Consecutive Measures Research Articles

Determinants of high-risk coronary artery disease in ostensibly healthy male master endurance athletes

Abstract Background Healthy male master endurance athletes have a greater prevalence of high coronary calcium (CAC) scores compared to healthy sedentary counterparts, and some demonstrate high-risk plaque features. A number of theories have been postulated but reasons remain unclear. Concurrently atherosclerotic coronary artery disease (CAD) is the most common cause of sudden cardiac death in male master athletes drawing much public and scientific interest and making this an important public health issue. Purpose To examine the relationship of age, resting systolic blood pressure (SBP), exercise dose and sporting discipline with high-risk CAD markers in male master endurance athletes. Methods A prospective study undertaken over 19 months evaluated 214 male master (40–65 years) endurance athletes, free from known cardiovascular risk factors, symptoms or relevant health conditions. Clinical evaluation included cardiopulmonary exercise test, resting blood pressure (BP) and coronary computed tomogram angiography (CCTA). CCTA assessed CAC score, significant stenosis, (>50%) and plaque vulnerability markers. Exercise dose was defined by years of endurance exercise and average MET-hours/week (lifetime exercise volume multiplied by the metabolic equivalent scores). Resting BP was the average of 3 consecutive supine measures after at least 5 minutes rest. Results Athletes (mean age 51, SD 70.1) exercised for minimum 6 hours/week (median 8.5) for a median of 15 years (2–26). Almost half (60.2%) were multi-endurance athletes i.e. any combination swimming, cycling and running. The remainder were runners (22.4%) and cyclists (15.4%). Median Framingham risk score 3.2% (1.8–5.8). The mean resting BP was 129/80 mmHg and a quarter (26%) of athletes were hypertensive (≥140/90 mmHg) at rest. A CAC score >100 Agatston units (AU) was present in 16% of athletes. There was a total of 15 stenotic lesions in 11 (5%) athletes. 13% had plaque vulnerability markers. Logistic regression evaluated whether age, resting SBP, exercise dose measures and sporting discipline were predictive for a CAC score >100 AU, significant stenosis and plaque vulnerability markers (table 1). CAC score was associated with age, years of endurance exercise and resting SBP. A Stenosis >50% and plaque vulnerability markers were associated with resting SBP and cycling compared with all other sporting disciplines. Conclusion Despite correcting for age, higher exercise dose (years endurance exercise) is associated with CAC score >100 AU but does not predict significant stenosis or plaque vulnerability markers. Resting SBP and cycling strongly predict high-risk disease. Cycling enables a greater intensity of exercise compared with other endurance sports, which may be associated with prolonged rises in SBP. Resting SBP and cycling are important determinants for high-risk CAD in middle-aged male endurance athletes and should be considered when risk stratifying in pre-participation evaluation. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): British Heart Foundation Clinical Research Training Fellowship

Continuous positive airway pressure to reduce the risk of early peripheral oxygen desaturation after onset of apnoea in children: A double-blind randomised controlled trial.

Continuous positive airway pressure (CPAP) during anaesthesia induction improves oxygen saturation (SpO2) outcomes in adults subjected to airway manipulation, and could similarly support oxygenation in children. We evaluated whether CPAP ventilation and passive CPAP oxygenation in children would defer a SpO2 decrease to 95% after apnoea onset compared to the regular technique in which no positive airway pressure is applied. In this double-blind, parallel, randomised controlled clinical trial, 68 children aged 2-6 years with ASA I-II who underwent surgery under general anaesthesia were divided into CPAP and control groups (n = 34 in each group). The intervention was CPAP ventilation and passive CPAP oxygenation using an anaesthesia workstation. The primary outcome was the elapsed time until SpO2 decreased to 95% during a follow-up period of 300 s from apnoea onset (T1). We also recorded the time required to regain baseline levels from an SpO2 of 95% aided by positive pressure ventilation (T2). The median T1 was 278 s (95% confidence interval [CI]: 188-368) in the CPAP group and 124 s (95% CI: 92-157) in the control group (median difference: 154 s; 95% CI: 58-249; p = 0.002). There were 17 (50%) and 32 (94.1%) primary events in the CPAP and control groups, respectively. The hazard ratio was 0.26 (95% CI: 0.14-0.48; p<0.001). The median for T2 was 21 s (95% CI: 13-29) and 29 s (95% CI: 22-36) in the CPAP and control groups, respectively (median difference: 8 s; 95% CI: -3 to 19; p = 0.142). SpO2 was significantly higher in the CPAP group than in the control group throughout the consecutive measures between 60 and 210 s (with p ranging from 0.047 to <0.001). Thus, in the age groups examined, CPAP ventilation and passive CPAP oxygenation deferred SpO2 decrease after apnoea onset compared to the regular technique with no positive airway pressure.

