scholarly journals Retrospective study of prognostic factors in pediatric invasive pneumococcal disease

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e2941 ◽  
Author(s):  
Nan-Chang Chiu ◽  
Hsin Chi ◽  
Chun-Chih Peng ◽  
Hung-Yang Chang ◽  
Daniel Tsung-Ning Huang ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Mortality Rate ◽  
Invasive Pneumococcal Disease ◽  
Pneumococcal Disease ◽  
Large Scale ◽  
Small Sample Size ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Small Sample ◽  
Significant Prognostic Factor

Streptococcus pneumoniaeremains the leading causative pathogen in pediatric pneumonia and bacteremia throughout the world. The invasive pneumococcal disease (IPD) is known as isolation ofS. pneumoniaefrom a normally sterile site (e.g., blood, cerebrospinal fluid, synovial fluid, pericardial fluid, pleural fluid, or peritoneal fluid). The aim of this study is to survey the clinical manifestations and laboratory results of IPD and identify the prognostic factors of mortality. From January 2001 to December 2006, a retrospective review of chart was performed in a teaching hospital in Taipei. The hospitalized pediatric patients with the diagnosis of pneumonia, arthritis, infectious endocarditis, meningitis or sepsis were recruited. Among them, 50 patients were pneumococcal infections proved by positive culture results or antigen tests. Clinical manifestations, laboratory data and hospitalization courses were analyzed. The median age was 3.5-year-old and there were 30 male patients (60%). Eight patients (16%) had underlying disease such as leukemia or congenital heart disease. Hemolytic uremic syndrome (HUS) was observed in ten patients and extracorporeal membrane oxygenation (ECMO) was performed in three patients. Leukocytosis, elevated C-reactive protein and AST level were noted in most of the patients. The overall mortality rate was 10%. We found that leukopenia, thrombocytopenia and high CRP level were significant predictors for mortality. In conclusion,S. pneumoniaeremains an important health threat worldwide and IPD is life-threatening with high mortality rate. We found leukopenia, thrombocytopenia, and high CRP levels to be associated with mortality in pediatric IPD, and these factors are worthy of special attention at admission. Although we failed to identify a statistically significant prognostic factor in multivariate analysis due to relatively small sample size, we suggest an aggressive antibiotic treatment in patients with these factors at admission. Further large-scale studies are warranted.

scholarly journals Streptococcus pneumoniaemeningitis in Alberta pre- and postintroduction of the 7-valent pneumococcal conjugate vaccine

2011 ◽  
Vol 22 (4) ◽  
pp. 137-141 ◽  
Author(s):  
Jennie Johnstone ◽  
Gregory J. Tyrrell ◽  
Thomas J. Marrie ◽  
Sipi Garg ◽  
James D. Kellner ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Mortality Rate ◽  
Conjugate Vaccine ◽  
Invasive Pneumococcal Disease ◽  
High Mortality ◽  
Clinical Characteristics ◽  
Pneumococcal Disease ◽  
Laboratory Data ◽  
Appropriate Therapy ◽  
Meningitis In Children

