Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Insights into mammalian adaptive evolution through genomics data

Although the genome sequencing revolution is still in its infancy, we must acknowledge it as the major driver of biology since the beginning of the 21st century. The availability of a large collection of complete mammalian genomes due to high-throughput sequencing technologies allows us to begin the exploration of how the evolutionary diversification of gene content reflects the ecological adaptations of different taxa. Novelty arises in evolution through the transformation or combination of existing systems and, as shown recently, also from scratch. This thesis is centered around these different mechanisms of evolutionary innovation. It includes a common methodological part in which we propose a simple method to optimize multiple alignments and examine its effect in positive selection analyses, the exploration of the origin and evolution of mammalian-specific genes, and the study of gene regulation in mammalian adaptations (e.g. hibernation) using high-throughput technologies.Tot i que la denominada era de la genòmica es troba encara a la seva infància, ha estat un dels principals impulsors de la biologia des del començament del segle 21. L’accés a una creixent col•lecció de genomes complets de mamífers, gràcies a les tècniques de seqüenciació massiva, ens permet explorar com la diversificació evolutiva dels gens es tradueix en les diferents adaptacions ecològiques dels diferents tàxons. La innovació apareix a l’evolució a través de la transformació o la combinació de sistemes preexistents, fins i tot, nous gens poden aparèixer a partir de regions prèviament no codificants, com s’ha demostrat recentment. Aquesta tesi s’articula al voltant d’aquests mecanismes d’innovació evolutiva. Inclou una part metodològica comuna on es proposa un mètode simple per optimitzar alineaments múltiples i avaluar-ne l’efecte en anàlisis de selecció positiva, l’exploració de l’origen i evolució de gens específics de mamífers i l’estudi de la regulació gènica en una adaptació pròpia dels mamífers (hibernació) mitjançant tècniques de seqüenciació massiva

Insights into mammalian adaptive evolution through genomics data

Although the genome sequencing revolution is still in its infancy, we must acknowledge it as the major driver of biology since the beginning of the 21st century. The availability of a large collection of complete mammalian genomes due to high-throughput sequencing technologies allows us to begin the exploration of how the evolutionary diversification of gene content reflects the ecological adaptations of different taxa. Novelty arises in evolution through the transformation or combination of existing systems and, as shown recently, also from scratch. This thesis is centered around these different mechanisms of evolutionary innovation. It includes a common methodological part in which we propose a simple method to optimize multiple alignments and examine its effect in positive selection analyses, the exploration of the origin and evolution of mammalian-specific genes, and the study of gene regulation in mammalian adaptations (e.g. hibernation) using high-throughput technologies.Tot i que la denominada era de la genòmica es troba encara a la seva infància, ha estat un dels principals impulsors de la biologia des del començament del segle 21. L’accés a una creixent col•lecció de genomes complets de mamífers, gràcies a les tècniques de seqüenciació massiva, ens permet explorar com la diversificació evolutiva dels gens es tradueix en les diferents adaptacions ecològiques dels diferents tàxons. La innovació apareix a l’evolució a través de la transformació o la combinació de sistemes preexistents, fins i tot, nous gens poden aparèixer a partir de regions prèviament no codificants, com s’ha demostrat recentment. Aquesta tesi s’articula al voltant d’aquests mecanismes d’innovació evolutiva. Inclou una part metodològica comuna on es proposa un mètode simple per optimitzar alineaments múltiples i avaluar-ne l’efecte en anàlisis de selecció positiva, l’exploració de l’origen i evolució de gens específics de mamífers i l’estudi de la regulació gènica en una adaptació pròpia dels mamífers (hibernació) mitjançant tècniques de seqüenciació massiva

Stress related TFBS predictions in Drosophila melanogaster and Humans

The dataset consists of the prediction of transcription factor binding sites (ChIP-seq data) and transcription factor binding motifs (Position weight matrices and Transcription factor flexible models) in Drosophila melanogaster and humans.Although transposable elements (TEs) are an important source of regulatory variation, their genome-wide contribution to the transcriptional regulation of stress response genes has not been studied yet. Stress is a major aspect of natural selection in the wild, leading to changes in the transcriptional regulation of a variety of genes that are often triggered by one or a few transcription factors. In this work, we take advantage of the wealth of information available for Drosophila melanogaster and humans to analyze the role of TEs in stress regulatory networks. We used in silico predictions and chromatin immunoprecipitation sequencing (ChIP-seq) data to localize transcription factor binding sites (TFBS) for several stress-response transcription factors involved in six stress regulatory networks: immune, hypoxia, oxidative, xenobiotic, heat shock, and heavymetal stress responses. The predictions at the DNA level were complemented with the analysis of biochemical and genomic features, such as chromatin characteristics and location regarding nearby genes. In addition, we also used population level information to identify a subset of TEs that were more likely to contain functional TFBS. For a representative subset of the most likely candidate TEs, we performed in vivo transgenic reporter assays in different stress conditions. Overall, our results showed that TEs are relevant contributors to the transcriptional regulation of stress response genes.This work was funded by the Ministerio de Economia y Competitividad BFU2014-57779-P, Ministerio de Ciencia, Innovación y Universidades/AEI (BFU2017-82937-P) and the European Commission (H2020-ERC-2014-CoG-647900).Peer reviewe

