Nevin Manimala

Euro Surveill. 2022 Nov;27(46). doi: 10.2807/1560-7917.ES.2022.27.46.2200082.

ABSTRACT

BackgroundSurveillance of antimicrobial resistance (AMR) and antimicrobial use (AMU) in Europe is currently annual.AimTo study the feasibility and scalability of a quarterly AMR/AMU surveillance system in the European Union/European Economic Area (EU/EEA).MethodsWe conducted a longitudinal study within the scope of the EU-JAMRAI project. Seventeen partners from 11 EU/EEA countries prospectively collected 41 AMU and AMR indicators quarterly from September 2017 to May 2020 for the hospital sector (HS) and primary care (PC). Descriptive statistics and coefficients of variation (CV) analysis were performed.ResultsData from 8 million hospital stays and 45 million inhabitants per quarter were collected at national (n = 4), regional (n = 6) and local (n = 7) levels. Of all partners, five were able to provide data within 3 months after each preceding quarter, and eight within 3-6 months. A high variability in AMU was found between partners. Colistin was the antibiotic that showed the highest CV in HS (1.40; p < 0.0001). Extended-spectrum beta-lactamase-producing Escherichia coli presented the highest incidence in HS (0.568 ± 0.045 cases/1,000 bed-days per quarter), whereas ciprofloxacin-resistant E. coli showed the highest incidence in PC (0.448 ± 0.027 cases/1,000 inhabitants per quarter). Barriers and needs for implementation were identified.ConclusionThis pilot study could be a first step towards the development of a quarterly surveillance system for AMU and AMR in both HS and PC in the EU/EEA. However, committed institutional support, dedicated human resources, coordination of data sources, homogeneous indicators and modern integrated IT systems are needed first to implement a sustainable quarterly surveillance system.

PMID:36398580 | DOI:10.2807/1560-7917.ES.2022.27.46.2200082

Zhongguo Dang Dai Er Ke Za Zhi. 2022 Nov 15;24(11):1195-1201. doi: 10.7499/j.issn.1008-8830.2204120.

ABSTRACT

OBJECTIVES: To investigate the influence of early-stage hypotension defined as mean arterial pressure (MAP)<gestational age (weeks) or MAP<30 mmHg on the short-term prognosis of preterm infants with a gestational age of <32 weeks.

METHODS: A total of 320 preterm infants who were admitted to Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology from April 2020 to August 2021 and met the inclusion criteria were enrolled in this prospective study. Blood pressure within 72 hours was monitored. The definition of hypotension and grouping were as follows: (1) Of the 320 preterm infants, those with MAP<gestational age in 2 consecutive measurements served as the hypotension group (n=104), and the others (n=216) served as the control group; (2) Of the 320 preterm infants, those with MAP<30 mmHg in 2 consecutive measurements served as the hypotension group (n=114), and the others served as the control group (n=206). Perinatal data and clinical data during hospitalization were collected.Poor short-term prognosis was defined as death during hospitalization and/or grade Ⅲ-Ⅳ periventricular-intraventricular hemorrhage identified within 1 week after birth. The multivariate logistic regression analysis was used to investigate the influence of hypotension based on the above two definitions on the short-term prognosis of preterm infants.

RESULTS: Compared with the control group, the hypotension group based on the above two definitions had higher incidence rates of the clinical manifestations of hypoperfusion, poor prognosis, hemodynamically significant patent ductus arteriosus, and pulmonary hemorrhage (P<0.05). In addition, compared with the control group, the hypotension group defined by MAP<30 mmHg had higher incidence rates of periventricular-intraventricular hemorrhage and bronchopulmonary dysplasia and mortality rate during hospitalization (P<0.05). The incidence of poor short-term prognosis in the hypotension group defined by MAP<30 mmHg was higher than that in the hypotension group defined by MAP<gestational age (18.4% vs 12.5%), but the difference was not statistically significant (P>0.05).The univariate analysis showed that the poor short-term prognosis was related to birth of cesarean section, gestational age, an Apgar score of ≤ 5 at 5 minutes, use of vasoactive drugs within 72 hours, mechanical ventilation within 72 hours, and hypotension under the two definitions (P<0.05).The multivariate logistic regression showed that hypotension based on either definition was not an independent risk factor for poor prognosis (P>0.05).

