Edema Disease Research Articles

173-LB: Cognitive Performance and Diabetic Retinopathy

Background: Diabetic retinopathy (DR) is a chronic diabetes complication. People with type 2 diabetes mellitus (T2DM) have two times the risk for dementia, suggesting it is a new chronic diabetes complication. Objective: Evaluate the association of DR with cognitive performance in a T2DM population. Methods: Cross-sectional study with 400 T2DM adults from whom socio-demographic, clinical, laboratory data, screening test for depression symptoms [Patient Health Questionaire-9 (PHQ-9) ], Mini Mental State Examination (MMSE) , Semantic Verbal Fluency test, Trail Making test A and B, Word Memory test were collected and performed. All cognitive test scores were converted into Global Cognition z-Score [GCS (z) ]. The association between GCS (z) < 0 with DR was performed using backward multivariate binary logistic regression model adjusted forage ≥ 65 years, school years ≤ 6 years, DM duration ≥ 10 years, depression symptoms score > 9 at PHQ-9, arterial hypertension, physical activity, diabetic retinopathy, macular edema and cardiovascular disease. Results: After exclusions, the 251 eligible patients were 56.6% female, mean age 61.1 (±9.8) years, DM duration of 12.6 (±8.9) years and 7.6 (±4.2) years of school education. DR prevalence was 46.5%. Multivariate Binaric Logistic Regression Model showed an association between DR and GCS (z) < 0, with odds ratio (CI95%) of 2.50 (1.18-5.34) , adjusted for age, low education level, arterial hypertension and depression symptoms [OD and CI95%respectively: 5.46 (2.42-12.34) ; 12.19 (5.62-26.46) ; 2.55 (0.88-7.39) ; 3.53 (1.55-8.07) ]. Conclusion: In this T2DMpopulation, having DR increased the chance for worse cognitive performance even when adjusted for age, low education level, presence of arterial hypertension, and depression symptoms. Disclosure A. R. A. Faria: None.

Smart Graphene Nanoplatelet Strain Sensor for Natural Frequency Sensing of Stainless Steel (SS304) and Human Health Monitoring

The main purpose of this article is to monitor the natural frequency of stainless steel (SS304) with and without defect by spray-coated smart graphene nanoplatelet (GNPs)-doped poly (methyl methacrylate) (PMMA) nanocomposite strain sensor and human health by smart Lycra denim textile sensor. Methods such as impact hammer test and NI-daq, finite element method (FEM) simulation by Abaqus 6.12, and fast Fourier transform (FFT) study were applied for frequency monitoring of SS304. For human health monitoring, edema disease inspection, cough, and biceps locomotion were studied by graphene sol–gel textile sensor. We report eight sensors fabricated by scotch tape exfoliation method and their sensitivity was checked in terms of gauge factor (GF). The highest and lowest GF-based sensors were checked for sensitivity in the defect (hole) specimen. These sensors were used to sense the natural frequency of SS304 at three different positions in the cantilever beam. The same quantity of GNPs was used for making Lycra denim textile sensors for human health monitoring. The Lycra denim textile sensor showed a 216% change in resistance in the left calf muscle, which is less than right leg flexibility, indicating good sensitivity. In addition, the textile sensor helped in sensing coughing and biceps monitoring. The ease in fabrication and high sensitivity demonstrate the potential ability of GNPs for futuristic smart material for structural and human health monitoring.

Labeling Noncontrast Head CT Reports for Common Findings Using Natural Language Processing.

Prioritizing reading of noncontrast head CT examinations through an automated triage system may improve time to care for patients with acute neuroradiologic findings. We present a natural language-processing approach for labeling findings in noncontrast head CT reports, which permits creation of a large, labeled dataset of head CT images for development of emergent-finding detection and reading-prioritization algorithms. In this retrospective study, 1002 clinical radiology reports from noncontrast head CTs collected between 2008 and 2013 were manually labeled across 12 common neuroradiologic finding categories. Each report was then encoded using an n-gram model of unigrams, bigrams, and trigrams. A logistic regression model was then trained to label each report for every common finding. Models were trained and assessed using a combination of L2 regularization and 5-fold cross-validation. Model performance was strongest for the fracture, hemorrhage, herniation, mass effect, pneumocephalus, postoperative status, and volume loss models in which the area under the receiver operating characteristic curve exceeded 0.95. Performance was relatively weaker for the edema, hydrocephalus, infarct, tumor, and white-matter disease models (area under the receiver operating characteristic curve > 0.85). Analysis of coefficients revealed finding-specific words among the top coefficients in each model. Class output probabilities were found to be a useful indicator of predictive error on individual report examples in higher-performing models. Combining logistic regression with n-gram encoding is a robust approach to labeling common findings in noncontrast head CT reports.

