Combining deep neural networks, a rule-based expert system and targeted manual coding for ICD-10 coding causes of death of French death certificates from 2018 to 2019.

OBJECTIVE: For ICD-10 coding causes of death in France in 2018 and 2019, predictions by deep neural networks (DNNs) are employed in addition to fully automatic batch coding by a rule-based expert system and to interactive coding by the coding team focused on certificates with a special public health interest and those for which DNNs have a low confidence index. METHODS: Supervised seq-to-seq DNNs are trained on previously coded data to ICD-10 code multiple causes and underlying causes of death. The DNNs are then used to target death certificates to be sent to the coding team and to predict multiple causes and underlying causes of death for part of the certificates. Hence, the coding campaign for 2018 and 2019 combines three modes of coding and a loop of interaction between the three. FINDINGS: In this campaign, 62% of the certificates are automatically batch coded by the expert system, 3% by the coding team, and the remainder by DNNs. Compared to a traditional campaign that would have relied on automatic batch coding and manual coding, the present campaign reaches an accuracy of 93.4% for ICD-10 coding of the underlying cause (95.6% at the European shortlist level). Some limitations (risks of under- or overestimation) appear for certain ICD categories, with the advantage of being quantifiable. CONCLUSION: The combination of the three coding methods illustrates how artificial intelligence, automated and human codings are mutually enriching. Quantified limitations on some chapters of ICD codes encourage an increase in the volume of certificates sent for manual coding from 2021 onward.

Roles for a lipid phosphatase in the activation of its opposing lipid kinase.

Fig4 is a phosphoinositide phosphatase that converts PI3,5P2 to PI3P. Paradoxically, mutation of Fig4 results in lower PI3,5P2, indicating that Fig4 is also required for PI3,5P2 production. Fig4 promotes elevation of PI3,5P2, in part, through stabilization of a protein complex that includes its opposing lipid kinase, Fab1, and the scaffold protein Vac14. Here we show that multiple regions of Fig4 contribute to its roles in the elevation of PI3,5P2: its catalytic site, an N-terminal disease-related surface, and a C-terminal region. We show that mutation of the Fig4 catalytic site enhances the formation of the Fab1-Vac14-Fig4 complex, and reduces the ability to elevate PI3,5P2. This suggests that independent of its lipid phosphatase function, the active site plays a role in the Fab1-Vac14-Fig4 complex. We also show that the N-terminal disease-related surface contributes to the elevation of PI3,5P2 and promotes Fig4 association with Vac14 in a manner that requires the Fig4 C-terminus. We find that the Fig4 C-terminus alone interacts with Vac14 in vivo and retains some functions of full-length Fig4. Thus, a subset of Fig4 functions are independent of its phosphatase domain and at least three regions of Fig4 play roles in the function of the Fab1-Vac14-Fig4 complex.

Evaluation of water quality and heavy metal concentrations in the RAMSAR Wetland El Yali (Central Chile, 33°45'S).

The EYNR is the most important wetland in central Chile because it is protected as a RAMSAR site. It includes coastal lagoons, estuaries and saltmarshes, sustaining an important biodiversity. The chemical complexity was described using water and soil samples, which are characterized by high levels of alkalinity and soil cations. In addition, high concentrations of Cu (0.01-0.080 mg L-1) and Pb (0.120-0.566 mg L-1) in water were measured. Using a simplified index of water quality for oxygen demand, the ecological status of the wetland was classified as bad quality due to the existing use of land. Multivariable analyses and heavy metal index classified this wetland as having low to intermediate deterioration due to the combination of heavy metals. If this trend is allowed to continue unabated, the food web complexes in this wetland are likely to be at the highest risk of induced heavy metal contamination.

Health-Related Quality of Life and Survival Outcomes of Pediatric Patients With Nonmetastatic Osteosarcoma Treated in Countries With Different Resources.

PURPOSE: Health-related quality of life (HRQOL) improves throughout treatment of patients with nonmetastatic osteosarcoma. We compared HRQOL for patients in the United States and Chile treated on an international trial (OS99) with polychemotherapy and surgery, and we assessed the relationships among HRQOL measures, event-free survival (EFS), and overall survival (OS). MATERIALS AND METHODS: Patients with newly diagnosed, localized osteosarcoma and their parents completed three HRQOL instruments (PedsQL v.4, PedsQL Cancer v.3, and Symptom Distress Scale [SDS]). Data were collected at four time points throughout therapy. Repeated measures models were used to investigate the effect of treatment site on instrument scores. The log-rank test examined the impact of treatment site on survival outcomes, and Cox proportional hazards regression models evaluated baseline HRQOL measures as predictors of EFS and OS. RESULTS: Of 71 eligible patients, 66 (93%) participated in the HRQOL studies in the United States (n = 44) and Chile (n = 22). The median age was 13.4 years (range, 5 to 23 years). Clinical characteristics were similar between treatment sites. US patients reported better scores for physical ( P = .030), emotional ( P = .027), and school functioning ( P < .001). Chilean patients reported poorer scores for worry ( P < .001) and nausea ( P = .007). Patient and parent nausea scores were similar between patients treated in the United States and Chile by the end of therapy. Differences in symptom distress were not observed between the countries. Neither HRQOL measures nor treatment site were associated with EFS or OS. CONCLUSION: Although significant differences in HRQOL were observed between countries, outcomes were similar, and HRQOL measures were not associated with prognosis.

