1,721,095 research outputs found
Caratterizzazione delle AOPP (Advanced Oxidation Protein Products) come indicatori di stress ossidativo e processi infiammatori nella bovina
Full text linkThe aim of this study was to characterize markers of oxidation of proteins in cattle, developing the assay method of AOPP (advanced oxidation protein products).
Using standard commercial proteins (Bovine serum Albumin, bovine g-Globuline), oxidations In vitro were performed with chlorinated oxidant (hypochlorous acid) and hydroperoxide (cumene hydroperoxide) determining the relationship between AOPP and carbonyl groups by spectrophotometric and Western blotting analysis.
The conformational changes of the standards were observed by one-dimensional electrophoresis kept in non-reducing conditions.
In the second part of this project, we have studied the relationship between inflammation indicators and AOPP in both healthy cow and in animals with inflammatory processes, supporting the hypothesis that AOPP are specific indicators of protein oxidation by chlorinated oxidants produced by neutrophilis.
The third part of the work has focused on the production of oxidative standard protein (AOPP-BSA) for the development of ELISA systems to detect autoantibodies directed against epitopes of oxidized proteins.Lo scopo del presente studio è stato quello di caratterizzare indicatori dell’ossidazione delle proteine nella specie bovina, sviluppando la metodica del dosaggio delle AOPP (advanced oxidation protein products).
A partire da standard proteici commerciali (Albumina bovina e g-Globuline bovine) sono state eseguite delle ossidazioni in vitro con ossidante clorurato (acido ipocloroso) ed idroperossido (Cumene idroperossido) determinando la relazione tra AOPP e gruppi carbonilici tramite analisi spettrofotometriche e densitometriche tramite Western blotting. Le modificazioni conformazionali degli standard sono state osservate mediante elettroforesi monodimensionali mantenute in condizioni non riducenti.
La seconda parte del progetto sono state studiate le relazioni tra indicatori del processo infiammatorio e le AOPP in animali sani e/o con processi infiammatori in atto, avvalorando l’ipotesi che le AOPP siano degli indicatori specifici dell’ossidazione proteica da parte di ossidanti clorurati di origine neutrofilica.
La terza parte del lavoro si è focalizzata sulla produzione di standard proteici ossidati (AOPP-BSA) per la messa a punto di sistemi ELISA per l’individuazione di autoanticorpi diretti contro epitopi ossidati delle proteine
Use of a Large Language Model to Identify and Classify Injuries with Free-Text Emergency Department Data
Full text linkThis cross-sectional study assesses the accuracy, sensitivity, and specificity of a large language model used to process unstructured, non-English emergency department (ED) data in medical records
Multistep antimicrobial stewardship intervention on antibiotic prescriptions and treatment duration in children with pneumonia
Full text linkIntroduction The Italian antimicrobial prescription rate is one of the highest in Europe, and antibiotic resistance has become a serious problem with high costs and severe consequences, including prolonged illnesses, the increased period of hospitalization and mortality. Inadequate antibiotic prescriptions have been frequently reported, especially for lower respiratory tract infections (LRTI); many patients receive antibiotics for viral pneumonia or bronchiolitis or broadspectrum antibiotics for not complicated community-acquired pneumonia. For this reason, healthcare organizations need to implement strategies to raise physicians' awareness about this kind of drug and their overall effect on the population. The implementation of antibiotic stewardship programs and the use of Clinical Pathways (CPs) are excellent solutions because they have proven to be effective tools at diagnostic and therapeutic levels. Aims This study evaluates the impact of CPs implementation in a Pediatric Emergency Department (PED), analyzing antibiotic prescriptions before and after the publication in 2015 and 2019. The CP developed in 2019 represents an update of the previous one with the introduction of serum procalcitonin. The study aims to evaluate the antibiotic prescriptions in patients with communityacquired pneumonia (CAP) before and after both CPs (2015 and 2019). Methods The periods analyzed are seven semesters (one before CP-2015 called PRE period, five post CP-2015 called POST 1-5 and 1 post CP-2019 called POST6). The patients have been split into two groups: (i) children admitted to the Pediatric Acute Care Unit (INPATIENTS), and (ii) patients evaluated in the PED and sent back home (OUTPATIENTS). We have