Required warfarin dose and time in therapeutic range in patients with diagnosed Nonalcoholic Fatty Liver Disease (NAFLD) or Nonalcoholic Steatohepatitis (NASH).

Warfarin has been widely used to treat thromboembolism. The effect of nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH), on warfarin dosing remains unknown. This study aims to examine the effects of NAFLD/NASH on the average daily dose (ADD) of warfarin and the time in therapeutic range (TTR). This is a retrospective study utilizing an administrative data. We included patients with at least 2 months of warfarin dispensing and two subsequent consecutive INR measures. The ADD of warfarin to achieve therapeutic range INR levels, and TTR were compared between patients with and without NAFLD/NASH in four subgroups of patients accounting for the presence of obesity and diabetes. Generalized linear models (GLM) with Propensity score (PS) fine stratification were applied to evaluate the relative differences (RD) of warfarin ADD and TTR (>60%) in four subgroups. A total of 430 NAFLD/NASH patients and 38,887 patients without NAFLD/NASH were included. The ADD and TTR, were not significant in the overall cohort between those with and without NAFLD/NASH. However, GLM results in patients without diabetes or obesity (N = 26,685) showed a significantly lower warfarin ADD (RD: -0.38; 95%CI: -0.74–-0.02) and shorter TTR (OR: 0.71; 95%CI: 0.52–0.97) in patients diagnosed with NAFLD/NASH. The effects of NAFLD/NASH on warfarin dose or TTR were observed in patients without obesity and diabetes. Obesity and diabetes appear to be significant modifiers for the effects of NAFLD/NASH on warfarin dose and TTR.

Psychometric Properties of the Safety Climate Survey in Austrian Acute Care: Factor Structure, Reliability, and Usability.

BackgroundHospitals are complex organizations with a potential for medical errors that can be influenced by safety culture. Safety climate, as measurable element of safety culture, illustrates the perception of safety-relevant aspects of health care staff at a certain time. The Safety Climate Survey is applied internationally to measure safety climate. However, psychometrics for the German version of the survey have yet not been evaluated. The aim of this study is to explore the factor structure, reliability, and potential usefulness of the Safety Climate Survey in Austrian acute care.MethodsCross-sectional surveys of physicians, therapists, and nurses/midwives were implemented. An exploratory factor analysis was carried out, both in total sample and split by 2 selected professions. After deriving a factor structure for both professions, internal consistency and scale means were calculated for the subscales. Finally, mean subscale differences between physicians and nurses/midwives were tested.ResultsOf 5160 eligible staff, 933 respondents participated. A 6-factor solution explaining 59.1% of total variance was identified. Comparison by profession illustrated that the factor structures and item loading patterns differ between physicians and nurses/midwives. To achieve an overarching solution, 5 items were excluded from consecutive subscale measures because of cross-loadings and contradictory factor loadings. Subscales demonstrated good to low internal consistency (α = 0.794–0.535). Significant mean differences between subscales of professions were found relating to 3 factors.ConclusionsThe German Safety Climate Survey measures safety climate multidimensionally rather than unidimensionally and demonstrated some limitations in factor structures and item loadings but overall had satisfactory reliability of the 6 subscales.

Transperineal ultrasound shear-wave elastography is a reliable tool for assessment of the elastic properties of the levator ani muscle in women

