Mortality, Functional Status, and Quality of Life after 5 Years of Patients Admitted to Critical Care for Spontaneous Intracerebral Hemorrhage.

BACKGROUND: The objective of this study was to assess long-term outcome in patients with spontaneous intracerebral hemorrhage admitted to the intensive care unit. METHODS: Mortality and Glasgow Outcome Scale, Barthel Index, and 5-level EQ-5D version (EQ-5D-5L) scores were analyzed in a multicenter cohort study of three Spanish hospitals (336 patients). Mortality was also analyzed in the Medical Information Mart for Intensive Care III (MIMIC-III) database. RESULTS: The median (25th percentile-75th percentile) age was 62 (50-70) years, the median Glasgow Coma Score was 7 (4-11) points, and the median Acute Physiology and Chronic Health disease Classification System II (APACHE-II) score was 21 (15-26) points. Hospital mortality was 54.17%, mortality at 90 days was 56%, mortality at 1 year was 59.2%, and mortality at 5 years was 66.4%. In the Glasgow Outcome Scale, a normal or disabled self-sufficient situation was recorded in 21.5% of patients at 6 months, in 25.5% of patients after 1 year, and in 22.1% of patients after 5 years of follow-up (4.5% missing). The Barthel Index score of survivors improved over time: 50 (25-80) points at 6 months, 70 (35-95) points at 1 year, and 90 (40-100) points at 5 years (p < 0.001). Quality of life evaluated with the EQ-5D-5L at 1 year and 5 years indicated that greater than 50% of patients had no problems or slight problems in all items (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). In the MIMIC-III study (N = 1354), hospital mortality was 31.83% and was 40.5% at 90 days and 56.2% after 5 years. CONCLUSIONS: In patients admitted to the intensive care unit with a diagnosis of nontraumatic intracerebral hemorrhage, hospital mortality up to 90 days after admission is very high. Between 90 days and 5 years after admission, mortality is not high. A large percentage of survivors presented a significant deficit in quality of life and functional status, although with progressive improvement over time. Five years after the hemorrhagic stroke, a survival of 30% was observed, with a good functional status seen in 20% of patients who had been admitted to the hospital.

Evolution of Carbonate-Intercalated γ-NiOOH from a Molecularly Derived Nickel Sulfide (Pre)Catalyst for Efficient Water and Selective Organic Oxidation.

The development of a competent (pre)catalyst for the oxygen evolution reaction (OER) to produce green hydrogen is critical for a carbon-neutral economy. In this aspect, the low-temperature, single-source precursor (SSP) method allows the formation of highly efficient OER electrocatalysts, with better control over their structural and electronic properties. Herein, a transition metal (TM) based chalcogenide material, nickel sulfide (NiS), is prepared from a novel molecular complex [NiII (PyHS)4 ][OTf]2 (1) and utilized as a (pre)catalyst for OER. The NiS (pre)catalyst requires an overpotential of only 255 mV to reach the benchmark current density of 10 mA cm-2 and shows 63 h of chronopotentiometry (CP) stability along with over 95% Faradaic efficiency in 1 m KOH. Several ex situ measurements and quasi in situ Raman spectroscopy uncover that NiS irreversibly transformed to a carbonate-intercalated γ-NiOOH phase under the alkaline OER conditions, which serves as the actual active structure for the OER. Additionally, this in situ formed active phase successfully catalyzes the selective oxidation of alcohol, aldehyde, and amine-based organic substrates to value-added chemicals, with high efficiencies.

Upper gastrointestinal bleeding secondary to late gastric metastasis of renal cell carcinoma.

Clear cell renal cell carcinoma is the most common renal neoplasm in adults. It has a relatively slow growth pattern that delays diagnosis until the onset of local, paraneoplastic or metastasis-related manifestations, and an unpredictable behavior ranging from aggressive tumors with poor short-term prognosis to late recurrence cases where metastases are identified years after nephrectomy, the latter scenario being the subject of the case we herein report.

Early Use of Sarilumab in Patients Hospitalized with COVID-19 Pneumonia and Features of Systemic Inflammation: the SARICOR Randomized Clinical Trial.

