Journal articles on the topic 'EPER database'
To see the other types of publications on this topic, follow the link: EPER database.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 42 journal articles for your research on the topic 'EPER database.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Kondo, Tadashi. "Cancer proteome-expression database: Genome Medicine Database of Japan Proteomics." Expert Review of Proteomics 7, no. 1 (February 2010): 21–27. http://dx.doi.org/10.1586/epr.09.87.
Full text
2
Pitondo-Silva, André, Luciene A. R. Minarini, Ilana L. B. C. Camargo, and Ana Lúcia C. Darini. "Clonal relationships determined by multilocus sequence typing among enteropathogenicEscherichia coliisolated in Brazil." Canadian Journal of Microbiology 55, no. 6 (June 2009): 672–79. http://dx.doi.org/10.1139/w09-019.
Full textAbstract:
Enteropathogenic Escherichia coli (EPEC) infections are a leading cause of infantile diarrhea in developing nations. Multilocus sequence typing (MLST) characterizes bacterial strains based on the sequences of internal fragments in housekeeping genes. Little is known about strains of EPEC analyzed by MLST from Brazil. In this study, a diverse collection of 29 EPEC strains isolated from patients with diarrhea, admitted to the University Hospital of Ribeirao Preto, was characterized by MLST. Strain analysis demonstrated 22 different sequence types (STs), of which almost half (48%) were new, indicating a high genotype diversity. The 22 STs were divided by eBURST into 12 clonal complexes. It was not possible to correlate typical and atypical EPEC with other strains in the MLST database. This is the first study that analyzed EPEC strains from South America that are included in the E. coli MLST database. Nine (31%) out of 29 strains are part of the CC10 clonal complex, the major clonal complex in the database, which comprises 174 strains and 86 different STs, suggesting that these strains might be the most important intestinal pathogenic E. coli worldwide. Genetic relationships between typical and atypical EPEC, enterohemorrhagic E. coli, and enteroaggregative E. coli strains were not established by MLST.
3
Li, M., I. Rosenshine, S. L. Tung, X. H. Wang, D. Friedberg, C. L. Hew, and K. Y. Leung. "Comparative Proteomic Analysis of Extracellular Proteins of Enterohemorrhagic and Enteropathogenic Escherichia coli Strains and Their ihf and ler Mutants." Applied and Environmental Microbiology 70, no. 9 (September 2004): 5274–82. http://dx.doi.org/10.1128/aem.70.9.5274-5282.2004.
Full textAbstract:
ABSTRACT Enterohemorrhagic and enteropathogenic Escherichia coli (EHEC and EPEC, respectively) strains are closely related human pathogens that are responsible for food-borne epidemics in many countries. Integration host factor (IHF) and the locus of enterocyte effacement-encoded regulator (Ler) are needed for the expression of virulence genes in EHEC and EPEC, including the elicitation of actin rearrangements for attaching and effacing lesions. We applied a proteomic approach, using two-dimensional polyacrylamide gel electrophoresis in combination with matrix-assisted laser desorption ionization-time of flight mass spectrometry and a protein database search, to analyze the extracellular protein profiles of EHEC EDL933, EPEC E2348/69, and their ihf and ler mutants. Fifty-nine major protein spots from the extracellular proteomes were identified, including six proteins of unknown function. Twenty-six of them were conserved between EHEC EDL933 and EPEC E2348/69, while some of them were strain-specific proteins. Four common extracellular proteins (EspA, EspB, EspD, and Tir) were regulated by both IHF and Ler in EHEC EDL933 and EPEC E2348/69. TagA in EHEC EDL933 and EspC and EspF in EPEC E2348/69 were present in the wild-type strains but absent from their respective ler and ihf mutants, while FliC was overexpressed in the ihf mutant of EPEC E2348/69. Two dominant forms of EspB were found in EHEC EDL933 and EPEC E2348/69, but the significance of this is unknown. These results show that proteomics is a powerful platform technology for accelerating the understanding of EPEC and EHEC pathogenesis and identifying markers for laboratory diagnoses of these pathogens.
4
Pinget, Christophe, Elisabeth Allain, and François Saucy. "VP46 Cost Analysis Of Popliteal Aneurysm Management." International Journal of Technology Assessment in Health Care 33, S1 (2017): 168. http://dx.doi.org/10.1017/s0266462317003282.
Full textAbstract:
INTRODUCTION:Popliteal artery aneurysm (PAA) is the most common peripheral arterial aneurysm and the second most common aneurysm after abdominal aortic aneurysm (AAA). It presents a risk of occlusion, which may lead to acute ischemia and leg amputation. To prevent these risks, asymptomatic PAA >2cm and symptomatic PAA must be treated. Although open PPA repair (OPAR) is still the gold standard, endovascular PAA repair (EPAR) is increasingly used to manage PAA. The objective of this study is to compare the cost of these two medical procedures from the hospital perspective.METHODS:Data were retrieved from the administrative database of Lausanne University Hospital (CHUV – Switzerland). Based on diagnostic codes and medical procedure codes, we selected all patients who underwent OPAR or EPAR between 2011 and 2015. Patient's age, length of stay and cost were compared between both groups using Student t-test.RESULTS:We included seventy-three patient stays (OPAR forty and EPAR thirty-three). Gender balance was identical between groups (97 percent of male), but age was statistically significantly different (OPAR 67.5, EPAR 73, p = .04). EPAR induced shorter mean length of stay (5.1 days versus 11.7 days, p = .0000) and lower mean global cost (CHF 16,555 versus CHF23,514, p = .0085). Cost of procedure amounted to CHF 9,536 for OPAR versus CHF 3,848 for EPAR, medical supply and implants amounted to CHF 1,284 for OPAR versus CHF 7,041 for EPAR and other costs of hospital stay amounted to CHF 12,694 for OPAR versus CHF 5,666 for EPAR. (CHF 1.00 = USD1.00 = EURO 0.93)CONCLUSIONS:With higher patency rate, OPAR is still associated with better medical outcomes than EPAR. But EPAR is significantly less costly than OPAR. Implant cost of EPAR is more than offset by longer length of stay and operating time of OPAR.
5
Pattin, Kristine A., and Jason H. Moore. "Role for protein–protein interaction databases in human genetics." Expert Review of Proteomics 6, no. 6 (December 2009): 647–59. http://dx.doi.org/10.1586/epr.09.86.
Full text
6
Minhas, Rajan, Gregory Vogelaar, Dongmei Wang, Wadhah Almansoori, Eddy Lang, Ian E. Blanchard, Gerald Lazarenko, and Andrew McRae. "A prehospital treat-and-release protocol for supraventricular tachycardia." CJEM 17, no. 4 (February 23, 2015): 395–402. http://dx.doi.org/10.1017/cem.2014.53.
Full textAbstract:
ABSTRACTObjectiveParoxysmal supraventricular tachycardia (SVT) is a common dysrhythmia treated in the prehospital setting. Emergency medical service (EMS) agencies typically require patients treated for SVT to be transported to the hospital. This retrospective cohort study evaluated the impact, paramedic adherence, and patient re-presentation rates of a treat-and-release (T+R) protocol for uncomplicated SVT.MethodsData were linked from the Alberta Health Services EMS electronic patient care record (EPCR) database for the City of Calgary to the Regional Emergency Department Information System (REDIS). All SVT patients treated by EMS between September 1, 2010, and September 30, 2012, were identified. Databases were queried to identify re-presentations to EMS or an emergency department (ED) within 72 hours of T+R.ResultsThere were 229 confirmed SVT patient encounters, including 75 T+R events. Of these 75 T+R events, 10 (13%, 95% confidence interval [CI] [7.4, 23]) led to an EMS re-presentation within 72 hours, and 4 (5%, 95% CI [2.1, 13]) led to an ED. All re-presentations were attributed to a single individual. After excluding 15 records that were incomplete due to limitations in the EPCR platform, 43 of 60 (72%) T+R encounters met all protocol criteria for T+R.ConclusionThe T+R protocol evaluated in this study applied to a significant proportion of patients presenting to EMS with SVT. Risk of re-presentation following T+R was low, and paramedic protocol adherence was reasonable. T+R appears to be a viable option for uncomplicated SVT in the prehospital setting.
7
Gomez-Peralta, Fernando, Cristina Abreu, Manuel Benito, and Rafael J. Barranco. "Geographical clustering and socioeconomic factors associated with hypoglycemic events requiring emergency assistance in Andalusia (Spain)." BMJ Open Diabetes Research & Care 9, no. 1 (January 2021): e001731. http://dx.doi.org/10.1136/bmjdrc-2020-001731.
Full textAbstract:
IntroductionThe geographical distribution of hypoglycemic events requiring emergency assistance was explored in Andalusia (Spain), and potentially associated societal factors were determined.Research design and methodsThis was a database analysis of hypoglycemia requiring prehospital emergency assistance from the Public Company for Health Emergencies (Empresa Pública de Emergencias Sanitarias (EPES)) in Andalusia during 2012, which served 8 393 159 people. Databases of the National Statistics Institute, Basic Spatial Data of Andalusia and System of Multiterritorial Information of Andalusia were used to retrieve spatial data and population characteristics. Geographic Information System software (QGIS and GeoDA) was used for analysis and linkage across databases. Spatial analyses of geographical location influence in hypoglycemic events were assessed using Moran’s I statistics, and linear regressions were used to determine their association with population characteristics.ResultsThe EPES attended 1 137 738 calls requesting medical assistance, with a mean hypoglycemia incidence of 95.0±61.6 cases per 100 000 inhabitants. There were significant differences in hypoglycemia incidence between basic healthcare zones attributable to their geographical location in the overall population (Moran’s I index 0.122, z-score 7.870, p=0.001), women (Moran’s I index 0.088, z-score 6.285, p=0.001), men (Moran’s I index 0.076, z-score 4.914, p=0.001) and aged >64 years (Moran’s I index 0.147, z-score 9.753, p=0.001). Hypoglycemia incidence was higher within unemployed individuals (β=0.003, p=0.001) and unemployed women (β=0.005, p=0.001), while lower within individuals aged <16 years (β=−0.004, p=0.040), higher academic level (secondary studies) (β=−0.003, p=0.004) and women with secondary studies (β=−0.005, p<0.001). In subjects aged >64 years, lower rate of hypoglycemia was associated with more single-person homes (β=−0.008, p=0.022) and sports facilities (β=−0.342, p=0.012).ConclusionsThis analysis supports the geographical distribution of hypoglycemia in the overall population, both genders and subjects aged >64 years, which was affected by societal factors such as unemployment, literacy/education, housing and sports facilities. These data can be useful to design specific prevention programs.
