Phylogenetic position of a whale-fall lancelet (Cephalochordata) inferred from whole mitochondrial genome sequences

<p>Abstract</p> <p>Background</p> <p>The lancelet <it>Asymmetron inferum </it>(subphylum Cephalochordata) was recently discovered on the ocean floor off the southwest coast of Japan at a depth of 229 m, in an anaerobic and sulfide-rich environment caused by decomposing bodies of the sperm whale <it>Physeter macrocephalus</it>. This deep sulfide-rich habitat of <it>A. inferum </it>is unique among the lancelets. The distinguishing adaptation of this species to such an extraordinary habitat can be considered in a phylogenetic framework. As the first step of reconstruction of the evolutionary processes in this species, we investigated its phylogenetic position based on 11 whole mitochondrial genome sequences including the newly determined ones of the whale-fall lancelet <it>A. inferum </it>and two coral-reef congeners.</p> <p>Results</p> <p>Our phylogenetic analyses showed that extant lancelets are clustered into two major clades, the <it>Asymmetron </it>clade and the <it>Epigonichthys </it>+ <it>Branchiostoma </it>clade. <it>A. inferum </it>was in the former and placed in the sister group to <it>A. lucayanum </it>complex. The divergence time between <it>A. inferum </it>and <it>A. lucayanum </it>complex was estimated to be 115 Mya using the penalized likelihood (PL) method or 97 Mya using the nonparametric rate smoothing (NPRS) method (the middle Cretaceous). These are far older than the first appearance of large whales (the middle Eocene, 40 Mya). We also discovered that <it>A. inferum </it>mitogenome (mitochondrial genome) has been subjected to large-scale gene rearrangements, one feature of rearrangements being unique among the lancelets and two features shared with <it>A. lucayanum </it>complex.</p> <p>Conclusion</p> <p>Our study supports the monophyly of genus <it>Asymmetron </it>assumed on the basis of the morphological characters. Furthermore, the features of the <it>A. inferum </it>mitogenome expand our knowledge of variation within cephalochordate mitogenomes, adding a new case of transposition and inversion of the <it>trnQ </it>gene. Our divergence time estimation suggests that <it>A. inferum </it>remained a member of the Mesozoic and the early Cenozoic large vertebrate-fall communities before shifting to become a whale-fall specialist.</p

Portable Health Clinic Packages for BoP

The 14th World Congress on Medical and Health Informatics(Medinfo2013), 20-23 August, 2013,Copenhagen, Denmar

Impact of a learning health system on acute care and medical complications after intracerebral hemorrhage

Introduction: Patients with stroke often experience pneumonia during the acute stage after stroke onset. Oral care may be effective in reducing the risk of stroke‐associated pneumonia (SAP). We aimed to determine the changes in oral care, as well as the incidence of SAP, in patients with intracerebral hemorrhage, following implementation of a learning health system in our hospital. Methods: We retrospectively analyzed the data of 1716 patients with intracerebral hemorrhage who were hospitalized at a single stroke center in Japan between January 2012 and December 2018. Data were stratified on the basis of three periods of evolving oral care: period A, during which conventional, empirically driven oral care was provided (n = 725); period B, during which standardized oral care was introduced, with SAP prophylaxis based on known risk factors (n = 469); and period C, during which oral care was risk‐appropriate based on learning health system data (n = 522). Logistic regression analysis was performed to evaluate associations between each of the three treatment approaches and the risk of SAP. Results: Among the included patients, the mean age was 71.3 ± 13.6 years; 52.6% of patients were men. During the course of each period, the frequency of oral care within 24 hours of admission increased (P < .001), as did the adherence rate to oral care ≥3 times per day (P < .001). After adjustment for confounding factors, a change in the risk of SAP was not observed in period B; however, the risk significantly decreased in period C (odds ratio 0.61; 95% confidence interval 0.43‐0.87) compared with period A. These associations were maintained for SAP diagnosed using strict clinical criteria or after exclusion of 174 patients who underwent neurosurgical treatment. Conclusions: Risk‐appropriate care informed by the use of learning health system data could improve care and potentially reduce the risk of SAP in patients with intracerebral hemorrhage in the acute stage

Health Checkup and Telemedical Intervention Program for Preventive Medicine in Developing Countries: Verification Study

