Context:
Hyponatremia is common after acute subarachnoid hemorrhage (SAH) but the etiology is unclear and there is a paucity of prospective data in the field. The cause of hyponatremia is variously ...attributed to the syndrome of inappropriate antidiuresis (SIAD), acute glucocorticoid insufficiency, and the cerebral salt wasting syndrome (CSWS).
Objective:
The objective was to prospectively determine the etiology of hyponatremia after SAH using sequential clinical examination and biochemical measurement of plasma cortisol, arginine vasopressin (AVP), and brain natriuretic peptide (BNP).
Design:
This was a prospective cohort study.
Setting:
The setting was the National Neurosurgery Centre in a tertiary referral centre in Dublin, Ireland.
Patients:
One hundred patients with acute nontraumatic aneurysmal SAH were recruited on presentation.
Interventions:
Clinical examination and basic biochemical evaluation were performed daily. Plasma cortisol at 0900 hours, AVP, and BNP concentrations were measured on days 1, 2, 3, 4, 6, 8, 10, and 12 following SAH. Those with 0900 hours plasma cortisol <300 nmol/L were empirically treated with iv hydrocortisone.
Main Outcome Measures:
Plasma sodium concentration was recorded daily along with a variety of clinical and biochemical criteria. The cause of hyponatremia was determined clinically. Later measurement of plasma AVP and BNP concentrations enabled a firm biochemical diagnosis of the cause of hyponatremia to be made.
Results:
Forty-nine of 100 developed hyponatremia <135 mmol/L, including 14/100 <130 mmol/L. The cause of hyponatremia, and determined by both clinical examination and biochemical hormone measurement, was SIAD in 36/49 (71.4%), acute glucocorticoid insufficiency in 4/49 (8.2%), incorrect iv fluids in 5/49 (10.2%), and hypovolemia in 5/49 (10.2%). There were no cases of CSWS.
Conclusions:
The most common cause of hyponatremia after acute nontraumatic aneurysmal SAH is SIAD. Acute glucocorticoid insufficiency accounts for a small but significant number of cases. We found no cases of CSWS.
Objectives We present an overview of the literature between 1997 and 2007 on parental stress reactions following the diagnosis of childhood cancer and we evaluate methodological strengths and ...weaknesses of the studies. Methods PubMed, PsychInfo, and Cinahl databases were used. Sixty-seven were included in the review. Results The conceptualization of parental stress and timing of assessment varies considerably between the studies, which makes comparison difficult. Most emotional stress reactions are seen around the time of diagnosis, with mothers reporting more symptoms than fathers. As a group, parents seem relatively resilient, although a subset of parents reports continuing stress even up to 5 years or more postdiagnosis. Conclusions The authors recommend clear definitions of parental stress, fixed points in time to assess parental stress, and an approach that highlights both parental strengths and weaknesses. Improved assessment can contribute to tailoring psychological care to those parents most in need.
The impact of ocean acidification (OA) on coral calcification, a subject of intense current interest, is poorly understood in part because of the presence of symbionts in adult corals. Early life ...history stages of Acropora spp. provide an opportunity to study the effects of elevated CO2 on coral calcification without the complication of symbiont metabolism. Therefore, we used the Illumina RNAseq approach to study the effects of acute exposure to elevated CO2 on gene expression in primary polyps of Acropora millepora, using as reference a novel comprehensive transcriptome assembly developed for this study. Gene ontology analysis of this whole transcriptome data set indicated that CO2‐driven acidification strongly suppressed metabolism but enhanced extracellular organic matrix synthesis, whereas targeted analyses revealed complex effects on genes implicated in calcification. Unexpectedly, expression of most ion transport proteins was unaffected, while many membrane‐associated or secreted carbonic anhydrases were expressed at lower levels. The most dramatic effect of CO2‐driven acidification, however, was on genes encoding candidate and known components of the skeletal organic matrix that controls CaCO3 deposition. The skeletal organic matrix effects included elevated expression of adult‐type galaxins and some secreted acidic proteins, but down‐regulation of other galaxins, secreted acidic proteins, SCRiPs and other coral‐specific genes, suggesting specialized roles for the members of these protein families and complex impacts of OA on mineral deposition. This study is the first exhaustive exploration of the transcriptomic response of a scleractinian coral to acidification and provides an unbiased perspective on its effects during the early stages of calcification.
Introduction
Currently, very few guidelines for supportive care for children with cancer exist. In the Netherlands, nationwide guidelines are over 10 years old and mostly based on expert opinion. ...Consequently, there is growing support and need for clinical practice guidelines (CPGs), which ought to be developed with a well-defined methodology and include a systematic search of literature, evidence summaries, and a transparent description of the decision process for the final recommendations. Development of CPGs is time consuming; therefore, it is important to prioritize topics for which there is the greatest clinical demand.
