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Accidents between right-turning commercial vehicles and crossing vulnerable road users (VRUs) in urban environments often lead to serious or fatal injuries and therefore play a significant role in forensic accident analysis. To reduce the risk of accidents, blind spot assistance systems have been installed in commercial vehicles for several years, among other things, to detect VRUs and warn the driver in time. However, since such systems cannot reliably prevent all turning accidents, an investigation by experts must clarify how the accident occurred and to what extent the blind spot assistance system influenced the course of the accident. The occurrence of the acoustic warning message can be defined as an objective reaction prompt for the driver, so that the blind spot assistance system can significantly influence the avoidability assessment. In order to be able to integrate the system into forensic accident analysis, a precise knowledge of how the system works and its limitations is required. For this purpose, tests with different systems and accident constellations were conducted and evaluated. It was found that the type of sensor used for the assistance systems has a great influence on the system's performance. The lateral distance between the right side of the commercial vehicle and the VRU, as well as obstacles between them, along with the speed difference can have great influence on the reliability of the assistance system. Depending on the concrete time of the system's warning signal, the accident can be avoided or not by the driver when reacting to this signal.
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Understanding decision-making in complex and dynamic environments is relevant for designing strategies targeting safety improvements and error rate reductions. However, studies evaluating brain dynamics in realistic situations are scarce in the literature. Given the evidence that specific microstates may be associated with perception and attention, in this work we explored for the first time the application of the microstate model in an ecological, dynamic and complex scenario. More specifically, we evaluated elite helicopter pilots during engine-failure missions in the vicinity of the so called "dead man's curve," which establishes the operational limits for a safe landing after the execution of a recovery maneuver (autorotation). Pilots from the Brazilian Air Force flew a AS-350 helicopter in a certified aerodrome and physiological sensor data were synchronized with the aircraft's flight test instrumentation. We assessed these neural correlates during maneuver execution, by comparing their modulations and source reconstructed activity with baseline epochs before and after flights. We show that the topographies of our microstate templates with 4, 5, and 6 classes resemble the literature, and that a distinct modulation characterizes decision-making intervals. Moreover, the source reconstruction result points to a differential activity in the medial prefrontal cortex, which is associated to emotional regulation circuits in the brain. Our results suggest that microstates are promising neural correlates to evaluate realistic situations, even in a challenging and intrinsically noisy environment. Furthermore, it strengthens their usage and expands their application for studying cognition under more realistic conditions.
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Aeronaves , Concienciación/fisiología , Pilotos , Corteza Prefrontal/fisiología , Desempeño Psicomotor/fisiología , Pensamiento/fisiología , Adulto , Electroencefalografía , Humanos , Masculino , Persona de Mediana Edad , Personal MilitarRESUMEN
OBJECTIVE: DNA methylation analysis via real-time PCR or other analytical techniques requires purified bisulfite converted DNA. We report on an automated high throughput solution for DNA extraction, bisulfite-conversion, and purification of 96 samples with an input volume of up to 3.5 mL of plasma or urine, using reagents from the commercially available Epi BisKit. RESULTS: Magnetic bead-based DNA extraction, bisulfite conversion at high temperature, and efficient DNA purification was conducted on a customized commercially available liquid-handling platform. A highly interlaced 4 × 24 sample protocol was implemented for DNA extraction, elution in a 96-well plate, efficient bisulfite-conversion and extensive purification. The resulting bisulfite-converted DNA was stored in a 96-well format, ready for PCR set-up or other down-stream applications. The automated method is a walk-away solution for processing 96 samples in 7 h 30 min. Performance of the method was validated by comparison with the standard manual method of the Epi BiSKit using technical and biological samples. Overall DNA yield was assessed with a standardized ß-actin assay. The automated workflow demonstrated equivalent performance to the manual method for technical, plasma and urine samples. It may provide a new standard for effective high-throughput preparation of bisulfite-converted DNA from a variety of high volume liquid biopsy specimens.
