures for visualization of medical care and public health programs related to cancer control, which will enable better overview of the activities at hospitals and local communities and allow various stakeholders to share the information about such activities. The aim of this study was to propose a new tool for proper implementation of cancer information and support programs provided under the national cancer control policy in Japan. Considering 5 elements reported by Handler et al (macro context, mission, structural capacity, processes, and outcomes), we conducted the focus group discussions to confirm the goals of activities of Cancer Information and Support Centers. Eventually, 2 final goals (“reduction in the number of patients/families having difficulties related to cancer” and “being able to live at ease even after diagnosis of cancer”) were identified, accompanied by 5 semifinal goals and 16 prerequisite conditions needed to achieve the final goals, as well as the necessary states and the activity indicators corresponding to them. This tool was utilized by 180 (42.7%) of 422 cancer care hospitals designated by the government of Japan (designated cancer care hospitals [DCCHs]) in 2016 and by 336 (77.1%) of 436 DCCHs in 2018, which were the data at 6 months and 3 years after introduction of the tool, respectively. Thus, the tool for evaluating the Cancer Information and Support Centers' activity presented here is expected to stimulate the stakeholders involved in providing supports in various fields of each local community, to share the final goals, to evaluate the status of their achievement, and to further advance their own activities.
Psychometric Design and Validation of an Adverse Event Vulnerability Scale in Prehospital Emergency Care
Authors: Montero García Antonio , Jiménez Guerrero Olga Patricia , Caravias Chaves Esther , González Aranda Lázaro , García Mayor Silvia , Morales Asencio José Miguel
Published: March 2020

Objective

Care in prehospital emergencies presents differences in terms of safety with respect to that provided in the hospital setting, generating situations of high vulnerability in patients. Vulnerability is intimately related to the possibility of experiencing an adverse event. Currently, there is no validated system to evaluate this issue. The aim of this study was to design and validate an instrument to determine the level of vulnerability of patients treated in the emergency prehospital care.

Methods

A clinimetric validation study was conducted in patients who attended prehospital emergency services.

Results

An eight-item instrument with adequate content validity (0.93) was designed and empirically tested in a sample of 549 subjects (50.1% men and 49.9% women) with an average age of 61.56 years (standard deviation = 19.76). Cronbach α was 0.81, with a good interitem and item-total correlation and interobserver reliability, with an intraclass correlation coefficient of 0.90 (95% confidence interval = 0.87–0.93). The exploratory factor analysis identified a bifactorial model that explained 61.27% of the total variance, corroborated by confirmatory factor analysis (goodness-of-fit index = 0.97, normed fit index = 0.96, TLI = 0.92, and root mean square error of approximation = 0.093). Instrument scores showed a moderate and significant positive correlation with the age of the subjects (r = 0.31).

Conclusions

The instrument shows a good reliability and validity for its use in the environment of prehospital emergency services, with a structure composed of a group of items related to condition characteristics safety (consciousness, patient communication, risk factors, and patient coping), and mobility, and a second factor including respiratory and medical interventions safety.
Seeing the light: Improving the usability of fluorescence-guided surgery by adding an optimized secondary light source
Authors: Elliott Jonathan T. , Wirth Dennis J. , Davis Scott C. , Olson Jonathan D. , Simmons Nathan E. , Ryken Timothy C. , Paulsen Keith D. , Roberts David W.
Published: March 2020

Background

Tumors that take up and metabolize 5-aminolevulinic acid (5-AlA) emit bright pink fluorescence when illuminated with blue light, aiding surgeons in identifying the margin of resection. The adoption of this method is hindered by the blue light illumination, which is too dim to safely operate under, and therefore, necessitates switching back and forth from white-light mode. This paper examines the addition of an optimized secondary illuminant adapter (SIA) to improve usability of blue-light mode without degrading tumor contrast.

Methods

We used color science methods to evaluate the color of the secondary illuminant and its impact on color rendering index (CRI) as well as the tumor-to-background color contrast (TBCC). A secondary illuminant adapter was built to provide 475-600 nm light the intensity of which can be controlled by the surgeon and was evaluated in two patients.

Results

Secondary illuminant color had opposing effects on color rendering index (CRI) and tumor to background color contrast (TBCC); providing surgeon control of intensity allows this trade-off to be balanced in real-time. Experience in two cases suggests additional visibility adds value.