8
Goldenberg, M., A. Felner, R. Stern, G. Sharon, N. Sturtevant, R. C. Holte, and J. Schaeffer. "Enhanced Partial Expansion A*." Journal of Artificial Intelligence Research 50 (May 28, 2014): 141–87. http://dx.doi.org/10.1613/jair.4171.
Full textAbstract:
When solving instances of problem domains that feature a large branching factor, A* may generate a large number of nodes whose cost is greater than the cost of the optimal solution. We designate such nodes as surplus. Generating surplus nodes and adding them to the OPEN list may dominate both time and memory of the search. A recently introduced variant of A* called Partial Expansion A* (PEA*) deals with the memory aspect of this problem. When expanding a node n, PEA* generates all of its children and puts into OPEN only the children with f = f (n). n is re-inserted in the OPEN list with the f -cost of the best discarded child. This guarantees that surplus nodes are not inserted into OPEN. In this paper, we present a novel variant of A* called Enhanced Partial Expansion A* (EPEA*) that advances the idea of PEA* to address the time aspect. Given a priori domain- and heuristic- specific knowledge, EPEA* generates only the nodes with f = f(n). Although EPEA* is not always applicable or practical, we study several variants of EPEA*, which make it applicable to a large number of domains and heuristics. In particular, the ideas of EPEA* are applicable to IDA* and to the domains where pattern databases are traditionally used. Experimental studies show significant improvements in run-time and memory performance for several standard benchmark applications. We provide several theoretical studies to facilitate an understanding of the new algorithm.
9
Kim, Tae Yeul, Tae-Min La, Taesoo Kim, Sun Ae Yun, Sang-Won Lee, Hee Jae Huh, and Nam Yong Lee. "Whole-Genome Sequencing Analysis of a stx-Negative Escherichia coli O63:H6 Isolate Associated with Hemolytic Uremic Syndrome." Diagnostics 11, no. 10 (October 2, 2021): 1823. http://dx.doi.org/10.3390/diagnostics11101823.
Full textAbstract:
Shiga toxin-encoding genes (stx) of enterohemorrhagic Escherichia coli (EHEC) can be lost during infection or in vitro cultivation, and in clinical practice, it is difficult to distinguish EHEC that have lost stx (EHEC-LST) from enteropathogenic E. coli (EPEC), as both are stx-negative and eae-positive. In this study, we performed whole-genome sequencing (WGS) of a stx-negative, eae-positive E. coli O63:H6 isolate from a child with hemolytic uremic syndrome and compared its genome with those of nine E. coli O63:H6 strains in public databases. Virulence gene profiles were analyzed and core-genome multilocus sequence typing (cgMLST) was conducted. The virulence gene profile of our isolate was consistent with EHEC, except for the absence of stx, and the isolate clustered with seven EHEC strains but was distant from two EPEC strains in cgMLST. In genome alignment, our isolate exhibited a high nucleotide identity with EHEC strain 377323_2f but displayed a gap corresponding to the stx-harboring prophage sequence. Overall, our isolate was genetically closely related to EHEC strains, consistent with this being an EHEC-LST strain. As EHEC-LST may be misdiagnosed as EPEC in routine laboratories, comparative genomic analysis using WGS can be useful to determine whether stx-negative and eae-positive isolates are EHEC-LST or EPEC.
10
Ruhl, Stefan. "The scientific exploration of saliva in the post-proteomic era: from database back to basic function." Expert Review of Proteomics 9, no. 1 (February 2012): 85–96. http://dx.doi.org/10.1586/epr.11.80.
Full text
11
Walker, Chad. "Using the United States Wind Turbine Database to Identify Increasing Turbine Size, Capacity and Other Development Trends." Energy and Power Engineering 12, no. 07 (2020): 407–31. http://dx.doi.org/10.4236/epe.2020.127025.
Full text
12
Schmeller, Gabriella, Gábor Nagy, Noémi Sarkadi, Anikó Cséplő, Ervin Pirkhoffer, István Geresdi, Richárd Balogh, Levente Ronczyk, and Szabolcs Czigány. "Trends in extreme precipitation events (SW Hungary) based on a high-density monitoring network." Hungarian Geographical Bulletin 71, no. 3 (September 29, 2022): 231–47. http://dx.doi.org/10.15201/hungeobull.71.3.2.
Full textAbstract:
Climate change is commonly associated with extreme weather phenomena. Extreme weather patterns may bring prolonged drought periods, more intense runoff and increased severity of floods. Rainfall distribution is extremely erratic both in space and time, particularly in areas of rugged topography and heterogeneous land use. Therefore, locating major rainfall events and predicting their hydrological consequences is challenging. Hence, our study aimed at exploring the spatial and temporal patterns of daily rainfall totals of R ≥ 20 mm, R ≥ 30 mm and R ≥ 40 mm (extreme precipitation events, EPE) in Pécs (SW Hungary) by a hydrometeorological network (PHN) of 10 weather stations and the gridded database of the Hungarian Meteorological Service (OMSZ). Our results revealed that (a) OMSZ datasets indicated increasing frequencies of EPEs for the period of 1971–2020 in Pécs, (b) the OMSZ dataset generally underestimated EPE frequencies, particularly for R ≥ 40 mm EPEs, for the period of 2013 to 2020, and (c) PHN indicated a slight orographic effect, demonstrating spatial differences of EPEs between the two datasets both annually and seasonally for 2013–2020. Our results pointed out the adequacy of interpolated datasets for mesoscale detection of EPE distribution. However, topographically representative monitoring networks provide more detailed microscale data for the hydrological management of urban areas. Data from dense rain-gauge networks may complement interpolated datasets, facilitating complex environmental management actions and precautionary measures, particularly during weather-related calamities.
13
Kuzevicova, Zofia, Diana Bobikova, Stefan Kuzevic, and Samer Khouri. "Changes in the Country and Their Impact on Topographic Data of Agricultural Land—A Case Study of Slovakia." Land 10, no. 11 (November 8, 2021): 1208. http://dx.doi.org/10.3390/land10111208.
Full textAbstract:
Due to natural phenomena as well as human activities, changes are occurring in land use. Techniques and environment GIS have made it possible to process large amounts of data from various sources. In Slovakia, mapping of topography and elevation is being carried out as part of the elaboration of land readjustment projects. This is also a starting point for updating estimated pedologic-ecological units (EPEUs). Therefore, it is necessary to make efforts to harmonize the real state of the country with the data stored in the EPEU database, which are the basis for spatial analyses in the country and the creation of price maps. The EPEU system was built in the 1970s; however, only after 1990, due to changes in ownership and user conditions of the land, did it begin to seriously address the issue of updating data. This study examines selected sources of altimetry data, especially airborne laser scanning (ALS), and their potential role in processing purpose maps and harmonizing boundary curves and slope and exposure characteristics at a stable 5-position EPEU local code. Based on the obtained results, the use of ALS data and the Digital Terrain Model (DTM) derived from them may lead to the streamlining of some processes in terms of planning and decision-making regarding land use, even outside the context of the ongoing land reforms in the Slovak Republic.
14
Dayer, Guillem, Mehran L. Masoom, Melissa Togtema, and Ingeborg Zehbe. "Virus–Host Protein–Protein Interactions between Human Papillomavirus 16 E6 A1 and D2/D3 Sub-Lineages: Variances and Similarities." International Journal of Molecular Sciences 21, no. 21 (October 27, 2020): 7980. http://dx.doi.org/10.3390/ijms21217980.
Full textAbstract:
High-risk strains of human papillomavirus are causative agents for cervical and other mucosal cancers, with type 16 being the most frequent. Compared to the European Prototype (EP; A1), the Asian-American (AA; D2/D3) sub-lineage seems to have increased abilities to promote carcinogenesis. Here, we studied protein–protein interactions (PPIs) between host proteins and sub-lineages of the key transforming E6 protein. We transduced human keratinocyte with EP or AA E6 genes and co-immunoprecipitated E6 proteins along with interacting cellular proteins to detect virus–host binding partners. AAE6 and EPE6 may have unique PPIs with host cellular proteins, conferring gain or loss of function and resulting in varied abilities to promote carcinogenesis. Using liquid chromatography-mass spectrometry and stringent interactor selection criteria based on the number of peptides, we identified 25 candidates: 6 unique to AAE6 and EPE6, along with 13 E6 targets common to both. A novel approach based on pathway selection discovered 171 target proteins: 90 unique AAE6 and 61 unique EPE6 along with 20 common E6 targets. Interpretations were made using databases, such as UniProt, BioGRID, and Reactome. Detected E6 targets were differentially implicated in important hallmarks of cancer: deregulating Notch signaling, energetics and hypoxia, DNA replication and repair, and immune response.
