Meta-analysis of neuron specific enolase in predicting pediatric brain injury outcomes

A reliable biomarker has not been identified to predict the outcome of traumatic brain injury (TBI) in children. Therefore, the present systematic review and meta-analysis aimed to assess the association between neuron specific enolase (NSE) and traumatic brain injury (TBI) in children. Two independent reviewers searched electronic databases of EMBASE, Cochrane library, Medline and Scopus and then they summarized the results and did a quality control check. At the end, standardized mean difference (SMD) with 95 % confidence interval (CI) and performance of NSE were assessed. 10 studies were included in the present meta-analysis. Average serum (SMD=1.3; 95 % CI: 0.5 to 2.1; p=0.001) and CSF levels (SMD=2.45; 95 % CI: 1.04 to 3.8; p<0.0001) of NSE biomarker were significantly higher in children with TBI with unfavorable outcome compared with other children. Serum NSE had an area under the curve, sensitivity and specificity of 0.75 (95 % CI: 0.72 to 0.79), 0.74 (95 % CI: 0.64 to 0.82) and 0.69 (95 % CI: 0.59 to 0.77), respectively in prediction outcome of TBI. Positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of serum NSE were 2.4 (95 % CI: 1.7 to 3.3), 0.38 (95 % CI: 0.26 to 0.55) and 6.0 (95 % CI: 3.0 to 12.0), respectively. The results show that the performance of NSE is in a moderate level in prediction of unfavorable outcome in children with TBI. However, data in this aspect is not sufficient and more studies are needed

Homeodomain protein transforming growth factor beta-induced factor 2 like, X-linked function in colon adenocarcinoma cells

A member of homeodomain protein namely TGIF2LX has been implicated as a tumor suppressor gene in human malignancy as well as in spermatogenesis. However, to our knowledge, dynamic functional evidence of the TGIF2LX has not yet been provided. The aim of the present study was to investigate the human TGIF2LX target gene(s) using a cDNA-AFLP as a differential display method. A pEGFP-TGIF2LX construct containing the wild-type TGIF2LX cDNA was stably transfected into SW48 cells. UV microscopic analysis and Real-time RT-PCR were used to confirm TGIF2LX expression. The mRNA expressions of TGIF2LX in transfected SW48 cells, the cells containing empty vector (pEGFP-N), and untransfected cells were compared. Also, a Real-time PCR technique was applied to validate cDNA-AFLP results. The results revealed a significant down-regulation and up-regulationby TGIF2LX of Nir1 and Nir2 genes, respectively. The genes are engaged in the cell morphogenesis process. Our findings may provide new insight into the complex molecular pathways underlying colorectal cancer development

Efficacy of Enema via Cecostomy for Fecal Disorders in Children: A Systematic Review and Meta-Analysis

Background   Some controversy exists about the role of cecostomy in the management of fecal disorders. The present meta-analysis aims provide a comprehensive evaluation on the role of cecostomy on management of fecal incontinence and constipation in children.   Materials and Methods   An extensive search was performed on the Medline, Embase, Scopus, and Web of Science until July 2017. Two independent researchers screened the title and abstracts of the studies and then relevant studies were included. Finally, pooled effect size was presented as standardized mean difference (SMD) or pooled prevalence with 95% confidence interval (95% CI).   Results   14 articles were entered (740 children). The success rate of cecostomy in management of fecal disorders was 90.6% (success rate=90.6%; 95% CI: 86.4 to 94.2). The most common side effects of this technique include granulation tissue formation (29.6%), cecostomy tube leakage (8.5%), tube dislodgement (7.0%), and tube site infection (2.3%).   Conclusion   The results of the present meta-analysis show that the cecostomy is safe and an effective technique in the management of fecal disorder in children. However, the findings presented on the eligible articles have have shown a low level of evidence and it is suggested that clinical trials should be conducted in this field

