Incidence, impact and risk factors for multidrug-resistant organisms (MDRO) in patients with major trauma: a European Multicenter Cohort Study

xlomafota.13 shared this article with you from Inoreader Incidence, impact and risk factors for multidrug-resistant organisms (MDRO) in patients with major trauma: a European Multicenter Cohort Study Via Latest Results for European Journal of Trauma and Emergency Surgery Abstract Introduction The burden of MDRO in health systems is a global issue, and a growing problem. We conducted a European multicenter cohort study to assess the incidence, impact and risk factors for multidrug-resistant organisms in patients with major trauma. We conducted this study because the predictive factors and effects of MDRO in severely injured patients are not yet described. Our hypothesis is that positive detection of MDRO in severely injured patients is associated with a less favorable outcome. Methods Retrospective study of four level-1 trauma centers including all patients after major trauma with an injury severity score (ISS) ≥ 9 admitted to an intensive care unit (ICU) between 2013 and 2017. Outcome was measured using the Glasgow outcome scale (GOS). Results Of 4131 included patients, 95 (2.3%) had a positive screening for MDRO. Risk factors for MDRO were male gender (OR 1.73 [95% CI 1.04–2.89]), ISS (OR 1.01 [95% CI 1.00–1.03]), PRBC's given (OR 1.73 [95% CI 1.09–2.78]), ICU stay > 48 h (OR 4.01 [95% CI 2.06–7.81]) and mechanical ventilation (OR 1.85 [95% CI 1.01–3.38]). A positive MDRO infection correlates with worse outcome. MDRO positive cases GOS: good recovery = 0.6%, moderate disability = 2.1%, severe disability = 5.6%, vegetative state = 5.7% (p < 0.001). Conclusions MDRO in severely injured patients are rare but associated with a worse outcome at hospital discharge. We identified potential risk factors for MDRO in severely injured patients. Based on our results, we recommend a standardized screening procedure for major trauma patients. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sagittal imbalance and symptoms of depression in adults: Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study (LOHAS)

xlomafota.13 shared this article with you from Inoreader Sagittal imbalance and symptoms of depression in adults: Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study (LOHAS) Via Latest Results for European Spine Journal Abstract Purpose With spinal deformities, mental health can deteriorate due to sagittal imbalance of the spine. The purpose of this study was to clarify the relationship between sagittal imbalance and symptoms of depression among local residents in the community. Methods This study used data from the Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS) in 2010. The sagittal vertical axis (SVA) was identified as an indicator of sagittal imbalance. Symptoms of depression were assessed using the 5-item version of the Mental Health Inventory. Participants were classified into three categories based on the SVA balance as normal (< 40 mm), moderate imbalance (40–95 mm), and severe imbalance (> 95 mm). To evaluate the relationship between sagittal imbalance of the spine and symptoms of depression, the adjusted risk ratio (RR) and the 95% confidence interval (CI) were calculated using a generalized linear model with Poisson link. Results There were 786 participants included in the statistical analysis. Overall, the mean age was 68.1 y (standard deviation, 8.8 y), and 39.4% were men. The prevalence of symptoms of depression by SVA category was 18.6% for normal, 23.8% for moderate, and 40.6% for severe. On multivariate analysis, the RR of SVA for symptoms of depression compared to the normal category was 1.12 (95% CI 0.7–1.70) for the moderate category and 2.29 (95% CI 1.01–5.17) for the severe category. Conclusion In local community residents, sagittal imbalance had a significant association with symptoms of depression. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Application of an attention U-Net incorporating transfer learning for optic disc and cup segmentation

xlomafota.13 shared this article with you from Inoreader Application of an attention U-Net incorporating transfer learning for optic disc and cup segmentation Via Latest Results for Signal, Image and Video Processing Abstract Optic disc (OD) and optic cup (OC) regional parameters are of utmost importance in the early diagnosis of glaucoma. Improving the accuracy of OD/OC segmentation results and parameter extraction in colour fundus images plays a very important role in early glaucoma screening. To improve the accuracy and inference speed of fundus image segmentation, an algorithm for fundus image segmentation based on an attention U-Net with transfer learning is proposed in this paper. First, an attention gate was added between the encoder and decoder of U-Net to focus on the target areas, thus forming the architecture of the attention U-Net. Then, after the network had been trained on the DRIONS-DB dataset to partially obtain the weights of the encoder, it was trained on the Drishti-GS dataset to further modify the weights. Finally, the trained attention U-Net model incorporating transfer learning was used to segment fundus images. OD/OC extraction using this method shows obvious ad vantages in model parameter quantity and inference time compared with existing algorithms, the parameter quantity is much smaller than that of existing algorithms, and the model inference time is 0.33 s, representing a reduction of more than 50%. The proposed method can be applied to a fundus image dataset with only a small number of labels. Whilst offering fast OD/OC segmentation, it also guarantees a relatively high segmentation accuracy. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evaluating the Relationship Between Post Traumatic Stress Disorder Symptoms and Psychological Resilience in a Sample of Turkoman Refugees in Turkey