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ADN/aislamiento & purificación , Epigénesis Genética , Ensayos Analíticos de Alto Rendimiento/métodos , Sulfitos/química , Automatización , Humanos , Biopsia Líquida , Plasma/metabolismo , OrinaRESUMEN
BACKGROUND: Guideline recommendations on carotid endarterectomy are based predominantly on randomized, controlled trials, in which women or elderly patients are often under-represented. This study analyzed the association of age and sex with the risk of in-hospital stroke or death following carotid endarterectomy under routine conditions in Germany. METHODS AND RESULTS: Secondary data analysis using the Statutory German Quality Assurance Database on all carotid endarterectomy procedures (n=142 074) performed between 2009 and 2014. Primary outcome was any stroke or death until discharge; secondary outcomes were any in-hospital stroke (alone), and death (alone). Descriptive statistics and multilevel multivariable regression analyses were applied. Patients were predominately male (68%), with mean age 71 years. Carotid stenosis was symptomatic in 40%. Primary outcome occurred in 1.8% of women and 1.9% of men. Multivariable regression analysis revealed that more-advanced age was associated with a higher primary outcome rate (relative risk [RR] per 10-year increase: 1.19; 95% CI, 1.14-1.24). Risk of death (alone) was associated with age (RR, 1.68; 95% CI, 1.54-1.84). Age was associated with the risk of stroke (alone; RR, 1.05; 95% CI, 1.00-1.11). Sex was not associated with primary outcome rate (1.01; 95% CI, 0.93-1.10), nor did it significantly modify the age effect. CONCLUSIONS: This study shows that increasing age, but not sex, is associated with a higher risk of in-hospital stroke or death following carotid endarterectomy under everyday conditions in Germany. Whereas the risk of death (alone) is significantly associated with age, the association between age and the risk of stroke (alone) can be considered of minor importance.
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Estenosis Carotídea/complicaciones , Endarterectomía Carotidea/métodos , Vigilancia de la Población , Mejoramiento de la Calidad , Medición de Riesgo/métodos , Accidente Cerebrovascular/etiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedades Asintomáticas , Estenosis Carotídea/diagnóstico , Estenosis Carotídea/cirugía , Causas de Muerte/tendencias , Femenino , Estudios de Seguimiento , Alemania/epidemiología , Mortalidad Hospitalaria/tendencias , Humanos , Pacientes Internos , Angiografía por Resonancia Magnética , Masculino , Estudios Retrospectivos , Factores de Riesgo , Stents , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/prevención & control , Factores de Tiempo , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler Dúplex , Ultrasonografía Doppler TranscranealRESUMEN
INTRODUCTION: Low-dose computed tomography (LDCT) is used for screening for lung cancer (LC) in high-risk patients in the United States. The definition of high risk and the impact of frequent false-positive results of low-dose computed tomography remains a challenge. DNA methylation biomarkers are valuable noninvasive diagnostic tools for cancer detection. This study reports on the evaluation of methylation markers in plasma DNA for LC detection and discrimination of malignant from nonmalignant lung disease. METHODS: Circulating DNA was extracted from 3.5-mL plasma samples, treated with bisulfite using a commercially available kit, purified, and assayed by real-time polymerase chain reaction for assessment of DNA methylation of short stature homeobox 2 gene (SHOX2), prostaglandin E receptor 4 gene (PTGER4), and forkhead box L2 gene (FOXL2). In three independent case-control studies these assays were evaluated and optimized. The resultant assay, a triplex polymerase chain reaction combining SHOX2, PTGER4, and the reference gene actin, beta gene (ACTB), was validated using plasma from patients with and without malignant disease. RESULTS: A panel of SHOX2 and PTGER4 provided promising results in three independent case-control studies examining a total of 330 plasma specimens (area under the receiver operating characteristic curve = 91%-98%). A validation study with 172 patient samples demonstrated significant discriminatory performance in distinguishing patients with LC from subjects without malignancy (area under the curve = 0.88). At a fixed specificity of 90%, sensitivity for LC was 67%; at a fixed sensitivity of 90%, specificity was 73%. CONCLUSIONS: Measurement of SHOX2 and PTGER4 methylation in plasma DNA allowed detection of LC and differentiation of nonmalignant diseases. Development of a diagnostic test based on this panel may provide clinical utility in combination with current imaging techniques to improve LC risk stratification.