The objective of this study was to describe the epidemiology, clinical characteristics, microbiology and outcomes of patients of all ages withStreptococcus pneumoniaemeningitis between 2000 and 2004; two years pre- and postintroduction of anS pneumoniae7-valent conjugate vaccine program in Alberta in children younger than two years of age. The high mortality rate associated withS pneumoniaemeningitis, despite appropriate therapy, suggests that prevention ofS pneumoniaemeningitis is critical. Despite implementation of a PCV-7 program in Alberta, rates ofS pneumoniaemeningitis in children younger than two years of age is still high. Thus, continued research into safe and efficacious vaccines covering a broader range ofS pneumoniaeserotypes is necessary.OBJECTIVE: To describe the epidemiology, clinical characteristics, microbiology and outcomes of patients of all ages withStreptococcus pneumoniaemeningitis two years pre- and postintroduction of aS pneumoniae7-valent conjugate vaccine program in Alberta in children <2 years of age.METHODS: Between 2000 and 2004, all cases of invasive pneumococcal disease in Alberta were identified. From this cohort, patients withS pneumoniaemeningitis were identified by chart review. Clinical data, laboratory data and in-hospital outcomes were collected.RESULTS: Of the 1768 cases of invasive pneumococcal disease identified between 2000 and 2004, 110 (6.2%) hadS pneumoniaemeningitis. The overall incidence was 0.7 per 100,000 persons and remained unchanged over the study period. The rate in children <2 years of age appeared to fall over time, from 10.5 per 100,000 persons in 2000 to five per 100,000 persons in 2004, although there was insufficient evidence of a statistically significant time trend within any age group. Overall, the mean age was 30 years and 47% were male. In-hospital mortality was 20%, ranging from 6% in those ≤2 years of age to 31% for those ≥18 years of age, despite appropriate antimicrobial therapy.CONCLUSION: The high mortality rate associated withS pneumoniaemeningitis suggests that prevention by vaccination is critical. In children <2 years of age, there was a downward trend in the rate ofS pneumoniaemeningitis after implementation of theS pneumoniae7-valent conjugate vaccine program, but rates were still high.

CONTRIBUTION OF DNA COPY-NUMBER VARIATION (CNV) TO CANCER SUSCEPTIBILITY AND LARGE-SCALE GENOME ALTERATIONS IN OSTEOSARCOMA (OS)

2008 ◽  
Vol 31 (4) ◽  
pp. 19
Author(s):  
I Pasic ◽  
A Shlien ◽  
A Novokmet ◽  
C Zhang ◽  
U Tabori ◽  
...  
Keyword(s):  
Genomic Instability ◽  
Large Scale ◽  
Structural Variation ◽  
Age Of Onset ◽  
Cancer Susceptibility ◽  
Small Sample Size ◽  
Snp Array ◽  
Tumour Suppressor Gene ◽  
Small Sample ◽  
International Hapmap Project

Introduction: OS, a common Li-Fraumeni syndrome (LFS)-associated neoplasm, is a common bone malignancy of children and adolescents. Sporadic OS is also characterized by young age of onset and high genomic instability, suggesting a genetic contribution to disease. This study examined the contribution of novel DNA structural variation elements, CNVs, to OS susceptibility. Given our finding of excessive constitutional DNA CNV in LFS patients, which often coincide with cancer-related genes, we hypothesized that constitutional CNV may also provide clues about the aetiology of LFS-related sporadic neoplasms like OS. Methods: CNV in blood DNA of 26 patients with sporadic OS was compared to that of 263 normal control samples from the International HapMap project, as well as 62 local controls. Analysis was performed on DNA hybridized to Affymetrix genome-wide human SNP array 6.0 by Partek Genomic Suite. Results: There was no detectable difference in average number of CNVs, CNV length, and total structural variation (product of average CNV number and length) between individuals with OS and controls. While this data is preliminary (small sample size), it argues against the presence of constitutional genomic instability in individuals with sporadic OS. Conclusion: We found that the majority of tumours from patients with sporadic OS show CN loss at chr3q13.31, raising the possibility that chr3q13.31 may represent a “driver” region in OS aetiology. In at least one OS tumour, which displays CN loss at chr3q13.31, we demonstrate decreased expression of a known tumour suppressor gene located at chr3q13.31. We are investigating the role ofchr3q13.31 in development of OS.

scholarly journals Review of the Studies in the Use of Biofeedback Therapy in Rehabilitation and Physiatrics of Neurological Patients

Doctor Ru ◽  
2021 ◽  
Vol 20 (9) ◽  
pp. 43-47
Author(s):  
E.Yu. Mozheyko ◽  
◽  
O.V. Petryaeva ◽  
◽  
◽  
...  
Keyword(s):  
Large Scale ◽  
Small Sample Size ◽  
Small Sample ◽  
Healthy Population ◽  
Biofeedback Therapy ◽  
Level Of Evidence ◽  
Double Blind ◽  
Key Points ◽  
Neurological Patients ◽  
Drug Free