Objectives
This study aims to prioritize childhood cancer supportive care topics for development of CPGs.
Methods
A Delphi survey consisting of two rounds was conducted to prioritize relevant childhood cancer supportive care topics for the development of CPGs. A group of experts comprising 15 pediatric oncologists, 15 pediatric oncology nurses, and 15 general pediatricians involved in care for childhood cancer patients were invited to participate. All relevant supportive care topics in childhood cancer were rated.
Results
In both rounds, 36 panellists (82 %) responded. Agreement between panellists was very good, with an intraclass correlation coefficient of 0.918 (95 % confidence interval (CI) = 0.849–0.966,
p
< 0.001) in round 2. The ten topics with the highest score in the final round were infection, sepsis, febrile neutropenia, pain, nausea/vomiting, restrictions in daily life and activities, palliative care, procedural sedation, terminal care, and oral mucositis.
Conclusion
We successfully used a Delphi survey to prioritize childhood cancer supportive care topics for the development of CPGs. This is a first step towards uniform and evidence-based Dutch guidelines in supportive care in childhood cancer. Even though performed nationally, we believe that this study can also be regarded as an example starting point for international development of CPGs in the field of supportive care in cancer or any other field for that matter.
1. Dwarf stands of the mangrove Rhizophora mangle L. are extensive in the Caribbean. We fertilized dwarf trees in Almirante Bay, Bocas del Toro Province, north-eastern Panamá with nitrogen (N) and ...phosphorus (P) to determine (1) if growth limitations are due to nutrient deficiency; and (2) what morphological and/or physiological factors underlie nutrient limitations to growth. 2. Shoot growth was 10-fold when fertilized with P and twofold with N fertilization, indicating that stunted growth of these mangroves is partially due to nutrient deficiency. 3. Growth enhancements caused by N or P enrichment could not be attributed to increases in photosynthesis on a leaf area basis, although photosynthetic nutrient-use efficiency was improved. The most dramatic effect was on stem hydraulic conductance, which was increased sixfold by P and 2·5-fold with N enrichment. Fertilization with P enhanced leaf and stem P concentrations and reduced C: N ratio, but did not alter leaf damage by herbivores. 4. Our findings indicate that addition of N and P significantly alter tree growth and internal nutrient dynamics of mangroves at Bocas del Toro, but also that the magnitude, pattern and mechanisms of change will be differentially affected by each nutrient.
Primary analysis of the double-blind, phase III Efficacy of XL184 (Cabozantinib) in Advanced Medullary Thyroid Cancer (EXAM) trial demonstrated significant improvement in progression-free survival ...with cabozantinib versus placebo in patients with progressive medullary thyroid cancer (MTC). Final analysis of overall survival (OS), a key secondary endpoint, was carried out after long-term follow-up.
EXAM compared cabozantinib with placebo in 330 patients with documented radiographic progression of metastatic MTC. Patients were randomized (2:1) to cabozantinib (140mg/day) or placebo. Final OS and updated safety data are reported.
Minimum follow-up was 42months. Kaplan–Meier analysis showed a 5.5-month increase in median OS with cabozantinib versus placebo (26.6 versus 21.1months) although the difference did not reach statistical significance stratified hazard ratio (HR), 0.85; 95% confidence interval (CI), 0.64–1.12; P=0.24. In an exploratory assessment of OS, progression-free survival, and objective response rate, cabozantinib appeared to have a larger treatment effect in patients with RET M918T mutation–positive tumors compared with patients not harboring this mutation. For patients with RET M918T-positive disease, median OS was 44.3months for cabozantinib versus 18.9months for placebo HR, 0.60; 95% CI, 0.38–0.94; P=0.03 (not adjusted for multiple subgroup analyses), with corresponding values of 20.2 versus 21.5months (HR, 1.12; 95% CI, 0.70–1.82; P=0.63) in the RET M918T–negative subgroup. Median treatment duration was 10.8months with cabozantinib and 3.4months with placebo. The safety profile for cabozantinib remained consistent with that of the primary analysis.
The secondary end point was not met in this final OS analysis from the trial of cabozantinib in patients with metastatic, radiographically progressive MTC. A statistically nonsignificant increase in OS was observed for cabozantinib compared with placebo. Exploratory analyses suggest that patients with RET M918T–positive tumors may experience a greater treatment benefit with cabozantinib.
NCT00704730
Objective
To investigate the effect of interpregnancy interval (IPI) on preterm birth (PTB) according to whether the previous birth was preterm or term.