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Biomarcadores de Tumor/genética , Metilación de ADN , Proteínas de Homeodominio/genética , Enfermedades Pulmonares/genética , Neoplasias Pulmonares/genética , Subtipo EP4 de Receptores de Prostaglandina E/genética , Carcinoma Pulmonar de Células Pequeñas/genética , Adenocarcinoma/sangre , Adenocarcinoma/clasificación , Adenocarcinoma/genética , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/sangre , Carcinoma de Células Escamosas/clasificación , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patología , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Humanos , Enfermedades Pulmonares/sangre , Enfermedades Pulmonares/clasificación , Enfermedades Pulmonares/patología , Neoplasias Pulmonares/sangre , Neoplasias Pulmonares/clasificación , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Curva ROC , Carcinoma Pulmonar de Células Pequeñas/sangre , Carcinoma Pulmonar de Células Pequeñas/clasificación , Carcinoma Pulmonar de Células Pequeñas/patología , Tasa de SupervivenciaRESUMEN
BACKGROUND: Associations between hospital volume and the risk of stroke or death following carotid endarterectomy (CEA) and carotid artery stenting (CAS) on a national level in Germany were analyzed. METHODS AND RESULTS: Secondary data analysis using microdata from the nationwide statutory German quality assurance database on all surgical or endovascular carotid interventions on the extracranial carotid artery between 2009 and 2014. Hospitals were categorized into empirically determined quintiles according to the annual case volume. The resulting volume thresholds were 10, 25, 46, and 79 for CEA and 2, 6, 12, and 26 for CAS procedures. The primary outcome was any stroke or death before hospital discharge. For risk-adjusted analyses, a multilevel regression model was applied. The analysis included 161 448 CEA and 17 575 CAS procedures. In CEA patients, the crude risk of stroke or death decreased monotonically from 4.2% (95% confidence interval, 3.6%-4.9%) in low-volume hospitals (first quintile 1-10 CEA per year) to 2.1% (2.0%-2.2%) in hospitals providing ≥80 CEA per year (fifth quintile; P<0.001 for trend). The overall risk of any stroke or death in CAS patients was 3.7% (3.5%-4.0%), but no trend on annual volume was seen (P=0.304). Risk-adjusted analyses confirmed a significant inverse relationship between hospital volume (categorized or continuous) and the risk of stroke or death after CEA but not CAS procedures. CONCLUSIONS: An inverse volume-outcome relationship in CEA-treated patients was demonstrated. No significant association between hospital volume and the risk of stroke or death was found for CAS.
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Angioplastia de Balón/instrumentación , Angioplastia de Balón/mortalidad , Enfermedades de las Arterias Carótidas/terapia , Endarterectomía Carotidea/mortalidad , Mortalidad Hospitalaria , Hospitales de Alto Volumen , Hospitales de Bajo Volumen , Evaluación de Procesos, Atención de Salud , Garantía de la Calidad de Atención de Salud , Stents , Accidente Cerebrovascular/mortalidad , Anciano , Anciano de 80 o más Años , Angioplastia de Balón/efectos adversos , Enfermedades de las Arterias Carótidas/complicaciones , Enfermedades de las Arterias Carótidas/diagnóstico , Enfermedades de las Arterias Carótidas/mortalidad , Bases de Datos Factuales , Endarterectomía Carotidea/efectos adversos , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Indicadores de Calidad de la Atención de Salud , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etiología , Factores de Tiempo , Resultado del TratamientoRESUMEN
Sleep is characterized by a loss of consciousness, which has been attributed to a breakdown of functional connectivity between brain regions. Global field synchronization (GFS) can estimate functional connectivity of brain processes. GFS is a frequency-dependent measure of global synchronicity of multi-channel EEG data. Our aim was to explore and extend the hypothesis of disconnection during sleep by comparing GFS spectra of different vigilance states. The analysis was performed on eight healthy adult male subjects. EEG was recorded during a baseline night, a recovery night after 40â h of sustained wakefulness and at 3 h intervals during the 40â h of wakefulness. Compared to non-rapid eye movement (NREM) sleep, REM sleep showed larger GFS values in all frequencies except in the spindle and theta bands, where NREM sleep showed a peak in GFS. Sleep deprivation did not affect GFS spectra in REM and NREM sleep. Waking GFS values were lower compared with REM and NREM sleep except for the alpha band. Waking alpha GFS decreased following sleep deprivation in the eyes closed condition only. Our surprising finding of higher synchrony during REM sleep challenges the view of REM sleep as a desynchronized brain state and may provide insight into the function of REM sleep.