The objective of this study was to investigate the efficacy and safety of early treatment with sarilumab, added to standard of care (SOC), in hospitalized adults with COVID-19. Methods included phase II, open-label, randomized, controlled clinical trial of hospitalized patients with COVID-19 pneumonia and interleukin (IL)-6 levels ≥ 40 pg/mL and/or d-dimer > 1,500 ng/mL. Participants were randomized (1:1:1) to receive SOC (control group), SOC plus a single subcutaneous dose of sarilumab 200 mg (sarilumab-200 group), or SOC plus a single subcutaneous dose of sarilumab 400 mg (sarilumab-400 group). The primary outcome variable was the development of acute respiratory distress syndrome (ARDS) requiring high-flow nasal oxygenation (HFNO), non-invasive mechanical ventilation (NIMV) or invasive mechanical ventilation (IMV) at day 28. One-hundred and 15 participants (control group, n = 39; sarilumab-200, n = 37; sarilumab-400, n = 39) were included. At randomization, 104 (90%) patients had supplemental oxygen and 103 (90%) received corticosteroids. Eleven (28%) patients in the control group, 10 (27%) in sarilumab-200, and five (13%) in sarilumab-400 developed the primary outcome (hazard ratio [95% CI] of sarilumab-400 vs control group: 0.41 [0.14, 1.18]; P = 0.09). Seven (6%) patients died: three in the control group and four in sarilumab-200. There were no deaths in sarilumab-400 (P = 0.079, log-rank test for comparisons with the control group). In patients recently hospitalized with COVID-19 pneumonia and features of systemic inflammation, early IL-6 blockade with a single dose of sarilumab 400 mg was safe and associated with a trend for better outcomes. (This study has been registered at ClinicalTrials.gov under identifier NCT04357860.).

Ethmoidal metastasis as an uncommon presentation and diagnostic form of hepatocellular carcinoma.

Nasopharynx metastases are an extremely rare cause of hepatocarcinoma debut. We report the case of a 71 year old man who presented symptoms of nosebleed and diplopia event, diagnosed by imaging and biopsy of ethmoidal metastasis of hepatocarcinoma.

Capecitabine-induced hyperammonemic encephalopathy.

We report the case of a 79-year-old male who had undergone surgery for a mucus-secreting, stage-III pancreatic adenocarcinoma 2 years previously, who was recently started on capecitabine monotherapy for radiographic local progression. He developed disorientation, asterixis, nausea and elevated serum ammonia (221 µmol/L) 48-72 hours after treatment onset with preserved liver function. After ruling out potential causes of encephalopathy and tumor progression by abdominal and brain CT scans, his symptoms were related by exclusion to the recently initiated treatment with capecitabine. Capecitabine discontinuation, onset of standard anti-encephalopathy measures, and intravenous hydration led to a rapid, complete resolution of symptoms with serum ammonia normalization.

Diagnosis of biliary papillomatosis with a Spyglass® cholangioscope.

We report the case of a 78-year-old woman with dyspepsia for several years and a history of cholecystectomy, informed by pathology as calculous cholecystopathy, where CT revealed a left-sided intrahepatic bile duct dilation. Cholangio-MRI confirmed a size increase in the distal intrahepatic bile duct on the left side, with T2-hyperintense contents with scarce contrast enhancement, which resulted in the observed dilation. . A Spybite® forceps was used to obtain a biopsy sample, which showed a benign papillary growth compatible with biliary papillomatosis. Biliary papillomatosis or intraductal papillary neoplasm of the biliary tract is a rare, uncommon condition characterized by intraductal papillary growth of the biliary epithelium. It has a tendency towards malignization, hence must be considered a premalignant condition . Major symptoms include jaundice, abdominal pain, and repeat cholangitis, with imaging studies being key for diagnostic suspicion . The development of cholangioscopy with biopsies allows an early diagnosis of malignant precursor lesions of the bile duct, thus allowing early treatment.

Endoscopic submucosal dissection of gastric plexiform fibromyxoma, an alternative to the traditional approach.

We report the case of a 62-year-old woman with no history of interest who presented with dyspepsia of 2 years' standing. Gastroscopy revealed a subepithelial lesion at the greater antral curvature with irregular surface and preserved mucosal and vascular pattern, 15 mm in diameter. Because of clinical persistence a radial endoscopic ultrasonogram (EUS) was performed, which showed a well-delimited hypoechoic lesion with heterogeneous areas that was dependent on the muscularis mucosae layer. A biopsy was obtained using the "bite-on-bite" technique, which provided no pathological findings. With these findings an endoscopic submucosal dissection (ESD) procedure was performed with wide margins and no complications. Pathology found low-grade mesenchymal fusicellular proliferation dependent on the muscularis mucosae with immunohistochemistry positive for smooth-muscle vimentin and actin, consistent with plexiform fibromyxoma.

