4,152 research outputs found
Ultrasonic locating devices for central venous cannulation: meta-analysis
OBJECTIVES: To assess the evidence for the clinical
effectiveness of ultrasound guided central venous
cannulation.
DATA SOURCES: 15 electronic bibliographic databases,
covering biomedical, science, social science, health
economics, and grey literature.
DESIGN: Systematic review and meta-analysis of
randomised controlled trials.
POPULATIONS: Patients scheduled for central venous
access.
INTERVENTION REVIEWED: Guidance using real time two
dimensional ultrasonography or Doppler needles and
probes compared with the anatomical landmark
method of cannulation.
DATA EXTRACTION: Risk of failed catheter placement
(primary outcome), risk of complications from
placement, risk of failure on first attempt at
placement, number of attempts to successful
catheterisation, and time (seconds) to successful
catheterisation.
DATA SYNTHESIS: 18 trials (1646 participants) were
identified. Compared with the landmark method, real
time two dimensional ultrasound guidance for
cannulating the internal jugular vein in adults was
associated with a significantly lower failure rate both
overall (relative risk 0.14, 95% confidence interval
0.06 to 0.33) and on the first attempt (0.59, 0.39 to
0.88). Limited evidence favoured two dimensional
ultrasound guidance for subclavian vein and femoral
vein procedures in adults (0.14, 0.04 to 0.57 and 0.29,
0.07 to 1.21, respectively). Three studies in infants
confirmed a higher success rate with two dimensional
ultrasonography for internal jugular procedures (0.15,
0.03 to 0.64). Doppler guided cannulation of the
internal jugular vein in adults was more successful
than the landmark method (0.39, 0.17 to 0.92), but the
landmark method was more successful for subclavian
vein procedures (1.48, 1.03 to 2.14). No significant
difference was found between these techniques for
cannulation of the internal jugular vein in infants. An
indirect comparison of relative risks suggested that
two dimensional ultrasonography would be more
successful than Doppler guidance for subclavian vein
procedures in adults (0.09, 0.02 to 0.38).
CONCLUSIONS: Evidence supports the use of two
dimensional ultrasonography for central venous
cannulation
The prevalence of medical reasons for non-participation in the Scottish breast and bowel cancer screening programmes
Objective: Increasing uptake of cancer screening is a priority for health systems internationally, however, some patients may not attend because they are undergoing active treatment for the cancer of interest or have other medical reasons that mean participation would be inappropriate. This study aims to quantify the proportion of non-participants who have a medical reason for not attending cancer screening.<p></p>
Methods: Medical reasons for not participating in breast and bowel screening were defined a priori on the basis of a literature review and expert opinion. The notes of 700 patients at two GP practices in Scotland were reviewed, to ascertain the prevalence of medical reasons amongst non-participants. Simple proportions and confidence intervals were calculated.<p></p>
Results: 17.4% of breast and 2.3% of bowel screening non-participants had a medical reason to not participate. The two most common reasons were previous breast cancer follow up (8.86%) and recent mammogram (6.57%).<p></p>
Conclusion: These patients may not benefit from screening while also being distressed by receiving an invitation. This issue also makes accurate monitoring and target-setting for improving uptake difficult. Further work is needed to estimate robustly the extent to which medical reasons account for screening non-participation in a larger population.<p></p>
Quantum Chessboards in the Deuterium Molecular Ion
We present a new algorithm for vibrational control in deuterium molecules
that is feasible with current experimental technology. A pump mechanism is used
to create a coherent superposition of the D2+ vibrations. A short, intense
infrared control pulse is applied after a chosen delay time to create selective
interferences. A `chessboard' pattern of states can be realized in which a set
of even- or odd-numbered vibrational states can be selectively annihilated or
enhanced. A technique is proposed for experimental realization and observation
of this effect using 5 fs pulses of 790 nm radiation, with intermediate
intensity (5e13 W/cm2)Comment: 12 pages, 5 figure
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ESICM LIVES 2017 : 30th ESICM Annual Congress. September 23-27, 2017.