15
Gergely, G., S. Gurban, M. Menyhard, and A. Jablonski. "Determination of Surface-Excitation Parameters for Elastic Peak Electron Spectroscopy (EPES) Using the Database of Goto." Journal of Surface Analysis 15, no. 2 (2008): 159–65. http://dx.doi.org/10.1384/jsa.15.159.
Full text
16
Schaumann, Reiner, Nicolas Knoop, Gelimer H. Genzel, Kevin Losensky, Christiane Rosenkranz, Catalina S. Stîngu, Wolfgang Schellenberger, Arne C. Rodloff, and Klaus Eschrich. "Discrimination of Enterobacteriaceae and Non-fermenting Gram Negative Bacilli by MALDI-TOF Mass Spectrometry." Open Microbiology Journal 7, no. 1 (June 28, 2013): 118–22. http://dx.doi.org/10.2174/1874285801307010118.
Full textAbstract:
Discrimination of Enterobacteriaceae and Non-fermenting Gram Negative Bacilli by MALDI-TOF Mass Spectrometry Matrix assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) has proven to be an effective identification tool in medical microbiology. Discrimination to subspecies or serovar level has been found to be challenging using commercially available identification software. By forming our own reference database and using alternative analysis methods, we could reliably identify all implemented Enterobacteriaceae and non-fermenting gram negative bacilli by MALDI-TOF MS and even succeeded to distinguish Shigella sonnei from Escherichia coli (E. coli) and Salmonella enterica spp. enterica serovar Enteritidis from Salmonella enterica spp. enterica serovar Typhimurium. Furthermore, the method showed the ability to separate Enterohemorrhagic E. coli (EHEC) and Enteropathogenic E. coli (EPEC) from non-enteropathogenic E. coli.
17
Engertsberger, Lara, Martin Benesch, Martin Mynarek, Svenja Tonn, Martina Stickan-Verfürth, Angela Funk, Kristian W. Pajtler, et al. "EPEN-19. Impact of molecular classification on prognosis in children and adolescents with spinal ependymoma: Results from the HIT-MED database." Neuro-Oncology 24, Supplement_1 (June 1, 2022): i42—i43. http://dx.doi.org/10.1093/neuonc/noac079.156.
Full textAbstract:
Abstract PURPOSE: Ependymomas of the spinal cord are rare among children, and individual risks of disease progression are difficult to predict. This study aims at evaluating the prognostic impact of DNA methylation-based classification in children with spinal ependymoma. METHODS: Eighty-two patients with spinal ependymoma <22 years registered in the HIT-MED database between 1992 and 2021 were included. Clinical, radiological, and histopathological data were collected retrospectively. DNA methylation profiles of 46 tumors were classified according to the Heidelberg Brain Tumor Classifier. RESULTS: Spinal myxopapillary ependymoma (SP-MPE, n=27) was the most common methylation group followed by spinal ependymoma (SP-EPN, n=15). Two cases belonged to MYCN-amplified subgroup, one had no match, and one was re-classified as anaplastic pilocytic astrocytoma (the latter excluded from final analysis). WHO grade I and III ependymomas (according to the WHO 2016 classification) classified predominantly as SP-MPE, whereas grade II ependymomas clustered into SP-MPE and SP-EPN. 6/15 patients with SP-EPN (40%) suffered from Neurofibromatosis type 2. Among patients with SP-MPE, 23 underwent gross-total and four a subtotal resection (GTR/STR). Relapses of SP-MPE were more common following STR (5-year progression-free survival (5y-PFS) [STR] 25.0% [95% confidence interval: 0.0-68.4], [GTR] 75.0% [53.4-96.6], p=0.003). In the SP-EPN group, 2/8 patients relapsed after STR (5y-PFS 64.3% [22,3-100]) and 0/7 after GTR (n.s.). WHO I° ependymoma had significantly inferior PFS than II° and III° ependymoma (5y-PFS [I°] 39.0% [5.8-62.2], [II°] 82.4% [67.8-97.0], [III°] 50.5% [18.9-82.1], p=0.009). However, PFS did not significantly differ between SP-MPE and SP-EPN (5y-PFS 65.9% [44.9-86.9], 76.9% [46.3-100], respectively). CONCLUSION: Spinal ependymomas of WHO grade I go along with relatively poor PFS in our cohort, while DNA methylation profiling does not segregate patients into distinct risk groups. Still, larger cohorts and further investigations of methylation class heterogeneity in pediatric spinal ependymomas are needed to complete the basis for future clinical decision-making.
18
Ruzante, Juliana M., Katherine Olin, Breda Munoz, Jeff Nawrocki, Rangaraj Selvarangan, and Lindsay Meyers. "Real-time gastrointestinal infection surveillance through a cloud-based network of clinical laboratories." PLOS ONE 16, no. 4 (April 30, 2021): e0250767. http://dx.doi.org/10.1371/journal.pone.0250767.
Full textAbstract:
Acute gastrointestinal infection (AGI) represents a significant public health concern. To control and treat AGI, it is critical to quickly and accurately identify its causes. The use of novel multiplex molecular assays for pathogen detection and identification provides a unique opportunity to improve pathogen detection, and better understand risk factors and burden associated with AGI in the community. In this study, de-identified results from BioFire® FilmArray® Gastrointestinal (GI) Panel were obtained from January 01, 2016 to October 31, 2018 through BioFire® Syndromic Trends (Trend), a cloud database. Data was analyzed to describe the occurrence of pathogens causing AGI across United States sites and the relative rankings of pathogens monitored by FoodNet, a CDC surveillance system were compared. During the period of the study, the number of tests performed increased 10-fold and overall, 42.6% were positive for one or more pathogens. Seventy percent of the detections were bacteria, 25% viruses, and 4% parasites. Clostridium difficile, enteropathogenic Escherichia coli (EPEC) and norovirus were the most frequently detected pathogens. Seasonality was observed for several pathogens including astrovirus, rotavirus, and norovirus, EPEC, and Campylobacter. The co-detection rate was 10.2%. Enterotoxigenic E. coli (ETEC), Plesiomonas shigelloides, enteroaggregative E. coli (EAEC), and Entamoeba histolytica were detected with another pathogen over 60% of the time, while less than 30% of C. difficile and Cyclospora cayetanensis were detected with another pathogen. Positive correlations among co-detections were found between Shigella/Enteroinvasive E. coli with E. histolytica, and ETEC with EAEC. Overall, the relative ranking of detections for the eight GI pathogens monitored by FoodNet and BioFire Trend were similar for five of them. AGI data from BioFire Trend is available in near real-time and represents a rich data source for the study of disease burden and GI pathogen circulation in the community, especially for those pathogens not often targeted by surveillance.
19
Redfield, Colby, Abdulhakim Tlimat, Yoni Halpern, David W. Schoenfeld, Edward Ullman, David A. Sontag, Larry A. Nathanson, and Steven Horng. "Derivation and validation of a machine learning record linkage algorithm between emergency medical services and the emergency department." Journal of the American Medical Informatics Association 27, no. 1 (October 12, 2019): 147–53. http://dx.doi.org/10.1093/jamia/ocz176.
Full textAbstract:
Abstract Objective Linking emergency medical services (EMS) electronic patient care reports (ePCRs) to emergency department (ED) records can provide clinicians access to vital information that can alter management. It can also create rich databases for research and quality improvement. Unfortunately, previous attempts at ePCR and ED record linkage have had limited success. In this study, we use supervised machine learning to derive and validate an automated record linkage algorithm between EMS ePCRs and ED records. Materials and Methods All consecutive ePCRs from a single EMS provider between June 2013 and June 2015 were included. A primary reviewer matched ePCRs to a list of ED patients to create a gold standard. Age, gender, last name, first name, social security number, and date of birth were extracted. Data were randomly split into 80% training and 20% test datasets. We derived missing indicators, identical indicators, edit distances, and percent differences. A multivariate logistic regression model was trained using 5-fold cross-validation, using label k-fold, L2 regularization, and class reweighting. Results A total of 14 032 ePCRs were included in the study. Interrater reliability between the primary and secondary reviewer had a kappa of 0.9. The algorithm had a sensitivity of 99.4%, a positive predictive value of 99.9%, and an area under the receiver-operating characteristic curve of 0.99 in both the training and test datasets. Date-of-birth match had the highest odds ratio of 16.9, followed by last name match (10.6). Social security number match had an odds ratio of 3.8. Conclusions We were able to successfully derive and validate a record linkage algorithm from a single EMS ePCR provider to our hospital EMR.
20
Ritzmann, Timothy, Anbarasu Lourdusamy, Andrew Jackson, Lisa Storer, Andrew Donson, Andrea Griesinger, Nicholas Foreman, Hazel Rogers, and Richard Grundy. "EPEN-23. A COMPUTATIONAL ANALYSIS OF THE TUMOUR IMMUNE MICROENVIRONMENT IN PAEDIATRIC EPENDYMOMA." Neuro-Oncology 22, Supplement_3 (December 1, 2020): iii312. http://dx.doi.org/10.1093/neuonc/noaa222.160.