Background: The prevalence of non-communicable diseases is increasing throughout the world, including developing countries. / Objective: The intent was to conduct a study of a preventive medical service in a developing country, combining eHealth checkups and teleconsultation as well as assess stratification rules and the short-term effects of intervention. / Methods: We developed an eHealth system that comprises a set of sensor devices in an attaché case, a data transmission system linked to a mobile network, and a data management application. We provided eHealth checkups for the populations of five villages and the employees of five factories/offices in Bangladesh. Individual health condition was automatically categorized into four grades based on international diagnostic standards: green (healthy), yellow (caution), orange (affected), and red (emergent). We provided teleconsultation for orange- and red-grade subjects and we provided teleprescription for these subjects as required. / Results: The first checkup was provided to 16,741 subjects. After one year, 2361 subjects participated in the second checkup and the systolic blood pressure of these subjects was significantly decreased from an average of 121 mmHg to an average of 116 mmHg (P<.001). Based on these results, we propose a cost-effective method using a machine learning technique (random forest method) using the medical interview, subject profiles, and checkup results as predictor to avoid costly measurements of blood sugar, to ensure sustainability of the program in developing countries. / Conclusions: The results of this study demonstrate the benefits of an eHealth checkup and teleconsultation program as an effective health care system in developing countries

Radial Shortening Osteotomy Using Volar Locking Plate for Kienb&ouml;ck\u27s Disease

Purpose:The purpose of this study was to report the preliminary results for radial shortening osteotomyfollowed by volar locking plate fixation without post-operative immobilization for the treatment of Kienb&ouml;ck\u27sdisease.Methods:Ten consecutive patients with Kienb&ouml;ck\u27s disease of stages III were treated by radial shorteningosteotomy at the metaphysis using a volar locking plate system. Radial shortening osteotomy was performed for patients with negative or neutral ulnar variance, and combined shortening of radius and ulna for those with positive ulnar variance. The active motion of the digits, wrist, and forearm was encouraged immediately after surgery, and no splints were used.Results:The average follow-up was 26 months. In all the patients, the osteotomized bone united after an average of 11 weeks. Follow-up radiographs showed no further progression of the disease in carpal height,St&aring;hl\u27s index, or Lichtman\u27s stage classification. Moderate pain reported by all the patients preoperativelysignificantly improved by the final follow-up. Wrist extension, flexion, grip strength, and the Mayo wrist score were significantly improved compared with preoperative values.Conclusions:Volar locking plate fixation without immobilization is a safe and effective procedure for radial shortening osteotomy of Kienb&ouml;ck\u27s disease

Reducing the Clinical and Public Health Burden of Familial Hypercholesterolemia A Global Call to Action

Q1Q1Artículo completoE1-E13IMPORTANCE Familial hypercholesterolemia (FH) is an underdiagnosed and undertreated genetic disorder that leads to premature morbidity and mortality due to atherosclerotic cardiovascular disease. Familial hypercholesterolemia affects 1 in 200 to 250 people around the world of every race and ethnicity. The lack of general awareness of FH among the public and medical community has resulted in only 10% of the FH population being diagnosed and adequately treated. The World Health Organization recognized FH as a public health priority in 1998 during a consultation meeting in Geneva, Switzerland. The World Health Organization report highlighted 11 recommendations to address FH worldwide, from diagnosis and treatment to family screening and education. Research since the 1998 report has increased understanding and awareness of FH, particularly in specialty areas, such as cardiology and lipidology. However, in the past 20 years, there has been little progress in implementing the 11 recommendations to prevent premature atherosclerotic cardiovascular disease in an entire generation of families with FH. OBSERVATIONS In 2018, the Familial Hypercholesterolemia Foundation and the World Heart Federation convened the international FH community to update the 11 recommendations. Two meetings were held: one at the 2018 FH Foundation Global Summit and the other during the 2018 World Congress of Cardiology and Cardiovascular Health. Each meeting served as a platform for the FH community to examine the original recommendations, assess the gaps, and provide commentary on the revised recommendations. The Global Call to Action on Familial Hypercholesterolemia thus represents individuals with FH, advocacy leaders, scientific experts, policy makers, and the original authors of the 1998 World Health Organization report. Attendees from 40 countries brought perspectives on FH from low-, middle-, and high-income regions. Tables listing country-specific government support for FH care, existing country-specific and international FH scientific statements and guidelines, country-specific and international FH registries, and known FH advocacy organizations around the world were created. CONCLUSIONS AND RELEVANCE By adopting the 9 updated public policy recommendations created for this document, covering awareness; advocacy; screening, testing, and diagnosis; treatment; family-based care; registries; research; and cost and value, individual countries have the opportunity to prevent atherosclerotic heart disease in their citizens carrying a gene associated with FH and, likely, all those with severe hypercholesterolemia as well