Score-based prediction model for severe vitamin D deficiency in patients with critical illness: development and validation.

BACKGROUND: Severe vitamin D deficiency (SVDD) dramatically increases the risks of mortality, infections, and many other diseases. Studies have reported higher prevalence of vitamin D deficiency in patients with critical illness than general population. This multicenter retrospective cohort study develops and validates a score-based model for predicting SVDD in patients with critical illness. METHODS: A total of 662 patients with critical illness were enrolled between October 2017 and July 2020. SVDD was defined as a serum 25(OH)D level of < 12 ng/mL (or 30 nmol/L). The data were divided into a derivation cohort and a validation cohort on the basis of date of enrollment. Multivariable logistic regression (MLR) was performed on the derivation cohort to generate a predictive model for SVDD. Additionally, a score-based calculator (the SVDD score) was designed on the basis of the MLR model. The model's performance and calibration were tested using the validation cohort. RESULTS: The prevalence of SVDD was 16.3% and 21.7% in the derivation and validation cohorts, respectively. The MLR model consisted of eight predictors that were then included in the SVDD score. The SVDD score had an area under the receiver operating characteristic curve of 0.848 [95% confidence interval (CI) 0.781-0.914] and an area under the precision recall curve of 0.619 (95% CI 0.577-0.669) in the validation cohort. CONCLUSIONS: This study developed a simple score-based model for predicting SVDD in patients with critical illness. TRIAL REGISTRATION: ClinicalTrials.gov protocol registration ID: NCT03639584. Date of registration: May 12, 2022.

Outcomes of early enteral feeding in patients after curative colorectal cancer surgery: A retrospective comparative study.

PURPOSE: To compare the clinical outcomes of patients with and without early enteral nutrition after colorectal cancer surgery. METHODS: This is a retrospective comparative study using propensity score-matched cases. The study subjects were patients who received colorectal cancer resection surgeries during 2013 and 2018 in a Taiwan medical center. Data of the following variables were retrieved from subjects' medical records: age, sex, diagnosis, pathological stage, surgical approach, comorbidity, risk of malnutrition, anesthesia duration, enteral nutrition, time to the first postoperative flatus, time to the first defecation, feeding associated symptoms, nutrition interruptions, time to achieve nutrition goals, postoperative complications, the length of hospital stay. Subjects who received enteral nutrition within 48 h after the surgery were considered as the early enteral nutrition group. RESULTS: After propensity score matching, 227 subjects in each group were included in the final analysis. The early enteral nutrition group showed better results in the time to first postoperative flatus (mean difference: 0.96, 95% confidence interval: 1.16 ~ -0.76), the time to achieve nutrition goals (mean difference: 1.26, 95% confidence interval: 0.65 ~ -1.87), and the length of hospital stay (mean difference: 1.53, 95% confidence interval: 2.56 ~ -0.42), compared with the delayed enteral nutrition group. There were no between-group differences in the incidences of vomiting, distension, ileus, anastomosis leak, infection, re-operation, and interruptions of enteral nutrition. CONCLUSIONS: Enteral feeding after colorectal cancer surgery can accelerate the recovery of gastrointestinal tract activities, promote nutrient intake, and shorten the length of hospital stay without increasing postoperative complications.

Prevalence of Vitamin D Deficiency and Associated Factors in Critically Ill Patients: A Multicenter Observational Study.

