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1.
Comput Math Methods Med ; 2021: 5812499, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34527076

RESUMO

Artificial intelligence (AI) is making computer systems capable of executing human brain tasks in many fields in all aspects of daily life. The enhancement in information and communications technology (ICT) has indisputably improved the quality of people's lives around the globe. Especially, ICT has led to a very needy and tremendous improvement in the health sector which is commonly known as electronic health (eHealth) and medical health (mHealth). Deep machine learning and AI approaches are commonly presented in many applications using big data, which consists of all relevant data about the medical health and diseases which a model can access at the time of execution or diagnosis of diseases. For example, cardiovascular imaging has now accurate imaging combined with big data from the eHealth record and pathology to better characterize the disease and personalized therapy. In clinical work and imaging, cancer care is getting improved by knowing the tumor biology and helping in the implementation of precision medicine. The Markov model is used to extract new approaches for leveraging cancer. In this paper, we have reviewed existing research relevant to eHealth and mHealth where various models are discussed which uses big data for the diagnosis and healthcare system. This paper summarizes the recent promising applications of AI and big data in medical health and electronic health, which have potentially added value to diagnosis and patient care.

2.
BMC Med Educ ; 21(1): 436, 2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34407810

RESUMO

BACKGROUND: The educational efficacy in neonatal resuscitation relies on the subject and teaching strategies. Therefore, it is imperative to test diverse educational methods if they are more instructive to engage students in active learning and practicing knowledge. Hence, the present study aims to investigate the efficacy of a pedagogical framework in neonatal resuscitation skill learning among nursing students in a resource-limited setting. METHODS: A single-blind randomized controlled trial was conducted between October 2020 to March 2021. Sixty nursing students in the 3rd and 4th year of professional training were randomly allocated to the pedagogy and the traditional group. The pedagogy group learned via 6-step LSPPDM (Learn, See, Practice, Prove, Do, Maintain) pedagogy including lectures, video, clinical observation, skill sessions under supervision, and self-directed practice. The traditional group learned through 2-step (Learn, Practice) method that included lectures and skill sessions under supervision. The outcomes measured included technical and non-technical skills in neonatal resuscitation. The technical skill deals with steps such as stimulation, ventilation, oxygenation, intubation, chest compression, medications, and reporting. Non-technical skills refer to teamwork skills that focus on the interaction between leader and helper. Both skills were measured through previously published validated tools two times before and after the intervention by blinded assessors in a simulated delivery room. RESULTS: Overall, the skill was significantly improved in both groups after intervention. Yet, the results showed that the mean difference of technical skill score in the pedagogy group (24.3 ± 3.5) was significantly higher (p <  0.001) compared to the traditional group (16.2 ± 2.4). Likewise, the mean difference of non-technical skill score in the pedagogy (36.9 ± 1.9) was highly significant (p <  0.001) compared to the traditional group (31.2 ± 1.7). CONCLUSIONS: The LSPPDM pedagogy was found more effective in enhancing technical and non-technical skills in neonatal resuscitation compared to the traditional method. The results of this study support the efficacy of the 6-step LSPPDM pedagogy in the education of nursing students regarding neonatal resuscitation in a resource-limited setting. TRIAL REGISTRATION: Prospectively registered at ClinicalTrials.gov ( NCT04748341 ).


Assuntos
Ressuscitação , Estudantes de Enfermagem , Competência Clínica , Humanos , Recém-Nascido , Aprendizagem , Método Simples-Cego
3.
BMJ Case Rep ; 14(8)2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344645

RESUMO

A 50-year-old man with no medical history of note presented with new onset of confusion and dyspnoea. He tested positive for coronavirus (COVID-19), and subsequently, was admitted to the intensive care unit due to severe sepsis and acute renal failure requiring haemodialysis. Shortly afterwards, he was intubated due to haemodynamic instability. His blood culture was positive for Staphylococcus aureus bacteraemia, and echocardiogram showed evidence of vegetation in the aortic valve area. He was commenced on intravenous antibiotics for infective endocarditis (IE). Following extubation, he underwent an MRI of the spine due to increasing back pain. This was suggestive of L5-S1 discitis, likely secondary to septic emboli from IE. A few days later, he developed acute ischaemia of the left toes and extensive thrombosis of the right cubital and left iliac veins. Following a prolonged hospital admission, he was discharged home and later underwent an elective forefoot amputation from which he made a good recovery.


