EEG recording latency in critically ill patients: Impact on outcome. An analysis of a randomized controlled trial (CERTA).

OBJECTIVE To assess, in adults with acute consciousness impairment, the impact of latency between hospital admission and EEG recording start, and their outcome. METHODS We reviewed data of the CERTA trial (NCT03129438) and explored correlations between EEG recording latency and mortality, Cerebral Performance Categories (CPC), and modified Rankin Scale (mRS) at 6 months, considering other variables, using uni- and multivariable analyses. RESULTS In univariable analysis of 364 adults, median latency between admission and EEG recordings was comparable between surviving (61.1 h; IQR: 24.3-137.7) and deceased patients (57.5 h; IQR: 22.3-141.1); p = 0.727. This did not change after adjusting for potential confounders, such as lower Glasgow Coma Score on enrolment (p < 0.001) and seizure or status epilepticus detection (p < 0.001). There was neither any correlation between EEG latency and mRS (rho 0.087, p 0.236), nor with CPC (rho = 0.027, p = 0.603). CONCLUSION This analysis shows no correlation between delays of EEG recordings and mortality or functional outcomes at 6 months in critically ill adults. SIGNIFICANCE These findings might suggest that in critically ill adults mortality correlates with underlying brain injury rather than EEG delay

Evaluación y comparación de índices de vegetación obtenido con imágenes satelitales Landsat 8.

Los Índice de Vegetación (VI) son combinaciones de bandas espectrales cuya función es diferenciar tipos de cobertura (agua, suelo, vegetación, urbano) y el estado de la vegetación a partir de su respuesta espectral. Se realizó una revisión bibliográfica de índices de vegetación, de los que se seleccionaron 13: RVI, NDVI, YVI, PVI, SAVI, ARVI, GEMI, MSAVI, GARI, EVI, GNDVI, DVI y TVI. Los índices se aplicaron y analizaron en un estudio multitemporal, teniendo en cuenta las variaciones de precipitación como indicador de clima de la zona con el fin de estudiar el comportamiento de los índices. Se emplearon 2 imágenes Landsat 8- sensor OLI en el área de estudio comprendida entre la región norte y centro del Valle del Cauca, Colombia y coberturas a escala 1:100.000. Para el estudio multitemporal se seleccionaron dos épocas: abril y diciembre del año 2017. Teniendo en cuenta las respuestas espectrales de cada tipo de cobertura (agua, suelo, vegetación, zona urbana) se calcularon los rangos de respuesta de cada índice y se compararon con los valores extraídos de estos, calculados a partir de las imágenes, en la muestra representativa de dichas coberturas. Los resultados obtenidos mostraron que cada índice responde a características como densidad de vegetación, suelo desnudo, nubes y cantidad de agua. Por consiguiente, es importante tener conocimiento de las coberturas que se están evaluando para aplicar un índice que describa realmente el estado de estas. Para facilitar el proceso se desarrolló una interfaz gráfica para calcular los índices en lenguaje Python.PregradoINGENIERO(A) TOPOGRAFIC

Comentarios del artículo: “Niveles de sedentarismo de una institución educativa en Popayán, Colombia”

Sr. Editor, recientemente leímos con interés el artículo publicado en la Revista Universidad y Salud en su volumen 21, número 3, denominado “Niveles de sedentarismo de una institución educativa en Popayán, Colombia, cuyo objetivo fue “determinar los niveles de sedentarismo de los estudiantes de una Institución Educativa de Popayán-Colombia”(1). Felicitamos a los autores por el gran valor y alta pertinencia del artículo en general, cuyos resultados contribuyen a elevar el nivel de conocimiento respecto a los niveles de sedentarismo relacionado a variables sociodemográficas, antropométricas y estilos de vida en niños y adolescentes, sin embargo, con el objetivo de aportar mayor e importante información nos gustaría exponer algunas reflexiones y complementar la información entregada a partir de los resultados, la discusión que se despliega del trabajo y la conclusión de este. Para realizar nuestros comentarios, nos permitimos en la Tabla 1, describir la clasificación para el Índice de Masa corporal (IMC), Circunferencia de Cintura (CC) e Índice Cintura/Cadera (ICC) según los estudios FUPRECOL sobre valores referenciales para escolares de Bogotá-Colombia(2,3)

Perfil morfológico en levantadores de pesas federados de la región de Valparaíso, Chile