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BACKGROUND AND PURPOSE: Guidelines recommend that carotid endarterectomy should be performed within 2 weeks in patients with a symptomatic carotid stenosis. Because a Swedish register study indicated that patients treated within the first days after a stroke or transient ischemic attack might have an increased perioperative stroke and mortality risk, this study aimed to find out whether these findings are also true under everyday conditions in Germany. METHODS: Secondary data analysis including 56 336 elective carotid endarterectomy procedures performed for symptomatic carotid stenosis under everyday conditions between 2009 and 2014. The patient cohort was divided into 4 groups according to time interval between index event and surgery (I: 0-2, II: 3-7, III: 8-14, and IV: 14-180 days). Primary outcome was any in-hospital stroke or death. For risk-adjusted analyses, a multilevel multivariable regression model was used. RESULTS: Mean patients' age was 71.1±9.6 years; 67.5% were men. Overall rate of any stroke or death was 2.5% (n=1434). Risk of any in-hospital stroke or death was 3.0% in group I, 2.5% in group II, 2.6% in group III, and 2.3% in group IV. Multivariable regression analysis revealed that the time interval was not significantly associated with the primary outcome. CONCLUSIONS: The time interval between the index event and carotid endarterectomy was not associated with the risk of any in-hospital stroke or death in patients with symptomatic carotid stenosis in Germany. In clinically stable patients, carotid endarterectomy might, therefore, be performed safely as soon as possible after the neurological index event.
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Estenosis Carotídea/cirugía , Endarterectomía Carotidea/estadística & datos numéricos , Accidente Cerebrovascular , Anciano , Anciano de 80 o más Años , Estenosis Carotídea/epidemiología , Endarterectomía Carotidea/efectos adversos , Femenino , Alemania , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/mortalidad , Factores de TiempoRESUMEN
Background: To present a case of conjunctival lymphangioma in a 4-year-old girl with tuberous sclerosis complex. Methods/results: A 4-year-old girl presented with a relapsing cystic lesion of the bulbar conjunctiva in the right eye with string-of-pearl-like dilation of lymphatic vessels and right-sided facial swelling with mild pain. Best-corrected vision was not impaired. Examination of the skin revealed three hypomelanotic macules and a lumbal Shagreen patch. Magnetic resonance imaging (MRI) findings displayed minimal enhancement of buccal fat on the right side. Cranial and orbital MRI showed signal enhancement in the right cortical and subcortical areas. Genetic analysis revealed a heterozygous deletion encompassing exon 1 and 2 of the TSC1 gene (tuberous sclerosis complex 1 gene), confirming the diagnosis of tuberous sclerosis complex. Conclusion: In conjunctival lymphangioma, tuberous sclerosis complex should be considered as the primary disease.
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For the subsequent analysis of the methylated mSEPT9 colorectal cancer screening marker in plasma, different blood collection tubes and blood storage conditions were investigated. The study demonstrated that methylated Septin 9 (mSEPT9) can be consistently detected in plasma samples derived from whole blood samples collected with S-Monovette® K3E and BD Vacutainer ® K2EDTA tubes stored at 2-8 °C for a maximum of 24 h and for samples collected in S-Monovette CPDA tubes stored at 18-25 °C for up to 48 h.
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Conservación de la Sangre/métodos , Recolección de Muestras de Sangre/métodos , Neoplasias Colorrectales/genética , ADN de Neoplasias/genética , Septinas/genética , Adulto , Anciano , Biomarcadores de Tumor/sangre , Biomarcadores de Tumor/genética , Recolección de Muestras de Sangre/instrumentación , Neoplasias Colorrectales/sangre , Neoplasias Colorrectales/diagnóstico , Metilación de ADN , ADN de Neoplasias/sangre , Ácido Edético/química , Femenino , Células HeLa , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Temperatura , Factores de TiempoRESUMEN
PURPOSE: While a variety of factors may play a role in fetal and neonatal deaths, postmaturity as a cause of stillbirth remains a topic of debate. It still is unclear, whether induction of labor at a particular gestational age may prevent fetal deaths. METHODS: A multidisciplinary working group was granted access to the most recent set of relevant German routine perinatal data, comprising all 5,291,011 hospital births from 2005 to 2012. We analyzed correlations in rates of induction of labor (IOL), perinatal mortality (in particular stillbirths) at different gestational ages, and fetal morbidity. Correlations were tested with Pearson's product-moment analysis (α = 5 %). All computations were performed with SPSS version 22. RESULTS: Induction rates rose significantly from 16.5 to 21.9 % (r = 0.98; p < 0.001). There were no significant changes in stillbirth rates (0.28-0.35 per 100 births; r = 0.045; p = 0.806). Stillbirth rates 2009-2012 remained stable in all gestational age groups irrespective of induction. Fetal morbidity (one or more ICD-10 codes) rose significantly during 2005-2012. This was true for both children with (from 33 to 37 %, r = 0.784, p < 0.001) and without (from 25 to 31 %, (r = 0.920, p < 0.001) IOL. CONCLUSIONS: An increase in IOL at term is not associated with a decline in perinatal mortality. Perinatal morbidity increased with and without induction of labor.