Full textAbstract:
Abstract Ependymoma is the third commonest childhood brain tumour. Relapse is frequent, often fatal and current therapeutic strategies are inadequate. Previous ependymoma research describes an immunosuppressive environment with T-cell exhaustion, indicating a lack of response to T-cell directed immunotherapy. Understanding the immune microenvironment is therefore critical. We present a computational analysis of ependymoma, gene expression derived, immune profiles. Using 465 ependymoma samples from gene expression datasets (GSE64415, GSE50385, GSE100240) and two RNA-seq databases from UK ependymomas, we applied bulk tumour deconvolution methods (CIBERSORT and xCell) to infer immune cell populations. Additionally, we measured checkpoint blockade related mRNAs and used immunohistochemistry to investigate cell populations in ependymoma sections. CIBERSORT indicated high proportions of M2-like macrophages and smaller proportions of activated natural killer (NK) cells, T follicular helper cells, CD4+ memory T-cells and B-cells. xCell overlapped with the M2-like macrophage and CD4+ memory T-cell signatures seen in CIBERSORT. On immunohistochemistry, T and B cells were scarce, with small numbers of CD8+, CD4+ and CD20+ cells in the parenchyma but greater numbers in surrounding regions. CD68 was more highly expressed in the parenchyma. Analysis of nine checkpoint ligands and receptors demonstrated only the TIM3/GAL9 combination was reliably detectable. GAL9 is implicated in tumour interactions with T-cells and macrophages elsewhere, possibly contributing to poorer outcomes. Our study supports the presence of myeloid cells being leading contributors to the ependymoma immune microenvironment. Further work will delineate the extent of myeloid contribution to immunosuppression across molecular subtypes. Modulation of tumour immunity may contribute to better clinical outcomes.
21
Griesinger, Andrea, Faith Harris, Andrew Donson, Austin Gillen, Kent Riemondy, Sujatha Venkataraman, Vladimir Amani, Michael Handler, Todd Hankinson, and Nicholas Foreman. "EPEN-26. NON-CANONICAL NF-κB SIGNALING DRIVES MESENCHYMAL EPENDYMAL CELL SUBPOPULATION IN PFA EPENDYMOMA." Neuro-Oncology 22, Supplement_3 (December 1, 2020): iii313. http://dx.doi.org/10.1093/neuonc/noaa222.163.
Full textAbstract:
Abstract NF-κB signaling is a hallmark of PFA1 ependymoma. Loss of LDOC1, through epigenetic silencing, leads to constitutively active NF-κB signaling and chronic IL-6 secretion. In this study, we investigate the loss of LDOC1 within the PFA tumor clusters. Using our PFA scRNAseq database, in which there are 5 clusters within the tumor cell compartment: mesenchymal (MEC), ciliated (CEC), transportive (TEC), and undifferentiated (UEC). LDOC1 expression was significantly reduced and had an inverse correlation with genes defining the unfavorable MEC subpopulation, predominate in PFA1. This is consistent with our findings that MEC was defined by an NF-κB2 signaling profile. In contrast, LDOC1 expression was higher and positively correlated with genes defining the favorable CEC subpopulation, mostly seen in PFA2. RELA expression, which we studied as a target of LDOC1, was not localized to MEC and was wide-spread throughout the PFA compartment. RELB, part of non-conical NF-κB signaling, was expressed only the MEC subpopulation correlating with IL-6 gene expression found only in this subpopulation. In MAF-811, a PFA cell line with more CEC-like gene phenotype, RELB co-immunoprecipates with the active form of NF-κB2 in both the nucleus and cytoplasm. IL-6 gene expression is almost completely lost when NF-κB2 is knock-down using shRNA. Additionally, loss of LDOC1 leads to over 3 fold increase in NF-κB2 expression. Combined with our previous work, this would suggest that NF-κB2 drives IL-6 expression by binding with RELB in MEC subpopulation and targeting loss of LDOC1 may shift the MEC subpopulation toward the more favorable CEC subpopulation.
22
Sharmila, Vallem, and K. Ashoka Reddy. "Identification of Premature Ventricular Cycles of Electrocardiogram Using Discrete Cosine Transform-Teager Energy Operator Model." Journal of Medical Engineering 2015 (March 2, 2015): 1–9. http://dx.doi.org/10.1155/2015/438569.
Full textAbstract:
An algorithm based on the ability of TEO to track the changes in the envelope of ECG signal is proposed for identifying PVCs in ECG. Teager energy is calculated from DCT coefficients of ECG signal. This method can be considered as computationally efficient algorithm when compared with the well-known DCT cepstrum technique. EPE is derived from the teager energy of DCT coefficients in DCT-TEO method and from the cepstrum of DCT coefficients in the existing method. EPE determines the decay rate of the action potential of ECG beat and provides sufficient information to identify the PVC beats in ECG data. EPEs obtained by DCT-TEO and existing DCT cepstrum models are compared. The proposed algorithm has resulted in performance measures like sensitivity of 98–100%, positive predictivity of 100%, and detection error rate of 0.03%, when tested on MIT-BIH database signals consisting of PVC and normal beats. Result analysis reveals that the DCT-TEO algorithm worked well in clear identification of PVCs from normal beats compared to the existing algorithm, even in the presence of artifacts like baseline wander, PLI, and noise with SNR of up to −5 dB.
23
Howland, Ian Ronald, Ian Lucas Howard, Yugan Pillay, Beverley Dawn Ludick, and Nicholas Raymond Castle. "Prehospital use of the traction splint for suspected mid-shaft femur fractures." Journal of Paramedic Practice 11, no. 9 (September 2, 2019): 390–95. http://dx.doi.org/10.12968/jpar.2019.11.9.390.
Full textAbstract:
Introduction: A retrospective audit of electronic patient care records (ePCRs) highlighted the infrequent use of the traction splint for the management of femur fractures. The aim of this study was to improve the use of the traction splint for patients presenting with a mid-shaft femur fracture in the absence of contraindications, by means of introducing a purpose-designed trauma CPD training course. Methods: An intervention consisting of a simulation-based mandatory trauma CPD training session for all operational prehospital care providers was implemented over a 3-month period, supported by a pre- and post-implementation staff survey regarding staff perceptions of using a traction splint. Following the intervention period, a repeat retrospective audit of the ePCR database was conducted to identify any improvement in the use of the traction splint. Results: The use of the traction splint for a femur fracture in the pre-intervention stage was found to be underutilised (Median 16%). Following the intervention period, however, traction splint use increased significantly (Median 50%). An improvement was also noted in staff perception and understanding of the management of femur fractures. Conclusion: This study found that focused trauma training is an effective means to improve patient care. Training should be ongoing in order to maintain skills and knowledge needed for management of femur fractures.
24
Kinsey, J. E., L. L. Lao, O. Meneghini, J. Candy, P. B. Snyder, and G. M. Staebler. "Equilibrium reconstruction of DIII-D plasmas using predictive modeling of the pressure profile." Physics of Plasmas 29, no. 6 (June 2022): 062502. http://dx.doi.org/10.1063/5.0078935.
Full textAbstract:
New workflows have been developed for predictive modeling of magnetohydrodynamic (MHD) equilibrium in tokamak plasmas. The goal of this work is to predict the MHD equilibrium in tokamak discharges without having measurements of the kinetic profiles. The workflows include a cold start tool, which constructs all the profiles and power flows needed by transport codes; a Grad–Shafranov equilibrium solver; and various codes for the sources and sinks. For validation purposes, a database of DIII-D tokamak discharges has been constructed that is comprised of scans in the plasma current, toroidal magnetic field, and triangularity. Initial efforts focused on developing a workflow utilizing an empirically derived pressure model tuned to DIII-D discharges with monotonic safety factor profiles. This workflow shows good agreement with experimental kinetic equilibrium calculations, but is limited in that it is a single fluid (equal ion and electron temperatures) model and lacks H-mode pedestal predictions. The best agreement with the H-mode database is obtained using a theory-based workflow utilizing pressure profile predictions from a coupled TGLF turbulent transport and EPED pedestal models together with external magnetics and Motional Stark Effect (MSE) data to construct the equilibrium. Here, we obtain an average root mean square error of 5.1% in the safety factor profile when comparing the predicted and experimental kinetic equilibrium. We also find good agreement with the plasma stored energy, internal inductance, and pressure profiles. Including MSE data in the theory-based workflow results in noticeably improved agreement with the q-profiles in high triangularity discharges in comparison with the results obtained with magnetic data only. The predictive equilibrium workflow is expected to have wide applications in experimental planning, between-shot analysis, and reactor studies.
25
Pal, Partha. "Ribotyping as a Molecular Biological Technique for Studying Diversity in Shigella Isolates - A Review." International Letters of Natural Sciences 19 (July 2014): 84–92. http://dx.doi.org/10.18052/www.scipress.com/ilns.19.84.
Full textAbstract:
Diarrhoea in developing countries is caused by an increasingly long list of bacterial, viral, and parasitic pathogens with rotavirus, Enterotoxigenic Escherichiacoli, Campylobacter, Shigella, and Salmonella heading the list. Using methods to detect most of the known enteropathogens, one or more enteropathogen(s) is isolated in two-thirds of diarrhoeal illnesses in the developing world. Deoxyribonucleic acid probes have proved very useful in detecting pathogens such as enterotoxigenic (ETEC), enteroinvasive (EIEC), enteropathogenic E. coli (EPEC), and Shigella but have not yet proved to be particularly rapid or less expensive. Molecular biology has proved useful in epidemiological studies as a means of strain identification and detection of genome diversity. Since the introduction of ribonucleic acid gene restriction patterns as taxonomic tools in 1986, ribotyping has become an established method for systematics, epidemiological, ecological population and genome diversity studies of microorganisms including Shigella. The technological development culminated in the automation of ribotyping which allowed for high-throughput applications. PCR ribotyping has proved being a highly discriminatory, flexible, robust and cost-efficient routine technique which makes inter-laboratory comparison and build of ribotype databases possible, too. The aim of the present review is to determine the present status of ribotyping technique in detecting the diversity in Shigella isolates.
26
Pal, Partha. "Ribotyping as a Molecular Biological Technique for Studying Diversity in <i>Shigella</i> Isolates - A Review." International Letters of Natural Sciences 19 (July 16, 2014): 84–92. http://dx.doi.org/10.56431/p-me872k.