Our main objective was to assess the intraoperator intersession reproducibility of transperineal ultrasound Shear Wave Elastography (SWE) to measure the levator ani muscle (LAM) elastic properties. Secondary objective was to compare reproducibility when considering the mean of three consecutives measurements versus one. In this prospective study involving non-pregnant nulliparous women, two visits were planned, with a measurement of the shear modulus (SM) on the right LAM at rest, during Valsalva maneuver and maximal contraction. Assessments were done with a transperineal approach, using an AIXPLORER device with a linear SL 18–5 (5-18 MHz) probe. For each condition, 3 consecutive measures were performed at each visit. The mean of the three measures, then the first one, were considered for the reproducibility by calculating intraclass correlation coefficient (ICC), and coefficient of variation (CV). Twenty women were included. Reproducibility was excellent when considering the mean of the 3 measures at rest (ICC = 0.90; CV = 15.7%) and Valsalva maneuver (ICC = 0.94; CV = 10.6%), or the first of the three measures at rest (ICC = 0.87; CV = 18.6%) and Valsalva maneuver (ICC = 0.84; CV = 19.9%). Reproducibility was fair for measurement during contraction. Transperineal ultrasound SWE is a reliable tool to investigate LAM elastic properties at rest and during Valsalva maneuver.

Acute mild dim light at night slightly modifies sleep but does not affect glucose homeostasis in healthy men

ObjectiveWe evaluated the effect of acute mild light exposure at night on sleep architecture and glucose homeostasis. Patients/methodsTwenty healthy normal-weight men took part in two conditions of a randomized, controlled, balanced cross-over experimental study: i) two-consecutive nights with 8-h of sleep under dLAN (<5 lux) or ii) total darkness (CON). Sleep was evaluated by polysomnography. In the morning following 'night2', glucose homeostasis was assessed by an intravenous glucose tolerance test (ivGTT) with consecutive measures of glucose, insulin, and c-peptide. Plasma cortisol was measured at night before sleep, after morning awakening, and during mid-afternoon hours. ResultsThere was no significant difference in total sleep time, sleep efficiency, and sleep latency between conditions (all p > 0.66). However, NREM sleep stage N3 latency was prolonged after dLAN (p = 0.02) and NREM sleep stage 2 was decreased after two nights with dLAN (p = 0.04). During the first sleep hour, power in slow-oscillations, slow-waves, and delta bands diminished after dLAN (all p < 0.04). Glucose, insulin, and c-peptide were not altered by dLAN (all p > 0.14). Cortisol was reduced in the afternoon after 'night1' and in the morning after 'night2' (both p < 0.03). ConclusionsdLAN slightly disturbed sleep architecture and quality without impairment of glucose homeostasis. Longer exposure to chronic dLAN might be needed to unmask its hypothesized metabolic consequences.

Anti-Thymocyte Globulin Exposure in CD34+T Cell Depleted Allogeneic Hematopoietic Cell Transplantation