analyzed all descriptive diagnosis of CAP (the assessment of episodes with a descriptive diagnosis were conducted independently by two pediatricians) and CAP with ICD9 classification. All antibiotic prescriptions for pediatric patients with CAP were analyzed. Results A drastic reduction of broad-spectrum antibiotics prescription for inpatients has been noticed; from 100.0% in the PRE-period to 66.7% in POST1, and up to 38.5% in POST6. Simultaneously, an increase in amoxicillin use from 33.3% in the PRE-period to 76.1% in POST1 (p-value 0.078 and 0.018) has been seen. The outpatients' group's broad-spectrum antibiotics prescriptions decreased from 54.6% PRE to 17.4% in POST6. Both for outpatients and inpatients, there was a decrease of macrolides. The inpatient group's antibiotic therapy duration decreased from 13.5 days (PRE-period) to 7.0 days in the POST6. Antibiotic therapy duration in the outpatient group decreased from 9.0 days (PRE) to 7.0 days (POST1), maintaining the same value in subsequent periods. Overlapping results were seen in the ICD9 group for both inpatients and outpatients. Conclusions This study shows that CPs are effective tools for an antibiotic stewardship program. Indeed, broad-spectrum antibiotics usage has dropped and amoxicillin prescriptions have increased after implementing the CAP CP-2015 and the 2019 update
A two-tiered high-flow nasal cannula approach to bronchiolitis was associated with low admission rate to intensive care and no adverse outcomes
No full textA SuperLearner-enforced approach for the estimation of treatment effect in pediatric trials
No full textBackground: Randomized Clinical Trials (RCT) represent the gold standard among scientific evidence. RCTs are tailored to control selection bias and the confounding effect of baseline characteristics on the effect of treatment. However, trial conduction and enrolment procedures could be challenging, especially for rare diseases and paediatric research. In these research frameworks, the treatment effect estimation could be compromised. A potential countermeasure is to develop predictive models on the probability of the baseline disease based on previously collected observational data. Machine learning (ML) algorithms have recently become attractive in clinical research because of their flexibility and improved performance compared to standard statistical methods in developing predictive models. Objective: This manuscript proposes an ML-enforced treatment effect estimation procedure based on an ensemble SuperLearner (SL) approach, trained on historical observational data, to control the confounding effect. Methods: The REnal SCarring Urinary infEction trial served as a motivating example. Historical observational study data have been simulated through 10,000 Monte Carlo (MC) runs. Hypothetical RCTs have been also simulated, for each MC run, assuming different treatment effects of antibiotics combined with steroids. For each MC simulation, the SL tool has been applied to the simulated observational data. Furthermore, the average treatment effect (ATE), has been estimated on the trial data and adjusted for the SL predicted probability of renal scar. Results: The simulation results revealed an increased power in ATE estimation for the SL-enforced estimation compared to the unadjusted estimates for all the algorithms composing the ensemble SL
Acute infectious osteomyelitis in children: new treatment strategies for an old enemy
No full textBackground: Acute osteomyelitis still represents a significant clinical challenge, with an increasing incidence in paediatric population. A careful assessment and a rapid diagnosis with proper timing and choice of empirical antimicrobial therapy are necessary to avoid sequelae. The initial treatment should consist of empirical antibiotic therapy, to cover the major responsible pathogens in each age group. Data sources: We made a literature search with PubMed and Cochrane database from 2000 to 2019 in English, French, and Spanish languages using the key words “osteomyelitis, children, clinical, diagnosis, and treatment”. Results: The child’s clinical features, age, and the microbiological profile of the geographic area should be evaluated for diagnosis and in the choice of antibiotic treatment. Latest data suggest the administration of intravenous antibiotics for a short period, with subsequent oral therapy, according to the improvement of clinical status and inflammatory markers. For children older than 3 months, the shift to oral medications is already possible after a short course of intravenous therapy, until recovery. The timing for the shift from cefazolin to cephalexin or cefuroxime, intravenous clindamycin to oral clindamycin, and intravenous ceftriaxone + oxacillin to oral equivalents will be decided according to the improvement of clinical status and inflammatory markers. We also present the approach to osteomyelitis due to difficult pathogens, such as Methicillin-resistant Staphylococcus aureus (MRSA) and Panton-Valentine leukocidin (PVL)-positive S. aureus infections. Conclusion: In this review, we present the current approach to the clinical diagnosis and management of osteomyelitis in childhood, with an update on recent recommendations, as a useful instrument to understand the rationale of antibiotic therapy
