Efficiency analysis by training sequence of high-fidelity simulation-based neonatal resuscitation program (NRP).

OBJECTIVE: This study was conducted to find a more effective education method in a neonatal resuscitation program (NRP) using a high-fidelity simulation that has recently shown positive results in terms of its effectiveness. STUDY DESIGN: A single-blind prospective cohort study was performed. The high-fidelity simulation model was used in a formal NRP training course for trainees caring for neonatal patients. The trainees were divided into a group that conducted the scenario after the lecture (Group A) and a group that attended the lecture after the scenario (Group B) and they both took the test before, during, and after the training. RESULTS: The increase in score after theory training was statistically significant in both groups, but the final score did not differ between the two groups. However, when compared by career, in Group A, trainees under 24 months tended to be more effective, and in Group B, trainees over 24 months tended to be more effective. CONCLUSION: The difference in short-term memory of trainees according to the order of education identified by the test score was not prominent, but it was found that the degree of difference in test scores for the order of education tended to be different according to the career. It is thought that the effectiveness of the training might be increased by changing the education order according to the degree of experience of each trainee. More effective educational methods should be introduced by continuously developing lectures for repeated education of various trainees in the future.

Clinical characteristics of defecation and micturition syncope compared with common vasovagal syncope.

BACKGROUND: Little is known about the clinical characteristics of patients with situational syncope such as defecation syncope (DS) or micturition syncope (MS) compared with those with common vasovagal syncope (VVS). METHODS: Among 680 consecutive patients, who underwent a head-up tilt test between January 2006 and November 2010, 282 patients (40.4±16.7 years; 48.6% men) diagnosed as DS (n = 38), MS (n = 38), or common VVS (n = 208) were included. RESULTS: Ages at diagnosis (38.7±17.3 vs 48.3±14.1 vs 42.0±13.8, P = 0.004) and the first syncope (33.7±18.4 vs 44.5±15.3 vs 37.5±14.6, P = 0.002) were significantly less in patients with common VVS than those with DS or MS, respectively. The patients with MS were more likely to be men (73.7%, P = 0.036), whereas patients with DS were more commonly women (73.7%). No sexual preference was observed in patients with common VVS. Body mass index was significantly lower (P = 0.047) and syncopal episodes were more recurrent (P = 0.049) in patients with common VVS than those with DS or MS. The frequency of drinking alcoholbefore syncope was significantly higher in patients with MS (39.5%, P < 0.001). CONCLUSIONS: DS tended to occur in older women, whereas MS tended to occur in middle-aged men and drinking alcohol was an important precipitating factor for MS. However, common VVS was observed more in a thin and young population, which was more recurrent compared with those situational syncopes.

Fatal Scedosporium prolificans infection in a paediatric patient with acute lymphoblastic leukaemia.

Scedosporium prolificans is a saprophytic fungus responsible for an increasing number of infections among immunocompromised hosts. Most disseminated S. prolificans infections prove fatal due to persistent neutropenia, and inherited resistance to currently available antifungal drugs. The authors report a fatal case of a paediatric Korean patient who progressed to severe sepsis from S. prolificans infection after induction chemotherapy for acute lymphoblastic leukaemia. Treatment with itraconazole was unsuccessful and the patient died within 6 days of admission.

Towards integrative gene prioritization in Alzheimer's disease.

Many methods have been proposed for facilitating the uncovering of genes that underlie the pathology of different diseases. Some are purely statistical, resulting in a (mostly) undifferentiated set of genes that are differentially expressed (or co-expressed), while others seek to prioritize the resulting set of genes through comparison against specific known targets. Most of the recent approaches use either single data or knowledge sources, or combine the independent predictions from each source. However, given that multiple kinds of heterogeneous sources are potentially relevant for gene prioritization, each subject to different levels of noise and of varying reliability, each source bearing information not carried by another, we claim that an ideal prioritization method should provide ways to discern amongst them in a true integrative fashion that captures the subtleties of each, rather than using a simple combination of sources. Integration of multiple data for gene prioritization is thus more challenging than its single data type counterpart. What we propose is a novel, general, and flexible formulation that enables multi-source data integration for gene prioritization that maximizes the complementary nature of different data and knowledge sources in order to make the most use of the information content of aggregate data. Protein-protein interactions and Gene Ontology annotations were used as knowledge sources, together with assay-specific gene expression and genome-wide association data. Leave-one-out testing was performed using a known set of Alzheimer's Disease genes to validate our proposed method. We show that our proposed method performs better than the best multi-source gene prioritization systems currently published.

The enrichment of TATA box and the scarcity of depleted proximal nucleosome in the promoters of duplicated yeast genes.

Population genetic theory of gene duplication suggests that the preservation of duplicate copies requires functional divergence upon duplication. Genes that can be readily modified to produce new gene expression patterns may thus be duplicated often. In yeast, genes exhibit dichotomous expression patterns based on their promoter architectures. The expression of genes that contain TATA box or occupied proximal nucleosome (OPN) tends to be variable and respond to external signals. On the other hand, genes without TATA box or with depleted proximal nucleosome (DPN) are expressed constitutively. We find that recent duplicates in the yeast genome are heavily biased to be TATA box containing genes and not to be DPN genes. This suggests that variably expressed genes, due to the functional organization in their promoters, have higher duplicability than constitutively expressed genes.

Experiences with acute kidney injury complicating non-fulminant hepatitis A.

AIM: To describe the clinical features and to identify factors related to development of acute kidney injury in acute hepatitis A patients. METHODS: The study and control groups consisted of 21 and 425 patients who did or did not develop acute kidney injury, respectively, after acute hepatitis A from January 1997 to May 2007. RESULTS: There were 13 men and eight women; their mean age at diagnosis was 28.8 +/- 8.2 years in the study group. Peak values for renal and liver function impairment consisted of a median serum creatinine of 4.6 mg/dL (range, 1.5-15.3 mg/dL) on day 6 (range, days 1-20) and a median total bilirubin of 10.7 mg/dL (range, 2.6-57.5 mg/dL) on day 8 (range, day 1-19). Serum creatinine concentrations returned to baseline level by a median of 16 days and total bilirubin levels returned to normal by a median of 62 days. Six of 21 (29%) patient underwent haemodialysis. Renal biopsies performed in two patients showed acute tubular necrosis and interstitial nephritis, respectively. Logistic regression analysis showed that a lower haematocrit, the presence of coagulopathy and high C-reactive protein concentration on admission, and higher peak bilirubin value during the illness were associated with development of acute kidney injury. CONCLUSION: Acute hepatitis A should be considered in the differential diagnosis of patients with acute kidney injury, even without fulminant hepatic failure. A lower haematocrit, the presence of coagulopathy and high C-reactive protein level at presentation, and higher peak bilirubin level during the illness were associated with development of acute kidney injury in acute hepatitis A patients.