Objective of the Review: To collect information, analyse and evaluate previous studies in the use of biofeedback in neurological patients. Key Points. Despite the wide practical application and a lot of available publications, the level of evidence of this method is low because of a small sample size and the challenges with biofeedback mechanism description. A review of various types of biocontrol, its mechanisms and developments shows that drug-free therapy using only patient’s resources (organic, psychological, emotional and volitional) can activate the mechanisms of neuroplasticity, which are poorly studied. Still, it does not prevent from using biocontrol for the therapy of patients and/or prevention of various diseases in healthy population. Conclusion. Biofeedback therapy has proven to be a safe, relatively efficient and easy-to-use method. However, organisation of a large-scale double blind randomized trial is one of the predominant directions in the future. Keywords: biofeedback, biocontrol, neurofeedback, biofeedback therapy.

scholarly journals Combining Bayesian Approaches and Evolutionary Techniques for the Inference of Breast Cancer Networks

2017 ◽  
Author(s):  
Stefano Beretta ◽  
Mauro Castelli ◽  
Ivo Gonçalves ◽  
Ivan Merelli ◽  
Daniele Ramazzotti
Keyword(s):  
Breast Cancer ◽  
Graphical Models ◽  
Protein Interactions ◽  
Large Scale ◽  
Small Sample Size ◽  
Small Sample ◽  
Cancer Data ◽  
Correlation Networks ◽  
Model Complex ◽  
Cancer Networks

AbstractGene and protein networks are very important to model complex large-scale systems in molecular biology. Inferring or reverseengineering such networks can be defined as the process of identifying gene/protein interactions from experimental data through computational analysis. However, this task is typically complicated by the enormously large scale of the unknowns in a rather small sample size. Furthermore, when the goal is to study causal relationships within the network, tools capable of overcoming the limitations of correlation networks are required. In this work, we make use of Bayesian Graphical Models to attach this problem and, specifically, we perform a comparative study of different state-of-the-art heuristics, analyzing their performance in inferring the structure of the Bayesian Network from breast cancer data.

scholarly journals Prognostic factors for mortality in invasive pneumococcal disease: a system review and meta-analysis

2021 ◽  
Author(s):  
Hao Chen ◽  
Hiromi Matsumoto ◽  
Nobuyuki Horita ◽  
Yu Hara ◽  
Nobuaki Kobayashi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Nursing Home ◽  
Prognostic Factors ◽  
Nosocomial Infection ◽  
Invasive Pneumococcal Disease ◽  
Pneumococcal Disease ◽  
Meta Analysis ◽  
Solid Organ ◽  
Factors Associated ◽  
Overall Mortality

Abstract Risk factors associated with mortality in invasive pneumococcal disease remain unclear. The present work is a meta-analysis of studies that enrolled only patients with invasive pneumococcal disease and reported on mortality. Potentially eligible reports were identified from PubMed, CHAHL, and Web of Science, comprising 26 reports in total. Overall mortality for invasive pneumococcal disease was reported as 20.8% (95% confidence interval (CI) 17.5–24%). Factors associated with mortality were age (odds ratio (OR) 3.04, 95%CI 2.5–3.68), nursing home (OR 1.62, 95%CI 1.13–2.32), nosocomial infection (OR 2.10, 95%CI 1.52–2.89), septic shock (OR 13.35, 95%CI 4.54–39.31), underlying chronic diseases (OR 2.34, 95%CI 1.78–3.09), solid organ tumor (OR 5.34, 95%CI 2.07–13.74), immunosuppressed status (OR 1.67, 95%CI 1.31–2.14), and alcohol abuse (OR 3.14, 95%CI 2.13–4.64). Mortality rates with invasive pneumococcal disease remained high, and these findings may help clinicians provide appropriate initial treatment for this disease.Key points: The overall mortality rate from IPD has remained high, at 20.8% and older age, septic shock, immunosuppressed status, underlying chronic diseases, solid organ tumor, alcohol abuse, nursing home, and nosocomial infection were prognostic factors for mortality from IPD.