Assuntos
Bacteriemia , COVID-19 , Endocardite Bacteriana , Endocardite , Infecções Estafilocócicas , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus
5.
Acta Parasitol ; 2021 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-33990896

RESUMO

BACKGROUND: Ticks are blood-sucking ectoparasites and transmit various types of protozoal, bacterial, and viral diseases in a wild as well as domestic animals and humans globally. Only a few  published reports are avaliable on the prevalence of tick-borne diseases in sheep and goats in Pakistan. AIM AND OBJECTIVE: The aim of this systematic review and meta-analysis was to evaluate the prevalence (2000-2020) of tick-borne disease (theileriosis, babesiosis, Crimean-Congo hemorrhagic fever infection, and anaplasmosis) in sheep and goats in Pakistan. METHODS: A systematic review of articles published in English language (since 2000-2020) was conducted using PubMed and Google Scholar. Diagnostic methods used in the original reference articles were PCR, PCR-RLB, microscopy, and ELISA. RESULTS: The overall prevalence of theileriosis, babesiosis, anaplasmosis, and Crimean-Congo hemorrhagic fever (CCHF) infections was 15.40%, 21.18%, 26.78%, and 11.62%, respectively. The prevalence of anaplasmosis was 22.06% (90/408) in sheep, 21.11% (76/360) in goats, and 40% (120/300) in both sheep and goats with substantial differences (P < 0.001). The prevalence of babesiosis among sheep was 29.88% (104/348) with highly significant differences (P < 0.001), in goats was 29.88% (25/60) with slightly significant differences (P < 0.031%), and in both sheep and goats were 7% (21/300) with highly significant differences (P < 0.001) according to subgroup analysis. The percentage of prevalence of theileriosis was 17.70% (207/1169) in sheep with highly substantial differences (P < 0.001), 4.51% (31/687) in goats with significant differences (P < 0.133), and 25% (125/500) in both sheep and goats with a significant difference among them (P < 0.001). The prevalence of CCHF among sheep was 18.63% (149/800) and 4.63% (37/800) in goats, respectively. The widely used detection method was microscopy (45.56%) followed by ELISA (38.38%), PCR (12.56%), and PCR-RLB (3.48%) test, respectively. This is a comprehensive report on the status of tick-borne disease in sheep and goats in Pakistan. CONCLUSION: Based on our results, among tick-borne diseases anaplasmosis had the highest prevalence rate in sheep and goats. Due to its high prevalence, control measures should be taken to diagnose and prevent it.

6.
Sci Total Environ ; 787: 147506, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-33991911

RESUMO

Altered stormwater flow characteristics and associated changes in nutrient and sediment fluxes due to urbanization threaten the water quality of many water bodies. For example, particle-bound phosphorus in stormwater runoff adds to the nutrient pool that can produce harmful algal blooms, and the associated particulate material can endanger fish and other living organisms in surface waters by increasing turbidity. While many studies have investigated how Total Solids (TS) particle size distributions vary in urban stormwater and the associated design criteria for Best Management Practices (BMPs) to remove TS, few studies have included different forms of phosphorus and their association with particle sizes to characterize design criteria to specifically maximize Total Phosphorus (TP) removal. This highlights a gap in our understanding of how the particle size distributions of TP and TS are related, and how these particle size distributions vary within and between storm events. Bridging this knowledge gap can improve design methods for BMPs specifically targeting phosphorus removal. This study characterizes within event (i.e., hourly) TP and TS particle size distributions and associated fluxes from urban catchments in the City of Cambridge, Massachusetts, to characterize potential TP and TS removal based on four different diversion and treatment strategies. The stormwater diversion strategies integrate new insights on temporal variations in particle size distributions and mass loading characteristics. In terms of diverted stormwater, the volume of stormwater treated tends to control more than what water is treated (e.g., first flush, event high flows, or smaller event flows). Based on the event data obtained in this study, considering flow volume different diversion approaches are optimal for TP vs TS, but treatment combined with particles sizes < 100 µm is best for both TP and TS.