CONCLUSIONS: Hypotension based on either definition is not an independent risk factor for short-term poor prognosis in preterm infants with a gestational age of <32 weeks. Hypotension defined by MAP<30 mmHg might be more sensitive than that defined by MAP<gestational age in predicting short-term adverse outcomes, which needs further analysis by large sample studies.

PMID:36398543 | DOI:10.7499/j.issn.1008-8830.2204120

J Microbiol Biotechnol. 2022 Oct 24;32(12):1-10. doi: 10.4014/jmb.2209.09052. Online ahead of print.

ABSTRACT

In this study, we investigated the optimal conditions for 3D structure printing of alternative fats that have the textural properties of lard using beeswax (BW) oleogel-based alternative fat materials by an experimental statistical method. Products printed with over 15% BW oleogel at 50% and 75% infill level (IL) showed high printing accuracy with the lowest dimensional printing deviation for the designed model. The hardness, cohesion, and adhesion of printed samples were influenced by BW concentration and infill level. For multi-response optimization, fixed target values (hardness, adhesiveness, and cohesiveness) were applied with lard printed at 75% IL. The preparation parameters obtained as a result of multiple reaction prediction were 58.9% IL and 16.0% BW, and printing with this oleogel achieved fixed target values similar to those of lard. In conclusion, our study shows that 3D printing based on the BW oleogel system produces complex internal structures that allow adjustment of the textural properties of the printed samples, and BW oleogels could potentially serve as an excellent replacement for fat.

PMID:36398443 | DOI:10.4014/jmb.2209.09052

JPEN J Parenter Enteral Nutr. 2022 Nov 17. doi: 10.1002/jpen.2465. Online ahead of print.

ABSTRACT

BACKGROUND: Short bowel syndrome is the most common cause of intestinal failure (IF) in infants. We aimed to evaluate growth, nutritional intakes and predictors of weaning from parenteral nutrition (PN) of infants with IF.

METHODS: Clinical parameters, nutritional intakes and body weight and length z-scores were compared monthly from1st to 12th and at 18 and 24 months of life among infants on PN and those weaned. Logistic regression analysis was conducted to explore the predictors of weaning.

RESULTS: We included 23 infants (10/23 weaned). Median [range] birth weight and gestational age were: 1620 [590;3490] g and 31 [24;39] weeks respectively. All infants showed a growth retardation with similar median delta weight z-score from birth to discharge: -1.48 [-1.92;-0.94] in not-weaned and -1.18 [-2.70;0.31] in weaned infants, p=0.833 and a subsequent regain after the discharge: 0.20 [-3.47;3.25] and 0.84 [-0.03;2.58] respectively, p=0.518. No differences in length z-score were found among groups. After the sixth month, infants weaned from PN received lower PN energy and protein intakes compared to not-weaned. Infants weaned from PN showed lower parenteral nutrition dependency index (PNDI%) from 5 months onwards (45% for weaned and 113% for not-weaned infants at 5 months: p<0.001). The Belza’s score, a predictor of enteral autonomy computed at 6 months, is associated with being weaned from PN within 24 months (OR:1.906; p=0.039).

CONCLUSIONS: Infants weaned and not-weaned showed similar growth patterns. Our findings support the clinical relevance of Belza’s score and PNDI% as predictors of weaning from PN. Keywords This article is protected by copyright. All rights reserved.

PMID:36398420 | DOI:10.1002/jpen.2465

Paediatr Anaesth. 2022 Nov 17. doi: 10.1111/pan.14603. Online ahead of print.

NO ABSTRACT

PMID:36398409 | DOI:10.1111/pan.14603

Med Phys. 2022 Nov 17. doi: 10.1002/mp.16106. Online ahead of print.

ABSTRACT

BACKGROUND: Contouring of internal gross target volume (iGTV) is an essential part of treatment planning in radiotherapy to mitigate the impact of intra-fractional target motion. However, it is usually time-consuming and easily subjected to intra-observer and inter-observer variability. So far, few studies have been explored to directly predict iGTV by deep learning technique, because the iGTV contains not only the gross target volume (GTV) but also the motion information of the GTV.

PURPOSE: This work was an exploratory study to present a deep learning-based framework to segment iGTV rapidly and accurately in 4D CT images for lung cancers.