Background: Traditional weight-based dosing results in variable rabbit anti-thymocyte-globulin (rATG) clearance that can delay CD4+Tcell immune reconstitution (CD4+IR) leading to higher mortality. Methods: In a retrospective, pharmacokinetic (PK)/pharmacodynamic analysis of patients undergoing their first CD34+ T-cell depleted (TCD) Allogeneic Hematopoietic Cell Transplantation (HCT) after myeloablative conditioning with rATG, we estimated post-HCT rATG exposure as area-under-the-curve (AUC;AU*d/L) using a validated population-PK model. We related rATG exposure to non-relapse mortality (NRM), CD4+IR (CD4+≥50/µL at two consecutive measures within 100 days after HCT), overall survival, relapse, and acute-graft versus host disease (GVHD) to define an optimal rATG-exposure. Cox-proportional hazard models, and multi-state competing risk models were used. Results: 554 patients were included (age 0.1-73 years). Median post-HCT rATG exposure was 47AU*d/L (range 0–101). Low post–HCT AUC ( 55AU*d/L and 30-55AU*d/L groups, respectively, compared to <30AU*d/L group. Post-HCT rATG exposure ≥55AU*d/L was associated with higher risk of acute GVHD (HR 2.28,95%CI 1.01-5.16). Conclusions: High post-HCT rATG-exposure is associated with higher NRM secondary to poor CD4+IR after TCD-HCT. Using personalized PK-directed rATG dosing to achieve optimal exposure may improve survival after HCT. Funding Information: MSK authors acknowledge the support of the NCI Cancer Center Support Grant P30 CA008748. Declaration of Interests: Madhavi Lakkaraja, MD, MPH, Audrey Mauguen, PhD, Christina Cho, MD, Sean Devlin, PhD, Scott T Avecilla, MD PhD, Farid Boulad, MD, Maria I. Cancio, MD, Ann A. Jakubowski, MD PhD, , Andrew L. Kung, MD, PhD, Esperanza B. Papadopoulos, MD, Ichelle Roessel, Josel D Ruiz, MPH, Brian C. Shaffer, MD, Gunjan Shah, MD, Barbara Spitzer, MD, Roni Tamari, MD : No Disclosures Michael Scordo, MD - Research support: Angiocrine Bioscience, Inc.; Omeros Corporation. Consultancy: Angiocrine Bioscience, Inc.; Omeros Corporation; McKinsey & Company. Ad-hoc advisory board: Kite – A Gilead Company. One-time speaking commitment: i3Health (CME). Kevin J. Curran, MD- Consultancy: Mesoblast, Consultancy and Research funding: Novartis, Research funding: Celgene. Nancy A. Kernan, MD - Equity in Amgen, Johnson and Johnson, Pfizer and Merck. Richard J O'Reilly, MD - Consultancy, Patents & Royalties: EBV-specific T-cell bank and Research Funding : Atara Biotherapeutics Susan Prockop, MD – Support for the conduct of clinical trials, Atara Biotherapeutics, Jasper Pharmaceuticals, AlloVir. Advisory Boards - Mesoblast, Neovii. S.E.P. is an inventor of intellectual property licensed to Atara Biotherapeutics by MSKCC; S.E.P. assigned all rights to MSKCC and has no financial interest in Atara Biotherapeutics. Andromachi Scaradavou, MD - Membership on an entity's Board of Directors or advisory committees: Excellthera Sergio A. Giralt, MD- Consultancy, Honoraria and Research funding : Celgene, Novartis, Consultancy and Research funding: Amgen, Actinuum, Miltenyi, Consultancy and Honoraria: Jazz, Omeros, Research funding: Takeda, Consultancy: Kite Miguel-Angel Perales, MD- Dr. Perales reports honoraria from Abbvie, Astellas, Bristol-Myers Squibb, Celgene, Equilium, Incyte, Karyopharm, Kite/Gilead, Merck, Miltenyi Biotec, MorphoSys, Novartis, Nektar Therapeutics, Omeros, Takeda, and VectivBio AG, Vor Biopharma. He serves on DSMBs for Cidara Therapeutics, Medigene, Sellas Life Sciences, and Servier, and the scientific advisory board of NexImmune. He has ownership interests in NexImmune and Omeros. He has received research support for clinical trials from Incyte, Kite/Gilead, Miltenyi Biotec, and Novartis. He serves in a volunteer capacity as a member of the Board of Directors of the American Society for Transplantation and Cellular Therapy (ASTCT) and Be The Match (National Marrow Donor Program, NMDP), as well as on the CIBMTR Cellular Immunotherapy Data Resource (CIDR) Executive Committee. Jaap Jan Boelens, MD, PhD -Consultancy: Race Oncology, Omeros, Avrobio, Takeda, Advanced Clinical, Bluerock. Ethics Approval Statement: The study protocol was approved by the institutional review board at Memorial Sloan Kettering Cancer Center (MSKCC).

Repeatability and reproducibility of the pressure biofeedback unit

IntroductionAlthough the pressure biofeedback unit (PBU) is used for muscular assessment and training, there is little evidence of its reproducibility and repeatability. ObjectiveThis study aims to assess intra- and inter-rater reproducibility and repeatability of the PBU in the assessment of the transverse abdominal (TrA), internal oblique (IO), low back multifidi, and deep neck flexors (DNF). MethodsFifty individuals had three muscular groups tested: TrA/IO, lower back multifidi, and DNF. For repeatability, one rater did three consecutive measures; for intra-rater reproducibility the same rater did two measures with seven-day intervals, and for inter-rater reproducibility, three raters, on the same day, did the measures. Data were analyzed with: Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC). (α = 0,05). ResultsRepeatability: TrA/IO (ICC = 0.847), Multifidi (ICC = 0.860), DNF (ICC = 0.831). Inter-rater reproducibility: TrA/IO (ICC = 0.876), Multifidi (ICC = 0.508), DNF (ICC = 0.442). Intra-rater reproducibility: TrA/IO (ICC = 0.747), Multifidi (ICC = 0.293), DNF (ICC = 0.685). Except for Multifidi, all the SEM values were less than 10 mmHg and the MDC values were less than 15 mmHg. ConclusionsThe PBU can be used with reliability by different evaluators, although the evaluation of multifidi is not indicated.