Introducción: En la halterofilia los perfiles antropométricos permiten una mejor planificación y ejecución del entrenamiento deportivo. Objetivo: Describir y comparar según sexo, el perfil antropométrico y somatotipo de levantadores de pesas federados de la región de Valparaíso, Chile. Materiales y métodos: Estudio descriptivo, transversal. Participaron 40 adultos levantadores de pesas. La evaluación antropométrica fue realizada utilizando el protocolo de medición y marcaje de la Sociedad Internacional de Avances en Cineantropometría; método pentacompartimental de Ross y Kerr y somatotipo de Heath-Carter. Se aplicó la T de Student para muestras independientes y U Mann-Whitney para comparar características antropométricas entre grupos. El poder estadístico y el tamaño efecto se calculó con “d” de Cohen. Resultados: Existen diferencias significativas entre grupos, para masa muscular relativa (p=0,003; d=0,96) y absoluta (p≤0,001; d=2,42); masa adiposa relativa (p≤0,001; d=1,46); masa ósea absoluta (p≤0,001; d=1,41); masa piel relativa (p≤0,001; d=1,96) y absoluta (p≤0,001; d=0,97); masa residual relativa (p=0,006; d=1,08) y absoluta (p≤0,001; d=2,09), mientras que la distribución del somatotipo clasifica al grupo masculino como Endo-Mesomorfo y al femenino como Mesomorfo–Endomorfo, observando diferencias significativas en el mesomorfismo (p≤0,001; d=1,48). Conclusiones: Existe un predominio del somatotipo mesomórfico, existiendo diferencias significativas en los componentes de composición corporal

Immunotherapy for colorectal cancer: where are we heading?

Introduction: In the last few years, significant advances in molecular biology have provided new therapeutic options for colorectal cancer (CRC). The development of new drugs that target the immune response to cancer cells seems very promising and has already been established for other tumor types. In particular, the use of immune checkpoint inhibitors seems to be an encouraging immunotherapeutic strategy. Areas covered: In this review, the authors provide an update of the current evidence related to this topic, though most immunotherapies are still in early-phase clinical trials for CRC. To understand the key role of immunotherapy in CRC, the authors discuss the delicate balance between immune-stimulating and immune-suppressive networks that occur in the tumor microenvironment. Expert opinion: Modulation of the immune system through checkpoint inhibition is an emerging approach in CRC therapy. Nevertheless, selection criteria that could enable the identification of patients who may benefit from these agents are necessary. Furthermore, potential prognostic and predictive immune biomarkers based on immune and molecular classifications have been proposed. As expected, additional studies are required to develop biomarkers, effective therapeutic strategies and novel combinations to overcome immune escape resistance and enhance effector response

The clinical effectiveness of an integrated multidisciplinary evidence-based program to prevent intraoperative pressure injuries in high-risk children undergoing long-duration surgical procedures: a quality improvement study

The prevention of hospital-acquired pressure injuries (HAPIs) in children undergoing long-duration surgical procedures is of critical importance due to the potential for catastrophic sequelae of these generally preventable injuries for the child and their family. Long-duration surgical procedures in children have the potential to result in high rates of HAPI due to physiological factors and the difficulty or impossibility of repositioning these patients intraoperatively. We developed and implemented a multi-modal, multi-disciplinary translational HAPI prevention quality improvement program at a large European Paediatric University Teaching Hospital. The intervention comprised the establishment of wound prevention teams, modified HAPI risk assessment tools, specific education, and the use of prophylactic dressings and fluidized positioners during long-duration surgical procedures. As part of the evaluation of the effectiveness of the program in reducing intraoperative HAPI, we conducted a prospective cohort study of 200 children undergoing long-duration surgical procedures and compared their outcomes with a matched historical cohort of 200 children who had undergone similar surgery the previous year. The findings demonstrated a reduction in HAPI in the intervention cohort of 80% (p &lt; 0.01) compared to the comparator group when controlling for age, pathology, comorbidity, and surgical duration. We believe that the findings demonstrate that it is possible to significantly decrease HAPI incidence in these highly vulnerable children by using an evidence-based, multi-modal, multidisciplinary HAPI prevention strategy

Report from Working Group 3: Beyond the standard model physics at the HL-LHC and HE-LHC

This is the third out of five chapters of the final report [1] of the Workshop on Physics at HL-LHC, and perspectives on HE-LHC [2]. It is devoted to the study of the potential, in the search for Beyond the Standard Model (BSM) physics, of the High Luminosity (HL) phase of the LHC, defined as $3$ ab$^{-1}$ of data taken at a centre-of-mass energy of 14 TeV, and of a possible future upgrade, the High Energy (HE) LHC, defined as $15$ ab$^{-1}$ of data at a centre-of-mass energy of 27 TeV. We consider a large variety of new physics models, both in a simplified model fashion and in a more model-dependent one. A long list of contributions from the theory and experimental (ATLAS, CMS, LHCb) communities have been collected and merged together to give a complete, wide, and consistent view of future prospects for BSM physics at the considered colliders. On top of the usual standard candles, such as supersymmetric simplified models and resonances, considered for the evaluation of future collider potentials, this report contains results on dark matter and dark sectors, long lived particles, leptoquarks, sterile neutrinos, axion-like particles, heavy scalars, vector-like quarks, and more. Particular attention is placed, especially in the study of the HL-LHC prospects, to the detector upgrades, the assessment of the future systematic uncertainties, and new experimental techniques. The general conclusion is that the HL-LHC, on top of allowing to extend the present LHC mass and coupling reach by $20-50\%$ on most new physics scenarios, will also be able to constrain, and potentially discover, new physics that is presently unconstrained. Moreover, compared to the HL-LHC, the reach in most observables will, generally more than double at the HE-LHC, which may represent a good candidate future facility for a final test of TeV-scale new physics

Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

BACKGROUND: The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration. METHODS: To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets. FINDINGS: Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990. INTERPRETATION: Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action. FUNDING: Bill & Melinda Gates Foundation

Rare coding variants in PLCG2, ABI3, and TREM2 implicate microglial-mediated innate immunity in Alzheimer's disease

We identified rare coding variants associated with Alzheimer’s disease (AD) in a 3-stage case-control study of 85,133 subjects. In stage 1, 34,174 samples were genotyped using a whole-exome microarray. In stage 2, we tested associated variants (P<1×10-4) in 35,962 independent samples using de novo genotyping and imputed genotypes. In stage 3, an additional 14,997 samples were used to test the most significant stage 2 associations (P<5×10-8) using imputed genotypes. We observed 3 novel genome-wide significant (GWS) AD associated non-synonymous variants; a protective variant in PLCG2 (rs72824905/p.P522R, P=5.38×10-10, OR=0.68, MAFcases=0.0059, MAFcontrols=0.0093), a risk variant in ABI3 (rs616338/p.S209F, P=4.56×10-10, OR=1.43, MAFcases=0.011, MAFcontrols=0.008), and a novel GWS variant in TREM2 (rs143332484/p.R62H, P=1.55×10-14, OR=1.67, MAFcases=0.0143, MAFcontrols=0.0089), a known AD susceptibility gene. These protein-coding changes are in genes highly expressed in microglia and highlight an immune-related protein-protein interaction network enriched for previously identified AD risk genes. These genetic findings provide additional evidence that the microglia-mediated innate immune response contributes directly to AD development

Use of continuous and routine electroencephalography in neurocritical ill patients: Impact on outcome. An analysis of a randomized controlled trial (CERTA)

Latence d'enregistrement d’EEG chez les patients présentant un trouble de l’état de conscience : impact sur l’évolution clinique. Une analyse d'un essai contrôlé randomisé (CERTA) Objectif Évaluer l'impact de la latence entre l'admission à l'hôpital et le début de l'enregistrement EEG, ainsi que déterminer le moment de la détection des crises d’épilepsie. Méthode Nous avons analysé les données de CERTA (NCT03129438) et exploré les corrélations entre la latence d'enregistrement EEG et la mortalité, les catégories de performance cérébrale (CPC) et l'échelle de Rankin modifiée (mRS) à 6 mois, en tenant compte d'autres variables, à l'aide d'analyses uni- et multivariées. Nous avons également évalué si la détection des crises d’épilepsie, pendant ou en dehors des heures de bureau, jouait un rôle. Résultat 364 adultes ont été analysés. En analyse univariée, la latence médiane entre l'admission et les enregistrements EEG était comparable entre les patients survivants et les patients décédés (p = 0,727). Il n'y avait aucune corrélation entre la latence EEG et mRS, ni avec CPC. Le moment de la détection des crises n'a pas affecté le pronostic (p = 0,181). Conclusion Cette étude ne montre aucune corrélation entre la latence des enregistrements EEG et l’évolution clinique. De plus, le moment de la détection des crises d’épilepsie ne semble pas jouer de rôle. -- EEG continu versus de routine, chez les patients après un arrêt cardiaque. Analyse d'un essai contrôlé randomisé (CERTA) Introduction L'EEG est essentiel pour évaluer le pronostic chez les patients après un arrêt cardiaque (AC). L'utilisation de l'EEG continu (cEEG) augmente chez les patients aux soins intensifs, mais elle utilise plus de ressources que l'EEG de routine (rEEG). Les études observationnelles n'ont pas montré d'impact majeur du cEEG par rapport au rEEG sur l’évolution clinique, mais les études randomisées manquent. Méthode Nous avons effectué une analyse post hoc d'un essai randomisé (CERTA, NCT03129438) incluant des adultes comateux après AC subissant un cEEG (30-48 heures) ou deux rEEG (20-30 minutes chacun). Nous avons exploré les corrélations entre la mortalité (critère de jugement principal), et Catégories de performances cérébrales (CPC) évaluées en aveugle à 6 mois, en tenant compte d'autres variables pronostiques, à l'aide d'analyses uni- et multivariées. Résultats 112 adultes ont été analysés (52 rEEG, 60 cEEG,). En analyse univariée, la mortalité, CPC 1-2 (bonne évolution) et la mRS étaient comparables entre les groupes EEG. Cela n'a pas changé après l'ajustement par une régression logistique des variables montrant un certain déséquilibre entre les groupes concernant à la fois la mortalité rEEG vs cEEG (p = 0,477) et CPC 1-2 (p = 0,318). Conclusion Cette analyse montre que cEEG et rEEG sont comparables concernant l’évolution clinique de patients comateux survivant à un AC. Cette découverte ne soutient pas l'utilisation systématique du cEEG pour le pronostic de patients après un AC