Systematic review and network meta-analysis to compare vaccine effectiveness against porcine edema disease caused by Shiga toxin\u2010producing Escherichia coli

The comprehensive effect size of several commercial vaccines and vaccine candidates against edema disease (ED) has not been evaluated to date. To integrate the effectiveness of ED vaccines reported so far and to compare and evaluate the posterior-effect estimates of each vaccine type with network models, we identified eligible studies (n = 12) from the electronic databases using specified search strings. Data for dichotomous outcomes (i.e., mortality and clinical symptoms) and continuous outcomes (i.e., fecal shedding and average daily gain) were extracted and analyzed. Conventional meta-analysis shows that, compared with that in non-vaccinated pigs, vaccinated animals are likely to show reduced mortality (OR = 0.07) and clinical signs of ED (OR = 0.11), and increased productivity (SMD = 0.73). Although reduced fecal shedding (SMD = − 1.29) was observed in vaccinated pigs, this could not be fully determined on insufficient grounds. In contrast to mortality and clinical symptoms, fecal shedding (I2 = 88%) and average daily gain (I2 = 85%) showed immense heterogeneity, which was attributed to the small sample size and vaccination route, respectively. According to the Bayesian network meta-analysis, the plasmid-based DNA vaccine demonstrated a better effect for all outcomes compared to other types of vaccines. However, these findings should be carefully interpreted with consideration to potential mediators, insufficient data, and inconsistent network models.

Effect of chronic and acute enterotoxigenic E. coli challenge on growth performance, intestinal inflammation, microbiome, and metabolome of weaned piglets

Post-weaning enteropathies in swine caused by pathogenic E. coli, such as post-weaning diarrhea (PWD) or edema disease (ED), remain a significant problem for the swine industry. Reduction in the use of antibiotics over concerns of antibiotic resistance and public health concerns, necessitate the evaluation of effective antibiotic alternatives to prevent significant loss of livestock and/or reductions in swine growth performance. For this purpose, an appropriate piglet model of pathogenic E. coli enteropathy is required. In this study, we attempted to induce clinical signs of post-weaning disease in a piglet model using a one-time acute or lower daily chronic dose of a pathogenic E. coli strain containing genes for both heat stable and labile toxins, as well as Shiga toxin. The induced disease state was monitored by determining fecal shedding and colonization of the challenge strain, animal growth performance, cytokine levels, fecal calprotectin, histology, fecal metabolomics, and fecal microbiome shifts. The most informative analyses were colonization and shedding of the pathogen, serum cytokines, metabolomics, and targeted metagenomics to determine dysbiosis. Histopathological changes of the gastrointestinal (GI) tract and tight junction leakage as measured by fecal calprotectin concentrations were not observed. Chronic dosing was similar to the acute regimen suggesting that a high dose of pathogen, as used in many studies, may not be necessary. The piglet disease model presented here can be used to evaluate alternative PWD treatment options.

Managing Shiga Toxin-Producing E. coli Using Statistical Process Control Charts for Routine Health and Production Monitoring in Pig Farming.

Oedema disease (ED) caused by Shiga-toxin-producing E. coli in pigs is a serious life-threatening disease, particularly among weaned piglets. When a preventive protocol is adopted in a specific farm, interpretation of effectiveness is often complicated in field conditions due to natural or “common cause” variation. For this reason, in this study a Statistical process control (SPC) approach was used to retrospectively evaluate the application of an ED preventive protocol (lower protein diet, ad-libitum fiber, vaccination at 5 days of age) in an infected commercial piglets' weaning site. The analysis was established over a 9-years period (n = 75 consecutive batches; 1,800 weaners per batch) using mortality for each batch as the key parameter of health and production; the statistics and the control limits (mean ± 3-fold sd; UCL, upper control limit; LCL, lower control limit) were based on data from the first 28 batches (Period 1) before the onset of the first ED clinical signs. The charts allowed the detection of defined out of control batches (i.e., with mortality out of the intervention limits) from batch 29 ongoing, exploring a Period 2 (unstable production and ED clinical signs; 36 batches) and a Period 3 (application of the ED preventive protocol; 11 batches). Mortality evaluation using SPC revealed a production system defined under-control (mean moving range bar = 1,34%; UCL = 4,37%; LCL = 0%) during Period 1. During Period 2, charts lost the state of statistical control, as showed by several signals of special cause variation due to the ED outbreak. Period 3 was characterized again by a state of statistical control, where no signals of special cause variation was showed. In conclusion, the retrospective application of SPC charts in the present study was able to confirm the efficacy of an ED preventive protocol in reducing mortality in a piglets' weaning site. SPC charting is suggested as an useful tool to provide insights into relationships between health, managerial, and welfare decision and some selected iceberg parameters in livestock.