A Novel Intervention Technology for Cerebral Palsy: Brain Stimulation

Abstract:A common pediatric disorder with posture and motor dysfunctionin neurological diseases is known as cerebral palsy (CP). Recently,a series of effective techniques have been developed for treatmentof CP. These promising methods need high-tech equipment forbrain stimulation and mainly classified into invasive and noinvasiveapproaches. This study aimed to introduce these techniquesfor treatment of patients who suffer from CP. The potential andperformance of currently available brain stimulation techniques havebeen mentioned in detail. Moreover, the clinical application, safety,efficacy and challenges of these methods have been discussed. Herewe review the recent advances in the CP treatment with an emphasison brain stimulation techniquesKeywords:Cerebral palsy; Brain stimulation; Pediatric disorde

Potential diagnostic and prognostic value of serum and cerebrospinal fluid biomarkers in traumatic spinal cord injury: a systematic review

It remains unclear whether biomarkers in the serum or cerebrospinal fluid (CSF) can be used for diagnosis or prognosis of spinal cord injuries (SCI). Therefore, a systematic review was undertaken to evaluate the prognostic or diagnostic value of serum and CSF biomarkers in assessing the severity of SCI and the outcome of patients. Two independent reviewers summarized the human studies retrieved from the electronic databases of Medline, Embase, Scopus and ISI Web of Science until April 2018. Seventeen studies were included (1065 patients aged 16 to 94 years old). Although the findings of the included studies suggest that inflammatory and structural proteins may be useful in assessing the severity of SCI and prediction of neurological outcome, the level of evidence is generally low. Given limitations to the available evidence, further investigation in this field is required using large prospective datasets with rigorous analysis of sensitivity, specificity and prediction

The Effects of Different Dose of Chronic Ritalin on the Brain of Prepubertal Female Balb/C Mice

Background Methylphenidate (MPH) is commonly prescribed for children who have been diagnosed with attention deficit hyperactivity disorder (ADHD); however, the action mechanisms of methylphenidate have not been fully elucidated. Studies have shown a relationship between apoptosis signaling pathways and psychiatric disorders, as well as therapeutic targets for such disorders. So, we examined the effects of chronic methylphenidate administration on the brain of mice. Materials and Methods Animals were administered MPH at doses of 2, 5 and 10 mg/kg for 60 days.  At the age of three months and in estrous phase, brian tissues were removed and washed in cold phosphate-buffered saline and some of them were frozen at -80oC for Western blot analysis. We measured the levels of pro-apoptotic protein, Bax and anti-apoptoticprotein, Bcl-2, in the brain of neonate female Balb/c mice. The rest of the brains were fixed in formalin (10% phosphate-buffered, pH = 7.4). Then samples were embedded in paraffin according to routine histologic procedures. Results: Our results showed that MPH with a dose of 10 mg/kg causes a considerable increase in the level of the Bax protein as compared with other groups. In contrast, in the partial cortex of female mice under treatment with high dose of MPH (10 mg/kg) could less Bcl2 levels as compared with 5 mg/kg MPH. However, 5 mg/kg MPH have a significant effect on Bcl2 levels compare with each of mentioned doses (

Predicting the Presence of Traumatic Chest Injuries Using Machine Learning Algorithm

Introduction: Various tools have been developed to determine the priority of radiography in trauma patients. This study aimed to investigate the role of machine learning models in predicting chest injuries following multiple trauma. Methods: We used the database of a comprehensive cross-sectional survey conducted in 2015. Eight machine learning models were developed using demographic characteristics, physical exam findings, and radiologic results of 2860 patients. Results: Area under the receiver operating characteristic curve (AUC) was greater than 0.96 in Random Forest, Gradient Boosting, XGBoost, Decision Tree, Support Vector Machine (SVM), Logistic Regression, K-Nearest Neighbors (KNN), and Neural Network models. The random forest model, XGBoost and Gradient Boosting had the highest accuracy (0.99). Sensitivity was also highest in the Gradient Boosting, XGBoost and KNN models (0.99). The specificity of all of the models in predicting chest radiography outcomes of multiple trauma patients was higher than 0.97, except for logistic regression and SVM (0.912 and 0.885 respectively). Conclusions: Our study highlights the strong potential of machine learning models, especially Random Forest and Gradient Boosting, in predicting chest trauma outcomes with high accuracy and sensitivity

Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens