Failure of early non-invasive ventilation in preterm infants with respiratory distress syndrome in current care practice in Spanish level-III neonatal intensive care units – a prospective observational study

Non-invasive respiratory ventilation; Preterm infant; Respiratory distress syndromeVentilación respiratoria no invasiva; Bebé prematuro; Síndrome de dificultad respiratoriaVentilació respiratòria no invasiva; Nadó prematur; Síndrome de dificultat respiratòriaIntroduction: Despite advances in respiratory distress syndrome (RDS) management over the past decade, non-invasive ventilation (NIV) failure is frequent and associated with adverse outcomes. There are insufficient data on the failure of different NIV strategies currently used in clinical practice in preterm infants. Methods: This was a prospective, multicenter, observational study of very preterm infants [gestational age (GA) <32 weeks] admitted to the neonatal intensive care unit for RDS that required NIV from the first 30 min after birth. The primary outcome was the incidence of NIV failure, defined as the need for mechanical ventilation for <72 h of life. Secondary outcomes were risk factors associated with NIV failure and complication rates. Results: The study included 173 preterm infants with a median GA of 28 (IQR 27–30) weeks and a median birth weight of 1,100 (IQR 800–1,333) g. The incidence of NIV failure was 15.6%. In the multivariate analysis, lower GA (OR, 0.728; 95% CI, 0.576–0.920) independently increased the risk of NIV failure. Compared to NIV success, NIV failure was associated with higher rates of unfavorable outcomes, including pneumothorax, intraventricular hemorrhage, periventricular leukomalacia, pulmonary hemorrhage, and a combined outcome of moderate-to-severe bronchopulmonary dysplasia or death. Conclusion: NIV failure occurred in 15.6% of the preterm neonates and was associated with adverse outcomes. The use of LISA and newer NIV modalities most likely accounts for the reduced failure rate. Gestational age remains the best predictor of NIV failure and is more reliable than the fraction of inspired oxygen during the first hour of life.This study was supported by Chiesi España, S.A.U., Barcelona, Spain. Chiesi España and S.A.U. were not involved in the collection and interpretation of the data or in the writing of the manuscript

Aid decision algorithms to estimate the risk in congenital heart surgery

Background and objective: In this paper, we have tested the suitability of using different artificial intelligence-based algorithms for decision support when classifying the risk of congenital heart surgery. In this sense, classification of those surgical risks provides enormous benefits as the a priori estimation of surgical outcomes depending on either the type of disease or the type of repair, and other elements that influence the final result. This preventive estimation may help to avoid future complications, or even death. Methods: We have evaluated four machine learning algorithms to achieve our objective: multilayer perceptron, self-organizing map, radial basis function networks and decision trees. The architectures implemented have the aim of classifying among three types of surgical risk: low complexity, medium complexity and high complexity. Results: Accuracy outcomes achieved range between 80% and 99%, being the multilayer perceptron method the one that offered a higher hit ratio. Conclusions: According to the results, it is feasible to develop a clinical decision support system using the evaluated algorithms. Such system would help cardiology specialists, paediatricians and surgeons to forecast the level of risk related to a congenital heart disease surgery

Cross-eyed - cross-spectral iris/periocular recognition database and competition

This work presents a novel dual-spectrum database containing both iris and periocular images synchronously captured from a distance and within a realistic indoor environment. This database was used in the 1st Cross-Spectrum Iris/Periocular Recognition Competition (Cross-Eyed 2016). This competition aimed at recording recent advances in cross- spectrum iris and periocular recognition. Six submissions were evaluated for cross-spectrum periocular recognition, and three for iris recognition. The submitted algorithms are briefly introduced. Detailed results are reported in this paper, and comparison of the results is discussed

Effects of soluble humic acids on the uptake of heavy metals by Vetiveria zizanioides (L.) Nash in contaminated mining soils

In the past, mining wastes were left wherever they might lie in the surroundings of the mine area. Unfortunately, inactive and abandoned mines continue to pollute our environment, reason why these sites should be restored with minimum impact. Phytoextraction is an environmental-friendly and cost-effective technology less harmful than traditional methods that uses metal hyperaccumulator or at least tolerant plants to extract heavy metals from polluted soils. One disadvantage of hyperaccumulator species is their slow growth rate and low biomass production. Vetiveria zizanioides (L.) Nash, perennial species adapted to Mediterranean climate has a strong root system which can reach up to 3 m deep, is fast growing, and can survive in sites with high metal levels (Chen et al., 2004). Due to the fact that metals in abandoned mine tailings become strongly bonded to soil solids, humic acids used as chelating agents could increase metal bioavailability (Evangelou et al., 2004; Wilde et al., 2005) and thereby promote higher accumulation in the harvestable parts of the plant. The objective of this study was to examine the performance of humic acid assisted phytoextraction using Vetiveria zizanioides (L.) Nash in heavy metals contaminated soils

Trimethylamine-N-Oxide (TMAO) Predicts Cardiovascular Mortality in Peripheral Artery Disease

Peripheral artery disease (PAD) is a major cause of acute and chronic illness, with extremely poor prognosis that remains underdiagnosed and undertreated. Trimethylamine-N-Oxide (TMAO), a gut derived metabolite, has been associated with atherosclerotic burden. We determined plasma levels of TMAO by mass spectrometry and evaluated their association with PAD severity and prognosis. 262 symptomatic PAD patients (mean age 70 years, 87% men) categorized in intermittent claudication (IC, n = 147) and critical limb ischemia (CLI, n = 115) were followed-up for a mean average of 4 years (min 1-max 102 months). TMAO levels were increased in CLI compared to IC (P 2.26 µmol/L exhibited higher risk of cardiovascular death (sub-hazard ratios ≥2, P < 0.05) that remained significant after adjustment for confounding factors. TMAO levels were associated to disease severity and CV-mortality in our cohort, suggesting an improvement of PAD prognosis with the measurement of TMAO. Overall, our results indicate that the intestinal bacterial function, together with the activity of key hepatic enzymes for TMA oxidation (FMO3) and renal function, should be considered when designing therapeutic strategies to control gut-derived metabolites in vascular patients

Evaluating radiological response in pancreatic neuroendocrine tumours treated with sunitinib : comparison of Choi versus RECIST criteria (CRIPNET_ GETNE1504 study)

The purpose of our study was to analyse the usefulness of Choi criteria versus RECIST in patients with pancreatic neuroendocrine tumours (PanNETs) treated with sunitinib. A multicentre, prospective study was conducted in 10 Spanish centres. Computed tomographies, at least every 6 months, were centrally evaluated until tumour progression. One hundred and seven patients were included. Median progression-free survival (PFS) by RECIST and Choi were 11.42 (95% confidence interval [CI], 9.7-15.9) and 15.8 months (95% CI, 13.9-25.7). PFS by Choi (Kendall's τ = 0.72) exhibited greater correlation with overall survival (OS) than PFS by RECIST (Kendall's τ = 0.43). RECIST incorrectly estimated prognosis in 49.6%. Partial response rate increased from 12.8% to 47.4% with Choi criteria. Twenty-four percent of patients with progressive disease according to Choi had stable disease as per RECIST, overestimating treatment effect. Choi criteria predicted PFS/OS. Changes in attenuation occurred early and accounted for 21% of the variations in tumour volume. Attenuation and tumour growth rate (TGR) were associated with improved survival. Choi criteria were able to capture sunitinib's activity in a clinically significant manner better than RECIST; their implementation in standard clinical practice shall be strongly considered in PanNET patients treated with this drug