Innovations in Emergency Airway Management: Lessons-Learned from Early Cross-Cultural Management of Covid-19

The Texas Tech University Center for Emerging Energy Sciences Research Group implemented rapid translation and analytics of Chinese COVID-19 medical literature in February 2020, which enabled emerging innovations in patient care. Specifically, techniques to optimize patient care through improved ventilation and oxygenation recognizing newly discovered pathophysiology were designed and prototyped in this invention. COVID-19 respiratory distress distinguishes itself from acute respiratory distress syndrome (ARDS) and pathophysiology of SARS-COV-2 by requiring higher O2 and lower pressure requirements for adequate oxygenation. Specifically, low positive end-expiratory pressure ventilator parameters are necessary to optimize patient care. Paradoxically, COVID-19 patients display severe "silent" hypoxemia often associated with near normal respiratory compliance. This clinical presentation is considered unusual for severe ARDS patients and implies non-uniformity in disease management of acute respiratory and pre-hospital patients. A clinical need for new innovative approaches to management that may also benefit decompression sickness, high altitude pulmonary edema and other chronic respiratory disease patients.<br/> We present these observations as an example of the need for closely-collaborating, interdisciplinary teams to facilitate rapid innovation when sudden, severe health threats first emerge. This approach is invaluable to medical innovations needed to counter threats due natural to man-made conditions.

The efficacy of the use of succinic and formol-succinic biostimulants for the prevention and treatment of edematous disease and salmonellosis in piglets

This article is devoted to evaluating the efficacy of the use of succinic and formol-succinic biostimulant for the prevention and treatment of edematous disease and salmonellosis in piglets, namely, its influence on the infectious process and therapeutic effectiveness in these diseases. To assess the efficacy of edematous disease, we took five-day-old piglets, which were further divided into three groups: two groups for each drug and, accordingly, the third was a control. The case of salmonellosis was a spontaneous situation during the vaccination of piglets. All piglets were also divided into three groups, but selection was not chaotic as with edematous disease. The piglets were divided into groups only after a clinical examination into "sick", "suspicious" and "clinically healthy". The scheme of using drugs for salmonellosis was similar to that for edematous disease. It should be said the course of treatment with the use of an succinic biostimulant in combination with gentamicin provided a favorable fracture of the disease after a single injection of drugs. All animals of this group had only residual symptoms of the disease on the second day. In fact, a similar pattern was observed when using a formol-succinic biostimulant, but still one piglet from this group fell. In the situation with salmonellosis, the use of formol-succinic biostimulant on clinically healthy piglets during the outbreak was very successful. There are no cases of the disease were registered. In the group of piglets that were treated with one succinic biostimulant, 1 (4.5%) case of suspected salmonellosis was registered. The incidence of salmonellosis in the control group was 15%. It should be noted that the intensive therapy course, including a succinic biostimulant in combination with gentamicin, proved to be quite effective for the treatment of sick animals of the control group. In all piglets, clinical recovery was achieved after the first administration of the drugs. Thus, based on the results of the conducted experience, it was possible to draw the following conclusions: - the preventive use of succinic and formol-succinic biostimulants for piglets provides effective correction of immunometabolic processes, which is an important condition for increasing the body's resistance to pathogens of colibacteriosis and salmonellosis.

Wild Boars as Reservoir of Highly Virulent Clone of Hybrid Shiga Toxigenic and Enterotoxigenic Escherichia coli Responsible for Edema Disease, France.

Edema disease is an often fatal enterotoxemia caused by specific strains of Shiga toxin–producing Escherichia coli (STEC) that affect primarily healthy, rapidly growing nursery pigs. Recently, outbreaks of edema disease have also emerged in France in wild boars. Analysis of STEC strains isolated from wild boars during 2013–2019 showed that they belonged to the serotype O139:H1 and were positive for both Stx2e and F18 fimbriae. However, in contrast to classical STEC O139:H1 strains circulating in pigs, they also possessed enterotoxin genes sta1 and stb, typical of enterotoxigenic E. coli. In addition, the strains contained a unique accessory genome composition and did not harbor antimicrobial-resistance genes, in contrast to domestic pig isolates. These data thus reveal that the emergence of edema disease in wild boars was caused by atypical hybrid of STEC and enterotoxigenic E. coli O139:H1, which so far has been restricted to the wildlife environment.

Role of Concurrent use of Thoracic Section Ultrasonography with 2D Echocardiography among Patients with Commonly Diagnosed Respiratory Illnesses- A Cross-sectional Study

Introduction: Respiratory diseases may affect the functioning of the heart, lung and heart work synchronously. Clinical assessment and work-up of patients with pulmonary problems may need an extension to cardiac disease. Thoracic Ultrasonography (TUS) is a diagnostic modality being used to assess respiratory conditions as it carries the inherent advantages of ultrasonography such as being reliable, inexpensive, safe, reproducible, and having no radiation hazard. Aim: To assess the usefulness of performing Thoracic Ultrasound (TUS) and 2D echocardiography in the same sitting, so as to confirm the respiratory diagnosis and to early identify various cardiac dysfunctions in patients with respiratory illnesses. Materials and Methods: This cross-sectional study was conducted in the Outpatient Department of Respiratory Medicine at Netaji Subhash Chandra Bose Medical College (tertiary care hospital), Jabalpur, Madhya Pradesh, India, from January 2019 to March 2020. Patients hospitalised with clinico-radiological diagnosis of pleural effusion, pneumonia, pulmonary fibrosis of interstitial lung disease, pulmonary oedema and Chronic Obstructive Pulmonary Disease (COPD) were subjected to TUS and echocardiography. Sonological findings and cardiac abnormalities were recorded. Data was analysed by applying descriptive statistics, t-test, and Chi-square test. Results: A total of 133 patients were enrolled with diagnosis of pleural effusion (n=46), pneumonia (n=22), pulmonary fibrosis (n=18), pulmonary oedema (n=14), and COPD (n=33). Out of total 46 patients,36 patients with pleural effusion had cardiac findings. The presence of pleural effusion showed a significant association with cor-pulmonale (p-value=0.012), dilated Right Ventricle (RV) (p-value=0.012), septal deviation (p-value=0.012), Pulmonary Hypertension (PH) (p-value=0.0002), Left Ventricular (LV) dysfunction (p-value=0.02) and Left Ventricular Ejection Fractions (LVEF) (p-value=0.006). The focal B-lines were seen in patients with pneumonia. Patients with Pulmonary fibrosis had scattered B-Lines, and patients with pulmonary oedema had bilateral diffuse B-lines. Among patients with pulmonary fibrosis, 11 (61.1%) had cor-pulmonale and dilated RV, whereas 10 (55.5%) had septal deviation. Patients with scattered B-lines more commonly had PH. A statistically significant association was found between lung ultrasound detected B-lines and cor-pulmonale, dilated RV, septal deviation, RV hypertrophy, Pulmonary Artery Systolic Pressure (PASP), and LVEF (p-value <0.005). In patients with COPD, cor-pulmonale was detected in 21 (68.8%), LV dysfunction in 5 (14.7%), mild PH in 14 (41.2%), moderate PH in 7 (20.6%), and severe PH in 5 (14.7%) using echocardiography. Conclusion: This study reveals the importance of performing a combination of TUS with 2D echocardiography and suggests its usefulness in early diagnosis of cardiac dysfunctions in patients with various respiratory illnesses.

A journey through the Corynebacterium pseudotuberculosis proteome promotes insights into its functional genome.

BackgroundCorynebacterium pseudotuberculosis is a Gram-positive facultative intracellular pathogen and the etiologic agent of illnesses like caseous lymphadenitis in small ruminants, mastitis in dairy cattle, ulcerative lymphangitis in equines, and oedematous skin disease in buffalos. With the growing advance in high-throughput technologies, genomic studies have been carried out to explore the molecular basis of its virulence and pathogenicity. However, data large-scale functional genomics studies are necessary to complement genomics data and better understating the molecular basis of a given organism. Here we summarize, MS-based proteomics techniques and bioinformatics tools incorporated in genomic functional studies of C. pseudotuberculosis to discover the different patterns of protein modulation under distinct environmental conditions, and antigenic and drugs targets.MethodologyIn this study we performed an extensive search in Web of Science of original and relevant articles related to methods, strategy, technology, approaches, and bioinformatics tools focused on the functional study of the genome of C. pseudotuberculosis at the protein level.ResultsHere, we highlight the use of proteomics for understating several aspects of the physiology and pathogenesis of C. pseudotuberculosis at the protein level. The implementation and use of protocols, strategies, and proteomics approach to characterize the different subcellular fractions of the proteome of this pathogen. In addition, we have discussed the immunoproteomics, immunoinformatics and genetic tools employed to identify targets for immunoassays, drugs, and vaccines against C. pseudotuberculosis infection.ConclusionIn this review, we showed that the combination of proteomics and bioinformatics studies is a suitable strategy to elucidate the functional aspects of the C. pseudotuberculosis genome. Together, all information generated from these proteomics studies allowed expanding our knowledge about factors related to the pathophysiology of this pathogen.

Genomic Characteristics of Stx2e-Producing Escherichia coli Strains Derived from Humans, Animals, and Meats.

Shiga toxin (Stx) can be classified into two types, Stx1 and Stx2, and different subtypes. Stx2e is a subtype commonly causing porcine edema disease and rarely reported in humans. The purpose of this study was to analyze the prevalence and genetic characteristics of Stx2e-producing Escherichia coli (Stx2e-STEC) strains from humans compared to strains from animals and meats in China. Stx2e-STEC strains were screened from our STEC collection, and whole-genome sequencing was performed to characterize their genetic features. Our study showed a wide distribution of Stx2e-STEC among diverse hosts and a higher proportion of Stx2e-STEC among human STEC strains in China. Three human Stx2e-STEC isolates belonged to O100:H30, Onovel26:H30, and O8:H9 serotypes and varied in genetic features. Human Stx2e-STECs phylogenetically clustered with animal- and food-derived strains. Stx2e-STEC strains from animals and meat showed multidrug resistance, while human strains were only resistant to azithromycin and tetracycline. Of note, a high proportion (55.9%) of Stx2e-STEC strains, including one human strain, carried the heat-stable and heat-labile enterotoxin-encoding genes st and lt, exhibiting a STEC/enterotoxigenic E. coli (ETEC) hybrid pathotype. Given that no distinct genetic feature was found in Stx2e-STEC strains from different sources, animal- and food-derived strains may pose the risk of causing human disease.

Orbitopatía tiroidea. Revisión sobre puntos clave para el diagnóstico y tratamiento

Introducción y objetivo: La orbitopatía tiroidea (OT) es una patología autoinmune de etiología desconocida. Se trata de una enfermedad edematosa e inflamatoria crónica y a veces subaguda o aguda, cuyas características principales son edema palpebral, úlceras corneales, hipertensión ocular, exoftalmos generalmente bilateral, estrabismo restrictivo, diplopía y neuropatía óptica. Objetivo: Realizar una revisión y actualización acerca del enfoque diagnóstico y terapéutico de la OT. Métodos: Revisión de la literatura publicada referente a la OT y manera actual de enfocar esta patología. Resultados: OT es una enfermedad inflamatoria orbitaria con un posible origen autoinmune y que suele asociarse a trastornos metabólicos de la glándula tiroidea. Fisiopatológicamente su mecanismo no está claro. Afecta mayormente a mujeres y está negativamente influenciada por factores como el tabaquismo, la edad, el sexo y la raza. Es imprescindible clasificarla en cuanto a su severidad y su actividad para un correcto manejo. Conclusiones: El conocimiento clínico de OT es esencial para el diagnóstico precoz de la enfermedad. El tratamiento médico, en caso de OT activa, debe ser precoz, agresivo y acorde a la fase en que se presente el paciente con el fin de evitar las graves consecuencias de la OT. El tratamiento quirúrgico deberá ser lógico y ordenado, pero a su vez rápido, con el fin de devolver al paciente al entorno laboral, social y familiar.