INTRODUCTION. Unplanned readmission to intensive care is highly
undesirable in that it contributes to increased variance in care,
disruption, difficulty in resource allocation and may increase length
of stay and mortality particularly if subject to delays. Unlike the ICU
admission from the ward, readmission prediction has received
relatively little attention, perhaps in part because at the point of ICU
discharge, full physiological information is systematically available to
the clinician and so it is expected that readmission should be largely
due to unpredictable factors. However it may be that there are
multidimensional trends that are difficult for the clinician to perceive
that may nevertheless be predictive of readmission.
OBJECTIVES. We investigated whether machine learning (ML)
techniques could be used to improve on the simple published SWIFT
score [1] for the prediction of unplanned readmission to ICU within
48 hours.
METHODS. We extracted systolic BP, pulse pressure, heart and
respiration rate, temperature, SpO2, bilirubin, creatinine, INR, lactate,
white cell count, platelet count, pH, FiO2, and total Glasgow Coma
Score from ICU stays of over 2000 adult patients from our hospital
electronic patient record system. We trained our own custom
multidimensional / time-sensitive algorithmic ML system to predict
failed discharges defined as either readmission or unexpected death
within 48 hours of discharge. We used 10-fold cross validation to assess performance. We also assessed the effect of augmenting our
system by transfer learning (TL) with 44,000 additional cases from
the MIMIC III database.
RESULTS. The SWIFT score performed relatively poorly with an
AUROC of around 0.6 which our ML system trained on local data was
also able to match. However when augmented with an additional
dataset by TL, the AUROC for the ML system improved statistically
and clinically significantly to over 0.7.
CONCLUSIONS. Machine learning is able to improve on predictors
based on simple multiple logistic regression. Thus there is likely to
be information in the trends and in combinations of variables. A
disadvantage with this technique is that ML approaches require large
amounts of data for training. However, ML approaches can be
improved by TL. Basing prediction models on locally derived data
augmented by TL is a potentially novel approach to generating tools
that customised to the institution yet can exploit the potential power
of ML algorithms.
REFERENCES
[1] Gajic O, Malinchoc M, Comfere TB, et al. The Stability and
Workload Index for Transfer score predicts unplanned intensive care
unit patient readmission: initial development and validation. Crit Care
Med. 2008;36(3):676–82.
Grant Acknowledgement
This work was internally funded
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A single H/ACA small nucleolar RNA mediates tumor suppression downstream of oncogenic RAS.
Small nucleolar RNAs (snoRNAs) are a diverse group of non-coding RNAs that direct chemical modifications at specific residues on other RNA molecules, primarily on ribosomal RNA (rRNA). SnoRNAs are altered in several cancers; however, their role in cell homeostasis as well as in cellular transformation remains poorly explored. Here, we show that specific subsets of snoRNAs are differentially regulated during the earliest cellular response to oncogenic RASG12V expression. We describe a novel function for one H/ACA snoRNA, SNORA24, which guides two pseudouridine modifications within the small ribosomal subunit, in RAS-induced senescence in vivo. We find that in mouse models, loss of Snora24 cooperates with RASG12V to promote the development of liver cancer that closely resembles human steatohepatitic hepatocellular carcinoma (HCC). From a clinical perspective, we further show that human HCCs with low SNORA24 expression display increased lipid content and are associated with poor patient survival. We next asked whether ribosomes lacking SNORA24-guided pseudouridine modifications on 18S rRNA have alterations in their biophysical properties. Single-molecule Fluorescence Resonance Energy Transfer (FRET) analyses revealed that these ribosomes exhibit perturbations in aminoacyl-transfer RNA (aa-tRNA) selection and altered pre-translocation ribosome complex dynamics. Furthermore, we find that HCC cells lacking SNORA24-guided pseudouridine modifications have increased translational miscoding and stop codon readthrough frequencies. These findings highlight a role for specific snoRNAs in safeguarding against oncogenic insult and demonstrate a functional link between H/ACA snoRNAs regulated by RAS and the biophysical properties of ribosomes in cancer
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