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Mortalidad Fetal/tendencias , Trabajo de Parto Inducido/estadística & datos numéricos , Mortalidad Perinatal/tendencias , Nacimiento a Término , Femenino , Muerte Fetal , Alemania/epidemiología , Edad Gestacional , Humanos , Lactante , Mortalidad Infantil , Trabajo de Parto Inducido/tendencias , Masculino , Muerte Perinatal , Embarazo , Mortinato/epidemiologíaRESUMEN
INTRODUCTION: Providing current, reliable and evidence based information for clinicians and researchers in a synthesised and summarised way can be challenging particularly in the area of traumatic brain injury where a vast number of reviews exists. These reviews vary in their methodological quality and are scattered across varying sources. In this paper, we present an overview of systematic reviews that evaluate the pharmacological interventions in traumatic brain injury (TBI). By doing this, we aim to evaluate the existing evidence for improved outcomes in TBI with pharmacological interventions, and to identify gaps in the literature to inform future research. METHODS: We searched the Neurotrauma Evidence Map on systematic reviews relating to pharmacological interventions for managing TBI in acute phase. Two reviewers independently screened search results and appraised each systematic review using the validated AMSTAR tool and extracted data from the review. RESULTS: A total of 288 systematic reviews relating to TBI were available on the Neurotrauma Evidence Map at the time of this study. We identified 19 systematic reviews on pharmacological management for acute TBI with publications dates ranging from 1998 to 2014. The studies were of varying methodological quality, with a mean AMSTAR score of 7.78 (range 2-11]. CONCLUSION: The evidence from high quality systematic reviews show that there is currently insufficient evidence for the use of magnesium, monoaminergic and dopamine agonists, progesterone, aminosteroids, excitatory amino acid inhibitors, haemostatic and antifibrinolytic drugs in TBI. Anti-convulsants are only effective in reducing early seizures with no significant difference between phenytoin and leviteracetam. There is no difference between propofol and midazolam for sedation in TBI patients and ketamine may not cause increased ICP. Overviews of systematic review provide informative and powerful summaries of evidence based research.
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Anticonvulsivantes/uso terapéutico , Lesiones Traumáticas del Encéfalo/tratamiento farmacológico , Agonistas de Dopamina/uso terapéutico , Medicina Basada en la Evidencia , Hipnóticos y Sedantes/uso terapéutico , Progesterona/uso terapéutico , Investigación Biomédica/tendencias , Lesiones Traumáticas del Encéfalo/fisiopatología , Lesiones Traumáticas del Encéfalo/rehabilitación , HumanosRESUMEN
BACKGROUND: Numerous studies from around the world have shown a positive association between case numbers and the quality of medical care. The evidence to date suggests that conformity to guidelines for the treatment of patients with breast cancer is better in German hospitals that have higher case numbers. METHODS: We used data obtained by an external program for quality assurance in inpatient care (externe stationäre Qualitätssicherung, esQS) for the years 2013 and 2014 to investigate seven process indicators in the area of breast surgery, including histologic confirmation of the diagnosis before definitive treatment, axillary dissection as recommended by the guidelines, and an appropriate temporal interval between diagnosis and operation. Case numbers were categorized with the aid of various threshold values. Moreover, subgroup analyses were carried out for patients under age 65, patients in good general health, patients without lymph-node involvement, and patients with a tumor size pT0 or pT1 or an overall tumor size less than 5 cm. RESULTS: Data on 153,475 patients from 939 hospitals were analyzed. Six of seven indicators had values that were better overall, to a statistically significant extent, in hospitals with higher case numbers. Although this relationship was not consistently seen, the worst results were generally found in the category with the lowest case numbers. Similar though less striking results were obtained in the subgroup analyses. An exception to the general finding was that, in hospitals with higher case numbers, the interval between diagnosis and operation was more often longer than three weeks. CONCLUSION: Guideline adherence is higher in hospitals that treat more cases. The present study does not address the question whether this, in turn, affects morbidity or mortality. To improve process quality in peripheral hospitals, the quality assurance program should be continued.