Full textAbstract:
Diarrhoea in developing countries is caused by an increasingly long list of bacterial, viral, and parasitic pathogens with rotavirus, Enterotoxigenic Escherichiacoli, Campylobacter, Shigella, and Salmonella heading the list. Using methods to detect most of the known enteropathogens, one or more enteropathogen(s) is isolated in two-thirds of diarrhoeal illnesses in the developing world. Deoxyribonucleic acid probes have proved very useful in detecting pathogens such as enterotoxigenic (ETEC), enteroinvasive (EIEC), enteropathogenic E. coli (EPEC), and Shigella but have not yet proved to be particularly rapid or less expensive. Molecular biology has proved useful in epidemiological studies as a means of strain identification and detection of genome diversity. Since the introduction of ribonucleic acid gene restriction patterns as taxonomic tools in 1986, ribotyping has become an established method for systematics, epidemiological, ecological population and genome diversity studies of microorganisms including Shigella. The technological development culminated in the automation of ribotyping which allowed for high-throughput applications. PCR ribotyping has proved being a highly discriminatory, flexible, robust and cost-efficient routine technique which makes inter-laboratory comparison and build of ribotype databases possible, too. The aim of the present review is to determine the present status of ribotyping technique in detecting the diversity in Shigella isolates.
27
Mercer, Nathaniel P., Leona Ward, Alexander Hoberman, Joseph J. Cronin, Eoghan T. Hurley, and John G. Kennedy. "Outcomes of Endoscopic Treatment for Plantar Fasciitis: A Systematic Review." Foot & Ankle Orthopaedics 7, no. 1 (January 2022): 2473011421S0036. http://dx.doi.org/10.1177/2473011421s00365.
Full textAbstract:
Category: Other Introduction/Purpose: Endoscopic plantar fascia release (EPFR) is an established operative treatment for recalcitrant plantar fasciitis. The purpose of this systematic review is to provide a comprehensive review on the outcomes of endoscopic plantar fascia release in the treatment of plantar fasciitis at mid- and long-term follow-up. Methods: A systematic review was performed using, MEDLINE, EMBASE, and Cochrane library databases in May 2020 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included were evaluated with regards to the level of evidence (LOE) and quality of evidence (QoE) using the Coleman methodological score. Clinical outcomes and complications were also evaluated. Results: Twenty-five studies including 729 feet were included in this systematic review with a mean follow-up of 25.1 months. 18 papers used the American Orthopaedic Foot & Ankle Society (AOFAS) score. The weighted mean preoperative AOFAS score was 55.6 and the postoperative score was 89.6 out of 100. The total number of patients who had complications was 117 of 729 (16.1%). The most common complication was a recurrence of pain experienced by 6.5% of patients (47 of 117). Conclusion: Endoscopic plantar fascia release provides good clinical and functional outcomes in patients with refractory plantar fasciitis. However, this procedure is associated with a moderately high complication rate.
28
Conway, Nicholas T., Michael Bluett, Cathy Shields, Andrew Taylor, Deborah J. Wake, and Scott G. Cunningham. "A Longitudinal Perspective on User Uptake of an Electronic Personal Health Record for Diabetes, With Respect To Patient Demographics." Journal of Diabetes Science and Technology 15, no. 5 (April 17, 2021): 993–1004. http://dx.doi.org/10.1177/19322968211005734.
Full textAbstract:
Introduction: The growing prevalence of diabetes has increased the need for scalable technologies to improve outcomes. My Diabetes My Way (MDMW) is an electronic personal health record (ePHR) available to all people with diabetes in Scotland since 2010, associated with improved clinical outcomes among users. MDMW pulls data from a national clinician-facing informatics platform and provides self-management and educational information. This study aims to describe MDMW user demographics through time with respect to the national diabetes population, with a view to addressing potential health inequalities. Methods: Aggregate data were obtained retrospectively from the MDMW database and annual Scottish Diabetes Survey (SDS) from 2010 to 2020. Variables included diabetes type, sex, age, socioeconomic status, ethnicity, and glycemic control. Prevalence of MDMW uptake was calculated using corresponding SDS data as denominators. Comparisons between years and demographic sub-groups were made using Chi- Squared tests. Results: Overall uptake of MDMW has steadily increased since implementation. By 2020, of all people with T1D or T2D in Scotland, 13% were fully enrolled to MDMW (39,881/312,326). There was proportionately greater numbers of users in younger, more affluent demographic groups (with a clear social gradient) with better glycemic control. As uptake has increased through time, so too has the observed gaps between different demographic sub-groups. Conclusions: The large number of MDMW users is encouraging, but remains a minority of people with diabetes in Scotland. There is a risk that innovations like MDMW can widen health inequalities and it is incumbent upon healthcare providers to identify strategies to prevent this.
29
Li, Michelle, Kyle Wang, Ashley Tang, Aaron Tang, Andrew Chen, and Zuyi Huang. "Investigation of the Genes Involved in the Outbreaks of Escherichia coli and Salmonella spp. in the United States." Antibiotics 10, no. 10 (October 19, 2021): 1274. http://dx.doi.org/10.3390/antibiotics10101274.
Full textAbstract:
Salmonella spp. and Escherichiacoli (E. coli) are two of the deadliest foodborne pathogens in the US. Genes involved in antimicrobial resistance, virulence, and stress response, enable these pathogens to increase their pathogenicity. This study aims to examine the genes detected in both outbreak and non-outbreak Salmonella spp. and E. coli by analyzing the data from the National Centre for Biotechnology Information (NCBI) Pathogen Detection Isolates Browser database. A multivariate statistical analysis was conducted on the genes detected in isolates of outbreak Salmonella spp., non-outbreak Salmonella spp., outbreak E. coli, and non-outbreak E. coli. The genes from the data were projected onto a two-dimensional space through principal component analysis. Hierarchical clustering was then used to quantify the relationship between the genes in the dataset. Most of the outlier genes identified in E. coli isolates are virulence genes, while outlier genes identified in Salmonella spp. are mainly involved in stress response. Gene epeA, which encodes a high-molecular-weight serine protease autotransporter of Enterobacteriaceae (SPATE) protein, along with subA and subB that encode cytotoxic activity, may contribute to the pathogenesis of outbreak E. coli. The iro operon and ars operon may play a role in the ecological success of the epidemic clones of Salmonella spp. Concurrent relationships between esp and ter operons in E. coli and pco and sil operons in Salmonella spp. are found. Stress-response genes (asr, golT, golS), virulence gene (sinH), and antimicrobial resistance genes (mdsA and mdsB) in Salmonella spp. also show a concurrent relationship. All these findings provide helpful information for experiment design to combat outbreaks of E. coli and Salmonella spp.
30
Speedy, Kathryn, Lokesh Nukalapati, Kathryn Speedy, and Megan Davies-Kabir. "Melatonin prescribing practices and the provision of sleep hygiene/parent-led sleep behavioural Interventions in S-CAMHS, Aneurin Bevan University Health Board (ABUHB)- Service evaluation as part of quality improvement project." BJPsych Open 7, S1 (June 2021): S351—S352. http://dx.doi.org/10.1192/bjo.2021.920.
Full textAbstract:
AimsTo identify the number of patients currently on melatoninTo determine the average duration of use of melatonin in patients under the care of S-CAMHS in ABUHBTo investigate whether behaviour interventions were tried and reinforced from time to timeTo identify any areas of improvementMethodData were collected at St. Cadoc's hospital, in January, 2021. S-CAMHS database was used. Out of total 346 patient currently being managed with pharmacological therapies, 115 (33.2%) are currently on melatonin. 57/115 were randomly selected as a sample for this this project. Patient notes and EPEX software were also used to collect information regarding the sleep management practices.ResultDuring analysis, it was noticed that within the sample, only 46 patients were actively on melatonin. Melatonin is prescribed for sleep related issues in ASD (8/46), ADHD (15/46), ASD and ADHD (10/46), ADHD and mood disorder (0/46), ASD and mood disorder (6/46), ADHD and behaviour difficulties (2/46), ASD with behaviour difficulties (1/46), mood disorder (4/46).39/46 patients are currently on melatonin for more than a year (85%). These patients also include 10 patients who have been using melatonin for 5 years or more.35 patients (76%) reported improved sleep or some benefit from melatonin.Evidence for implementation of parent-led sleep behavioural interventions:Prior to commencing melatonin- Clear evidence available for 35 patients only (76%). These interventions were however not deemed helpful by most of the service users.While prescribing melatonin- Clear evidence available for 39(85%) patients. Evidence base for melatonin was also discussed during this visit.During last follow-up visit- Evidence available for 31 patients only (67%).ConclusionMajority of patients under S-CAMHS ABUHB remain on melatonin therapy for longer than one year. Most of these patients have reported benefit from this therapy and preferred to remain on it despite being informed about evidence base for melatonin. Also, there is evidence for implementation of sleep behavioural interventions prior to prescribing melatonin, however their benefit remains unclear.Recommendations:The quality of education on sleep hygiene offered should be assessed and improved if neededFormal group sessions/workshops on sleep hygiene/parent-led sleep behavioural interventions at regular intervals might be useful in reducing the chances of long term polypharmacy or unlicensed drugsUse of outcome measures such as Child Sleep Habits Questionnaire at intervals can be helpful in identifying any improvement from educational/pharmacological interventionsS-CAMHS database (for patients actively on medications) needs a review and update
31
Vokinger, Kerstin Noëlle, and Aaron S. Kesselheim. "Application of orphan drug designation to cancer treatments (2008–2017): a comprehensive and comparative analysis of the USA and EU." BMJ Open 9, no. 10 (October 2019): e028634. http://dx.doi.org/10.1136/bmjopen-2018-028634.
Full textAbstract:
ObjectiveTo determine differences in the characteristics of cancer drugs designated as orphan drugs by the Food and Drug Administration (FDA) and European Medicines Agency (EMA).Design and settingIdentification of all cancer drugs (initial or supplementary indication) with orphan status approved by the FDA between 2008–2017 based on publicly accessible reports. The European public assessment reports (EPAR) was searched to determine whether these FDA-approved drugs were also approved by the EMA.Main outcome measuresExtraction of active ingredient, trade name, approval date and approved indication from two FDA data sources (Orphan Drug Product Designation Database, Drugs@FDA) and comparison with the same data from EPAR.ResultsThe FDA approved 135 cancer drugs with orphan indications that met our inclusion criteria, of which 101 (75%) were also approved by the EMA. 80/101 (79%) were first approved in the USA. Only 41/101 (41%) also received orphan designation by the EMA. 33/101 (33%) were approved for biomarker-based indications in the USA, however, only nine approved cancer drug indications by the EMA were biomarker-derived drugs. 78% (47/60) of approved cancer drugs that were only approved in the USA with orphan status were indicated for solid tumours, 22% (13/60) had indications for non-solid tumours. By contrast, out of those approved cancer drugs that received orphan designation by both agencies, 20% (8/41) were indicated for solid, and 80% (33/41) for non-solid tumours.ConclusionsOrphan designation was intended to encourage drug development for rare conditions. This study shows that the FDA approves more cancer drugs with such designations compared with the EMA, especially for subgroups of more prevalent cancers. One reason for the difference could be that the European Union requires demonstration of significant benefit for drugs that target the same indication as a drug already on the market to earn the orphan designation.
32
Carter, A., J. Cook, M. Beals, J. Goldstein, A. Travers, J. Jensen, T. Dobson, S. A. Carrigan, and P. Vanberkel. "P029: Paramedic and nurse-staffed rural collaborative emergency centres: the rate of relapse for discharged patients." CJEM 19, S1 (May 2017): S87. http://dx.doi.org/10.1017/cem.2017.231.
Full textAbstract:
Introduction: Collaborative Emergency Centres (CECs) provide access to care in rural communities. After hours, registered nurses (RNs) and paramedics work together in the ED with telephone support by an emergency medical services (EMS) physician. The safety of such a model is unknown. Relapse visits are often used as a proxy measure for safety in emergency medicine. The primary outcome of this study is to measure unscheduled relapses to emergency care. Methods: The electronic patient care record (ePCR) database was queried for all patients who visited two CECs from April 1, 2012 to April 1, 2013. Abstracted data included demographics, time, acuity score, clinical impression, chief complaint, and disposition. Records were searched for each discharged CEC patient to identify unscheduled relapses to emergency care, defined as presenting back to EMS, CEC, or any other ED within the Health Authority within 48 hours of CEC discharge. Results: There were 894 CEC visits, of which 66 were excluded due to missing data. The dispositions from CEC were: 131/828 (15.8%) transferred to regional ED; 264/828 (31.9%) discharged home; 488/828 (58.9%) discharged with follow up visit booked; and 11/82 (1.2%) left the CEC without being seen. There was 37/828 (4.5%) visits which relapsed back to emergency care, all of whom were discharged from CEC or left without being seen: 3/828 (0.4%) relapsed back to EMS (two taken to regional ED and one to CEC); 16/828 (1.9%) relapsed to regional ED (by walking-in); and 18/828 (2.2%) had a relapse to the CEC (walk-in). 516/828 (62.3%) CEC visits were resolved in a single visit. Conclusion: This study was based on only two of the 7 operating CECs due to accessing paper-based charts for multiple health regions. We also acknowledge the limitations of using relapse as a proxy for safety, and that low volumes and acuity will make detection of adverse events challenging. Albeit a proxy measure, the rate of patients who relapse to emergency care was under 5% in this case series of two CECs. Most patients had their concern resolved in a single visit to a CEC. Further research is underway to determine the effectiveness, optimal utilization and safety of this collaborative model of rural emergency care.
33
Torres, Tania, Jeanine M. Walenga, Walter Jeske, Vicki Escalante, Erin Coglianese, Jeffrey Schwartz, and Mamdouh Bakhos. "Down-Regulation of Protein C Pathway Associated with Increased Inflammation in Patients with Implanted Ventricular Assist Devices As a Potential Cause of Pump Thrombosis." Blood 128, no. 22 (December 2, 2016): 4995. http://dx.doi.org/10.1182/blood.v128.22.4995.4995.
Full textAbstract:
Abstract Introduction: The use of left ventricular assist devices (LVADs) is increasingly common in patients suffering from heart failure. However, the placement of an LVAD comes with risks, including pump thrombosis that occurs in up to 20% of patients. Pump thrombosis constitutes a major cause of death in this patient population, and understanding the mechanism behind this complication will allow its prevention. The protein C pathway is critical in the maintenance of blood hemostasis, aiding in the prevention of hypercoagulability. It is hypothesized that the state of inflammation in LVAD patients dysregulates the protein C pathway, creating a hypercoagulable state with resultant thrombosis. The objective of this project was to characterize changes in the protein C pathway in patients supported by an LVAD who experienced a thrombotic event. Materials and Methods: Citrated plasma sampleswere collected peri-operatively and at varying times post-operatively from 22 patients implanted with a Thoratec HeartMate II LVAD. Plasma samples were stored frozen (-80°C) and batch analyzed for levels of total protein S, free protein S, protein C, C-reactive protein (CRP), soluble endothelial cell protein C receptor (EPCR) and soluble thrombomodulin (TM) by ELISA. Samples near the time of an event and 1-3 months earlier were analyzed. The occurrence of adverse clinical events was determined retrospectively using an internal RedCap database. LVAD-associated thrombosis was characterized as: cerebrovascular accident/transient ischemic attack diagnosed by a neurologist, rise in LDH or plasma free hemoglobin, hemolysis, evidence of pump dysfunction consistent with thrombus identified by pump parameters, echocardiographic or computed tomographic evidence of clot, or surgical pump exchange for thrombus. A comparative group was composed of patients with LVAD-associated bleeding (the other frequent complication in this population) events characterized as: anemia and bleeding determined by a cardiologist. Results: The median level of CRP was higher and levels of total and free protein S were lower in patients with thrombotic events compared to those with bleeding events. Median levels of protein C and TM were comparable in patients with thrombotic or bleeding events. Secondly, for patients with a thrombotic event, levels of total protein S, free protein S, and protein C (but not TM or CRP) were further decreased at time near the event. No changes were observed in any of these parameters preceding or at the time of a bleeding complication. Compared to normal ranges, levels of proteins C and S were consistent with low-dose warfarin therapy (INR 1.5-2.0) given to all LVAD patients; TM levels were similar to normal (2.8 ng/ml). EPCR levels were lower than normal (828 ng/ml) in all groups with no apparent change at time of event. Compared to normal (0.8 µg/ml) CRP levels were very elevated in the thrombosis patients and slightly elevated in the bleeding patients. Conclusions: This data demonstrates excessively high CRP levels in patients who experienced LVAD-associated thrombosis. These patients also had lower total protein S and free protein S levels which decreased further at time of the thrombotic event. In the immunoassays used in this study no difference was observed between the levels of total and free protein S. Whether the up-regulated inflammatory state increases levels of the protein S linked C4b binding protein and whether the function of protein S is inhibited could not be proven here. This study suggests that protein S is a gatekeeper for the function of the protein C pathway. Clinically, in addition to measuring protein S levels and/or function, the degree of the inflammatory state should be considered as the level of C4b binding protein would be altered affecting the functionality of protein S. Our study has shown that abnormal levels of protein S and CRP are components that establish a hypercoagulable environment in LVAD implanted patients where pump thrombus develops weeks later. Table Table. Disclosures No relevant conflicts of interest to declare.
34
Qie, Shuai, Hongyun Shi, Fang Wang, Fangyu Liu, Jinling Gu, Xiaohui Liu, Yanhong Li, and Xiaoyue Sun. "Construction of survival prediction model for elderly esophageal cancer." Frontiers in Oncology 12 (October 19, 2022). http://dx.doi.org/10.3389/fonc.2022.1008326.
Full textAbstract:
BackgroundThe purpose of this study was to analyze the clinical characteristics and prognosis of EPEC and to construct a prediction model based on the SEER database.MethodsAll EPECs from the SEER database were retrospectively analyzed. A comprehensive and practical nomogram that predicts the overall survival (OS) of EPEC was constructed. Univariate and multivariate Cox regression analysis was performed to explore the clinical factors influencing the prognosis of EPEC, and finally, the 1 -, 3 - and 5-year OS were predicted by establishing the nomogram. The discriminant and predictive ability of the nomogram was evaluated by consistency index (C-index), calibration plot, area under the curve (AUC), and receiver operating characteristic (ROC) curve. Decision curve analysis (DCA) was used to evaluate the clinical value of the nomogram.ResultsA total of 3478 patients diagnosed with EPEC were extracted from the SEER database, and the data were randomly divided into the training group (n=2436) and the validation group (n=1402). T stage, N stage, M stage, surgery, chemotherapy, radiotherapy, age, grade, and tumor size were independent risk factors for 1 -, 3 - and 5-year OS of EPEC (P< 0.05), and these factors were used to construct the nomogram prediction mode. The C-index of the validation and training cohorts was 0.718 and 0.739, respectively, which were higher than those of the TNM stage system. The AUC values of the nomogram used to predict 1-, 2-, and 3-year OS were 0.751, 0.744, and 0.786 in the validation cohorts (0.761, 0.777, 0.787 in the training cohorts), respectively. The calibration curve of 1-, 2-, and 3-year OS showed that the prediction of the nomogram was in good agreement with the actual observation. The nomogram exhibited higher clinical utility after evaluation with the 1-, 2-, and 3-year DCA compared with the AJCC stage system.ConclusionsThis study shows that the nomogram prediction model for EPEC based on the SEER database has high accuracy and its prediction performance is significantly better than the TNM staging system, which can accurately and individually predict the OS of patients and help clinicians to formulate more accurate and personalized treatment plans.