A new definition about the relationship of intercellular fluid in the brain with the mandibular and parotid lymph nodes.

This study was carried out to reveal the relationship of the brain with both the mandibular lymph node (MLN) and parotid lymph node (PLN) by the hyperspectral fluorescence imaging techniques of Qdot 800 (QD) nanoparticles using in vivo. This relationship of the brain with both lymph nodes offers the preliminary morphological definition of lymphatic drainage. QD was injected into the left parietal brain lobe of each rat at a depth of 2.50 mm. In 65% of the rats that were imaged in vivo, signals were received first from the right MLN and PLN, and then from the left MLN and PLN. In contrast, in two female rats, the first signal was received from the right PLN. There was no difference between the female and male rats overall. The most noteworthy finding of this study was that the tracer injected into the left parietal lobe reached the right mandibular and parotid lymph nodules earlier. This result indicates a different and unknown pathway in the brain that communicates with the lymph nodes. Moreover, this study shows that these lymph nodes pathways can be used in the treatment of diseases such as brain trauma, cerebral edema, and Alzheimer's disease (AD).

The Pheno- and Genotypic Characterization of Porcine Escherichia coli Isolates.

Escherichia (E.) coli is the main causative pathogen of neonatal and post-weaning diarrhea and edema disease in swine production. There is a significant health concern due to an increasing number of human infections associated with food and/or environmental-borne pathogenic and multidrug-resistant E. coli worldwide. Monitoring the presence of pathogenic and antimicrobial-resistant E. coli isolates is essential for sustainable disease management in livestock and human medicine. A total of 102 E. coli isolates of diseased pigs were characterized by antimicrobial and biocide susceptibility testing. Antimicrobial resistance genes, including mobile colistin resistance genes, were analyzed by PCR and DNA sequencing. The quinolone resistance-determining regions of gyrA and parC in ciprofloxacin-resistant isolates were analyzed. Clonal relatedness was investigated by two-locus sequence typing (CH clonotyping). Phylotyping was performed by the Clermont multiplex PCR method. Virulence determinants were analyzed by customized DNA-based microarray technology developed in this study for fast and economic molecular multiplex typing. Thirty-five isolates were selected for whole-genome sequence-based analysis. Most isolates were resistant to ampicillin and tetracycline. Twenty-one isolates displayed an ESBL phenotype and one isolate an AmpC β-lactamase-producing phenotype. Three isolates had elevated colistin minimal inhibitory concentrations and carried the mcr-1 gene. Thirty-seven isolates displayed a multi-drug resistance phenotype. The most predominant β-lactamase gene classes were blaTEM-1 (56%) and blaCTX-M-1 (13.71%). Mutations in QRDR were observed in 14 ciprofloxacin-resistant isolates. CH clonotyping divided all isolates into 51 CH clonotypes. The majority of isolates belonged to phylogroup A. Sixty-four isolates could be assigned to defined pathotypes wherefrom UPEC was predominant. WGS revealed that the most predominant sequence type was ST100, followed by ST10. ST131 was detected twice in our analysis. This study highlights the importance of monitoring antimicrobial resistance and virulence properties of porcine E. coli isolates. This can be achieved by applying reliable, fast, economic and easy to perform technologies such as DNA-based microarray typing. The presence of high-risk pathogenic multi-drug resistant zoonotic clones, as well as those that are resistant to critically important antibiotics for humans, can pose a risk to public health. Improved protocols may be developed in swine farms for preventing infections, as well as the maintenance and distribution of the causative isolates.

A validation study of the modified Canadian Preoperative Prediction Rule for Hydrocephalus in children with posterior fossa tumors