Missed intracranial injuries are rare in emergency departments using the PECARN head injury decision rules
No full textPurpose: The PECARN head trauma (HT) prediction rules have been developed to guide computed tomography–related decision-making for children with minor HT (mHT). There are currently limited data on the rate of unscheduled revisits to emergency departments (EDs), and initially missed intracranial injuries, in children with mHT initially assessed using the PECARN rules. This study aimed to fill this gap in knowledge. Methods: Clinical charts of children assessed for mHT over a 5-year period at two EDs that implemented the PECARN rules in Italy and France were reviewed retrospectively. Children who returned to EDs for mHT-related, or potentially related complaints, within 1 month of initial assessment were included. Results: The total number of children with mHT presenting for the first time to the EDs of both sites was 11,749. Overall, 180 (1.5%) unscheduled revisits to the EDs occurred for mHT-related or potentially related complaints. Twenty-three of these 180 patients underwent neuroimaging, and seven had an intracranial injury (including one ischemic stroke). Of these, three were hospitalized and none needed neurosurgery or intensive care. Conclusion: Unscheduled revisits for mHT in EDs using the PECARN rules were very uncommon. Initially missed intracranial injuries were rare, and none needed neurosurgery or intensive care
Congenital malformations in neonates admitted to a neonatal intensive care unit in a low-resource setting
No full textIntroduction: Congenital malformations (CMs) are among the major causes of infant mortality in middle- and low-resource countries. This is the first study describing CMs in neonates admitted to the Neonatal Intensive Care Unit (NICU) of a referral hospital in Mozambique. Methods: We included all neonates with CMs admitted to the NICU of Beira Central Hospital from January 2015 to December 2016. CMs were classified according to the International Classification of Disease (ICD-10). All data were retrieved from medical charts. Results: CMs were found in 143/4767 (3%) neonates admitted to the NICU. The most frequent CMs were musculoskeletal (31%), neurological (18%), multiple congenital anomalies (12%), chromosomopathies (11%), cardiovascular (10%), and gastrointestinal (8%). Forty-three patients (30%) underwent corrective surgery. Overall mortality rate was 50%. Conclusions: The prevalence of CMs was 3%, with a mortality rate of 50%. Alongside implementation of antenatal screening programs, improvement on expertise and postnatal care of CMs are warranted
A Bayesian Sample Size Estimation Procedure Based on a B-Splines Semiparametric Elicitation Method
No full textSample size estimation is a fundamental element of a clinical trial, and a binomial experiment is the most common situation faced in clinical trial design. A Bayesian method to determine sample size is an alternative solution to a frequentist design, especially for studies conducted on small sample sizes. The Bayesian approach uses the available knowledge, which is translated into a prior distribution, instead of a point estimate, to perform the final inference. This procedure takes the uncertainty in data prediction entirely into account. When objective data, historical information, and literature data are not available, it may be indispensable to use expert opinion to derive the prior distribution by performing an elicitation process. Expert elicitation is the process of translating expert opinion into a prior probability distribution. We investigated the estimation of a binomial sample size providing a generalized version of the average length, coverage criteria, and worst outcome criterion. The original method was proposed by Joseph and is defined in a parametric framework based on a Beta-Binomial model. We propose a more flexible approach for binary data sample size estimation in this theoretical setting by considering parametric approaches (Beta priors) and semiparametric priors based on B-splines
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