Aggressive treatment of non-metastatic osteosarcoma improves health-related quality of life in children and adolescents.

BACKGROUND: Health-related quality of life (HRQOL) of paediatric patients with osteosarcoma has not been documented longitudinally during treatment. Aims of this prospective study were to assess treatment effects on patients' HRQOL at diagnosis, during therapy and after completion of therapy, to assess sex- and age-related differences in HRQOL ratings and to assess differences between patients' and parents' reports. PATIENTS AND METHODS: Sixty-six patients (median age, 13.4 years) with newly diagnosed, localised disease completed three HRQOL instruments, and their parents completed two of the same instruments at diagnosis, before surgery (Week 12), at Week 23 and a median of 20 weeks after treatment completion. RESULTS: Significant improvements in most domains and worsening of nausea were reported by patients and parents from diagnosis to Weeks 12 and 23. Symptom distress decreased from diagnosis to Weeks 12 and 23 in 81% and 64% of patients, respectively. There were no sex- and few age-related differences in scores. Scores from patients and parents achieved good agreement. CONCLUSIONS: The HRQOL of patients improves during aggressive treatment for non-metastatic osteosarcoma, except in the domain of nausea. Clinicians can use these findings to prepare their patients for the distressing symptoms that they will likely experience at certain time points and to provide reassurance that these will significantly improve.

Monomethylarsonate (MMAv) exerts stronger effects than arsenate on the structure and thermotropic properties of phospholipids bilayers.

Methylation of inorganic arsenic has been regarded as a detoxification mechanism because its metabolites monomethylarsonic acid (MMA(v)) and dimethylarsinic acid (DMA(v)) are supposed to be less toxic than inorganic arsenite and arsenate. In recent years, however, this interpretation has been questioned. Additionally, there are insufficient reports concerning the effects of arsenic compounds on cell membrane structure and functions. With the aim to better understand the molecular mechanisms of the interaction of MMA(v) and arsenate with cell membranes, we have utilized molecular models consisting in bilayers of dimyristoylphosphatidylcholine (DMPC) and dimyristoylphosphatidylethanolamine (DMPE), representative of phospholipid classes located in the outer and inner monolayers of many cell membranes including that of the human erythrocyte. The capacity of MMA(v) and arsenate to perturb the bilayer structures of DMPC and DMPE was evaluated by X-ray diffraction; the modifications of their thermotropic behavior were followed by differential scanning calorimetry (DSC), while DMPC large unilamellar vesicles (LUV) were studied by fluorescence spectroscopy. It was found that MMA(v) and arsenate did not structurally perturb DMPC bilayers; however, DMPE bilayers did suffer structural perturbations by MMA(v). DSC measurements also revealed that DMPE's thermotropic properties were significantly affected by arsenicals, where MMA(v) was more effective than arsenate, whilst only slight modifications were observed in the case of DMPC-MMA(v) system.

Arsenite interactions with phospholipid bilayers as molecular models for the human erythrocyte membrane.

There are scanty reports concerning the effects of arsenic compounds on the structure and functions of cell membranes. With the aim to better understand the molecular mechanisms of the interaction of arsenite with cell membranes we have utilized bilayers of dimyristoylphosphatidylcholine (DMPC) and dimyristoylphosphatidylethanolamine (DMPE), representative of phospholipid classes located in the outer and inner monolayers of the human erythrocyte membrane, respectively. The capacity of arsenite to perturb the bilayer structures was determined by X-ray diffraction and fluorescence spectroscopy, whilst the modification of their thermotropic behaviour was followed by differential scanning calorimetry (DSC). The experiments carried out by X-ray diffraction and calorimetry clearly indicated that NaAsO(2) interacted with DMPE and modified its thermotropic behaviour. No such information has been so far reported in the literature.

Sodium arsenite affects Na+ transport in the isolated skin of the toad Pleurodema thaul.