35
Zhang, Yajing, Senyu Wang, Songtao Han, and Yangchun Feng. "Pan-Cancer Analysis Based on EPOR Expression With Potential Value in Prognosis and Tumor Immunity in 33 Tumors." Frontiers in Oncology 12 (March 14, 2022). http://dx.doi.org/10.3389/fonc.2022.844794.
Full textAbstract:
BackgroundErythropoietin receptor (EPOR), a member of the cytokine class I receptor family, mediates erythropoietin (EPO)-induced erythroblast proliferation and differentiation, but its significance goes beyond that. The expression and prognosis of EPOR in cancer remain unclear.MethodsThis study intended to perform a pan-cancer analysis of EPOR by bioinformatics methods. Several databases such as GTEx, TCGA, CCLE, and others were used to explore the overall situation of EPOR expression, and the correlation of EPOR expression with prognosis, microRNAs (miRNAs), immune infiltration, tumor microenvironment, immune checkpoint genes, chemokines, tumor mutation burden (TMB), microsatellite instability (MSI), methyltransferases, and DNA mismatch repair (MMR) genes in 33 tumors was analyzed. In addition, we compared the promoter methylation levels of EPOR in cancer tissues with those in normal tissues and performed protein–protein interaction network, gene–disease network, and genetic alteration analyses of EPOR, and finally enrichment analysis of EPOR-interacting proteins, co-expressed genes, and differentially expressed genes.ResultsThe TCGA database showed that EPOR expression was upregulated in BLCA, CHOL, HNSC, KIRC, LIHC, STAD, and THCA and downregulated in LUAD and LUSC. After combining the GTEx database, EPOR expression was found to be downregulated in 18 cancer tissues and upregulated in 6 cancer tissues. The CCLE database showed that EPOR expression was highest in LAML cell lines and lowest in HNSC cell lines. Survival analysis showed that high EPOR expression was positively correlated with OS in LUAD and PAAD and negatively correlated with OS in COAD, KIRC, and MESO. Moreover, EPOR had a good prognostic ability for COAD, LUAD, MESO, and PAAD and also influenced progression-free survival, disease-specific survival, disease-free survival, and progression-free interval in specific tumors. Further, EPOR was found to play a non-negligible role in tumor immunity, and a correlation of EPOR with miRNAs, TMB, MSI, and MMR genes and methyltransferases was confirmed to some extent. In addition, the enrichment analysis revealed that EPOR is involved in multiple cancer-related pathways.ConclusionThe general situation of EPOR expression in cancer provided a valuable clinical reference. EPOR may be target gene of hsa-miR-575, etc. A pan-cancer analysis of panoramic schema revealed that EPOR not only may play an important role in mediating EPO-induced erythroblast proliferation and differentiation but also has potential value in tumor immunity and is expected to be a prognostic marker for specific cancers.
36
Gergely, György, Miklós Menyhard, Attila Sulyok, Sándor Gurban, Beata Lesiak, Aleksander Jablonski, Andrzej Kosinski, József Toth, and Dezső Varga. "Evaluation of the inelastic mean free path (IMFP) of electrons in polyaniline and polyacetylene samples obtained from elastic peak electron spectroscopy (EPES)." Open Physics 5, no. 2 (January 1, 2007). http://dx.doi.org/10.2478/s11534-007-0012-y.
Full textAbstract:
AbstractThe inelastic mean free path (IMFP) of electrons was determined experimentally for selected polyaniline and polyacetylene samples with Ag and Ni references using elastic peak electron spectroscopy (EPES). The surface composition was determined by XPS and density by helium pycnometry. The high resolution hemispherical ESA-31 and ADES-400 spectrometers were used for measurements in the energy range E = 0.5–3.0 keV and E =0.4 − 1.6 keV, respectively. The integrated elastic peak intensity ratios for sample and reference were calculated using the Monte Carlo (MC) algorithm based on the electron elastic scattering cross-sections database NIST SRD64 version 3.1 and applying TPP-2M IMFPs for polymers. Surface excitation parameters (SEP) and material parameters (ach) for polymers were determined, using the model of Chen, from comparison of measured and MC calculated elastic peak intensity ratios. These corrections proved to be efficient in decreasing the percentage deviations between the obtained IMFPs and the TPP-2M formula IMFPs. The elastic peak of hydrogen was observed in the EPES spectra of polymers. The experimental contribution of the hydrogen to the total elastic peak was 0.58%, while this value obtained from the MC simulations was 1.98%.
37
Liu, Peng, Guo-Fei Wang, Hua Peng, Lei Zhang, Xiao-Yan Li, Qiao-Miao Zeng, Qian Li, and Jian-Hui Zhou. "Effectiveness and Safety of Targeted Agents Combined With Chemoradiotherapy for the Treatment of Esophageal Cancer: A Network Meta-Analysis." Frontiers in Oncology 11 (November 29, 2021). http://dx.doi.org/10.3389/fonc.2021.621917.
Full textAbstract:
BackgroundConcurrent chemoradiotherapy (CRT) is the preferred treatment strategy for inoperable esophageal cancer (EC). However, the effect of CRT needs to be improved.MethodsThis study comprehensively analyzed targeted agents combined with CRT for the treatment of EC by a network meta-analysis. The search was performed in public databases from incipient to 5 August 2021. Randomized controlled trials comparing the effect of targeted agents combined with CRT and CRT alone on EC patients were included.ResultsTen studies were included. For progression-free survival (PFS), nivolumab (67.4%) and erlotinib (64.6%) had advantages based on Cox analysis. Regarding the frequency of PFS, cetuximab (OR: 1.39; 95% CI: 1.01, 1.91; p=0.042) and nivolumab (OR: 1.81; 95% CI: 1.34, 2.44; p<0.01) were significantly superior to the control. For overall survival (OS), nivolumab (71.6%) in Cox analysis and nimotuzumab (69.7%) in frequency analysis were found to have relative advantages. Nimotuzumab combined with CRT was significantly better than the control with regard to endoscopic and the pathologic complete response (epCR; OR: 2.81; 95% CI: 1.28, 6.14; p=0.011) and objective response rate (ORR; 4.71; 95% CI: 1.45, 15.29; p=0.008). The targeted drugs were not associated with significant SEA risk.ConclusionIn conclusion, compared to CRT alone, cetuximab and nivolumab combined with CRT were found to significantly improve the PFS rate only based on the frequency results. However, there was no benefit in terms of OS. For epCR and ORR, nimotuzumab was better than the blank control. Considering the limitations in this study, more well-designed RCTs are needed in the future to validate the results.
38
Ward, Leona, Nathaniel P. Mercer, Mohammad T. Azam, Alexander Hoberman, Eoghan T. Hurley, James J. Butler, Hugo Ubillus, Joseph Cronin, and John G. Kennedy. "Outcomes of Endoscopic Treatment for Plantar Fasciitis: A Systematic Review." Foot & Ankle Specialist, November 7, 2022, 193864002211291. http://dx.doi.org/10.1177/19386400221129167.
Full textAbstract:
Background Endoscopic plantar fascia release (EPFR) is an established operative treatment for recalcitrant plantar fasciitis. The purpose of this systematic review is to provide a comprehensive review on the outcomes of EPFR in the treatment of plantar fasciitis at mid-term and long-term follow-up. Methods A systematic review was performed using, MEDLINE, EMBASE, and Cochrane library databases in May 2020 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included were evaluated regarding level of evidence (LOE) and quality of evidence (QOE) using the modified Coleman methodological score. Clinical outcomes and complications were also evaluated. Results Twenty-six studies including 978 feet were included in this systematic review with a weighted mean follow-up of 25.6 ± 21.0 months. Eighteen papers used the American Orthopaedic Foot and Ankle Society (AOFAS) score. The weighted mean preoperative AOFAS score was 55.66 ± 10.3, and the postoperative score was 89.6 ± 5.2 out of 100. The total number of patients who had complications was 88 of 994 (8.9%). The most common complication was recurrence of pain experienced by 41 patients (4.2%). Conclusion Endoscopic plantar fascia release provides good clinical and functional outcomes in patients with refractory plantar fasciitis. However, this procedure is associated with a moderately high complication rate (8.9%) and should only be considered following failure of conservative management. Future prospective studies comparing the various endoscopic and open techniques with nonoperative treatment are required to elucidate the most effective management for recalcitrant plantar fasciitis. Levels of Evidence: Level I: Systematic review of level IV studies
39
Zewude, Rahel T., Laura C. Gioia, Mahesh P. Kate, Kim Liss, Brian R. Lowe, and Kenneth Butcher. "Abstract W P325: Hematoma Volumes Are Independent of Elevated Prehospital Blood Pressure in Patients with Intracerebral Hemorrhage." Stroke 46, suppl_1 (February 2015). http://dx.doi.org/10.1161/str.46.suppl_1.wp325.