Design
Cohort study.
Setting
USA (California), ...Australia, Finland, Norway (1980–2017).
Population
Women who gave birth to first and second (n = 3 213 855) singleton livebirths.
Methods
Odds ratios (ORs) for PTB according to IPIs were modelled using logistic regression with prognostic score stratification for potential confounders. Within‐site ORs were pooled by random effects meta‐analysis.
Outcome measure
PTB (gestational age <37 weeks).
Results
Absolute risk of PTB for each IPI was 3–6% after a previous term birth and 17–22% after previous PTB. ORs for PTB differed between previous term and preterm births in all countries (P‐for‐interaction ≤ 0.001). For women with a previous term birth, pooled ORs were increased for IPI <6 months (OR 1.50, 95% CI 1.43–1.58); 6–11 months (OR 1.10, 95% CI 1.04–1.16); 24–59 months (OR 1.16, 95% CI 1.13–1.18); and ≥ 60 months (OR 1.72, 95%CI 1.60–1.86), compared with 18–23 months. For previous PTB, ORs were increased for <6 months (OR 1.30, 95% CI 1.18–1.42) and ≥60 months (OR 1.29, 95% CI 1.17–1.42), but were less than ORs among women with a previous term birth (P < 0.05).
Conclusions
Associations between IPI and PTB are modified by whether or not the previous pregnancy was preterm. ORs for short and long IPIs were higher among women with a previous term birth than a previous PTB, which for short IPI is consistent with the maternal depletion hypothesis. Given the high risk of recurrence and assuming a causal association between IPI and PTB, IPI remains a potentially modifiable risk factor for women with previous PTB.
Tweetable
Short versus long interpregnancy intervals associated with higher ORs for preterm birth (PTB) after a previous PTB.
Tweetable
Short versus long interpregnancy intervals associated with higher ORs for preterm birth (PTB) after a previous PTB.
Abstract Purpose Soft tissue sarcomas (STS) represent a heterogeneous group of diseases, and selection of individualized treatments remains a challenge. The goal of this study was to determine ...whether radiomic features extracted from magnetic resonance (MR) images are independently associated with overall survival (OS) in STS. Methods and Materials This study analyzed 2 independent cohorts of adult patients with stage II-III STS treated at center 1 (N = 165) and center 2 (N = 61). Thirty radiomic features were extracted from pretreatment T1-weighted contrast-enhanced MR images. Prognostic models for OS were derived on the center 1 cohort and validated on the center 2 cohort. Clinical-only (C), radiomics-only (R), and clinical and radiomics (C+R) penalized Cox models were constructed. Model performance was assessed using Harrell's concordance index. Results In the R model, tumor volume (hazard ratio HR, 1.5) and 4 texture features (HR, 1.1-1.5) were selected. In the C+R model, both age (HR, 1.4) and grade (HR, 1.7) were selected along with 5 radiomic features. The adjusted c-indices of the 3 models ranged from 0.68 (C) to 0.74 (C+R) in the derivation cohort and 0.68 (R) to 0.78 (C+R) in the validation cohort. The radiomic features were independently associated with OS in the validation cohort after accounting for age and grade (HR, 2.4; P = .009). Conclusions This study found that radiomic features extracted from MR images are independently associated with OS when accounting for age and tumor grade. The overall predictive performance of 3-year OS using a model based on clinical and radiomic features was replicated in an independent cohort. Optimal models using clinical and radiomic features could improve personalized selection of therapy in patients with STS.
Extrinsic interference is routinely faced in systems engineering, and a common solution is to rely on a broad class of filtering techniques to afford stability to intrinsically unstable systems or ...isolate particular signals from a noisy background. Experimentalists leading the development of a new generation of quantum-enabled technologies similarly encounter time-varying noise in realistic laboratory settings. They face substantial challenges in either suppressing such noise for high-fidelity quantum operations or controllably exploiting it in quantum-enhanced sensing or system identification tasks , due to a lack of efficient, validated approaches to understanding and predicting quantum dynamics in the presence of realistic time-varying noise. In this work we use the theory of quantum control engineering and experiments with trapped 171 Yb+ ions to study the dynamics of controlled quantum systems. Our results provide the first experimental validation of generalized filter-transfer functions casting arbitrary quantum control operations on qubits as noise spectral filters. We demonstrate the utility of these constructs for directly predicting the evolution of a quantum state in a realistic noisy environment as well as for developing novel robust control and sensing protocols. These experiments provide a significant advance in our understanding of the physics underlying controlled quantum dynamics, and unlock new capabilities for the emerging field of quantum systems engineering.
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