Sensitizing the cytotoxic action of Docetaxel induced by Pentoxifylline in a PC3 prostate cancer cell line.

BACKGROUND: Prostate cancer is one of the most frequently diagnosed types of cancers worldwide. In its initial period, the tumor is hormone-sensitive, but in advanced states, it evolves into a metastatic castration-resistant tumor. In this state, chemotherapy with taxanes such as Docetaxel (DTX) comprises the first line of treatment. However, the response is poor due to chemoresistance and toxicity. On the other hand, Pentoxifylline (PTX) is an unspecific inhibitor of phosphodiesterases; experimental, and clinically it has been described as sensitizing tumor cells to chemotherapy, increasing apoptosis and decreasing senescence. We study whether the PTX sensitizes prostate cancer cells to DTX for greater effectiveness. METHODS: PC3 human prostate cancer cells were treated in vitro at different doses and times with PTX, DTX, or their combination. Viability was determined by the WST-1 assay by spectrophotometry, cell cycle progression, apoptosis, generic caspase activation and senescence by flow cytometry, DNA fragmentation and caspases-3, -8, and -9 activity by ELISA. RESULTS: We found that PTX in PC3 human prostate cancer cells induces significant apoptosis per se and increases that generated by DTX, while at the same time it reduces the senescence caused by the chemotherapy and increases caspases-3,-8, and -9 activity in PTX + DTX-treated cells. Both treatments blocked the PC3 cell in the G1 phase. CONCLUSIONS: Our results show that PTX sensitizes prostate tumor cells to apoptosis induced by DTX. Taken together, the results support the concept of chemotherapy with rational molecular bases.

Classification and Visualisation of Normal and Abnormal Radiographs; A Comparison between Eleven Convolutional Neural Network Architectures.

This paper investigates the classification of radiographic images with eleven convolutional neural network (CNN) architectures (GoogleNet, VGG-19, AlexNet, SqueezeNet, ResNet-18, Inception-v3, ResNet-50, VGG-16, ResNet-101, DenseNet-201 and Inception-ResNet-v2). The CNNs were used to classify a series of wrist radiographs from the Stanford Musculoskeletal Radiographs (MURA) dataset into two classes-normal and abnormal. The architectures were compared for different hyper-parameters against accuracy and Cohen's kappa coefficient. The best two results were then explored with data augmentation. Without the use of augmentation, the best results were provided by Inception-ResNet-v2 (Mean accuracy = 0.723, Mean kappa = 0.506). These were significantly improved with augmentation to Inception-ResNet-v2 (Mean accuracy = 0.857, Mean kappa = 0.703). Finally, Class Activation Mapping was applied to interpret activation of the network against the location of an anomaly in the radiographs.

Eosinophilic enterocolitis: an uncommon cause of chronic diarrhea.

Eosinophilic enterocolitis is a rare entity included in the group of primary eosinophilic gastrointestinal disorders. It is characterized by eosinophilic infiltrate in the absence of other causes of enterocolonic eosinophilia (infection, allergic or drug reaction, inflammatory disease, etc). The most common gastrointestinal manifestations are abdominal pain, diarrhea or malabsorption. The lack of well-defined diagnostic criteria and patchy microscopic involvement make diagnosis difficult. We report the case of a 44-year-old male with chronic diarrhea. After performing multiple studies, he was diagnosed of eosinophilic enterocolitis, with a suitable response to corticosteroids.

Bortezomib-induced acute pancreatitis, an uncommon adverse event.

Acute pancreatitis is one of the main reasons for hospitalization, with an increasing incidence and associated non-negligible morbidity and mortality. Its most common causes are alcohol and gallstones, and medications are a rare cause. The pathogenesis of acute drug pancreatitis is not yet known exactly and the diagnosis is based on the evident temporal relationship, having excluded the rest of the possible known causes of acute pancreatitis. We present the case of a 71-year-old patient diagnosed with IgG multiple myeloma treated with the Daratumumab, Bortezomib and Dexamethasone regimen. After Bortezomib administration, he developed epigastric pain and elevated pancreatic enzymes in the range of acute pancreatitis. After ruling out common causes, the diagnosis of acute pancreatitis caused by Bortezomib was reached, which presents a favorable rapid evolution after its elimination.