Full textAbstract:
INTRODUCTION: In a recent prehospital interventional trial, it was observed that high prehospital BP in intracerebral hemorrhage (ICH) patients is associated with larger ICH volumes. We tested the hypotheses that higher prehospital BP is associated with larger baseline ICH volumes outside a clinical trial setting. METHODS: We conducted a retrospective analysis of a prospectively-maintained centralized database of electronic patient health care reports (ePCR), including serial BP measurements, of all patients transported by Emergency Medical Services (EMS) to the Emergency Department (ED) of a single hospital with acute stroke symptoms during an 18-month period. All patients with an EMS dispatch code for suspected stroke were included. Hospital charts and neuroimaging were reviewed. Hematoma and intraventricular hemorrhage (IVH) volumes were measured planimetrically. RESULTS: A total of 877 patients were transported by EMS for suspected stroke. ICH was diagnosed in 50 (5.7%) patients. Median (IQR) time from symptom onset to first BP measurement was 82 (362) minutes. Mean prehospital SBP was 173 ± 32 mmHg. Median baseline hematoma volume was 31.8 (53.2) ml and median total ICH volume was 33.4 (58.1) ml. Mean prehospital BP was unrelated to hematoma volume (R=0.12, p=0.42) and total ICH volume (R=0.14, p=0.34). Mean prehospital SBP in patients with hematoma volumes <33 ml (169 ± 32 mmHg) was similar to those ≥33 ml (177 ± 32 mmHg, p=0.45). Similar results were found with 15 ml (p=0.82), 45 ml (p=0.52), and 60 ml (p=0.50) hematoma volume cutoffs. Mean prehospital SBP in patients with total ICH volume <33 ml was similar (168 ± 33 mmHg) to those ≥33 ml (177 ± 31 mmHg, p=0.39). IVH was present in 16 (32%) patients. The mean prehospital BP did not differ in patients with IVH (180 ± 27 mmHg) when compared to those without IVH (169 ± 34 mmHg, p=0.10). CONCLUSION: Prehospital BP is consistently high across different ICH volumes. Hematoma and total ICH volumes are independent of prehospital BP. These findings do not preclude a prehospital BP treatment effect.
40
Gioia, Laura C., Rahel T. Zewude, Mahesh P. Kate, Kim Liss, Brian H. Rowe, and Ken Butcher. "Abstract 91: Prehospital Blood Pressure Differentiates Acute Stroke From Mimics." Stroke 46, suppl_1 (February 2015). http://dx.doi.org/10.1161/str.46.suppl_1.91.
Full textAbstract:
Introduction: Elevated hospital admission blood pressure (BP) in acute stroke is common and associated with poor outcomes. The natural history of BP in suspected stroke patients in the prehospital setting is unknown. We tested the hypothesis that prehospital BP values are higher in acute stroke patients, relative to stroke mimics. Methods: We conducted a retrospective analysis of a prospectively-maintained centralized database of electronic patient health care reports (ePCR), including serial BP measurements, of all patients transported by Emergency Medical Services (EMS) to the Emergency Department (ED) of a single hospital with acute stroke symptoms during an 18-month period. All patients with an EMS dispatch code for suspected stroke were included. Hospital charts and neuroimaging review were utilized to determine final diagnosis of ischemic stroke, transient ischemic attack (TIA), intracerebral hemorrhage (ICH) or stroke mimic. BP data was analyzed by one-way ANOVA followed by Tukey’s test for independent comparisons. Results: A total of 877 patients were transported by EMS to the ED with suspected stroke. Median (IQR) time from symptom onset to first BP measurement was 70.5 (204) minutes. The final diagnosis was stroke in 524 (59.7%) patients (41.0% ischemic stroke, 11.7% TIA, 7.0% ICH) and 354 (40.4%) were considered mimics. Mean ± SD prehospital SBP was higher in acute stroke patients (155 ± 31 mmHg) compared to stroke mimics (143 ± 32 mmHg), p<0.001). Mean prehospital SBP was higher in ICH (171 ±33 mmHg, p=0.001) than both ischemic stroke (155 ± 27 mmHg) and TIA (153 ± 23 mmHg). SBP remained stable during EMS transport in all patients (median -3 (22) mmHg), p=0.16). Mean prehospital SBP was correlated with ED SBP (R=0.85, p<0.001). Mean SBP at ED arrival was higher in acute stroke patients (ICH: 170 ± 34 mmHg, ischemic stroke: 154 ± 30 mmHg, TIA: 153 ± 26 mmHg) than stroke mimics (142 ± 28 mmHg), p<0.001). Conclusion: Higher prehospital SBP differentiates acute stroke from stroke mimics. Blood pressures are highest in ICH patients. Prehospital BP remains stable until ED arrival. Elevated prehospital BP may help identify patients with acute stroke. Acute BP elevation may also represent an acute prehospital treatment target.
41
Ko, Patrick Chow-In, Nai-Kuan Chou, Matthew Huei-Ming Ma, Yu-Wen Chen, Tzong-Luen Wang, Wen-Han Chang, Wei-Fong Kao, et al. "Abstract 13104: Comparison of Patient Characteristics and Outcomes Between Adult Non-traumatic Out-of-hospital Cardiac Arrests With and Without Extracorporeal Cardiopulmonary Resuscitation - A Community-wide Evaluation." Circulation 132, suppl_3 (November 10, 2015). http://dx.doi.org/10.1161/circ.132.suppl_3.13104.
Full textAbstract:
Objectives: The outcome of patients after OHCA is poor. Return to spontaneous circulation (ROSC) dramatically decreases with the duration of CPR. Extracorporeal membrane oxygenation has been proposed to assist CPR (ECPR) in OHCA. This study was to investigate the effects and characteristics of ECPR for adult non-traumatic (ANT) OHCA versus Non-ECPR on a community-wide basis. Methods: A prospective four-year observational database collected from a community-wide OHCA web registry in an urban EMS (emergency medical services) was studied. The EMS ambulance teams were capable with advanced airway, intravenous (iv) fluid skills, basic and advanced life support and automated external defibrillator techniques. Outcomes included survival and cerebral performance category scale (CPC) at discharge. ANT OHCA with and without ECPR in emergency were compared by regression analysis including factors of patient, pre-hospital and hospital characteristics and outcomes. Results: Comparing OHCA receiving ECPR (n=79) to those without (n=959), ECPR group were younger (median age 56 vs 78 p<0.001) and had higher portion for men (89 vs 64% p<0;001), witnessed arrest (Wit) (60.8 vs 32.5% p<0.001), bystander CPR (BCPR) (53.2 vs 36.8% p=0.005), initial shockable rhythms (SR) (74.6 vs 12.2% p<0.001) and therapeutic hypothermia (TH) (22.8 vs 1.1%, p<0.001). They (EPCR vs non-ECPR) had no difference for prehospital time intervals (22.5 vs 23 min.), laryngeal mask airway treatment (55.7 vs 52.8%), EMS iv epinephrine (20.3 vs 15.5%), endotracheal intubation (6.3 vs 8.0%), prehospital ROSC (11.4 vs 6% p=0.09), and ROSC upon hospital arrival (10.1 vs 8.5%). Outcomes were better in ECPR for discharged survival (41 vs 7% p<0.001) and CPC 1or2 (20.8 vs 3.8% p<0.001). After adjusting for Wit, BCPR, SR, TH, age and sex, both survival (adjusted odds ratio: 3.6 [95% 2.0-6.6]) and good CPC 1or2 (adjusted OR: 2.9 [95% 1.2-6.9]) were still significantly higher in ECPR. Conclusions: In current emergency practice for ANT OHCA, ECPR tended to apply to patients of younger age, men, witnessed arrest, BCPR, and initially shockable rhythms regardless of positive ROSC upon hospital arrival, that can independently lead to higher survival and good neurological outcome compared to non-ECPR.
42
Gioia, Laura C., Rahel T. Zewude, Mahesh P. Kate, Kim Liss, Brian H. Rowe, and Ken Butcher. "Abstract T P324: Prehospital Neurological Deterioration Predicts Intracerebral Hemorrhage." Stroke 46, suppl_1 (February 2015). http://dx.doi.org/10.1161/str.46.suppl_1.tp324.
Full textAbstract:
Introduction: Elevated hospital admission blood pressure (BP) has been associated with early neurological deterioration (END) in acute stroke patients. We tested the hypothesis that higher prehospital BP is also associated with END. Methods: We conducted a retrospective analysis of a prospectively-maintained centralized database of electronic patient health care reports (ePCR), including serial BP and GCS measurements, of all patients transported by Emergency Transport Services (EMS) to the Emergency Department (ED) of a single hospital during an 18-month period. All patients with an EMS dispatch code for suspected stroke were included. Hospital charts and neuroimaging were utilized to determine final diagnosis of ischemic stroke (IS), intracerebral hemorrhage (ICH), and early death (prior to discharge). END was defined as ≥2 point drop in Glasgow Coma Scale (GCS) score prior to hospital arrival. Results: A total of 877 patients were transported by EMS to the ED with suspected stroke. Of these, 420 patients had a final diagnosis of acute stroke (360 IS, 60 ICH). Mean ± SD prehospital SBP was higher in ICH (172 ± 32 mmHg) than IS patients (155 ± 27 mmHg, p<0.001). Initial median (IQR) GCS was lower in ICH (13(5)) than IS patients (15(2), p=0.001). Prehospital END was more common in ICH (9/60 (14.8%) than IS (2/360 (0.6%), p<0.001). Univariate logistic regression indicated that prehospital END predicted the diagnosis of ICH (OR 5.6 (95% CI: 2.6-12.2)). Mean prehospital SBP was similar in patients with (171 ± 39 mmHg) and without END (158 ± 28 mmHg, p=0.29). SBP change during EMS transport was similar in patients with END (-5 (25) mmHg) than those without (-2 (23) mmHg, p=0.88). Prehospital END was more common in those who died (11.8%) than those who survived (0.8%, p=0.001). Mean prehospital SBP was higher in patients who died (166 ± 35 mmHg) than those who survived (157 ± 7 mmHg, p=0.04). Early death occurred more often in ICH (43%) than IS (12.5%, p<0.001). Conclusion: Prehospital END is predictive of ICH. Although mean prehospital BP was not higher in patients with END in this retrospective study, it was associated with early death, which is supportive of the hypothesis that elevated prehospital BP may be an acute treatment target.