Conclusion

The addition of a secondary illuminant may mitigate surgeon complaints that the operative field is too dark under the blue light illumination required for 5-ALA fluorescence guidance by providing improved CRI without completely sacrificing TBCC.
APEX2 proximity proteomics resolves flagellum subdomains and identifies flagellum tip-specific proteins inTrypanosoma brucei
Authors: Vélez-Ramírez Daniel E. , Shimogawa Michelle M. , Ray Sunayan , Lopez Andrew , Rayatpisheh Shima , Langousis Gerasimos , Gallagher-Jones Marcus , Dean Samuel , Wohlschlegel James A. , Hill Kent L.
Published: March 2020

Trypanosoma bruceiis the protozoan parasite responsible for sleeping sickness, a lethal vector-borne disease.T. bruceihas a single flagellum that plays critical roles in parasite biology, transmission and pathogenesis. An emerging concept in flagellum biology is that the organelle is organized into subdomains, each having specialized composition and function. Overall flagellum proteome has been well-studied, but a critical gap in knowledge is the protein composition of individual flagellum subdomains. We have therefore used APEX-based proximity proteomics to examine protein composition ofT. bruceiflagellum subdomains. To assess effectiveness of APEX-based proximity labeling, we fused APEX2 to the DRC1 subunit of the nexin-dynein regulatory complex, an axonemal complex distributed along the flagellum. We found that DRC1-APEX2 directs flagellum-specific biotinylation and purification of biotinylated proteins yields a DRC1 “proximity proteome” showing good overlap with proteomes obtained from purified axonemes. We next employed APEX2 fused to a flagellar membrane protein that is restricted to the flagellum tip, adenylate cyclase 1 (AC1), or a flagellar membrane protein that is excluded from the flagellum tip, FS179. Principal component analysis demonstrated the pools of biotinylated proteins in AC1-APEX2 and FS179-APEX2 samples are distinguished from each other. Comparing proteins in these two pools allowed us to identify an AC1 proximity proteome that is enriched for flagellum tip proteins and includes several proteins involved in signal transduction. Our combined results demonstrate that APEX2-based proximity proteomics is effective inT. bruceiand can be used to resolve proteome composition of flagellum subdomains that cannot themselves be readily purified.

IMPORTANCE

Sleeping sickness is a neglected tropical disease, caused by the protozoan parasiteTrypanosoma brucei. The disease disrupts the sleep-wake cycle, leading to coma and death if left untreated.T. bruceimotility, transmission, and virulence depend on its flagellum (aka cilium), which consists of several different specialized subdomains. Given the essential and multifunctional role of theT. bruceiflagellum, there is need of approaches that enable proteomic analysis of individual subdomains. Our work establishes that APEX2 proximity labeling can, indeed, be implemented in the biochemical environment ofT. brucei, and has allowed identification of proximity proteomes for different subdomains. This capacity opens the possibility to study the composition and function of other compartments. We further expect that this approach may be extended to other eukaryotic pathogens, and will enhance the utility ofT. bruceias a model organism to study ciliopathies, heritable human diseases in which cilia function is impaired.
Moderate early-life stress improves adult zebrafish (Danio rerio) spatial short-term memory but does not affect social and anxiety-like responses
Authors: Fontana Barbara D. , Gibbon Alistair J. , Cleal Madeleine , Sudwarts Ari , Pritchett David , Miletto Petrazzini Maria E. , Brennan Caroline H. , Parker Matthew O.
Published: March 2020

Early-life stress (ELS) is defined as a short or chronic period of trauma, environmental or social deprivation, which can affect different neurochemical and behavioral patterns during adulthood. Zebrafish (Danio rerio) have been widely used as a model system to understand human neurodevelopmental disorders and display translationally relevant behavioral and stress-regulating systems. In this study, we aimed to investigate the effects of moderate ELS by exposing young animals (six weeks post-fertilization), for three consecutive days, to three stressors, and analyzing the impact of this on adult zebrafish behavior (sixteen weeks post-fertilization). The ELS impact in adults was assessed though analysis of performance on tests of unconditioned memory (free movement pattern Y-maze test), exploratory and anxiety-related task (novel tank diving test) and social cohesion (shoaling test). Here, we show for the first time that moderate ELS increases the number of pure alternations compared to pure repetitions in the unconditioned Y-maze task, suggesting increased spatial short-term memory, but has no effect on shoal cohesion, locomotor profile or anxiety-like behavior. Overall, our data suggest that moderate ELS may be linked to adaptive flexibility which contributes to build ‘resilience’ in adult zebrafish by improving short-term spatial memory performance.
Machine learning approaches reveal genomic regions associated with sugarcane brown rust resistance
Authors: Aono Alexandre Hild , Costa Estela Araujo , Rody Hugo Vianna Silva , Nagai James Shiniti , Pimenta Ricardo José Gonzaga , Mancini Melina Cristina , dos Santos Fernanda Raquel Camilo , Pinto Luciana Rossini , de Andrade Landell Marcos Guimarães , de Souza Anete Pereira , Kuroshu Reginaldo Massanobu
Published: March 2020