7.
JMIR Res Protoc ; 10(5): e26240, 2021 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-33944790

RESUMO

BACKGROUND: Advancements in wearable sensors have caused a resurgence in their use, particularly because their miniaturization offers ambulatory advantages while performing continuous vital sign monitoring. Digital alerts can be generated following early recognition of clinical deterioration through breaches of set parameter thresholds, permitting earlier intervention. However, a systematic real-world evaluation of these alerting systems has yet to be conducted, and their efficacy remains unknown. OBJECTIVE: The aim of this study is to implement wearable sensors and digital alerting systems in acute general wards to evaluate the resultant clinical outcomes. METHODS: Participants on acute general wards will be screened and recruited into a trial with a pre-post implementation design. In the preimplementation phase, the SensiumVitals monitoring system, which continuously measures temperature, heart, and respiratory rates, will be used for monitoring alongside usual care. In the postimplementation phase, alerts will be generated from the SensiumVitals system when pre-established thresholds for vital parameters have been crossed, requiring acknowledgement from health care staff; subsequent clinical outcomes will be analyzed. RESULTS: Enrolment is currently underway, having started in September 2017, and is anticipated to end shortly. Data analysis is expected to be completed in 2021. CONCLUSIONS: This study will offer insight into the implementation of digital health technologies within a health care trust and aims to describe the effectiveness of wearable sensors for ambulatory continuous monitoring and digital alerts on clinical outcomes in acute general ward settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT04638738; https://clinicaltrials.gov/ct2/show/NCT04638738. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26240.

8.
Eur J Prev Cardiol ; 28(6): 598-605, 2021 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-34021576

RESUMO

AIMS: To evaluate the ability of a machine learning algorithm to identify patients at high risk of atrial fibrillation in primary care. METHODS: A retrospective cohort study was undertaken using the DISCOVER registry to validate an algorithm developed using a Clinical Practice Research Datalink (CPRD) dataset. The validation dataset included primary care patients in London, England aged ≥30 years from 1 January 2006 to 31 December 2013, without a diagnosis of atrial fibrillation in the prior 5 years. Algorithm performance metrics were sensitivity, specificity, positive predictive value, negative predictive value (NPV) and number needed to screen (NNS). Subgroup analysis of patients aged ≥65 years was also performed. RESULTS: Of 2,542,732 patients in DISCOVER, the algorithm identified 604,135 patients suitable for risk assessment. Of these, 3.0% (17,880 patients) had a diagnosis of atrial fibrillation recorded before study end. The area under the curve of the receiver operating characteristic was 0.87, compared with 0.83 in algorithm development. The NNS was nine patients, matching the CPRD cohort. In patients aged ≥30 years, the algorithm correctly identified 99.1% of patients who did not have atrial fibrillation (NPV) and 75.0% of true atrial fibrillation cases (sensitivity). Among patients aged ≥65 years (n = 117,965), the NPV was 96.7% with 91.8% sensitivity. CONCLUSIONS: This atrial fibrillation risk prediction algorithm, based on machine learning methods, identified patients at highest risk of atrial fibrillation. It performed comparably in a large, real-world population-based cohort and the developmental registry cohort. If implemented in primary care, the algorithm could be an effective tool for narrowing the population who would benefit from atrial fibrillation screening in the United Kingdom.

9.
Ann Surg Oncol ; 28(11): 5974-5984, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33821346

RESUMO

BACKGROUND: The role of radiation therapy (RT) following breast-conserving surgery (BCS) in ductal carcinoma in situ (DCIS) remains controversial. Trials have not identified a low-risk cohort, based on clinicopathologic features, who do not benefit from RT. A biosignature (DCISionRT®) that evaluates recurrence risk has been developed and validated. We evaluated the impact of DCISionRT on clinicians' recommendations for adjuvant RT. METHODS: The PREDICT study is a prospective, multi-institutional, observational registry in which patients underwent DCISionRT testing. The primary endpoint was to identify the percentage of patients where testing led to a change in RT recommendations. RESULTS: Overall, 539 women were included in this study. Pre DCISionRT testing, RT was recommended to 69% of patients; however, post-testing, a change in the RT recommendation was made for 42% of patients compared with the pre-testing recommendation; the percentage of women who were recommended RT decreased by 20%. For women initially recommended not to receive an RT pre-test, 35% had their recommendation changed to add RT following testing, while post-test, 46% of patients had their recommendation changed to omit RT after an initial recommendation for RT. When considered in conjunction with other clinicopathologic factors, the elevated DCISionRT score risk group (DS > 3) had the strongest association with an RT recommendation (odds ratio 43.4) compared with age, grade, size, margin status, and other factors. CONCLUSIONS: DCISionRT provided information that significantly changed the recommendations to add or omit RT. Compared with traditional clinicopathologic features used to determine recommendations for or against RT, the factor most strongly associated with RT recommendations was the DCISionRT result, with other factors of importance being patient preference, tumor size, and grade.


Assuntos
Neoplasias da Mama , Carcinoma Intraductal não Infiltrante , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/radioterapia , Carcinoma Intraductal não Infiltrante/cirurgia , Estudos de Coortes , Tomada de Decisões , Feminino , Humanos , Mastectomia Segmentar , Recidiva Local de Neoplasia , Estudos Prospectivos , Radioterapia Adjuvante
10.
JMIR Perioper Med ; 4(1): e18836, 2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33885367

RESUMO

BACKGROUND: Continuous vital sign monitoring using wearable sensors may enable early detection of patient deterioration and sepsis. OBJECTIVE: This study aimed to explore patient experiences with wearable sensor technology and carry out continuous monitoring through questionnaire and interview studies in an acute hospital setting. METHODS: Patients were recruited for a wearable sensor study and were asked to complete a 9-item questionnaire. Patients responses were evaluated using a Likert scale and with continuous variables. A subgroup of surgical patients wearing a Sensium Vital Sign Sensor was invited to participate in semistructured interviews. The Sensium wearable sensor measures the vital signs: heart rate, respiratory rate, and temperature. All interview data were subjected to thematic analysis. RESULTS: Out of a total of 500 patients, 453 (90.6%) completed the questionnaire. Furthermore, 427 (85.4%) patients agreed that the wearable sensor was comfortable, 429 (85.8%) patients agreed to wear the patch again when in hospital, and 398 (79.6%) patients agreed to wear the patch at home. Overall, 12 surgical patients consented to the interviews. Five main themes of interest to patients emerged from the interviews: (1) centralized monitoring, (2) enhanced feelings of patient safety, (3) impact on nursing staff, (4) comfort and usability, and (5) future use and views on technology. CONCLUSIONS: Overall, the feedback from patients using wearable monitoring sensors was strongly positive with relatively few concerns raised. Patients felt that the wearable sensors would improve their sense of safety, relieve pressure on health care staff, and serve as a favorable aspect of future health care technology.

11.
BMC Public Health ; 21(1): 638, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33794832

RESUMO

BACKGROUND: SARS-CoV-2 has ever-increasing attributed deaths. Vital sign trends are routinely used to monitor patients with changes in these parameters preceding an adverse event. Wearable sensors can measure vital signs continuously and remotely, outside of hospital facilities, recognising early clinical deterioration. We aim to determine the feasibility & acceptability of remote monitoring systems for quarantined individuals in a hotel suspected of COVID-19. METHODS: A pilot, proof-of-concept, feasibility trial was conducted in engineered hotels near London airports (May-June 2020). Individuals arriving to London with mild suspected COVID-19 symptoms requiring quarantine, as recommended by Public Health England, or healthcare professionals with COVID-19 symptoms unable to isolate at home were eligible. The SensiumVitals™ patch, measuring temperature, heart & respiratory rates, was applied on arrival for the duration of their stay. Alerts were generated when pre-established thresholds were breeched; trained nursing staff could consequently intervene. RESULTS: Fourteen individuals (M = 7, F = 7) were recruited; the mean age was 34.9 (SD 11) years. Mean length of stay was 3 (SD 1.8) days. In total, 10 vital alerts were generated across 4 participants, resulting in telephone contact, reassurance, or adjustment of the sensor. No individuals required hospitalisation or virtual general practitioner review. DISCUSSION: This proof-of-concept trial demonstrated the feasibility of a rapidly implemented model of healthcare delivery through remote monitoring during a pandemic at a hotel, acting as an extension to a healthcare trust. Benefits included reduced viral exposure to healthcare staff, with recognition of clinical deterioration through ambulatory, continuous, remote monitoring using a discrete wearable sensor. CONCLUSION: Remote monitoring systems can be applied to hotels to deliver healthcare safely in individuals suspected of COVID-19. Further work is required to evaluate this model on a larger scale. TRIAL REGISTRATION: Clinical trials registration information: ClinicalTrials.gov Identifier: NCT04337489 (07/04/2020).


Assuntos
COVID-19 , Quarentena , Tecnologia de Sensoriamento Remoto , SARS-CoV-2 , Adulto , Inglaterra , Estudos de Viabilidade , Feminino , Humanos , Londres , Masculino , Pandemias/prevenção & controle
12.
Open Heart ; 8(1)2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33649153

RESUMO

OBJECTIVE: Atrial fibrillation (AF) is the most common arrhythmia. Undiagnosed and poorly managed AF increases risk of stroke. The Hounslow AF quality improvement (QI) initiative was associated with improved quality of care for patients with AF through increased detection of AF and appropriate anticoagulation. This study aimed to evaluate whether there has been a change in stroke and bleeding rates in the Hounslow population following the QI initiative. METHODS: Using hospital admissions data from January 2011 to August 2018, interrupted time series analysis was performed to investigate the changes in standardised rates of admission with stroke and bleeding, following the start of the QI initiative in October 2014. RESULTS: There was a 17% decrease in the rate of admission with stroke as primary diagnosis (incidence rate ratio (IRR) 0.83; 95% CI 0.712 to 0.963; p<0.014). There was an even larger yet not statistically significant decrease in admission with stroke as primary diagnosis and AF as secondary diagnosis (IRR 0.75; 95% CI 0.550 to 1.025; p<0.071). No significant changes were observed in bleeding admissions. For each outcome, an additional regression model including both the level change and an interaction term for slope change was created. In all cases, the slope change was small and not statistically significant. CONCLUSION: Reduction in stroke admissions may be associated with the AF QI initiative. However, the immediate level change and non-significant slope change suggests a lack of effect of the intervention over time and that the decrease observed may be attributable to other events.


Assuntos
Gerenciamento Clínico , Hemorragia/terapia , Admissão do Paciente/estatística & dados numéricos , Melhoria de Qualidade , Acidente Vascular Cerebral/terapia , Seguimentos , Hemorragia/epidemiologia , Incidência , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Taxa de Sobrevida/tendências , Reino Unido/epidemiologia
13.
Pilot Feasibility Stud ; 7(1): 62, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33673868

RESUMO

BACKGROUND: The outbreak of SARS-CoV-2 (coronavirus, COVID-19), declared a pandemic by the World Health Organization (WHO), is a global health problem with ever-increasing attributed deaths. Vital sign trends are routinely used to monitor patients with changes in these parameters often preceding an adverse event. Wearable sensors can measure vital signs continuously (e.g. heart rate, respiratory rate, temperature) remotely and can be utilised to recognise early clinical deterioration. METHODS: We describe the protocol for a pilot, proof-of-concept, observational study to be conducted in an engineered hotel near London airports, UK. The study is set to continue for the duration of the pandemic. Individuals arriving to London with mild symptoms suggestive of COVID-19 or returning from high-risk areas requiring quarantine, as recommended by the Public Health England, or healthcare professionals with symptoms suggestive of COVID-19 unable to isolate at home will be eligible for a wearable patch to be applied for the duration of their stay. Notifications will be generated should deterioration be detected through the sensor and displayed on a central monitoring hub viewed by nursing staff, allowing for trend deterioration to be noted. The primary objective is to determine the feasibility of remote monitoring systems in detecting clinical deterioration for quarantined individuals in a hotel. DISCUSSION: This trial should prove the feasibility of a rapidly implemented model of healthcare delivery through remote monitoring during a global pandemic at a hotel, acting as an extension to a healthcare trust. Potential benefits would include reducing infection risk of COVID-19 to healthcare staff, with earlier recognition of clinical deterioration through ambulatory, continuous, remote monitoring using a discrete wearable sensor. We hope our results can power future, robust randomised trials. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04337489 .

14.
NPJ Digit Med ; 4(1): 7, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33420338

RESUMO

Advances in digital technologies have allowed remote monitoring and digital alerting systems to gain popularity. Despite this, limited evidence exists to substantiate claims that digital alerting can improve clinical outcomes. The aim of this study was to appraise the evidence on the clinical outcomes of digital alerting systems in remote monitoring through a systematic review and meta-analysis. A systematic literature search, with no language restrictions, was performed to identify studies evaluating healthcare outcomes of digital sensor alerting systems used in remote monitoring across all (medical and surgical) cohorts. The primary outcome was hospitalisation; secondary outcomes included hospital length of stay (LOS), mortality, emergency department and outpatient visits. Standard, pooled hazard ratio and proportion of means meta-analyses were performed. A total of 33 studies met the eligibility criteria; of which, 23 allowed for a meta-analysis. A 9.6% mean decrease in hospitalisation favouring digital alerting systems from a pooled random effects analysis was noted. However, pooled weighted mean differences and hazard ratios did not reproduce this finding. Digital alerting reduced hospital LOS by a mean difference of 1.043 days. A 3% mean decrease in all-cause mortality from digital alerting systems was noted. There was no benefit of digital alerting with respect to emergency department or outpatient visits. Digital alerts can considerably reduce hospitalisation and length of stay for certain cohorts in remote monitoring. Further research is required to confirm these findings and trial different alerting protocols to understand optimal alerting to guide future widespread implementation.

15.
Allergy Asthma Proc ; 42(1): 87-92, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33404392

RESUMO

Background: Specific antibody deficiency is a primary immunodeficiency characterized by normal immunoglobulins with an inadequate response to polysaccharide antigen vaccination. This disease can result in recurrent infections, the most common being sinopulmonary infections. Treatment options include clinical observation, prophylactic antibiotic therapy, and immunoglobulin supplementation therapy, each with limited clinical data about their efficacy. Objective: This study aimed to identify whether there was a statistically significant difference in the rate of infections for patients who were managed with clinical observation, prophylactic antibiotics, or immunoglobulin supplementation therapy. Methods: A retrospective chart review was conducted. Patients were eligible for the study if they had normal immunoglobulin levels, an inadequate antibody response to polysaccharide antigen-based vaccination, and no other known causes of immunodeficiency. Results: A total of 26 patients with specific antibody deficiency were identified. Eleven patients were managed with immunoglobulin supplementation, ten with clinical observation, and five with prophylactic antibiotic therapy. The frequency of antibiotic prescriptions was assessed for the first year after intervention. A statistically significant rate of decreased antibiotic prescriptions after intervention was found for patients treated with immunoglobulin supplementation (n = 11; p = 0.0004) and for patients on prophylactic antibiotics (n = 5; p = 0.01). There was no statistical difference in antibiotic prescriptions for those patients treated with immunoglobulin supplementation versus prophylactic antibiotics (p = 0.21). Conclusion: Prophylactic antibiotics seemed to be equally effective as immunoglobin supplementation therapy for the treatment of specific antibody deficiency. Further studies are needed in this area.

16.
Lancet ; 396(10265): 1805, 2020 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-33278933
17.
J Asian Nat Prod Res ; : 1-6, 2020 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-33307789

RESUMO

Brahucins A (1) and B (2), the new oleanane-type triterpene lactones, have been isolated from the EtOAc-soluble fraction of Spiraea brahuica Boiss, along with betulinic acid (3), oleanolic acid (4), 3-O-(ß-D-glucopyranosyl) oleanolic acid (5), vanillic acid (6) and caffeic acid (7), reported for the first time from this species. The structures of these compounds were elucidated by spectroscopic studies including MS, IR, 1D and 2D NMR.

