Functional outcomes in children related to self-care, mobility, and social function after stroke in early childhood: a cohort study

ABSTRACT Background: Stroke has been increasingly recognized as an important morbidity and mortality factor in neonates and children. Children have different and more diverse risk factors than adults, commonly related to an underlying disease. Stroke may compromise functional capacity in children. Few studies have focused on functional outcomes related to activities and participation. Objectives: To investigate post-stroke functionality of children related to self-care, mobility, and social function. Methods: We assessed the functional outcome of 14 children younger than 7.5 years who suffered a stroke in early childhood through the use of the Pediatric Evaluation of Disability Inventory (PEDI). Results: The average age of the sample at assessment was 3.6 ± 1.4 years (2 - 6 years). The average scores in the PEDI functional domains of self-care, mobility, and social function were, respectively, 37.6 ± 15.4, 36.2 ± 15.4, and 48.7 ± 11.1. Children showed age-appropriate functional outcomes in the PEDI functional domains: 71.4% of them in self-care and mobility and 92.9% in social function. Children with bilateral injuries (p = 0.05) and longer hospital stays (r = -0.79, p = 0.001) showed the worst scores in PEDI's social function domains. Conclusions: Overall, our sample of preschool children showed age-appropriate functional outcomes on self-care, mobility, and social function domains after stroke. However, children with bilateral injuries and longer hospital stays showed the worst scores in social function domains. We recommend focusing on functional rehabilitation to promote activities and participation and to monitor the development of children's social skills after stroke.

Red Spot on the European Green Map: Will the Extra Catastrophic Phenomenon Take the Polish Poaching-Pressured Ospreys to the Brink of Extinction?

Poland is the only European country where the Osprey population is declining due to the mortality of adult birds from poaching, which impacts not only single breeding attempts but also the Lifetime Reproductive Success (LRS) of specimens. However, what if there came an extra mortality factor in the moment of the lowest numbers of Osprey, already vulnerable in the country? In the years 2018–2020, we installed 22 trail cameras and five digital cameras (live online video feeds) on the nests. The total failure level observed in cameras (18.5%) was high. We observed, using these cameras, the extra mortality of chicks (10.7% of potentially fledged chicks) and even adult birds by unexpected predation by Northern Goshawk and White-tailed Eagle. This phenomenon is also common in the national population, as we found a total of ten cases of total losses by predators (eight or nine of them were birds of prey), including nests not covered by camera monitoring. The extra adult-predation by Goshawks means an extra drop in LRS. Those adult and chick predations are an example of exceptional catastrophic phenomena, which have been described as the direct cause of the extinction of animal populations throughout history. Only active conservation and stop poaching of the Polish population could stop the decline and save the Polish Ospreys.

Alteration of serum leptin and LEP/LEPR promoter methylation in Prader-Willi syndrome

Prader-Willi syndrome (PWS) is a rare neurodevelopmental disorder based on a loss of paternally expressed but maternally imprinted genes in chromosome region 15q11-13. During child development, PWS usually results in insatiable appetite with subsequent obesity representing the major mortality factor. The neurobiological basis of PWS-typical hyperphagia has remained poorly understood. Many PWS-typical abnormalities are based on hypothalamic dysregulation, the region in which hunger and satiety are hormonally regulated, with the hormone leptin being a main long-term regulator of satiety. Previous studies in PWS have inconsistently shown leptin alterations solely in early childhood, without investigating the leptin system on an epigenetic level. The present study investigates serum leptin levels (S-leptin) and methylation of the leptin (LEP) and leptin receptor gene (LEPR) promoter in 24 individuals with PWS compared to 13 healthy controls matched for sex, age, and body mass index (BMI) and relates the results to the extent of hyperphagia in PWS. S-Leptin levels were obtained by Enzyme-linked Immunosorbent Assay. LEP/LEPR-promoter methylation was assessed by DNA-bisulfite-sequencing, hyperphagia by Hyperphagia Questionnaire for Clinical Trials (HQ-CT). PWS and control groups differed significantly in S-leptin levels with higher S-leptin in PWS. Methylation analysis showed significant differences in mean promoter methylation rate both for LEP and LEPR with a lower methylation rate in PWS. LEPR, but not LEP methylation correlated with S-leptin levels. S-leptin and both LEP and LEPR methylation did not correlate with HQ-CT scores in PWS. The present study is the first to show significantly elevated S-leptin levels in an adult PWS cohort combined with an altered, downregulated LEP and LEPR promoter methylation status compared to BMI-matched controls. Analogous to previous studies, no link to the behavioral dimension could be drawn. Overall, the results suggest an increased leptin dysregulation in PWS, whereby the findings partly mirror leptin resistance seen in non-syndromic obesity.