Adaptive regularisation for ensemble Kalman inversion

We propose a new regularisation strategy for the classical ensemble Kalman inversion (EKI) framework. The strategy consists of: (i) an adaptive choice for the regularisation parameter in the update formula in EKI, and (ii) criteria for the early stopping of the scheme. In contrast to existing approaches, our parameter choice does not rely on additional tuning parameters which often have severe effects on the efficiency of EKI. We motivate our approach using the interpretation of EKI as a Gaussian approximation in the Bayesian tempering setting for inverse problems. We show that our parameter choice controls the symmetrised Kullback–Leibler divergence between consecutive tempering measures. We further motivate our choice using a heuristic statistical discrepancy principle. We test our framework using electrical impedance tomography with the complete electrode model. Parameterisations of the unknown conductivity are employed which enable us to characterise both smooth or a discontinuous (piecewise-constant) fields. We show numerically that the proposed regularisation of EKI can produce efficient, robust and accurate estimates, even for the discontinuous case which tends to require larger ensembles and more iterations to converge. We compare the proposed technique with a standard method of choice and demonstrate that the proposed method is a viable choice to address computational efficiency of EKI in practical/operational settings.

Clinical and hematologic features of experimental theileriosis in roan calves (Hippotragus equinus)

Theileria sp. (sable) infection commonly causes significant calf mortality in endangered roan antelopes (Hippotragus equinus). Schizont-induced leukocyte transformation and systemic immune dysregulation with associated cytopenias characterizes theileriosis in livestock. Data on related hematologic alterations are scarce in roan antelopes. The objective of this study was to investigate temporal changes in selected clinical parameters and hematologic measurands in experimentally infected (EI) roan calves. Six of eight calves developed theileriosis after inoculation with a Theileria sp. (sable)-infected tick stabilate. Consecutive measures of rectal temperature, lymph node size, white blood cell count (WBC), packed cell volume (PCV), hemoglobin concentration, differential leukocyte counts, leukocyte and erythrocyte morphology and percentage parasitemia were recorded. Data were compared with 15 age-matched PCR-negative control calves and nine older immune animals that had recovered from natural infection. Two non-pyrexic EI calves recovered uneventfully. Six pyrexic calves were treated, four of which died. Time to pyrexia and/or observation of schizonts and piroplasms was approximately two weeks. Total WBCs were unchanged post-infection (PI); neutrophils and typical monocytes decreased whereas typical lymphocytes (Ls) and atypical mononuclear leukocytes (AMLs), which were grouped together, increased. Parasitized and non-parasitized lymphocyte and AML (L/AML) size increased significantly PI. Piroplasms occurred intermittently at low frequencies («1 % of erythrocytes) after infection. Fatally infected calves were dehydrated, anemic, and icteric with hemorrhages and multi-organ infiltration by AMLs. The PCV and hemoglobin concentration increased PI, and platelet clumps were consistently observed. Experimental acute theileriosis in roan antelopes follows a similar pattern of disease progression to that in domestic livestock. Parasitized and non-parasitized AMLs are pivotal to the pathogenesis and require phenotypic characterization if we are to further our understanding of disease progression and severity in roan antelopes.

Rabbit Anti-Thymocyte Globulin Exposure (rATG) in CD34+ Selected Hematopoietic Cell Transplantation and Its Impact on Immune Reconstitution and Outcomes in Children and Adults

Rabbit Anti-Thymocyte Globulin Exposure (rATG) in CD34+ Selected Hematopoietic Cell Transplantation and Its Impact on Immune Reconstitution and Outcomes in Children and Adults

No benefit of hydroxychloroquine on SARS-CoV-2 viral load reduction in non-critical hospitalized patients with COVID-19.

BackgroundSome studies have shown that hydroxychloroquine (HCQ) is an effective drug in reducing the in vitro replication of SARS-CoV-2. However, the in vivo effect of HCQ still unclear.ObjectivesThis study aims to evaluate viral load clearance in patients with COVID-19 who underwent HCQ treatment in comparison with a control group that did not receive the drug.Study designThis prospective study comprised consecutive viral load measurements in patients with COVID-19 hospitalized with a moderate illness. Patients received 400 mg of HCQ every 12 h for 10 days according to the medical decision. Nasal swab samples were collected from patients during early, intermediary, and final clinical stage of COVID-19.ResultsA total of 155 samples were collected from 66 patients with COVID-19 (60% female), with a median age of 58 years. The viral load between studied groups, assumed as a semiquantitative measure of cycle threshold (Ct) values, presented no significant difference within the three consecutive measures (ΔCt) (p > 0.05). We also analyzed the ΔCt viral load at different intervals of sample collection (Δt < 7; 7–12; and > 12 days) without significant differences at any ΔCt (p > 0.05).ConclusionIn this study, we did not observe any change in viral load reduction in vivo with the use of HCQ.