METHODS: Five models including 3D UNet, mmUNet with point-wise add merging approach (mmUNet-add), mmUNet with concatenate fusion strategy (mmUNet-cat), gruUNet with point-wise add fusion approach (gruUNet-add) and gruUNet with concatenate method (gruUNet-cat) were adopted for iGTV segmentation. All the models were originated from the 3D UNet network, with multi-channel multi-path and convolutional gated recurrent unit (GRU) added in the mmUNet and gruUNet networks, respectively. 70 patients with lung cancers were collected and 55 cases were randomly selected as the training set, and 15 cases as the testing set. In addition, the segmentation results of the five models were compared with the ground truths qualitatively and quantitatively.

RESULTS: In terms of Dice Similarity Coefficient (DSC), the proposed four networks (mmUNet-add, mmUNet-cat, gruUNet-add and gruUNet-cat) increased the DSC score of 3D UNet from 0.6945 to 0.7342, 0.7253, 0.7405 and 0.7365, respectively. However, the differences were not statistically significant (p>0.05). After a simple post-processing to remove the small isolated connected regions, the mean 95th percentile Hausdorff distances (HD_95s) of the 3D UNet, mmUNet-add, mmUNet-cat, gruUNet-add and gruUNet-cat networks were 19.70 mm, 15.75 mm, 15.84 mm, 15.61 mm and 15.83 mm, respectively, corresponding to 25.35 mm, 25.96 mm, 25.11 mm, 28.23 mm and 24.47 mm before the post-processing. With regard to runtime, significant elapsed time growths (about 70s and 230s) were observed both in the mmUNet and gruUNet architectures due to the increasing parameters. But the mmUNet structure showed less growth.

CONCLUSIONS: Our study demonstrated the ability of the deep learning technique to predict iGTVs directly. With the introduction of multi-channel multi-path and convolutional GRU, the segmentation accuracy was improved under certain conditions with a reduced segmentation efficiency and a further research topic when the 3D UNet network would lead to poor performance is elicited. Less efficiency degradation was observed in the mmUNet structure. Besides, the element-wise add fusing strategy was favorable to increase DSC. Whereas, HD_95 benefited from the concentrate merging approach. Nevertheless, the segmentation accuracy by deep learning still remains to be improved. This article is protected by copyright. All rights reserved.

PMID:36398404 | DOI:10.1002/mp.16106

Ann Clin Transl Neurol. 2022 Nov 17. doi: 10.1002/acn3.51702. Online ahead of print.

ABSTRACT

OBJECTIVE: We conducted a Mendelian randomization (MR) study to disentangle causal associations between women’s reproductive behaviors and ischemic stroke (IS) and investigate the roles of two modifiable risk factors (body mass index (BMI) and educational attainment (EA)) in these associations.

METHODS: Using summary-level data from large-scale genome-wide association studies, we performed univariable MR to examine whether there is genetic evidence that women’s reproductive traits are causally associated with IS and its subtypes. Multivariable MR and MR mediation analysis were used to investigate whether BMI and EA are common mechanisms or mediators for these associations. A set of sensitivity analyses were conducted to test valid MR assumptions.

RESULTS: We observed consistent and statistically significant associations across female and sex-combined analyses for earlier age at first birth (AFB) and age at first sexual intercourse (AFS) with a higher risk of IS and large-artery atherosclerotic stroke (LAS) risk in the primary analysis. The odds ratios of IS per 1 SD increase in genetically predicted early AFB and AFS were 0.93 (95% CI, 0.86-0.99; p = 0.046) and 0.83 (95% CI, 0.70-0.97, p = 0.020), respectively. Further analyses indicated that BMI played a shared role in AFS and IS/LAS while EA played a shared role in AFS/AFB and IS/LAS as well as a mediator in the path from AFS to IS/LAS.

INTERPRETATION: These findings may inform prevention strategies and interventions directed toward relative women’s reproductive behaviors and IS. Future studies are warranted to explore other factors related to EA which are responsible for these causalities.

PMID:36398399 | DOI:10.1002/acn3.51702

J Sex Marital Ther. 2022 Nov 17:1-12. doi: 10.1080/0092623X.2022.2146026. Online ahead of print.