Diverse families of transposable elements affect the transcriptional regulation of stress-response genes in Drosophila melanogaster

Although transposable elements are an important source of regulatory variation, their genome-wide contribution to the transcriptional regulation of stress-response genes has not been studied yet. Stress is a major aspect of natural selection in the wild, leading to changes in the transcriptional regulation of a variety of genes that are often triggered by one or a few transcription factors. In this work, we take advantage of the wealth of information available for Drosophila melanogaster and humans to analyze the role of transposable elements in six stress regulatory networks: immune, hypoxia, oxidative, xenobiotic, heat shock, and heavy metal. We found that transposable elements were enriched for caudal, dorsal, HSF, and tango binding sites in D. melanogaster and for NFE2L2 binding sites in humans. Taking into account the D. melanogaster population frequencies of transposable elements with predicted binding motifs and/or binding sites, we showed that those containing three or more binding motifs/sites are more likely to be functional. For a representative subset of these TEs, we performed in vivo transgenic reporter assays in different stress conditions. Overall, our results showed that TEs are relevant contributors to the transcriptional regulation of stress-response genes.Ministerio de Economia y Competitividad [BFU2014-57779-P]; Ministerio de Ciencia, Innovación y Universidades/AEI [BFU2017-82937-P]; European Commission [H2020-ERC-2014-CoG-647900]. Funding for open access charge: European Commission [H2020-ERC-2014-CoG-647900]

Improving genome-wide scans of positive selection by using protein isoforms of similar length

Large-scale evolutionary studies often require the automated construction of alignments of a large number of homologous gene families. The majority of eukaryotic genes can produce different transcripts due to alternative splicing or transcription initiation, and many such transcripts encode different protein isoforms. As analyses tend to be gene centered, one single-protein isoform per gene is selected for the alignment, with the de facto approach being to use the longest protein isoform per gene (Longest), presumably to avoid including partial sequences and to maximize sequence information. Here, we show that this approach is problematic because it increases the number of indels in the alignments due to the inclusion of nonhomologous regions, such as those derived from species-specific exons, increasing the number of misaligned positions. With the aim of ameliorating this problem, we have developed a novel heuristic, Protein ALignment Optimizer (PALO), which, for each gene family, selects the combination of protein isoforms that are most similar in length. We examine several evolutionary parameters inferred from alignments in which the only difference is the method used to select the protein isoform combination: Longest, PALO, the combination that results in the highest sequence conservation, and a randomly selected combination. We observe that Longest tends to overestimate both nonsynonymous and synonymous substitution rates when compared with PALO, which is most likely due to an excess of misaligned positions. The estimation of the fraction of genes that have experienced positive selection by maximum likelihood is very sensitive to the method of isoform selection employed, both when alignments are constructed with MAFFT and with Prank(+F). Longest performs better than a random combination but still estimates up to 3 times more positively selected genes than the combination showing the highest conservation, indicating the presence of many false positives. We show that PALO can eliminate the majority of such false positives and thus that it is a more appropriate approach for large-scale analyses than Longest. A web server has been set up to facilitate the use of PALO given a user-defined set of gene families; it is available at http://evolutionarygenomics.imim.es/palo.This work was funded by Ministerio de Economía y Competitividad (FPI BES-2010-038494 to J.L.V.-C., Plan Nacional BIO2009-08160 and BFU2012-36820) and Fundació ICREA to M.M.A

Villanueva-Cañas_etal_families_sequences

Compressed file (.tar.gz) that contains the protein sequences for all gene families generated in the publication Villanueva-Cañas et al. Uncompressing the file will generates a folder with subfolders for the families in each node. It occupies ~7.1 Mb.<br

Villanueva-Cañas_etal_transcript_asemblies.tar.gz

Compressed file (.tar.gz) that contains the sequences of transcripts assembled from RNA-Seq data for different mammalian species. There are two types of files, novel.fa refers to transcripts that did not map to the gene annotations and annotated.fa to transcripts of already annotated genes. The data has been used in the publication Villanueva-Cañas et al. The uncompressed files occupy about 15 Gb.<br><br