Patterns of co‐altered brain structure and function underlying neurological soft signs in schizophrenia spectrum disorders

Neurological soft signs (NSS) comprise a broad range of subtle neurological deficits and are considered to represent external markers of sensorimotor dysfunction frequently found in mental disorders of presumed neurodevelopmental origin. Although NSS frequently occur in schizophrenia spectrum disorders (SSD), specific patterns of co‐altered brain structure and function underlying NSS in SSD have not been investigated so far. It is unclear whether gray matter volume (GMV) alterations or aberrant brain activity or a combination of both, are associated with NSS in SSD. Here, 37 right‐handed SSD patients and 37 matched healthy controls underwent motor assessment and magnetic resonance imaging (MRI) at 3 T. NSS were examined on the Heidelberg NSS scale. We used a multivariate data fusion technique for multimodal MRI data—multiset canonical correlation and joint independent component analysis (mCCA + jICA)—to investigate co‐altered patterns of GMV and intrinsic neural fluctuations (INF) in SSD patients exhibiting NSS. The mCCA + jICA model indicated two joint group‐discriminating components (temporoparietal/cortical sensorimotor and frontocerebellar/frontoparietal networks) and one modality‐specific group‐discriminating component (p < .05, FDR corrected). NSS motor score was associated with joint frontocerebellar/frontoparietal networks in SSD patients. This study highlights complex neural pathomechanisms underlying NSS in SSD suggesting aberrant structure and function, predominantly in cortical and cerebellar systems that critically subserve sensorimotor dynamics and psychomotor organization.     

Distribution of ABO blood groups in childhood acute leukemia

The distribution of ABO blood groups was determined in a multicenter study of 682 pediatric patients with acute lymphoblastic leukemia (ALL) and 224 patients with acute myeloid leukemia (AML) up to 12 years old. The overall distribution of blood groups was significantly different in both ALL and AML groups from the control group (p < .001). In the ALL group there were 56.5% (95% CI: 45.8-67.1) more patients with O blood group, 35.8% (95% CI: 27.0-44.5) fewer patients with A blood group, and 26.9% (95% CI: 12.7-39.2) fewer patients with B blood group. In the AML group, there were 28.8% (95% CI: 10.8-46.9) more patients with A blood group. The results indicate that alteration in ABO antigens might be associated with an increased risk of ALL.     

Treatment of persistent alopecia areata with sulfasalazine

Background  Alopecia areata is an autoimmune disease with no definitive treatment, and some cases persist despite standard therapies. Sulfasalazine has been reported to show success in the treatment of persistent cases of alopecia areata.
Objective  To assess the efficacy of sulfasalazine in cases of recalcitrant alopecia areata that do not respond to topical and intralesional corticosteroids, 5% minoxidil, or psoralen plus ultraviolet-A (PUVA) therapy.
Methods  Thirty-nine patients with persistent alopecia areata received 3 g of oral sulfasalazine for 6 months, and terminal hair regrowth was quantified as no response, moderate response, or good response.
Results  A good response occurred in 10 of the 39 patients (25.6%), a moderate response in 12 (30.7%), and a poor or no response in 17 (43.5%).
Conclusion  Sulfasalazine can be used as an alternative drug in patients with persistent alopecia areata.     

The Use of End-Tidal Capnography to Monitor Non-Intubated Patients Presenting with Acute Exacerbation of Asthma in the Emergency Department

Study ObjectiveTo determine if the slope of Phase II and Phase III, and the alpha angle of the expiratory capnographic waveform, as measured via computer-recognizable algorithms, can reflect changes in bronchospasm in acute asthmatic non-intubated patients presenting to the emergency department (ED).MethodsIn this prospective study carried out in a university hospital ED, 30 patients with acute asthma were monitored with clinical severity scoring and peak flow measurements, and then had a nasal cannula attached for sidestream sampling of expired carbon dioxide. The capnographic waveform was recorded onto a personal computer card for analysis. The patients were treated according to departmental protocols. After treatment, when they had improved enough for discharge, a second set of results was obtained for capnographic waveform recording. The pre-treatment and post-treatment results were then compared with paired-samples t-test analysis.ResultsOn the capnographic waveform pre- and post-treatment, there was a significant difference in the slope of Phase III (p < 0.001) and alpha angle (p < 0.001), but not in the Phase II slope (p = 0.35). There was significant change in peak flow meter reading, but it was poorly correlated with all the capnographic indices.ConclusionThe study provides some preliminary data showing that capnographic waveform indices can indicate improvement in airway diameter in acute asthmatics in the ED. Capnographic waveform analysis presents several advantages in that it is effort-independent, and provides continuous monitoring of normal tidal respiration. With further refined studies, it may serve as a new method of monitoring non-intubated asthmatics in the ED.     