Sugarcane is an economically important crop, but its genomic complexity has hindered advances in molecular approaches for genetic breeding. New cultivars are released based on the identification of interesting traits, and for sugarcane, brown rust resistance is a desirable characteristic due to the large economic impact of the disease. Although marker-assisted selection for rust resistance has been successful, the genes involved are still unknown, and the associated regions vary among cultivars, thus restricting methodological generalization. We used genotyping by sequencing of full-sib progeny to relate genomic regions with brown rust phenotypes. We established a pipeline to identify reliable SNPs in complex polyploid data, which were used for phenotypic prediction via machine learning. We identified 14,540 SNPs, which led to a mean prediction accuracy of 50% by using different models. We also tested feature selection algorithms to increase predictive accuracy, resulting in a reduced dataset with more explanatory power for rust phenotypes. Using different feature selection techniques, we achieved accuracy of up to 95% with a dataset of 131 SNPs related to brown rust QTL regions and auxiliary genes. Therefore, our novel strategy has the potential to assist studies of the genomic organization of brown rust resistance in sugarcane.
Amplitude Analysis of Polarization Modulation Data and 3D-Polarization Demodulation (3D-SPoD)
Authors: Albrecht Andreas , Pfennig Dominik , Nowak Julia , Matis Rainer , Schaks Matthias , Hafi Nour , Rottner Klemens , Walla Peter Jomo
Published: March 2020

Super-resolution optical fluctuation imaging (SOFI) is a technique that uses the amplitude of fluorescence correlation data for improved resolution of fluorescence images. Here, we explore if also the amplitude of superresolution by polarisation demodulation (SPoD) data can be used to gain additional information about the underlying structures. Highly organized experimental as well a simulated actin filament data demonstrate a principle information gain from this approach. In addition, we explored theoretically the benefits of analyzing the entire 3D-polarization information instead of only 2D-projections thereof. Due to fundamental principles, the probability of finding parallel orientations is approaching zero in 3D-SPoD in contrast to 2D-approaches. Using the modulation-amplitude based analysis we explored systematically simulated 3D-single molecules data (for which the true structures are known) under different conditions that are typically observed in experiments. We found that this approach can significantly improve the distinction, reconstruction and localization. In addition, these approaches are less sensitive to uncertainties in the knowledge about the true experimental point-spread-function (PSF) used for reconstruction compared to approaches using non-modulated data. Finally, they can effectively remove higher levels of non-modulated back-ground intensity.
Groucho/TLE opposes axial to hypaxial motor neuron development
Authors: Salin-Cantegrel Adèle , Dali Rola , Wang Jae Woong , Beaulieu Marielle , Deshmukh Mira , Tang Ye Man , Stifani Stefano
Published: March 2020

Spinal cord motor neuron diversity and the ensuing variety of motor circuits allow for the processing of elaborate muscular behaviours such as body posture and breathing. Little is known, however, about the molecular mechanisms behind the specification of axial and hypaxial motor neurons controlling postural and respiratory functions respectively. Here we show that the Groucho/TLE (TLE) transcriptional corepressor is a multi-step regulator of axial and hypaxial motor neuron diversification in the developing spinal cord. TLE first promotes axial motor neuron specification at the expense of hypaxial identity by cooperating with non-canonical WNT5A signalling within the motor neuron progenitor domain. TLE further acts during post-mitotic motor neuron diversification to promote axial motor neuron topology and axonal connectivity whilst suppressing hypaxial traits. These findings provide evidence for essential and sequential roles of TLE in the spatial and temporal coordination of events regulating the development of motor neurons influencing posture and controlling respiration.

HIGHLIGHTS

Groucho/TLE mediates non-canonical WNT signalling in developing motor neurons

Non canonical WNT:TLE pathway regulates thoracic motor neuron diversification

TLE promotes axial while inhibiting hypaxial motor neuron development

TLE influences developing motor neuron topology and muscle innervation

IN BRIEF

Salin-Cantegrel et al usein ovoengineered approaches to show that a non-canonical WNT:TLE pathway coordinates temporally and spatially separated elements of motor neuron diversification, repressing hypaxial motor neuron development to promote the axial fate.