scholarly journals Copy number variation analysis of twin pairs discordant for cleft lip with or without cleft palate

2019 ◽  
Vol 33 ◽  
pp. 205873841985587
Author(s):  
Luca Scapoli ◽  
Francesco Carinci ◽  
Annalisa Palmieri ◽  
Francesca Cura ◽  
Alessandro Baj ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Copy Number ◽  
Large Scale ◽  
Cleft Lip ◽  
Small Sample Size ◽  
Copy Number Variants ◽  
Monozygotic Twins ◽  
Monozygotic Twin ◽  
Small Sample ◽  
High Level

Non-syndromic cleft lip with or without cleft palate (nsCL/P) is a frequent orofacial malformation. The comparison of concordance rate observed in monozygotic and dizygotic twins supports high level of heritability and a strong genetic component. However, phenotype concordance for orofacial cleft in monozygotic twins is about 50%. The aim of the present investigation was to detect postzygotic events that may account for discordance in monozygotic twins. High-density SNP microarrays hybridization was used to genotype two pairs of monozygotic twins discordant for nsCL/P. Discordant SNP genotypes and copy number variants were analyzed to identify genetic differences responsible of phenotype discrepancy. A number of differences were observed, none involving known nsCL/P candidate genes or genomic regions. Considering the limitation of the study, related to the small sample size and to the large-scale investigation method, the results suggest that the detection of discordant events in other monozygotic twin pairs would be remarkable and warrant further investigations.

Estimating the mortality rate of humpback whale calves in the central North Pacific Ocean

2001 ◽  
Vol 79 (4) ◽  
pp. 589-600 ◽  
Author(s):  
Christine M Gabriele ◽  
Janice M Straley ◽  
Sally A Mizroch ◽  
C Scott Baker ◽  
Alison S Craig ◽  
...  
Keyword(s):  
Mortality Rate ◽  
North Pacific ◽  
Small Sample Size ◽  
North Pacific Ocean ◽  
Humpback Whale ◽  
Small Sample ◽  
Humpback Whales ◽  
First Year ◽  
Robust Estimate ◽  
Calf Mortality

Sighting histories of individually identified female humpback whales (Megaptera novaeangliae) in their winter and summer ranges were used to investigate mortality of North Pacific humpback whale calves. We compiled records collected between 1979 and 1995 by eight independent research groups, which yielded 29 cases where 25 different mothers sighted in Hawai'i were identified later the same year in Alaska. In 7 of 29 cases, a calf sighted with its mother in Hawai'i was missing from its mother's Alaska sighting(s). After investigating many factors, we determined that the largest potential bias would occur in late-autumn observations, when calf absences might indicate weaning or temporary mother–calf separation rather than calf mortality. Our minimal and most robust estimate excluded all mortalities and survivals based on sightings of the mother after October 31; 3 of 20 cases or 0.150 (95% confidence intervals (CI) = 0.032, 0.378). The maximal calf mortality rate, derived from all the available data, was 7 of 29 cases or 0.241 (95% CI = 0.103, 0.434). An intermediate estimate that excluded all cases based on single Alaska sightings and omitted late-season sightings (2 of 11 cases or 0.182; 95% CI = 0.023, 0.518) is perhaps closest to the actual first-year mortality rate for humpback whale calves, although it is compromised by its small sample size. Our results demonstrate both the value and the limitations of using longitudinal data to determine the life-history parameters that are essential for documenting the recovery of endangered populations.