Background: Vitamin D deficiency is common in the general population worldwide, and the prevalence and severity of vitamin D deficiency increase in critically ill patients. The prevalence of vitamin D deficiency in a community-based cohort in Northern Taiwan was 22.4%. This multicenter cohort study investigated the prevalence of vitamin D deficiency and associated factors in critically ill patients in Northern Taiwan. Methods: Critically ill patients were enrolled and divided into five groups according to their length of stay at intensive care units (ICUs) during enrolment as follows: group 1, <2 days with expected short ICU stay; group 2, <2 days with expected long ICU stay; group 3, 3-7 days; group 4, 8-14 days; and group 5, 15-28 days. Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D (25(OH)D) level < 20 ng/ml, and severe vitamin D deficiency was defined as a 25(OH)D level < 12 ng/ml. The primary analysis was the prevalence of vitamin D deficiency. The exploratory analyses were serial follow-up vitamin D levels in group 2, associated factors for vitamin D deficiency, and the effect of vitamin D deficiency on clinical outcomes in critically ill patients. Results: The prevalence of vitamin D deficiency was 59% [95% confidence interval (CI) 55-62%], and the prevalence of severe vitamin D deficiency was 18% (95% CI 15-21%). The median vitamin D level for all enrolled critically ill patients was 18.3 (13.7-23.9) ng/ml. In group 2, the median vitamin D levels were <20 ng/ml during the serial follow-up. According to the multivariable analysis, young age, female gender, low albumin level, high parathyroid hormone (PTH) level, and high sequential organ failure assessment (SOFA) score were significantly associated risk factors for vitamin D deficiency. Patients with vitamin D deficiency had longer ventilator use duration and length of ICU stay. However, the 28- and 90-day mortality rate were not associated with vitamin D deficiency. Conclusions: This study demonstrated that the prevalence of vitamin D deficiency is high in critically ill patients. Age, gender, albumin level, PTH level, and SOFA score were significantly associated with vitamin D deficiency in these patients.

Benchmarking of eight recurrent neural network variants for breath phase and adventitious sound detection on a self-developed open-access lung sound database-HF_Lung_V1.

A reliable, remote, and continuous real-time respiratory sound monitor with automated respiratory sound analysis ability is urgently required in many clinical scenarios-such as in monitoring disease progression of coronavirus disease 2019-to replace conventional auscultation with a handheld stethoscope. However, a robust computerized respiratory sound analysis algorithm for breath phase detection and adventitious sound detection at the recording level has not yet been validated in practical applications. In this study, we developed a lung sound database (HF_Lung_V1) comprising 9,765 audio files of lung sounds (duration of 15 s each), 34,095 inhalation labels, 18,349 exhalation labels, 13,883 continuous adventitious sound (CAS) labels (comprising 8,457 wheeze labels, 686 stridor labels, and 4,740 rhonchus labels), and 15,606 discontinuous adventitious sound labels (all crackles). We conducted benchmark tests using long short-term memory (LSTM), gated recurrent unit (GRU), bidirectional LSTM (BiLSTM), bidirectional GRU (BiGRU), convolutional neural network (CNN)-LSTM, CNN-GRU, CNN-BiLSTM, and CNN-BiGRU models for breath phase detection and adventitious sound detection. We also conducted a performance comparison between the LSTM-based and GRU-based models, between unidirectional and bidirectional models, and between models with and without a CNN. The results revealed that these models exhibited adequate performance in lung sound analysis. The GRU-based models outperformed, in terms of F1 scores and areas under the receiver operating characteristic curves, the LSTM-based models in most of the defined tasks. Furthermore, all bidirectional models outperformed their unidirectional counterparts. Finally, the addition of a CNN improved the accuracy of lung sound analysis, especially in the CAS detection tasks.

Breathing Sound Segmentation and Detection Using Transfer Learning Techniques on an Attention-Based Encoder-Decoder Architecture.

This paper focuses on the use of an attention-based encoder-decoder model for the task of breathing sound segmentation and detection. This study aims to accurately segment the inspiration and expiration of patients with pulmonary diseases using the proposed model. Spectrograms of the lung sound signals and labels for every time segment were used to train the model. The model would first encode the spectrogram and then detect inspiratory or expiratory sounds using the encoded image on an attention-based decoder. Physicians would be able to make a more precise diagnosis based on the more interpretable outputs with the assistance of the attention mechanism.The respiratory sounds used for training and testing were recorded from 22 participants using digital stethoscopes or anti-noising microphone sets. Experimental results showed a high 92.006% accuracy when applied 0.5 second time segments and ResNet101 as encoder. Consistent performance of the proposed method can be observed from ten-fold cross-validation experiments.