OBJECTIVE Perioperative management of hydrocephalus in children with posterior fossa tumors (PFTs) remains challenging. The modified Canadian Preoperative Prediction Rule for Hydrocephalus (mCPPRH) has been previously described as a useful tool in predicting which children are at higher risk for permanent hydrocephalus following PFT resection and can be used in guiding treatment. The aim of this study was to externally validate this predictive model. METHODS A retrospective review of the children treated in a single unit was conducted, recording all of the mCPPRH parameters (age, preoperative radiological diagnosis, presence of moderate/severe hydrocephalus, transependymal edema, and metastatic disease at the time of diagnosis), the need for a CSF diversion procedure at 6 months, time to surgery, and management of hydrocephalus. A receiver operating characteristic (ROC) curve was plotted using the mCPPRH, age, Evans index (EI), and frontooccipital horn ratio (FOHR), and an area under the curve (AUC) was calculated. A point-biserial correlation was run to determine the relationship between time to surgery, the insertion of an external ventricular drain (EVD), or initial EVD clamping and the development of postoperative persistent hydrocephalus. RESULTS From a total of 75 patients (mean age 6.99 years, 62.7% male) who were included in the study, 8 (10.7%) required permanent CSF diversion following PFT resection. The AUC of the ROC curve was 0.618 for the mCPPRH (p = 0.18, SE 0.088, 95% CI 0.446–0.791), 0.633 for age (p = 0.26, SE 0.119, 95% CI 0.4–0.867), 0.604 for the EI (p = 0.34, SE 0.11, 95% CI 0.389–0.818), and 0.663 for the FOHR (p = 0.17, SE 0.121, 95% CI 0.427–0.9). A significant positive correlation between EVD insertion (r = 0.239, p = 0.03) and insertion of a ventriculoperitoneal shunt was found. A negative correlation between the postoperative clamping of the EVD (r = −0.158, p = 0.4) and the time to PFT surgery (r = −0.06, p = 0.6) did not reach statistical significance. CONCLUSIONS The implementation of the mCPPRH score failed to reliably predict which children would require permanent CSF diversion following PFT resection when applied to this cohort. Clinical judgment remains the mainstay of choosing the perioperative treatment of hydrocephalus.

Management of respiratory distress following prehospital implementation of noninvasive ventilation in a physician-staffed emergency medical service: a single-center retrospective study

BackgroundNoninvasive ventilation (NIV) is recognized as first line ventilatory support for the management of acute pulmonary edema (APE) and chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to study the prehospital management of patients in acute respiratory distress with an indication for NIV and whether they received it or not.MethodsThis retrospective study included patients ≥18 years old who were cared for acute respiratory distress in a prehospital setting. Indications for NIV were oxygen saturation (SpO2) <90% and/or respiratory rate (RR) >25/min with a presumptive diagnosis of APE or COPD exacerbation. Study population characteristics, initial and at hospital vital signs, presumptive and definitive diagnosis were analyzed. For patients who received NIV, dyspnea level was evaluated with a dyspnea verbal ordinal scale (D-VOS, 0-10) and arterial blood gas (ABG) values were obtained at hospital arrival.ResultsAmong the 187 consecutive patients included in the study, most (n = 105, 56%) had experienced APE or COPD exacerbation, and 56 (30%) received NIV. In comparison with patients without NIV, those treated with NIV had a higher initial RR (35 ± 8/min vs 29 ± 10/min, p < 0.0001) and a lower SpO2 (79 ± 10 vs 88 ± 11, p < 0.0001). The level of dyspnea was significantly reduced for patients treated with NIV (on-scene D-VOS 8.4 ± 1.7 vs 4.4 ± 1.8 at admission, p < 0.0001). Among the 131 patients not treated with NIV, 41 (31%) had an indication. In the latter group, initial SpO2 was 80 ± 10% in the NIV group versus 86 ± 11% in the non-NIV group (p = 0.0006). NIV was interrupted in 9 (16%) patients due to either discomfort (n = 5), technical problem (n = 2), persistent desaturation (n = 1), or vomiting (n = 1).ConclusionsThe results of this study contribute to a better understanding of the prehospital management of patients who present with acute respiratory distress and an indication for NIV. NIV was started on clinically more severe patients, even if predefined criteria to start NIV were present. NIV allows to improve vital signs and D-VOS in those patients. A prospective study could further elucidate why patients with a suspected diagnosis of APE and COPD are not treated with NIV, as well as the clinical impact of the different strategies.Trial registrationThe study was approved by our institutional ethical committee (CER-VD 2020-01363).

Lettuce-based production of an oral vaccine against porcine edema disease for the seed lot system.