Scheimpflug Densitometry in Keratoconus: A New Method of Visualizing the Cone.

To report an observation made while performing Scheimpflug densitometry analysis on the corneal region affected in keratoconus (KC) that seems to delineate the base of the cone. Scheimpflug densitometries of 20 healthy subjects and 90 patients with KC were examined. Corneal densitometry was analyzed using both "1-layer" and "2-layer" approaches. The first considers the corneal transparency layer by layer at different depths, whereas the second averages densitometry between 2 corneal layers selected by the examiner. Fixed layers, 120 μm depth, and endothelium were selected. Repeated same-day scans and longitudinal series of scans were also evaluated to see whether the findings evolved over time. Eighty-eight of 90 KC cases displayed a bright area on the densitometry map that corresponded to the cone location. The area's characteristics, such as its brightness, contrast, and the presence of a delimiting arc correlated with KC severity and was more noticeable in advanced cases. No similar marks were found in any of the normal subjects. The shape, location, and extent of the mark were consistent over consecutive measures taken on the same day. Changes over time were also seen in eyes with known clinical progression but was also seen in eyes considered clinically stable. The densitometry mark seems to correspond with the zone most affected by KC and could be a supplementary tool for documenting KC stage, alongside conventional parameters. Further studies are required to ascertain whether it could prove useful in KC detection, to determine progression, and to relate it to corneal biomechanical behavior.

AML-035: Bleeding Outcomes in Thrombocytopenic Acute Leukemia Patients with Venous Thromboembolism at a Comprehensive Cancer Center

Context Cancer-associated thrombosis (CAT) in leukemia patients with severe thrombocytopenia poses a treatment challenge due to competing risks of bleeding and recurrent thrombosis resulting in a narrow therapeutic index for antithrombotic therapies. Objective To determine rates of clinically relevant bleeding (CRB) during management of acute venous thromboembolic event (VTE) in thrombocytopenic acute leukemia patients. Design Retrospective analysis using chart review. Patients Patients (n=74) with acute leukemia admitted to the University of Texas M.D. Anderson Cancer Center, January 2002 - March 2016. Included patients were older than 17 years, with proximal lower extremity deep venous thrombosis and/or pulmonary embolism, and thrombocytopenia (platelet levels ≤50×109/L) on at least two consecutive measures. Patients were sub-grouped into three VTE-treatment interventions: anticoagulation (32.4%), inferior vena cava filter (29.7%), and observation (37.8%). Main outcome measures Rates of CRB and by VTE-treatment intervention group. Association between CRB risk and clinical and laboratory characteristics by multivariate model based on backward model selection. Results Twenty-nine patients (39.2%) suffered CRB during the study (9 had clinically relevant non-major bleeding, 19 had major bleeding, and 1 had both major and non-major bleeding). Patients with relapsed leukemia bled more than those with de novo leukemia (P=0.0294). The use of anticoagulation did not increase the occurrence of CRB (P=0.6035). Use of chemotherapy increased the odds of bleeding by six times (P=0.043). Patients with CRB received more transfusions of platelets (P=0.0012), packed red blood cells (P=0.0017), and fresh frozen plasma (P=0.0573) compared to those who did not bleed. Baseline platelet count was not a significant factor associated to CRB(P=0.35), but the rate of increased platelet counts over time correlated with decreased bleeding chance (P=0.01). Conclusions There was a significant correlation between the occurrence of CRB and quantity of overall blood product transfusions, use of chemotherapy, and relapsed leukemia presentation. There was no difference in rates of CRB between VTE-treatment sub-groups, regardless of platelet count at time of VTE diagnosis. It appears the platelet count trajectory and the factors associated to a slower recovery of it are the main determinants for hemorrhagic complications during VTE treatment in acute leukemia.