xlomafota.13 shared this article with you from Inoreader Evaluating the Relationship Between Post Traumatic Stress Disorder Symptoms and Psychological Resilience in a Sample of Turkoman Refugees in Turkey Via Latest Results for Journal of Immigrant and Minority Health Abstract Turkey has witnessed an increase in migration of people belonging to neighboring countries due to civil war. Traumatic life events experienced by refugees bring along mental problems. Their psychological resilience enables them to cope with these difficulties. In this study, 101 Iraqi Turkoman refugees who migrated to Turkey following the increasing civil war events in their country were evaluated psychologically. Sociodemographic data form Resilience Scale for Adults (RSA) and Clinician-Administered Post-Traumatic Stress Disorder Scale (CAPS) were used for psychological evaluation. The prevalence of lifetime post-traumatic stress disorder (PTSD) among the refugees was 25.7%. There was no significant difference between the psychological resilience of the patients who developed PTSD and those who did not (p = 0.709). As the severity of trauma decreased, psychological resilience increased in the people who developed PTSD (p = 0.001, r = −0.622). Consi dering the psychological resilience of refugees, the area with the highest resilience is access to social resources, while the area with the lowest is the planned future. It was observed that the basic needs of refugees after migration could not be met clearly compared to the ones before migration. It was noteworthy that in cases diagnosed with PTSD, CAPS scores increased (p = 0.011, r: 0.251) and resilience decreased (p < 0.001, r: −0.376) as the inability to reach basic needs increased. Our study is very important in terms of defining how refugees are mentally affected after settling in another country and what determines their psychological resilience. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Numerical investigation of patient-specific thoracic aortic aneurysms and comparison with normal subject via computational fluid dynamics (CFD)

xlomafota.13 shared this article with you from Inoreader Numerical investigation of patient-specific thoracic aortic aneurysms and comparison with normal subject via computational fluid dynamics (CFD) Via Latest Results for Medical & Biological Engineering & Computing Abstract Vascular hemodynamics play an important role in cardiovascular diseases. This work aimed to investigate the effects of an increase in ascending aortic diameter (AAD) on hemodynamics throughout a cardiac cycle for real patients. In this study, two scans of thoracic aortic aneurysm (TAA) subject with different AADs (42.94 mm and 48.01 mm) and a scan of a normal subject (19.81 mm) were analyzed to assess the effects of hemodynamics on the progression of TAA with the same flow rate. Real-patient aortic geometries were scanned by computed tomography angiography (CTA), and steady and pulsatile flow conditions were used to simulate real patient aortic geometries. Aortic arches were obtained from routine clinical scans. Computational fluid dynamics (CFD) simulations were performed with in vivo boundary conditions, and 3D Navier-Stokes equations were solved by a UDF (user-defined function) code defining a real cardiac cycle of one patient using Fourier seri es (FS). Wall shear stress (WSS) and pressure distributions were presented from normal subject to TAA cases. The results show that during the peak systolic phase pressure load increased by 18.56% from normal subject to TAA case 1 and by 23.8% from normal subject to TAA case 2 in the aneurysm region. It is concluded that although overall WSS increased in aneurysm cases but was low in dilatation areas. As a result, abnormal changes in WSS and higher pressure load may lead to rupture and risk of further dilatation. CFD simulations were highly effective to guide clinical predictions and assess the progress of aneurysm regions in case of early surgical intervention. Graphical abstract View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Molecular Cloning and Differential Gene Expression Analysis of 1-Deoxy-D-xylulose 5-Phosphate Synthase (DXS) in Andrographis paniculata (Burm. f) Nees