Improvement of quality of life (QOL) between 1 and 3-4 years after traumatic brain injury (TBI) in ICU patients.

BACKGROUND: Evaluation of changes in quality of life (QOL) in ICU patients several years after traumatic brain injury (TBI) is not well documented. METHODS: A prospective cohort study was conducted in all patients with TBI admitted between 2004 and 2008 to the ICU of Regional Hospital of Malaga (Spain). Functional status was evaluated by Glasgow Outcome Scale (GOS) and QOL by PAECC (Project for the Epidemiologic Analysis of Critical Care patients) questionnaire between 0 (normal QOL) to 29 points (worst QOL). RESULTS: A total of 531 patients. Median(Quartile1,Quartile 3) age: 35 (22, 56) years. After 3-4 years, 175 died (33%). Survivor QOL was deteriorated (median total PAECC score: 5 (0, 11) points) although 75.76% of patients who survived showed good functional situation (GOS normal or mild dysfunction). An improvement in QOL scores between 1 and 3-4 years was observed (median PAECC score differences between 3-4 years and 1 year: - 1(- 4, 0) points). QOL score improved during this interval of time: 62.6% of patients. Change in QOL was related by multivariate analysis to admission cranial-computed tomography scan (Marshall's classification), age, and Injury Severity Score (ISS), with the biggest improvement seen in younger patients and with more severe ISS. Basic physiological activities were maintained in the majority of patients. Subjective aspects and working activities improved between 1 and 3-4 years but with a high proportion still impaired in these items after 3-4 years. CONCLUSIONS: ICU patients with TBI after 1 year show improvement in QOL between 1 and 3-4 years, with the biggest improvement in QOL seen in younger patients and in those with more severe ISS.

Todani type VI bile duct cyst: cystic duct malformation as an uncommon cause of abdominal pain.

We report the case of a 62-year-old woman who was admitted for epigastralgia and oral intolerance for 15 days, associating cholestasis in blood tests. A magnetic resonance cholangiography (MRC) revealed the presence of a lobulation continuous with the cystic duct that was consistent with a Todani VI bile duct cyst. The biliary cyst Todani VI is a rare entity within bile duct malformations. The first well-documented case was reported back in 1983, and its inclusion as sixth type in the classification was suggested in 1991. It is an uncommon cause of abdominal pain that we must keep in mind, and the importance of early diagnosis and treatment lies in the condition's oncogenic potential.

Wernicke's encephalopathy in a patient with late-onset enterocolic fistula after bariatric surgery.

Wernicke´s encephalopathy (WE) is an acute neurologic disorder secondary to thiamine deficiency. We report the case of a patient with history of bariatric surgery who develops a late-onset enterocolic fistula, with alcohol consumption associated.

A Bayesian Argumentation Framework for Distributed Fault Diagnosis in Telecommunication Networks.

Traditionally, fault diagnosis in telecommunication network management is carried out by humans who use software support systems. The phenomenal growth in telecommunication networks has nonetheless triggered the interest in more autonomous approaches, capable of coping with emergent challenges such as the need to diagnose faults' root causes under uncertainty in geographically-distributed environments, with restrictions on data privacy. In this paper, we present a framework for distributed fault diagnosis under uncertainty based on an argumentative framework for multi-agent systems. In our approach, agents collaborate to reach conclusions by arguing in unpredictable scenarios. The observations collected from the network are used to infer possible fault root causes using Bayesian networks as causal models for the diagnosis process. Hypotheses about those fault root causes are discussed by agents in an argumentative dialogue to achieve a reliable conclusion. During that dialogue, agents handle the uncertainty of the diagnosis process, taking care of keeping data privacy among them. The proposed approach is compared against existing alternatives using benchmark multi-domain datasets. Moreover, we include data collected from a previous fault diagnosis system running in a telecommunication network for one and a half years. Results show that the proposed approach is suitable for the motivational scenario.

A Rescorla-Wagner drift-diffusion model of conditioning and timing.