Residual Lesion Diagnostics in Pediatric Postcardiotomy Extracorporeal Membrane Oxygenation and Its Outcomes

Background: To assess the impact of diagnostic procedures in identifying residual lesions during extracorporeal membrane oxygenation (ECMO) on survival after pediatric cardiac surgery. Methods: Between January 2012 and December 2017, 74 patients required postcardiotomy ECMO. Patients were retrospectively divided into 2 groups: Group I underwent only echocardiography ([echo only] 46 patients, 62.2%) and group II (echo+) underwent additional diagnostic tests (ie, computed tomography [CT] or cardiac catheterization; 28 patients, 37.8%). Propensity score matching was used to balance the 2 groups by baseline characteristics. Results: Two equal groups (28 patients in each group) were formed by propensity score matching. Fourteen (50%) patients in the echo-only group and 20 (71%) patients in the echo+ group were successfully weaned from ECMO ( P = .17). Four (14.3%) patients survived in the echo-only group and 15 (53.5%) patients survived in the echo+ group ( P = .004). Patients in the echo+ group had a lower chance of dying compared to the echo-only group (odds ratio, 0.14.6; 95% CI, 0.039-0.52; P = .003). The residual lesions, which may have served as a mortality factor, were found by autopsy in 8 (40%) patients in the echo-only group, while none were found in the echo+ group ( P = .014). Conclusions: The autopsies of patients who died despite postcardiotomy ECMO support showed that in 40% of cases that had been investigated by echo only, residual lesions that had not been detected by echocardiography were present. The cardiac catheterization and CT during ECMO are effective and safe for identifying residual lesions. Early detection and repair of residual lesions may increase the survival rate of pediatric cardiac patients on ECMO.

Highly diverse flavobacterial phages isolated from North Sea spring blooms

It is generally recognized that phages are a mortality factor for their bacterial hosts. This could be particularly true in spring phytoplankton blooms, which are known to be closely followed by a highly specialized bacterial community. We hypothesized that phages modulate these dense heterotrophic bacteria successions following phytoplankton blooms. In this study, we focused on Flavobacteriia, because they are main responders during these blooms and have an important role in the degradation of polysaccharides. A cultivation-based approach was used, obtaining 44 lytic flavobacterial phages (flavophages), representing twelve new species from two viral realms. Taxonomic analysis allowed us to delineate ten new phage genera and ten new families, from which nine and four, respectively, had no previously cultivated representatives. Genomic analysis predicted various life styles and genomic replication strategies. A likely eukaryote-associated host habitat was reflected in the gene content of some of the flavophages. Detection in cellular metagenomes and by direct-plating showed that part of these phages were actively replicating in the environment during the 2018 spring bloom. Furthermore, CRISPR/Cas spacers and re-isolation during two consecutive years suggested that, at least part of the new flavophages are stable components of the microbial community in the North Sea. Together, our results indicate that these diverse flavophages have the potential to modulate their respective host populations.

ClusterMix K-Prototypes Algorithm to Capture Variable Characteristics of Patient Mortality With Heart Failure

Cardiovascular Disease (CVD) is one of the leading causes of many death worldwide, leading to heart failure incidence. The World Health Organization (WHO) says the number of people dying from cardiovascular disease from heart failure each year has an average of 17,9 million deaths each year, about 31 percent of the total deaths globally. Identify the mortality factors of heart failure patients that need to be formed, which reduces death due to heart failure. One of them is by using variable mortality due to heart failure by applying the k-prototypes algorithm. The clustering result is formed 2 clusters that are considered optimal based on the highest silhouette coefficient value of 0,5777. The results of the study were carried out as segmentation of patients with variable mortality of heart failure patients, which showed that cluster 1 is a cluster of patients who have a low risk of the chance of mortality due to heart failure and cluster 2 is a cluster of patients with a high risk of mortality due to heart failure. The segmentation is based on the average value of each variable of heart failure mortality factor in each cluster compared to normal conditions in serum creatine variables, ejection fraction, age, serum sodium, blood pressure, anemia, creatinine phosphokinase, platelets, smoking, gender, and diabetes.