Artificial intelligence and machine learning for predicting acute kidney injury in severely burned patients: A proof of concept

BackgroundBurn critical care represents a high impact population that may benefit from artificial intelligence and machine learning (ML). Acute kidney injury (AKI) recognition in burn patients could be enhanced by ML. The goal of this study was to determine the theoretical performance of ML in augmenting AKI recognition.MethodsWe developed ML models using the k-nearest neighbor (k-NN) algorithm. The ML models were trained-tested with clinical laboratory data for 50 adult burn patients that had neutrophil gelatinase associated lipocalin (NGAL), urine output (UOP), creatinine, and N-terminal B-type natriuretic peptide (NT-proBNP) measured within the first 24 h of admission.ResultsHalf of patients (50%) in the dataset experienced AKI within the first week following admission. ML models containing NGAL, creatinine, UOP, and NT-proBNP achieved 90–100% accuracy for identifying AKI. ML models containing only NT-proBNP and creatinine achieved 80–90% accuracy. Mean time-to-AKI recognition using UOP and/or creatinine alone was achieved within 42.7 ± 23.2 h post-admission vs. within 18.8 ± 8.1 h via the ML-algorithm.ConclusionsThe performance of UOP and creatinine for predicting AKI could be enhanced by with a ML algorithm using a k-NN approach when NGAL is not available. Additional studies are needed to verify performance of ML for burn-related AKI.     

Landscape of combination therapy trials in breast cancer brain metastasis

Combination therapy has become a cornerstone in cancer treatment to potentiate therapeutic effectiveness and overcome drug resistance and metastasis. In this work, we explore combination trials in breast cancer brain metastasis (BCBM), highlighting deficiencies in trial design and underlining promising combination strategies. On October 31, 2019, we examined ClinicalTrials.gov for interventional and therapeutic clinical trials involving combination therapy for BCBM, without limiting for date or location. Information on trial characteristics was collected. Combination therapies used in trials were analyzed and explored in line with evidence from the medical literature. Sixty-five combination therapy trials were selected (n = 65), constituting less than 0.7% of all breast cancer trials. Most trials (62%) combined ≥2 chemotherapeutic agents. Chemotherapy with radiation was main-stay in 23% of trials. Trastuzumab was mostly used in combination (31%), followed by lapatinib (20%) and capecitabine (15%). Common strategies involved combining tyrosine kinase inhibitors with thymidylate synthase inhibitors (6 trials), dual HER-dimerization inhibitors (3 trials), microtubule inhibitors and tyrosine kinase inhibitors (3 trials), and HER-dimerization inhibitors and tyrosine kinase inhibitors (3 trials). The combination of tucatinib and capecitabine yielded the highest objective response rate (83%) in early phase trials. The triple combination of trastuzumab, tucatinib and capecitabine lowered the risk of disease progression or death by 52% in patients with HER2-positive BCBM. Combining therapeutic agents based on biological mechanisms is necessary to increase the effectiveness of available anti-cancer regimens. Significant survival benefit has yet to be achieved in future combination therapy trials. Enhancing drug delivery through blood–brain barrier permeable agents may potentiate the overall therapeutic outcomes.     

Higher robotic colorectal surgery volume improves outcomes

In this study we sought to assess the effect of surgeon volume on outcomes of robotic colorectal operations performed by surgeons with low or high volume across a large health system. We performed a retrospective review of colon or rectal resections performed between January 1, 2013 and January 1, 2017 within the Providence Health System Hospitals. Procedures were separated into those performed by surgeons with high volume (30 or more robotic cases per year) vs. low volume. A total of 8 high volume and 41 low volume robotic surgeons were included in the study. High volume surgeons had a significantly shorter length of hospital stay, lower conversion rate, and lower total hospital cost. There were no differences in complications or rate of readmission. Many studies have shown that outcomes improve with increased experience. These data suggest that if a surgeon maintains robotic experience there can be improvements in cost, length of stay and conversion rates.