Computational models of classical conditioning have made significant contributions to the theoretic understanding of associative learning, yet they still struggle when the temporal aspects of conditioning are taken into account. Interval timing models have contributed a rich variety of time representations and provided accurate predictions for the timing of responses, but they usually have little to say about associative learning. In this article we present a unified model of conditioning and timing that is based on the influential Rescorla-Wagner conditioning model and the more recently developed Timing Drift-Diffusion model. We test the model by simulating 10 experimental phenomena and show that it can provide an adequate account for 8, and a partial account for the other 2. We argue that the model can account for more phenomena in the chosen set than these other similar in scope models: CSC-TD, MS-TD, Learning to Time and Modular Theory. A comparison and analysis of the mechanisms in these models is provided, with a focus on the types of time representation and associative learning rule used.

Deep learning for single-molecule science.

Exploring and making predictions based on single-molecule data can be challenging, not only due to the sheer size of the datasets, but also because a priori knowledge about the signal characteristics is typically limited and poor signal-to-noise ratio. For example, hypothesis-driven data exploration, informed by an expectation of the signal characteristics, can lead to interpretation bias or loss of information. Equally, even when the different data categories are known, e.g., the four bases in DNA sequencing, it is often difficult to know how to make best use of the available information content. The latest developments in machine learning (ML), so-called deep learning (DL) offer interesting, new avenues to address such challenges. In some applications, such as speech and image recognition, DL has been able to outperform conventional ML strategies and even human performance. However, to date DL has not been applied much in single-molecule science, presumably in part because relatively little is known about the 'internal workings' of such DL tools within single-molecule science as a field. In this Tutorial, we make an attempt to illustrate in a step-by-step guide how one of those, a convolutional neural network (CNN), may be used for base calling in DNA sequencing applications. We compare it with a SVM as a more conventional ML method, and discuss some of the strengths and weaknesses of the approach. In particular, a 'deep' neural network has many features of a 'black box', which has important implications on how we look at and interpret data.

[Hyperleptinemia associated with ischemic stroke]. / Hiperleptinemia asociada a evento vascular cerebral isquémico (EVCi).

INTRODUCTION: The major risk factors for stroke are obesity, diabetes mellitus, systemic arterial hypertension (SAH) and dyslipidemia. In 1994 leptin was identifies as adipokine produced by adipose tissue. Its main action is the regulation of energy balance. Currently, hyperleptinemia is associated with cardiovascular disease. OBJECTIVE: To determine the association between serum leptin and stroke in patients with SAH. METHODS: We determined serum leptin in subjects with stroke and SAH, and compared this with patients with SAH without stroke. We calculated Student t, χ², and odds ratio (OR) for quantitative and qualitative variables. RESULTS: 60 subjects were recruited, 30 subjects per group. Considering a value>3.93 ng/ml as hyperleptinemia, it also was found a t=2.8 (p=0.007), and χ² with one degree of freedom of 10.82 (p=0.001), obtaining an OR of 3.05 for the development of stroke in the presence of elevated leptin (95% CI: 0.9-9.6; p=0.05). CONCLUSIONS: Hyperleptinemia is more common in patients with stroke than in those without this condition. But the question remains whether hyperleptinemia is a stroke risk factor or protective factor.

Dynamic Oil Consumption Measurement of Internal Combustion Engines using Laser Spectroscopy.

A new approach has been developed to measure dynamic consumption of lubricant oil in an internal combustion engine. It is based on the already known technique where sulfur is used as a natural tracer of the engine oil. Since ejection of motor oil in gaseous form into the exhaust is by far the main source of engine oil consumption, detection of sulfur in the exhaust emission is a valuable way to measure engine oil consumption in a dynamic way. In earlier approaches, this is done by converting all sulfur containing chemical components into SO2 by thermal pyrolysis in a high temperature furnace at atmospheric pressure. The so-formed SO2 then is detected by broadband-UV-induced fluorescence or mass spectrometric methods. The challenge is to reach the necessary detection limit of 50 ppb. The new approach presented here includes sulfur conversion in a low-pressure discharge cell and laser-induced fluorescence with wavelength and fluorescence lifetime selection. A limit of detection down to 10 ppb at a temporal resolution in the time scale of few seconds is reached. Extensive, promising studies have been performed at a real engine test bench. Future developments of a compact, mobile device based on these improvements are discussed.