Arsenic, applied as sodium arsenite (As(III)) to either inner or outer surfaces of the isolated toad skin, dose-dependently decreased the short-circuit current (Isc), potential difference (PD) and sodium conductance (G(Na)) in the concentration range 1-1000 microM, with effects often lasting over 3 h. Maximal inhibitory effect was over 90% with an IC(50) of about 34 microM. Applied during amiloride block, As(III) did not change this effect. However, an increase in electric parameters was noted during the initial 30 min in 22 experiments, indicating a possible translocation of cytosolic protein kinase C (PKC) to the membrane within 15 min, thus stimulating sodium transport; this is followed by a progressive inhibition of kinase activity. Comparative effects of amiloride (8 microM), As(III) (100 microM, outer surface) and noradrenaline (NA, 10 microM, inner surface) showed a significant increase in the stimulatory effect of NA on the electric parameters, which could be the result of arsenite clustering of cell surface receptors and activation of ensuing cellular signal transduction pathways. Ouabain 5 microM, followed by As(III) 100 microM, also stimulated the skin response to NA (10 microM), although the duration of the two phases of the response was markedly shortened. The exact mechanism is still in doubt: however, As(III) increases cerebral metabolites of NA and ouabain can increase NA efflux from tissue slices. The amiloride test, performed with As(III) in the outer surface, confirmed significant decrease in all the parameters: the driving force (E(Na)), sodium conductance (G(Na)), and importantly, shunt conductance (G(sh)), due to the known fact that arsenic inhibits gap junctional intercellular communication.

Lack of cholesterol-lowering effect of graded doses of cholestyramine in children with Alagille syndrome: a pilot study.

BACKGROUND: There is controversy about the potential risk of sustained high concentrations of cholesterol and triglyceride in patients with cholestatic chronic liver disease. However, it is currently accepted that cholesterol-lowering therapy may reduce morbidity and mortality rates in hypercholesterolemic patients without preexisting coronary heart disease, as well as in those with coronary heart disease. The objective of this study was to evaluate the effect of cholestyramine on the serum lipid profile of a group of children with Alagille syndrome and hypercholesterolemia. METHODS: Five children with Alagille syndrome and basal serum cholesterol concentrations greater than 230 mg/dL were included. Total serum cholesterol, triglyceride, low-density, and high-density lipoprotein cholesterol concentrations were measured on days 0, 10, 20, and 30 after the administration of oral cholestyramine 100, 250, and 500 mg(kg.d), respectively. Lipid fractions were reported as mean +/- 1 SD. Statistical analysis was performed with Friedman analysis of variance. RESULTS: The basal values and those of the three 10-day subsequent 100-, 250-, and 500-mg(kg.d) cholestyramine periods were as follows: total cholesterol: 327.6 +/- 77.1, 305.4 +/- 52.1, 290.6 +/- 24.1, and 320.6 +/- 32.3, respectively (P = 0.668); triglyceride: 136.4 +/- 14.6, 144.8 +/- 41.3, 161 +/- 30.9, and 165.4 +/- 40.7, respectively (P = 0.356); low-density lipoprotein cholesterol: 245.4 +/- 57.8, 239.8 +/- 48.6, 242.2 +/- 68.6, and 246.4 +/- 49.5, respectively (P = 0.782); and high-density lipoprotein cholesterol: 44.4 +/- 11.2, 41.8 +/- 12.8, 44.6.2 +/- 13.2, and 47 +/- 8.5, respectively (P = 0.431). CONCLUSION: Under the conditions of the current study, no significant effect of variable doses of cholestyramine could be demonstrated on the serum lipid profile of a series of children with Alagille syndrome. While the controversy on the potential atherogenic risk of low-density lipoprotein hypercholesterolemia in patients with chronic liver disease persists, new, prospective pharmacologic or nutritional trials are required.

Factores psicosociales relacionados con accidentes del trabajo / Psychosocial factors related with work accidents

Se compararon 22 pacientes accidentados en el trabajo que habían sufrido una amputación grave, con 22 trabajadores en máquinas industriales de un riesgo similar a las que habían producido los accidentes, pareados por edad. Ambos grupos fueron investigados mediante encuestas en las que se obtiene información relevante previa al accidente, sobre condiciones de trabajo, sintomatología neurótica y psicosomática, nivel de estrés y cambios vitales. Los resultados mostraron que los dos grupos fueron similares en nivel educacional, estado civil y situación laboral. Los pacientes amputados tenían menor tiempo de experiencia en el trabajo, mayor cantidad de eventos vitales en los últimos 6 meses, y mostraron un nivel significativamente menor de sintomatología neurótica y psicosomática , así como de estrés laboral y extra-laboral. Se plantea que un período de shock emocional inmediatamente posterior al accidente puede explicar estos resultados. También se plantea que el mecanismo de actuación pueda ser relevante en el funcionamiento psicológico de los pacientes amputados