ABSTRACT

Gender affirming surgery (GAS) helps individuals to achieve a physical presence consistent with their gender identity. In this study, we explored the decision, expectation, experience, satisfaction, and quality of life (QOL) of transgender women (TGWs) who have undergone GAS and compared their QOL with transfeminine individuals (TFs) who have not and are seeking to do so in Thailand. The median overall QOL score of the TGWs who have undergone GAS was slightly higher than that of the TFs who have not (95 (92-103) vs. 92 (86-98); p = 0.003), which was also reflected in the specific domains of psychological health, social relationships, and environmental health, the exception being physical health. Not being financially prepared was the most relevant reason for delaying undergoing GAS among the TFs who have not undergone it and want to do so. In addition, more than half of the TGWs who have undergone GAS regretted not being socially accepted after surgery. Although the difference between the QOLs of the two groups is statistically significant, the clinical significance should be further investigated to provide more insight. In addition, the higher QOL of TGWs might not solely be due to having undergone GAS.

PMID:36398380 | DOI:10.1080/0092623X.2022.2146026

J Anim Ecol. 2022 Nov 17. doi: 10.1111/1365-2656.13838. Online ahead of print.

ABSTRACT

Dispersal is a key life-history trait for most species and is essential to ensure connectivity and gene flow between populations and facilitate population viability in variable environments. Despite the increasing importance of range shifts due to global change, dispersal has proved difficult to quantify, limiting empirical understanding of this phenotypic trait and wider synthesis. Here we introduce a statistical framework to estimate standardised dispersal kernels from biased data. Based on this, we compare empirical dispersal kernels for European breeding birds considering age (average dispersal; natal, before first breeding; and breeding dispersal, between subsequent breeding attempts) and sex (females and males) and test whether different dispersal properties are phylogenetically conserved. We standardised and analysed data from an extensive volunteer-based bird ring-recoveries database in Europe (EURING) by accounting for biases related to different censoring thresholds in reporting between countries and to migratory movements. Then, we fitted four widely used probability density functions in a Bayesian framework to compare and provide the best statistical descriptions of the different age and sex-specific dispersal kernels for each bird species. The dispersal movements of the 234 European bird species analysed were statistically best explained by heavy-tailed kernels, meaning that while most individuals disperse over short distances, long-distance dispersal is a prevalent phenomenon in almost all bird species. The phylogenetic signal in both median and long dispersal distances estimated from the best-fitted kernel was low (Pagel’s λ < 0.25), while it reached high values (Pagel’s λ >0.7) when comparing dispersal distance estimates for fat-tailed dispersal kernels. As expected in birds, natal dispersal was on average 5 km greater than breeding dispersal, but sex-biased dispersal was not detected. Our robust analytical framework allows sound use of widely available mark-recapture data in standardised dispersal estimates. We found strong evidence that long-distance dispersal is common among European breeding bird species and across life stages. The dispersal estimates offer a first guide to selecting appropriate dispersal kernels in range expansion studies and provide new avenues to improve our understanding of the mechanisms and rules underlying dispersal events.

PMID:36398379 | DOI:10.1111/1365-2656.13838

Artif Organs. 2022 Nov 17. doi: 10.1111/aor.14457. Online ahead of print.

ABSTRACT

BACKGROUND: ECMO support is associated with the development of a systemic hyper-inflammatory response, which may become quite significant and extreme in some cases. We hypothesise that Cytosorb or Jafron therapy may benefit patients on V-A ECMO in terms of levels of inflammatory markers such as IL-6, complications and overall outcomes.

METHODS: We conducted a retrospective study of prospectively collected data in a single tertiary care center between January 2021 and April 2022. At the time of the analysis of this article, 20 patients on V-A ECMO had cytokine adsorption while on ECMO support: Cytosorb group (n=10), Jafron group (n=10). In 10 ECMO supported patients cytokine adsorption was not used, this group served as a control group, which may be quite significant in some cases. Evaluation of the level of inflammatory markers (IL-1, 6, 8; CRP, Leukocyte, Lactate, PCT, NT-proBNP, TNF-α) were performed.

RESULTS: There were statistically significant longer CPB time, aortic cross clamp time and ICU stay in cytokine adsorption groups than in control group, but there were no differences between subgroups with different types of haemoadsorption used. Moreover, in control group mortality rate was higher than the cytokine adsorption groups (60 % vs 20%, p 0.02). All patients had elevation of inflammatory markers in perioperative and immediate postoperative period. After 72 hours of intensive care, blood inflammation markers had tendency to decline.

CONCLUSION: At the time of writing, hemadsorption in patients requiring V-A ECMO support represents good therapeutic effect. This effect is permanent for the whole period of extracorporeal cytokine hemadsorption application for both CytoSorb and Jafron HA330 devices.

PMID:36398369 | DOI:10.1111/aor.14457