Secreted expression of the classical swine fever virus glycoprotein E(rns) in yeast and application to a sandwich blocking ELISA.

E(rns) is an envelope glycoprotein of classical swine fever virus (CSFV) with RNase activity. The purpose of this study was to produce an active E(rns) for further applications using the yeast secreted expression system. The E(rns) gene was cloned into the expression vector pGAPZalphaC which was introduced into Pichia pastoris. Expression of E(rns) protein in culture supernatant was confirmed by Western blot analysis using both the monoclonal antibody against CSFV E(rns) and CSFV-positive swine serum. The yeast-expressed E(rns) (yE(rns)) was shown to have N-linked glycosylation and to form homodimer of 74 kDa molecules. All monomer, homodimer, and deglycosylated forms of yE(rns) demonstrated intrinsic ribonuclease activity and a clear preference for uridine-rich sequence. A direct sandwich blocking enzyme-linked immunosorbent assay (ELISA) based on the yE(rns) was developed with a high sensitivity and specificity. The yE(rns) which possesses enzymatic activity and retains antigenicity may provide a useful material for developing a diagnostic kit.

Using combined measurements for comparison of light induction of stomatal conductance, electron transport rate and CO2 fixation in woody and fern species adapted to different light regimes.

We aimed to understand the relation of photosynthetic rate (A) with g(s) and electron transport rate (ETR) in species of great taxonomic range and light adaptation capability during photosynthetic light induction. We studied three woody species (Alnus formosana, Ardisia crenata and Ardisia cornudentata) and four fern species (Pyrrosia lingus, Asplenium antiquum, Diplazium donianum and Archangiopteris somai) with different light adaptation capabilities. Pot-grown materials received 100 and/or 10% sunlight according to their light adaptation capabilities. At least 4 months after light acclimation, CO(2) and H(2)O exchange and chlorophyll fluorescence were measured simultaneously by equipment in the laboratory. In plants adapted or acclimated to low light, dark-adapted leaves exposed to 500 or 2000 µmol m(-2) s(-1) photosynthetic photon flux (PPF) for 30 min showed low gross photosynthetic rate (P(g)) and short time required to reach 90% of maximum P(g) (). At the initiation of illumination, two broad-leaved understory shrubs and the four ferns, especially ferns adapted to heavy shade, showed higher stomatal conductance (g(s)) than pioneer tree species; materials with higher g(s) had short at both 500 and 2000 µmol m(-2) s(-1) PPF. With 500 or 2000 µmol m(-2) s(-1) PPF, the g(s) for the three woody species increased from 2 to 30 min after the start of illumination, but little change in the g(s) of the four ferns. Thus, P(g) and g(s) were not correlated for all material measured at the same PPF and induction time. However, P(g) was positively correlated with ETR, even though CO(2) assimilation may be influenced by stomatal, biochemical and photoinhibitory limitations. In addition, was closely related to time required to reach 90% maximal ETR for all materials and with two levels of PPF combined. Thus, ETR is a good indicator for estimating the light induction of photosynthetic rate of species, across a wide taxonomic range and light adaptation and acclimation capability.

Thoracoscopic drainage of ascending mediastinitis arising from pancreatic pseudocyst.

Acute mediastinitis is a life-threatening disease. Common etiologies include surgical infection, esophageal perforation, and descending necrotizing mediastinitis from the oral cavity or pharynx. Mediastinitis caused by pancreatic disease is rare. The most common thoracic complication of pancreatic disease is reactive pleural effusion. We report a case of acute mediastinitis and bilateral empyema thoracis arising from a pancreatic pseudocyst. We utilized thoracoscopy to drain the mediastinum without drainage of the intra-abdominal cyst. The patient recovered well after operation.