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Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/cirugía , Adhesión a Directriz/estadística & datos numéricos , Mastectomía/estadística & datos numéricos , Mastectomía/normas , Evaluación de Procesos y Resultados en Atención de Salud/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/diagnóstico , Femenino , Alemania/epidemiología , Hospitalización/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud/normas , Prevalencia , Indicadores de Calidad de la Atención de Salud/normas , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Calidad de la Atención de Salud/clasificación , Calidad de la Atención de Salud/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Salud de la Mujer/estadística & datos numéricos , Carga de Trabajo , Adulto JovenRESUMEN
BACKGROUND: Measurement of the respiratory rate is an important instrument for assessing the severity of acute disease. The respiratory rate is often not measured in routine practice because its clinical utility is inadequately appreciated. In Germany, documentation of the respiratory rate is obligatory when a patient with pneumonia is hospitalized. This fact has enabled us to study the prognostic significance of the respiratory rate in reference to a large medical database. METHOD: We retrospectively analyzed data from the external quality-assurance program for community-acquired pneumonia for the years 2010-2012. All patients aged 18 years or older who were not mechanically ventilated on admission were included in the analysis. Logistic regression was used to determine the significance of the respiratory rate as a risk factor for in-hospital mortality. RESULTS: 705,928 patients were admitted to the hospital with community-acquired pneumonia (incidence: 3.5 cases per 1000 adults per year). The in-hospital mortality of these patients was 13.1% (92 227 persons). The plot of mortality as a function of respiratory rate on admission was U-shaped and slanted to the right, with the lowest mortality at a respiratory rate of 20/min on admission. If patients with a respiratory rate of 12-20/min are used as a baseline for comparison, patients with a respiratory rate of 27-33/min had an odds ratio (OR) of 1.72 for in-hospital death, and those with a respiratory rate above 33/min had an OR of 2.55. Further independent risk factors for in-hospital death were age, admission from a nursing home, hospital, or rehabilitation facility, chronic bedridden state, disorientation, systolic blood pressure, and pulse pressure. CONCLUSION: Respiratory rate is an independent risk marker for in-hospital mortality in community-acquired pneumonia. It should be measured when patients are admitted to the hospital with pneumonia and other acute conditions.
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Infección Hospitalaria/diagnóstico , Infección Hospitalaria/mortalidad , Mortalidad Hospitalaria/tendencias , Hospitalización/estadística & datos numéricos , Neumonía Bacteriana/diagnóstico , Neumonía Bacteriana/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Alemania/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neumonía , Pronóstico , Reproducibilidad de los Resultados , Frecuencia Respiratoria , Estudios Retrospectivos , Medición de Riesgo , Sensibilidad y Especificidad , Tasa de Supervivencia , Adulto JovenRESUMEN
BACKGROUND: Screening improves outcomes related to colorectal cancer (CRC); however, suboptimal participation for available screening tests limits the full benefits of screening. Non-invasive screening using a blood based assay may potentially help reach the unscreened population. OBJECTIVE: To compare the performance of a new Septin9 DNA methylation based blood test with a fecal immunochemical test (FIT) for CRC screening. DESIGN: In this trial, fecal and blood samples were obtained from enrolled patients. To compare test sensitivity for CRC, patients with screening identified colorectal cancer (n = 102) were enrolled and provided samples prior to surgery. To compare test specificity patients were enrolled prospectively (n = 199) and provided samples prior to bowel preparation for screening colonoscopy. MEASUREMENTS: Plasma and fecal samples were analyzed using the Epi proColon and OC Fit-Check tests respectively. RESULTS: For all samples, sensitivity for CRC detection was 73.3% (95% CI 63.9-80.9%) and 68.0% (95% CI 58.2-76.5%) for Septin9 and FIT, respectively. Specificity of the Epi proColon test was 81.5% (95% CI 75.5-86.3%) compared with 97.4% (95% CI 94.1-98.9%) for FIT. For paired samples, the sensitivity of the Epi proColon test (72.2% -95% CI 62.5-80.1%) was shown to be statistically non-inferior to FIT (68.0%-95% CI 58.2-76.5%). When test results for Epi proColon and FIT were combined, CRC detection was 88.7% at a specificity of 78.8%. CONCLUSIONS: At a sensitivity of 72%, the Epi proColon test is non- inferior to FIT for CRC detection, although at a lower specificity. With negative predictive values of 99.8%, both methods are identical in confirming the absence of CRC. TRIAL REGISTRATION: ClinicalTrials.gov NCT01580540.