xlomafota.13 shared this article with you from Inoreader Molecular Cloning and Differential Gene Expression Analysis of 1-Deoxy-D-xylulose 5-Phosphate Synthase (DXS) in Andrographis paniculata (Burm. f) Nees Via Latest Results for Molecular Biotechnology Abstract Andrographis paniculata 1-deoxy-D-xylulose-5-phosphate synthase (ApDXS) gene (GenBank Accession No MG271749.1) was isolated and cloned from leaves for the first time. Expression of ApDXS gene was carried out in Escherichia coli Rosetta cells. Tissue-specific ApDXS gene expression by quantitative RT-PCR (qRT-PCR) revealed maximum fold expression in the leaves followed by stem and roots. Further, the differential gene expression profile of Jasmonic acid (JA)-elicited in vitro adventitious root cultures showed enhanced ApDXS expression compared to untreated control cultures. A. paniculata 3-hydroxy-3-methylglutaryl-coenzyme A reductase (ApHMGR) gene expression was also studied where it was up-regulated by JA elicitation but showed lower expression compared to ApDXS. The highest expression of both genes was found at 25 µm JA elicitation followed by 50 µm. HPLC data i ndicated that the transcription levels were correlated with increased andrographolide accumulation. The peak level of andrographolide accumulation was recorded at 25 μM JA (9.38-fold) followed by 50 µM JA (7.58-fold) in elicitation treatments. The in silico generated ApDXS 3D model revealed 98% expected amino acid residues in the favored and 2% in the allowed regions of the Ramachandran plot with 92% structural reliability. Further, prediction of conserved domains and essential amino acids [Arg (249, 252, 255), Asn (307) and Ser (247)] involved in ligand/inhibitor binding was carried out by in silico docking studies. Our present findings will generate genomic information and provide a blueprint for future studies of ApDXS and its role in diterpenoid biosynthesis in A. paniculata. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Molecular detection and characterization of tick-borne hemoparasites and Anaplasmataceae in dogs in major cities of Malawi

xlomafota.13 shared this article with you from Inoreader Molecular detection and characterization of tick-borne hemoparasites and Anaplasmataceae in dogs in major cities of Malawi Via Latest Results for Parasitology Research Abstract Tick-borne pathogens (TBPs) in dogs have attracted much attention over the last decade since some are now known to be zoonotic and pose a threat to both animal and human health sectors. Despite the increase in the number of studies on canine TBPs worldwide, only a few studies have been conducted in resource-limited countries where research priority is given to food animals than companion animals. In the present study, the occurrence of TBPs of the genera Babesia, Hepatozoon, Anaplasma, and Ehrlichia was investigated in 209 owned and stray dogs in three major cities in Malawi through molecular techniques. Among the examined dogs, 93 (44.5%) were infected with at least one TBP. The detection rates were 23.1% for Babesia rossi, 2.9% for B. vogeli, 19.1% for Hepatozoon canis, 2.4% for Anaplasma platys, and 3.8% for Ehrlichia canis. This is the first molecular study that has provided evid ence that dogs in Malawi are infected with TBPs. Sensitization is required for veterinary practitioners, dog handlers, and pet owners as the detected pathogens affect the animals' wellbeing. Further studies focusing on rural areas with limited or no access to veterinary care are required to ascertain the extent of the TBP infection in dogs. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Hyalomma anatolicum resistance against ivermectin and fipronil is associated with indiscriminate use of acaricides in southwestern Balochistan, Pakistan

xlomafota.13 shared this article with you from Inoreader Hyalomma anatolicum resistance against ivermectin and fipronil is associated with indiscriminate use of acaricides in southwestern Balochistan, Pakistan Via Latest Results for Parasitology Research Abstract Ivermectin and fipronil have been used regularly to control the hard tick Hyalomma anatolicum (Acari: Ixodidae) in domestic ruminants for more than a half-decade in Balochistan, Pakistan. Inappropriate and indiscriminate use of these acaricides has resulted in the development of resistances in tick species. In this work, acaricides (ivermectin and fipronil) resistance was evaluated in H. anatolicum through in vitro and in vivo bioassays in a horse farm of Quetta, Balochistan province, Pakistan. A participatory epidemiological survey was conducted to assess potential risk factors associated with the development of acaricide resistance in H. anatolicum. The results of the epidemiological survey revealed that the horse keepers did not follow the manufacturer's instructions for the use of acaricides and applied indiscriminate doses of acaricides. The results of in vitro bioassays (adult immersion test and larval immersion test) showed tha t fipronil and ivermectin have protective efficacy against H. anatolicum. The results of in vivo bioassay (adult-tick mortality assay) revealed that fipronil had a higher efficacy (78.16%) than ivermectin (49.94%). More than 80% of tick mortality was not achieved in any bioassays, even for the highest acaricide concentration (100 ppm), which suggests the development of acaricide resistance against fipronil and ivermectin. This study highlights the urgency to implement a country-wide awareness about resistance monitoring and effective tick control. Graphical abstract View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Midterm results of homografts in pulmonary position: a retrospective single-center study