Nationwide Trends of Invasive Pneumococcal Disease in Spain From 2009 Through 2019 in Children and Adults During the Pneumococcal Conjugate Vaccine Era

2020 ◽  
Author(s):  
Sara de Miguel ◽  
Mirian Domenech ◽  
Fernando González-Camacho ◽  
Julio Sempere ◽  
Dolores Vicioso ◽  
...  
Keyword(s):  
Invasive Pneumococcal Disease ◽  
Pneumococcal Disease ◽  
National Laboratory ◽  
Laboratory Data ◽  
Pneumococcal Polysaccharide Vaccine ◽  
Conjugate Vaccines ◽  
Spanish Regions ◽  
Herd Protection ◽  
Immunocompetent Adults ◽  
The Impact

Abstract Background Introduction of pneumococcal conjugate vaccines (PCVs) has reduced the disease caused by vaccine serotypes in children, providing herd protection to adults. However, the emergence of nonvaccine serotypes is of great concern worldwide. Methods This study includes national laboratory data from invasive pneumococcal disease (IPD) cases that affected pediatric and adult populations during 2009–2019. The impact of implementing different vaccine strategies for immunocompetent adults by comparing Spanish regions that used the 13-valent PCV (PCV13) vs regions that used the 23-valent pneumococcal polysaccharide vaccine (PPV23) was also analyzed for 2017−2019. Results The overall reductions in IPD cases by PCV13 serotypes in children and adults were 88% and 59%, respectively, during 2009–2019, with a constant increase in serotype 8 in adults since 2015. IPD cases by additional serotypes covered by PPV23 increased from 20% in 2009 to 52% in 2019. In children, serotype 24F was the most frequent in 2019, whereas serotypes 3 and 8 accounted for 36% of IPD cases in adults. Introduction of PCV13 or PPV23 in the adult calendar of certain Spanish regions reduced the IPD cases by PCV13 serotypes by up to 25% and 11%, respectively, showing a decrease of serotype 3 when PCV13 was used. Conclusions Use of PCV13 in children has affected the epidemiology, reducing the burden of IPD in children but also in adults by herd protection; however, the increase in serotype 8 in adults is worrisome. Vaccination with PCV13 in adults seems to control IPD cases by PCV13 serotypes including serotype 3.

Facebook as a platform for co-creating music festival experiences

2016 ◽  
Vol 7 (2) ◽  
pp. 84-99 ◽  
Author(s):  
Emma Hoksbergen ◽  
Andrea Insch
Keyword(s):  
Young Adults ◽  
Large Scale ◽  
Small Sample Size ◽  
Small Sample ◽  
Survey Method ◽  
Future Research ◽  
Content Type ◽  
Music Festival ◽  
Alternative Means ◽  
On Line

Purpose The purpose of this paper is to address the need to understand how younger music festival-goers use and engage with a music festival’s Facebook page, and how they perceive this social networking service (SNS) as a potential on-line platform for value co-creation. Design/methodology/approach Face-to-face in-depth interviews were conducted with 16 young adults who attended an annual New Year’s Eve music festival, Rhythm and Vines, in Gisborne, New Zealand. Findings Analysis of the interview data revealed that the majority of participants did not actively engage with this platform and could be categorised as passive viewers or information-seekers. In addition, participants perceived five types of value from using this SNS: functional, social, emotional, interactive and aesthetic value. Even though participants were not segmented due to the small sample size, patterns in their levels of engagement with Facebook, attendance status, reasons for attending the festival and the combinations of forms of value that they perceived were identified. Research limitations/implications Future research should use a large-scale survey method to obtain a representative sample that is generalisable to a specific population of music festival-goers. Practical implications Dominance of features on Facebook providing festival-goers with functional value suggests they prefer a passive or co-optation approach to value co-creation in this context. Due to the limited extent of participants actively co-creating value on this platform, alternative means of encouraging interaction to co-create value with festival-goers should be investigated. Originality/value This study demonstrates that this SNS provides this group of young adults with a means to connect their real-time festival experience, with their on-line Facebook social network during the year.