Protocolo diagnóstico del hipogonadismo en varones

Male hypogonadism is characterized by testicular dysfunction, impairing spermatogenesis and/or testosterone synthesis. According its origin, hypogonadism is classified in hypogonadotropic or central hypogonadism (hypothalamic-pituitary axis), or hypergonadotropic or primary hypogonadism (testicular origin). Diagnosis requires, firstly, a proper anamnesis and physical examination that will allow knowing the appearance time and its possible etiology. Total testosterone serum levels have to be measured. If in two consecutive measures levels are diminished, levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) should be evaluated in order to distinguish between primary and central hypogonadism. Other diagnostic and management tests are study of pituitary hormone, genetic study, bone densitometry, magnetic resonance imaging, ultrasound, testicular biopsy and seminogram.

Repeatability of non-invasive break-up time measures with a new automated dry eye platform in healthy eyes.

To evaluate the intrasession repeatability for non-invasive break-up time (NIBUT) and tear meniscus height (TMH) measurements provided by a new multi-diagnostic platform, and to assess the interobserver reproducibility of TMH measures. Twenty-one healthy eyes of 21 patients (age, 23-65years) were enrolled. A complete eye examination was performed in all cases with the VX120+ device (Visionix-Luneau Technologies), including an analysis with the new Dry Eye module, performing three consecutive measurements. The within-subject standard deviation (Sw) and Bland-Altman plots were used to assess intersession repeatability. Differences between examiners for TMH were also analysed. No statistically significant differences were found between repeated measures of NIBUT (time associated with the first break) and TMH (p > 0.05). However, significant differences were found for NIBUT50% (time associated with half of breaks of the tear film) (p < 0.05). Mean Sw was 0.9s, 1.4s and 0.05mm for NIBUT, NIBUT50% and TMH, respectively. Ranges of agreement between consecutive measures were below 3.5s and 4.5s for NIBUT and NIBUT50%, respectively, and below 0.16mm for TMH. Furthermore, no significant differences were found between examiners in TMH measure, with an inter-examiner range of agreement of 0.12mm. The new dry eye platform of the VX120+ platform evaluated provides objective automated measures of NIBUT and TMH, with acceptable level of intrasession repeatability for clinical screening purposes.

Sex differences in nicotine-induced impulsivity and its reversal with bupropion in rats.

Enhancement in cognitive impulsivity and the resulting alterations in decision making serve as a contributing factor for the development and maintenance of substance-use disorders. Nicotine-induced increases in impulsivity has been previously reported in male humans and rodents. Although the potential for sex differences in nicotine-induced impulsivity has not been examined. In the present study, male and female Sprague Dawley rats were submitted to a delay discounting task, in which several consecutive measures of self-control were taken. Firstly, rats were tested with vehicle, and next with nicotine doses of 0.4 and 0.8 mg/kg. Thereafter, chronic treatment with bupropion started, and the animals were tested again. Half the animals continued to receive 0.8 mg/kg of nicotine, while the rest received nicotine and also a daily dose of 30 mg/kg of bupropion. When the animals were first tested with nicotine, female rats showed a significant nicotine dose dependent increase of impulsive behaviour, whereas male rats only showed a decrease on their elections of the larger but delayed reward under the highest dose of 0.8 mg/kg of nicotine. Treatment with bupropion blocked the effect of nicotine on decision making in female rats, as they showed results close to their baseline levels. On the other hand, bupropion did not affect the nicotine-induced delay discounting in male rats. These findings demonstrate sexually dimorphic effects of nicotine on cognitive impulsivity which may help to shed light on nicotine use vulnerabilities observed in women.

Early CD4+ T cell reconstitution as predictor of outcomes after allogeneic hematopoietic cell transplantation