Plant-made oral vaccines can be a cost-effective method to control infectious diseases of humans and farm animals. Pig edema is a bacterial disease caused by enterohemorrhagic Escherichia coli producing the toxin Shiga toxin 2e (Stx2e). In our previous report, we chose the non-toxic B subunit of Stx2e (Stx2eB) as a vaccine antigen, and Stx2eB was expressed in lettuce (Lactuca sativa L., cv. Green wave). We found that a double repeated Stx2eB (2×Stx2eB) accumulates to higher levels than a single Stx2eB. In this study, we analyzed progeny plants introduced with 2×Stx2eB in which the gene was expressed under the control of conventional cauliflower mosaic virus 35S RNA (CaMV 35S) promoter, and found that the lettuce underwent transgene silencing and bore few seeds. We resolved these problems by using a transgene cassette which harbored a transcriptional promoter derived from the lettuce ubiquitin gene and a longer version of HSPT. The lettuce harboring this expression construct will be valuable in establishing the seed lot system on the basis that thousands of seeds can be obtained from one plant body and the resulting progeny plants accumulate 2×Stx2eB at high levels without the transgene silencing.

Non-invasive Positive Pressure Ventilation for Acute Cardiogenic Pulmonary Edema and Chronic Obstructive Pulmonary Disease in Prehospital and Emergency Settings.

Non-invasive ventilation is an important intervention in treating acute respiratory failure caused by acute cardiogenic pulmonary edema (ACPE) and acute exacerbations of chronic obstructive pulmonary disease (COPD). Although there are studies that give evidence on the efficacy and safety of non-invasive ventilation over standard medical care for COPD and cardiogenic pulmonary edema, less are known about the form of non-invasive ventilation, continuous positive airway pressure (CPAP), or bilevel positive airway pressure (BiPAP) as an effective intervention for respiratory failure and its efficacy and safety in prehospital settings. We conducted a systematic review by using PubMed and Google Scholar as databases for collecting studies related to the effectiveness of CPAP and BiPAP for cardiogenic pulmonary edema and COPD; the major outcome studied was reducing rates of endotracheal intubation secondary and tertiary outcomes included mortality reduction and shortening length of hospital stay. The study follows the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist 2009. Sixteen studies were identified, including systematic reviews, randomized control trials, and observational studies. Studies published on or after 2010 in a population greater than 40 years old suffering from acute COPD and cardiogenic pulmonary edema were taken for review. Studies that described other respiratory diseases treated with non-invasive ventilation were excluded. Quality appraisal was done using the Cochrane risk bias tool for randomized control trials, Amstar-2 for systematic reviews, and New Castle Ottawa Tool for observational studies. Five studies compared the effectiveness of CPAP and BiPAP with standard medical care in prehospital and emergency settings. Six studies described prehospital intervention. Both forms of non-invasive ventilation were equally significant and effective. Prehospital use had tremendously reduced intubation rates, with not much variability noticed for mortality and hospital stay. Non-invasive ventilation is an effective measure for respiratory failure secondary to COPD and ACPE. Early out of hospital utilization of CPAP and BiPAP reduces the rate of invasive ventilation and reduces complications due to endotracheal intubation. Endotracheal intubation is associated with a considerable incidence of complications like failed intubation, hypotension, or circulatory arrest, even if the emergency physician is well trained, making these forms of non-invasive ventilation safe and effective interventions in the prehospital settings.

Effect of Edema Disease Vaccination on Mortality and Growth Parameters in Nursery Pigs in a Shiga Toxin 2e Positive Commercial Farm.

Diseases caused by Escherichia coli are recognized as major problems in the swine industry, one of them being edema disease (ED). Importantly, the current decrease in antibiotic use may cause difficulties in controlling the disorders caused by E. coli. Therefore, this study assessed the efficacy of a commercial vaccine against ED in nursery pigs from a farm with previous history of ED. A total of 1344 pigs were monitored; half of them were randomly assigned to a vaccinated group (VG) and the other half to a non-vaccinated group (NVG). The vaccine was administered at 7 days of age. Animals received a pre-starter feed with 2500 ppm of zinc oxide (ZnO) for 2 weeks and a starter feed without ZnO for another 3 weeks. Pen-group weights were recorded at 28 (weaning), 42 (end of pre-starter phase), and 63 days of life (end of nursery phase). Death/culling rates, average daily gain (ADG), and average daily feed intake (ADFI) were calculated for each group at each phase. The overall relative risk of dying/being culled for a pig in the NVG was 5 times higher than that of the VG group but increased to 12 times higher during the starter period. ADG and ADFI were also significantly higher in the VG group for that period. Vaccination against ED significantly reduced pig losses and improved ADG and ADFI, particularly when ZnO was not used.