GRAPHICAL ABSTRACT

TLE contribution to the development of thoracic somatic motor columns

Progenitor cells in the ventral pMN domain are exposed to higher concentrations of non-canonical WNTs and express more TLE. Cooperation of non-canonical WNTs and TLE renders ventral pMN progenitors refractory to a respiratory MN fate, thereby contributing to the separation of MMC and RMC MN lineages. Differentiating MNs that maintain high TLE expression also maintain LHX3 expression, adopt axial motor neuron topology and connect to axial muscles. TLE activity in differentiating MMC MNs prevents the acquisition of respiratory MN topology and innervation traits.
Crystal structures of the sheeppoxvirus encoded inhibitor of apoptosis SPPV14 bound to Hrk and Bax BH3 peptides
Authors: Suraweera Chathura D. , Burton Denis R. , Hinds Mark G. , Kvansakul Marc
Published: March 2020

Programmed death of infected cells is used by multicellular organisms to counter viral infections. Sheeppoxvirus encodes for SPPV14, a potent inhibitor of Bcl-2 mediated apoptosis. We reveal the structural basis of apoptosis inhibition by determining crystal structures of SPPV14 bound to BH3 motifs of proapoptotic Bax and Hrk. The structures show that SPPV14 engages BH3 peptides using the canonical ligand binding groove. Unexpectedly, Arg84 from SPPV14 forms an ionic interaction with the conserved Asp in the BH3 motif in a manner that replaces the canonical ionic interaction seen in almost all host Bcl-2:BH3 motif complexes. These results reveal the flexibility of virus encoded Bcl-2 proteins to mimic key interactions from endogenous host signalling pathways to retain BH3-binding and pro-survival functionality.
Genome assembly and annotation ofMacadamia tetraphylla
Authors: Niu Ying-Feng , Li Guo-Hua , Ni Shu-Bang , He Xi-Yong , Zheng Cheng , Liu Zi-Yan , Gong Li-Dan , Kong Guang-Hong , Liu Jin
Published: March 2020

Macadamia is a kind of evergreen nut trees which belong to the Proteaceae family. The two commercial macadamia species,Macadamia integrifoliaandM. tetraphylla, are highly prized for their edible kernels. Catherine et al. reportedM. integrifoliagenome using NGS sequencing technology. However, the lack of a high-quality assembly forM. tetraphyllahinders the progress in biological research and breeding program. In this study, we report a high-quality genome sequence ofM. tetraphyllausing the Oxford Nanopore Technologies (ONT) technology. We generated an assembly of 750.54 Mb with a contig N50 length of 1.18 Mb, which is close to the size estimated by flow cytometry and k-mer analysis. Repetitive sequence represent 58.57% of the genome sequence, which is strikingly higher compared withM. integrifolia. A total of 31,571 protein-coding genes were annotated with an average length of 6,055 bp, of which 92.59% were functionally annotated. The genome sequence ofM. tetraphyllawill provide novel insights into the breeding of novel strains and genetic improvement of agronomic traits.
SnToxA, SnTox1andSnTox3originated inParastagonospora nodorumin the Fertile Crescent
Authors: Ghaderi Fariba , Sharifnabi Bahram , Javan-Nikkhah Mohammad , Brunner Patrick C. , McDonald Bruce A.
Published: March 2020

The center of origin of the globally distributed wheat pathogenParastagnospora nodorumhas remained uncertain because only a small number of isolates from the Fertile Crescent, a region in the Middle East where wheat was domesticated from wild grasses, were included in earlier population genetic and phylogeographic studies. We isolated and genetically analyzed 193P. nodorumstrains from three naturally infected wheat fields distributed across Iran, a country located within the Fertile Crescent, using eleven neutral microsatellite loci. Compared to previous studies that included populations from North America, Europe, Africa, Australia and China, the populations from Iran had the highest genetic diversity globally and also exhibited greater population structure over smaller spatial scales, patterns typically associated with a species’ center of origin. Genes encoding the necrotrophic effectorsSnToxA, SnTox1andSnTox3were found at a high frequency in the Iranian population. By sequencing 96 randomly chosen Iranian strains, we detected new alleles for all three effector genes. Analyses of allele diversity showed that all three effector genes had higher diversity in Iran than in any population included in previous studies, with Iran acting as a hub for the effector diversity that was found in other global populations. Taken together, these findings support the hypothesis thatP. nodorumoriginated either within or nearby the Fertile Crescent with a genome that already encoded all three necrotrophic effectors during its emergence as a pathogen on wheat. Our findings also suggest thatP. nodorumwas the original source of theToxAgenes discovered in the wheat pathogensPhaeosphaeria avenariaf. sp.tritici1,Pyrenophora tritici-repentisandBipolaris sorokiniana.