Background: An association between early CD4+ T cell immune reconstitution (CD4+ IR) and survival after T-replete allogeneic hematopoietic cell transplantation (HCT) has been previously reported. Here we report validation of this relationship in a separate cohort that included recipients of ex vivo T-cell-depleted (TCD) HCT. We studied the relationship between CD4+ IR and clinical outcomes.Methods: A retrospective analysis of children/young adults receiving their first allogeneic HCT for any indication between January 2008 and December 2017 was performed. We related early CD4+ IR (defined as achieving >50 CD4+ T cells/µL on two consecutive measures within 100 days of HCT) to overall survival (OS), relapse, non-relapse mortality (NRM), event-free survival (EFS) and acute graft-versus-host disease (aGVHD). Fine and Gray competing risk models and Cox proportional hazard models were used.Results: In this analysis, 315 patients with a median age of 10.4 years (interquartile range 5.0–16.5 years) were included. The cumulative incidence of CD4+ IR at 100 days was 66.7% in the entire cohort, 54.7% in TCD (N = 208, hazard ratio [HR] 0.47, P < 0.001), 90.0% in uCB (N = 40) and 89.6% in T-replete (N = 47) HCT recipients. In multi-variate analyses, not achieving early CD4+ IR was a predictor of inferior OS (HR 2.35, 95% confidence interval [CI] 1.46–3.79, P < 0.001) and EFS (HR 1.80, 95% CI 1.20–2.69, P = 0.004) and increased NRM (HR 6.58, 95% CI 2.82–15.38, P < 0.001). No impact of CD4+ IR on relapse or aGVHD was found. Within the TCD group, similar associations were observed.Conclusion: In this HCT cohort, including recipients of TCD HCT, we confirmed that early CD4+ IR was an excellent predictor of outcomes. Finding strategies to predict or improve CD4+ IR may influence outcomes.

Mimicking the radiologists' workflow: Estimating pediatric hand bone age with stacked deep neural networks.

Pediatric endocrinologists regularly order radiographs of the left hand to estimate the degree of bone maturation in order to assess their patients for advanced or delayed growth, physical development, and to monitor consecutive therapeutic measures. The reading of such images is a labor-intensive task that requires a lot of experience and is normally performed by highly trained experts like pediatric radiologists. In this paper we build an automated system for pediatric bone age estimation that mimics and accelerates the workflow of the radiologist without breaking it. The complete system is based on two neural network based models: on the one hand a detector network, which identifies the ossification areas, on the other hand gender and region specific regression networks, which estimate the bone age from the detected areas. With a small annotated dataset an ossification area detection network can be trained, which is stable enough to work as part of a multi-stage approach. Furthermore, our system achieves competitive results on the RSNA Pediatric Bone Age Challenge test set with an average error of 4.56 months. In contrast to other approaches, especially purely encoder-based architectures, our two-stage approach provides self-explanatory results. By detecting and evaluating the individual ossification areas, thus simulating the workflow of the Tanner-Whitehouse procedure, the results are interpretable for a radiologist.

Prevalence and Correlates of Food Insecurity in Latino Farm Worker Households in California’s Central Valley

Abstract Objectives The twofold objective of the study was to assess the burden of food insecurity in Latino farm worker households and to identify its correlates in this population. Methods We conducted a secondary analysis using data from the Mexican Immigration to California: Agricultural Safety and Acculturation (MICASA) study, a cohort of Latino farm workers residing in Mendota, California. Interview data from a follow up assessment (when food security was first assessed), and clinical data from a sub-study conducted around the same time were analyzed. Food security was assessed using the U.S. Household Food Security Survey Module: Six-Item Short Form, but only asked to female participants (n = 346). Body mass index (BMI; kg/m2) was measured based on direct weight and height measurements. Abdominal fat was categorized as normal vs high risk (waist circumference &amp;gt;35 inches). Blood pressure was assessed based on two consecutive measures of systolic and diastolic blood pressure, and categorized as normal, elevated or high blood pressure. Depression was measured using a short version of the CES-D scale; a score of ≥10 was used as indication of depressive symptoms. Sociodemographic and acculturation data were also collected. We conducted bivariate analysis and multivariable logistic regression, considering the study survey design. Results Fifty five % of respondents were food secure, while 45% reported food insecurity (39% without hunger and 6% with hunger). In bivariate analysis, food insecurity was associated with income, education, age at immigration, depressive symptoms and season, but not with age, years living in the US, BMI status, blood pressure or abdominal fat. After controlling for income, education and season, those who immigrated younger than 21 y of age had lower odds of reporting food insecurity, while food insecurity was associated with higher odds of depressive symptoms. Conclusions Food insecurity is prevalent among Latino farm worker families. Among women in these families, immigration to US at a younger age seems to protect them from suffering food insecurity, but experiencing it may be associated with poor mental health. Funding Sources The NIOSH, the California Endowment and the UC Davis Western Center for Agricultural Health and Safety.