Highly diverse flavobacterial phages isolated from North Sea spring blooms

It is generally recognized that phages are a mortality factor for their bacterial hosts. This could be particularly true in spring phytoplankton blooms, which are known to be closely followed by a highly specialized bacterial community. We hypothesized that phages modulate these dense heterotrophic bacteria successions following phytoplankton blooms. In this study, we focused on Flavobacteriia, because they are main responders during these blooms and have an important role in the degradation of polysaccharides. A cultivation-based approach was used, obtaining 44 lytic flavobacterial phages (flavophages), representing twelve new species from two viral realms. Taxonomic analysis allowed us to delineate ten new phage genera and ten new families, from which nine and four, respectively, had no previously cultivated representatives. Genomic analysis predicted various life styles and genomic replication strategies. A likely eukaryote-associated host habitat was reflected in the gene content of some of the flavophages. Detection in cellular metagenomes and by direct-plating showed that part of these phages were actively replicating in the environment during the 2018 spring bloom. Furthermore, CRISPR/Cas spacers and re-isolation during two consecutive years suggested that, at least part of the new flavophages are stable components of the microbial community in the North Sea. Together, our results indicate that these diverse flavophages have the potential to modulate their respective host populations.

Observations on recent mass mortality events of marine mussels in the Oosterschelde, the Netherlands

Two mass mortality events (MMEs) of marine mussels that took place in the Oosterschelde, the Netherlands—the first in 2015/2016 and the second in 2019—both severely affected mussel production. The current study presents our observations on the onset and course of both MMEs and discusses probable putative causes. The two MMEs displayed a distinct course of events. The first event started in November 2015 with high mortality rates on culture plots, which remained elevated until the autumn of 2016. Approximately 40–50% of mussels from all age classes were lost on culture plots and 100% were lost from wild seed beds. The second event started in April–May 2019 and continued until the end of July, with mortality ranging from 20 to 100%, again from all age classes. Culture areas other than the Oosterschelde and other shellfish species were not affected. Histological and bacteriological screening produced no evidence for common pathogens or pollution as a primary mortality factor and there is no indication of abnormal environmental conditions preceding or during the events. We hypothesize that a cumulation of stressors results in weakening of the mussels and in elevated mortality rates. In 2019, this cumulation of stressors could be high spawning activities (an unusual high concentration of mussel larvae was found in April) that resulted in very low condition from April to June, a Phaeocystis bloom in April to May that prevented a quick recovery, and the development of granulocytomas that were found in up to 60 to 70% of live mussels as a consequence of cumulative stress. Although no (single) putative causes could be identified, this study contributes to the knowledge on MMEs in mussels and fits in a wider and disturbing trend on mortality events in shellfish.

Could Gnomoniopsis castaneae Be Used as a Biological Control Agent against Insect Pests?

Gnomoniopsis castaneae is the cause of the chestnut brown rot but has been also regarded as an important mortality factor for the chestnut gall wasp Dryocosmus kuriphilus. The question to whether G. castaneae could serve as a natural biocontrol agent against insect pests is investigated in the present study. We used three serious insect pests as experimental model insects: Plodia interpuctella and Trogoderma granarium, which are important pests of stored products, and Myzus persicae, a cosmopolitan, serious pest of annual and perennial crop plants. Although chemical pesticides represent effective control means, they are also related to several environmental and health risks. In search for alternative pest management methods, scientific interest has been focused, inter alia, on the use of entomopathogenic fungi. While Isaria fumosorosea has long been recognized as an effective control agent against several pests, G.castaneae has been very little studied. The present study examined whether and to what extent G. castaneae and I. fumosorosea exhibit insecticidal activity against fourth-instar larvae of P. interpunctella and T. granarium and adults of M. persicae. Mortality was examined in interrelation with dosage and time exposure intervals. Both fungi exhibited pesticidal action. However, G. castaneae induced noteworthy mortality only at very high doses. In general, we concluded that G. castaneae failed to cause high insect pathogenicity at normal doses and may not be an efficient biocontrol agent compared with other entomopathogens. On the other hand, our study reiterates the pathogenic potential of I. fumosorosea. More studies are needed to further our insight into the potential of EF species as a component of IPM.