ABCA3 Expression Predicts Response to Gemtuzumab Ozogamicin in AML

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3946-3946 ◽  
Author(s):  
Antony Ceraulo ◽  
Aminetou Mint-Mohamed ◽  
Delphine Maucort-Boulch ◽  
Etienne Paubelle ◽  
Xavier Thomas ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Relapse Rate ◽  
Small Sample Size ◽  
Univariate Analysis ◽  
Gemtuzumab Ozogamicin ◽  
Small Sample ◽  
Control Group ◽  
Prognostic Impact ◽  
Significant Difference

Abstract Background. The ATP binding cassette transporter 3 (ABCA3) has been recently found to induce a significant reduction in cytotoxicity following exposure to anthracyclines, mitoxantrone, etoposide, Ara-C, vincristine, and rituximab. ABCA3 acts through the modulation of multivesicular bodies (MVB) and contributes to drug sequestration in late endosomal organelles, i.e. MVB and lysosomes. Studies having investigated the prognostic impact of ABCA3 expression in AML have yielded conflicting results as ABCA3 expression has both been reported to exert unfavorable or neutral effects on patient outcomes. In addition, the small sample size of these studies precluded the use of multivariate analyses. Methods. Our goal was to investigate the prognostic impact of ABCA3 expression in adult patients with AML treated with IC with or without gemtuzumab ozogamicin (GO). To this end we investigated the relationship between ABCA3 expression and EFS in a representative series of 221 AML homogeneously treated in the ALFA-0701 trial. qRTPCR amplification of conserved ABCA3 mRNA sequences, as identified with FasterDB database, was performed with GUS and ABL as reference genes. Primer sets were complementary to conserved ABCA3 exons 6-7 and exon 19-20 junctions. Patients were given a 3+7 induction course without (control group, n=110) or with fractionated intravenous GO (n=111) (Castaigne S, Lancet 2012; 379:1508-1516). Results. Among the 278 randomized patients, 221 had available bone-marrow diagnostic samples with high-quality RNA. The same benefits associated with GO were observed in the 221 patients from the present study as in the entire trial population. Overall, median age, CR rate, relapse rate, median follow-up, 3-years EFS were 62.1 years, 76.5%, 66%, 47.45 months, 28±3%, respectively. There was no significant difference in the level of ABCA3 expression between responders and non-responders. In the 169 responders, ABCA3 expression at diagnosis was more than 3-fold higher in the 111 remitters who subsequently relapsed than in the 58 patients who remained in persistent CR (p=0.033). The level of ABCA3 expression was significantly lower in ELN favorable group than in intermediate and adverse risk AML (p= 0.004) and negatively correlated with CD33 expression (R=-0.272, p<10-4). Through univariate analysis, higher ABCA3 expression was associated with shorter EFS (3-years: 22±3 vs 45±7 % p=0.002). Multivariate analysis identified age, treatment arm, and ELN risk group as independent prognostic factors for EFS. In the control group, there was no significant association between ABCA3 expression and CR rate, relapse rate, and EFS. In the 111 patients within the GO arm, there was no significant difference in the level of ABCA3 expression between responders and non-responder whereas in the 89 responders, ABCA3 expression at diagnosis was more than 7-fold higher in the 53 remitters who subsequently relapsed than in the 36 patients who remained in persistent CR (p=0.006). Through univariate analysis, higher ABCA3 expression was associated with shorter EFS (3-years: 22±5 vs 64±9 % p=0.0002). Multivariate analysis identified ABCA3 expression, cytogenetics, CD33 expression, and ECOG as independent prognostic factors for EFS (Figure 1). Conclusion. WhileABCB1 has been previously found to attenuate GO-induced cytotoxicity in AML cells (Walter RB, Blood 2003; 102:1466-1473), present results indicate that higher ABCA3 expression independently predicts poor outcome in AML patients treated with fractionated GO and intensive chemotherapy (IC). GO is an anti-CD33 antibody carrying a toxic calicheamicin derivative that, after hydrolytic release within lysosomal vesicles, induces DNA strand breaks, apoptosis, and cell death. Whether the clinical effect of ABCA3 expression relies on the modulation of CD33 internalization, calicheamicin release or combination thereof is under investigation. Finally our results encourage inhibiting ABCA3, such as with indomethacin, in order to overcome drug resistance in AML treated with GO-IC. Figure 1 Figure 1. Disclosures Thomas: Pfizer: Consultancy.

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