18.
PLoS One ; 15(10): e0240355, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33044982

RESUMO

Kiwifruit (Actinidia chinensis) is a rich nutritious fruit crop owing to a markedly higher content of vitamin C and minerals. To promote fruit set and to increase the yield of kiwifruit, forchlorfenuron (CPPU) has been widely applied. However, the molecular details regarding CPPU controlling kiwifruit development, especially at the fastest fruit growth stage, remain unknown. In the present study, we measured the effect of CPPU on developmental regulation in red-fleshed kiwifruit (Actinidia chinensis 'Hongyang'). Additionally, a cytological analysis was performed to clarify the precise changes in the cell structure of the CPPU-treated kiwifruits. Moreover, the concentration of endogenous phytohormones, including indoleacetic acid (IAA), zeatin (ZT), gibberellic acid 3 (GA3), and abscisic acid (ABA), were measured by Enzyme-linked Immunosorbent Assay (ELISA). Furthermore, RNA-Seq was performed to dissect the complicated molecular mechanisms, with a focus on biosynthesis, metabolism, and signaling compounds, such as endogenous hormones, sugars, and L-ascorbic acid. Our results demonstrated that CPPU treatment not only regulates the size and weight of a single fruit but also improves the quality in 'Hongyang' kiwifruit through the accumulation of both soluble sugar and vitamin C. It was also seen that CPPU regulates kiwifruit development by enhancing cell expansion of epidermal cells and parenchyma cells, while, promoting cell division of subepidermal cells. Additionally, CPPU significantly increased the gibberellin and cytokinin biosynthetic pathway and signaling, while repressing auxin and ABA biosynthetic pathway; thus, signaling plays an essential role in CPPU controlling kiwifruit development. Notably, transcriptomic analysis revealed that a total of 2244 genes, including 352 unannotated genes, were differentially expressed in kiwifruits because of CPPU treatment, including 127 transcription factors. These genes are mainly enriched in plant hormone signal transduction, photosynthesis, MAPK signaling pathway, starch and sucrose metabolism, and phenylpropanoid biosynthesis. Overall, our results highlight that CPPU regulation of kiwifruit development is mainly associated with an antagonistic and/or synergistic regulatory role of endogenous phytohormones, and enhancing the energy supply. This provides new insights into the molecular details of CPPU controlling kiwifruit development at the fastest fruit growth stage, which is of agricultural importance for kiwifruit breeding and crop improvement.


Assuntos
Actinidia/crescimento & desenvolvimento , Vias Biossintéticas , Perfilação da Expressão Gênica/métodos , Reguladores de Crescimento de Plantas/genética , Reguladores de Crescimento de Plantas/metabolismo , Ácido Abscísico/metabolismo , Actinidia/genética , Actinidia/metabolismo , Frutas/genética , Frutas/crescimento & desenvolvimento , Regulação da Expressão Gênica de Plantas , Giberelinas/metabolismo , Ácidos Indolacéticos/metabolismo , Proteínas de Plantas/genética , Análise de Sequência de RNA , Zeatina/metabolismo
19.
Br Dent J ; 229(3): 182, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32811942
20.
Eur J Prev Cardiol ; : 2047487320942338, 2020 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-32787456

RESUMO

AIMS: To evaluate the ability of a machine learning algorithm to identify patients at high risk of atrial fibrillation in primary care. METHODS: A retrospective cohort study was undertaken using the DISCOVER registry to validate an algorithm developed using a Clinical Practice Research Datalink (CPRD) dataset. The validation dataset included primary care patients in London, England aged ≥30 years from 1 January 2006 to 31 December 2013, without a diagnosis of atrial fibrillation in the prior 5 years. Algorithm performance metrics were sensitivity, specificity, positive predictive value, negative predictive value (NPV) and number needed to screen (NNS). Subgroup analysis of patients aged ≥65 years was also performed. RESULTS: Of 2,542,732 patients in DISCOVER, the algorithm identified 604,135 patients suitable for risk assessment. Of these, 3.0% (17,880 patients) had a diagnosis of atrial fibrillation recorded before study end. The area under the curve of the receiver operating characteristic was 0.87, compared with 0.83 in algorithm development. The NNS was nine patients, matching the CPRD cohort. In patients aged ≥30 years, the algorithm correctly identified 99.1% of patients who did not have atrial fibrillation (NPV) and 75.0% of true atrial fibrillation cases (sensitivity). Among patients aged ≥65 years (n = 117,965), the NPV was 96.7% with 91.8% sensitivity. CONCLUSIONS: This atrial fibrillation risk prediction algorithm, based on machine learning methods, identified patients at highest risk of atrial fibrillation. It performed comparably in a large, real-world population-based cohort and the developmental registry cohort. If implemented in primary care, the algorithm could be an effective tool for narrowing the population who would benefit from atrial fibrillation screening in the United Kingdom.

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