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Neoplasias Colorrectales/diagnóstico , Detección Precoz del Cáncer , Sangre Oculta , Septinas/genética , Anciano , Anciano de 80 o más Años , Colonoscopía , Neoplasias Colorrectales/patología , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/normas , Femenino , Humanos , Masculino , Tamizaje Masivo/métodos , Tamizaje Masivo/normas , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Developmental venous anomalies (DVAs) are associated with epileptic seizures; however, the role of DVA in the epileptogenesis is still not established. Simultaneous interictal electroencephalogram/functional magnetic resonance imaging (EEG/fMRI) recordings provide supplementary information to electroclinical data about the epileptic generators, and thus aid in the differentiation of clinically equivocal epilepsy syndromes. The main objective of our study was to characterize the epileptic network in a patient with DVA and epilepsy by simultaneous EEG/fMRI recordings. A 17-year-old woman with recently emerging generalized tonic-clonic seizures, and atypical generalized discharges, was investigated using simultaneous EEG/fMRI at the university hospital. Previous high-resolution MRI showed no structural abnormalities, except a DVA in the right frontal operculum. Interictal EEG recordings showed atypical generalized discharges, corresponding to positive focal blood oxygen level dependent (BOLD) correlates in the right frontal operculum, a region drained by the DVA. Additionally, widespread cortical bilateral negative BOLD correlates in the frontal and parietal lobes were delineated, resembling a generalized epileptic network. The EEG/fMRI recordings support a right frontal lobe epilepsy, originating in the vicinity of the DVA, propagating rapidly to both frontal and parietal lobes, as expressed on the scalp EEG by secondary bilateral synchrony. The DVA may be causative of focal epilepsies in cases where no concomitant epileptogenic lesions can be detected. Advanced imaging techniques, such as simultaneous EEG/fMRI, may thus aid in the differentiation of clinically equivocal epilepsy syndromes.
Asunto(s)
Venas Cerebrales/anomalías , Electroencefalografía , Epilepsia del Lóbulo Frontal/diagnóstico , Epilepsia del Lóbulo Frontal/etiología , Malformaciones Arteriovenosas Intracraneales/complicaciones , Malformaciones Arteriovenosas Intracraneales/diagnóstico , Imagen por Resonancia Magnética , Adolescente , Anticonvulsivantes/uso terapéutico , Epilepsia del Lóbulo Frontal/tratamiento farmacológico , Epilepsia del Lóbulo Frontal/fisiopatología , Femenino , Humanos , Malformaciones Arteriovenosas Intracraneales/fisiopatologíaRESUMEN
This paper assesses the nitrogen and phosphorus removal efficiency of seven plant species (Schoenoplectus lacustris, Vetiveria zizanioides, Acorus calamus, Canna indica, Zizania latifolia, Phragmites communis, and Iris pseudacorus) commonly used in constructed wetland systems in southern China. The investigation considers two aspects that are relevant to determine nutrient removal efficiency: plants' biomass production and nutrient content in water effluent. Both assessments are correlated with each other. Three different hydraulic retention times with different nutrient loads have been applied in this ex-situ trial. The plants' biomass production correlates positively with the effluent's nutrient removal efficiency. Six out of seven species reviewed produce more biomass above ground than below ground (average: 67% of dried biomass in aerial part); only I. pseudacorus produces more biomass below ground. S. lacustris, V. zizanioides, I. pseudacorus, and C. indica have performed best in terms of nutrient removal efficiency (65.6-90.2% for nitrogen; 67.7-84.6% for phosphorus).