xlomafota.13 shared this article with you from Inoreader Midterm results of homografts in pulmonary position: a retrospective single-center study Via Latest Results for Indian Journal of Thoracic and Cardiovascular Surgery Abstract Objective Valved conduits play a pivotal role in the right ventricular outflow tract (RVOT) reconstruction in patients with congenital heart disease (CHD), and valved homografts have become the most commonly used conduits in pediatric cardiac surgery. This study aimed to assess the midterm performance of aortic and pulmonary homografts used in pulmonary position in patients with CHD. Methods Ninety-eight patients underwent surgical RVOT reconstruction with a homograft from January 2012 to December 2017. We collected all patient details from the institute patient record system. Echocardiographic data were obtained from the records. Postoperative data included survival and follow-up echocardiography. The primary endpoints of the study were homograft failure, homograft dysfunction, and freedom from re-intervention. Results We observed allograft failure in two patients (2%), one each due to pseudo-aneurysm formation and infective endocarditis. There were 8 early deaths (8/98, 8.2%) and 9 late deaths (9/98, 9.2%). The mean survival time was 6.1 years, and the postoperative survival rate at 1 and 5 years was 89.73% and 82.65%, respectively. Homograft regurgitation and homograft dysfunction were higher in the pulmonary homograft group. However, the re-intervention rates were more in the aortic homograft (24.24%) group due to the higher incidence of calcification associated with them. Conclusion Homografts used for RVOT reconstruction provide excellent intermediate-term outcomes, irrespective of the type of homograft used. Pulmonary homografts are more durable than aortic homografts and provide satisfactory results even in infants. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Review of acute kidney injury and continuous renal replacement therapy in pediatric extracorporeal membrane oxygenation

xlomafota.13 shared this article with you from Inoreader Review of acute kidney injury and continuous renal replacement therapy in pediatric extracorporeal membrane oxygenation Via Latest Results for Indian Journal of Thoracic and Cardiovascular Surgery Abstract Purpose To review the relevant literature of acute kidney injury (AKI) and continuous renal replacement therapy (CRRT) as it relates to pediatric extracorporeal membrane oxygenation (ECMO). Methods Available online relevant literature. Results ECMO is a therapeutic modality utilized to support patients with refractory respiratory and/or cardiac failure. AKI and fluid overload (FO) are frequently observed in this patient population. There are multiple modalities that can be utilized for AKI and FO which include the following: diuretics, in-line hemofiltration, and CRRT. There are multiple considerations when using CRRT with ECMO including access, CRRT flows, hemolysis, anticoagulation, and CRRT termination. Conclusion While each ECMO center has its own set of equipment, experiences, and practices, it is imperative that the international ECMO community continues to work together to provide an evidence-based approach to address the morbidity and mortality associated with AKI and FO. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Are We Ready for Bariatric Surgery in a Liver Transplant Program? A Meta-Analysis

xlomafota.13 shared this article with you from Inoreader Are We Ready for Bariatric Surgery in a Liver Transplant Program? A Meta-Analysis Via Latest Results for Obesity Surgery Abstract Background Obesity-related non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are two main causes of end-stage liver disease requiring a liver transplantation. Studies exploring bariatric surgery in the liver transplantation setting have increased in recent years; however, a systematic analysis of the topic is lacking to date. This meta-analysis was conducted to explore the perioperative and long-term outcomes of bariatric surgery in obese patients undergoing liver transplantation. Methods Electronic databases were systematically searched for studies reporting bariatric surgery in patients undergoing liver transplantation. The primary outcomes were postoperative complications and mortality. We also extracted data about excess weight loss, body mass index, and improvement of comorbidities after bariatric surgery. Results A total of 96 patients from 8 articles were included. Bariatric surgery–related morbidity and mortality rates were 37% (95% CI 0.27–0.47) and 0.6% (95% CI 0.02–0.13), respectively. Body mass index at 24 months was 31.02 (95% CI 25.96–36.09) with a percentage excess weight loss at 12 and 24 months of 44.08 (95% CI 27.90–60.26) and 49.2 (95% CI 31.89–66.66), respectively. After bariatric surgery, rates of improvement of arterial hypertension and diabetes mellitus were 61% (95% CI 0.45–0.75) and 45% (95% CI 0.25–0.66), respectively. In most patients, bariatric surgery was performed after liver transplant and the most frequent technique was sleeve gastrectomy. Conclusions Bariatric surgery can be performed safely in the setting of liver transplantation resulting in improvement of obesity-related comorbidities. The optimal timing and technique require further studies. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

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