Cord Blood Platelet Gel as a Treatment of Occipital Pressure Injuries in Newborns: Report of Two Cases

Background: A Pressure Ulcer (PU) is a severe event and could create discomfort to newborns. In newborns, one of mostly stricken location by PU is occipital area. Recent studies have highlighted that Cord Blood Platelet Gel (CBPG) might be a better alternative compared to traditional treatment. We report two cases of occipital PU treated with CBPG. Case report: Two male infants showing occipital PU were treated with standard local treatment, but no improvement was observed. After parental informed consent was obtained, CBPG application on PU was performed every 48 h. In these two cases of PU, a fast improvement in healing was observed since the first application of CBPG. The PU healed resulted in a scar after 53 and 50 days (Case 1 and Case 2, respectively) from development. No complications or infections were reported. Conclusions: CBPG contains many angiogenetic and growth factors, these characteristics make it indicated in treating soft tissue injuries. It would seem to be safe and an effective treatment of neonatal PUs reducing the time of the healing and the hospitalization and the infectious risks. Further studies are needed to evaluate long term aesthetic and functional results of PU treated with CBPG.

Methodological and conceptual challenges in rare and severe event forecast-verification

There are distinctive methodological and conceptual challenges in rare and severe event (RSE) forecast-verification, that is, in the assessment of the quality of forecasts involving natural hazards such as avalanches or tornadoes. While some of these challenges have been discussed since the inception of the discipline in the 1880s, there is no consensus about how to assess RSE forecasts. This article offers a comprehensive and critical overview of the many different measures used to capture the quality of an RSE forecast and argues that there is only one proper skill score for RSE forecast-verification. We do so by first focusing on the relationship between accuracy and skill and show why skill is more important than accuracy in the case of RSE forecast-verification. Subsequently, we motivate three adequacy constraints for a proper measure of skill in RSE forecasting. We argue that the Peirce Skill Score is the only score that meets all three adequacy constraints. We then show how our theoretical investigation has important practical implications for avalanche forecasting by discussing a recent study in avalanche forecast-verification using the nearest neighbour method. Lastly, we raise what we call the “scope challenge" that affects all forms of RSE forecasting and highlight how and why the proper skill measure is important not only for local binary RSE forecasts but also for the assessment of different diagnostic tests widely used in avalanche risk management and related operations. Finally, our discussion is also of relevance to the thriving research project of designing methods to assess the quality of regional multi-categorical avalanche forecasts.

Association Between Respiratory Alkalosis and the Prognosis of COVID-19 Patients

Aim: The aim of the study was to describe the clinical characteristics of patients with or without respiratory alkalosis, and analyze the relationship of respiratory alkalosis and the outcome of adult coronavirus disease 2019 (COVID-19) patients.Methods: Clinical and laboratory data of adult COVID-19 patients in a single center in China, were retrospectively collected and analyzed. The Kaplan-Meier (KM) curve and cox regression were adopted to analyze the association between respiratory alkalosis and prognosis of COVID-19 patients.Results: Of 230 adult COVID-19 patients, 66 patients (28.7%) had respiratory alkalosis on admission. Of 66 patients, the median age was 53 years old (range, 21–84 years), and 43 (65.2%) were female. Compared with those without respiratory alkalosis, patients with respiratory alkalosis were significantly older (P = 0.002), had a higher proportion of female (P = 0.004), and showed higher ratios of underlying diseases including hypertension (P = 0.023) and cardiovascular disease (P = 0.028). Moreover, they demonstrated higher proportion of severe events (P = 0.001). Patients with respiratory alkalosis had a higher possibility of developing severe events compared with those without respiratory alkalosis (Log Rank P = 0.001). After adjusting for gender, age, and comorbidities, patients with respiratory alkalosis still showed significantly elevated risks of developing to severe cases (HR 2.445, 95% CI 1.307–4.571, P = 0.005) using cox regression analyses.Conclusions: Respiratory alkalosis as a common acid—base disorder in COVID-19 patients, was associated with a higher risk of developing severe event.

Potential Traumatic Events through the Life Cycle in an Immigrant Population

Existing studies on traumatic events focused on children, while it has been understudied in older adults. This study aims to examine prevalence, frequency, and severity of life events in older Chinese Americans. The data were drawn from the Population Study of Chinese Elderly (PINE) in 2017–2019. Twenty life events were evaluated, including natural disasters, personal traumatic events, and historical events. Among 3125 participants, the mean age was 75.33 (standard deviation (SD) = 8.22) with 61.06% female. Cultural Revolution (73.27%) has the highest prevalence. A total of 1819 (58.39%) participants reported typhoon and experienced multiple times. Falsely accused of crime was reported as the most severe event. Women were more likely to report family-related life events. Those with higher education were more likely to report personal traumatic events. This study is among the first to profile life events in older Chinese Americans. Age cohorts, gender roles, and socioeconomic status shape individuals’ exposure to life events. This study could help identify which vulnerable groups have high risks of exposure to traumatic events.

Associations Between Blood Biomarkers, Cardiac Function, and Adverse Outcome in a Young Fontan Cohort

Background Patients who have undergone the Fontan procedure are at high risk of circulatory failure. In an exploratory analysis we aimed to determine the prognostic value of blood biomarkers in a young cohort who have undergone the Fontan procedure. Methods and Results In multicenter prospective studies patients who have undergone the Fontan procedure underwent blood sampling, cardiopulmonary exercise testing, and stress cardiac magnetic resonance imaging. Several biomarkers including NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), GDF‐15 (growth differentiation factor 15), Gal‐3 (galectin‐3), ST2 (suppression of tumorigenicity 2), DLK‐1 (protein delta homolog 1), FABP‐4 (fatty acid‐binding protein 4), IGFBP‐1 (insulin‐like growth factor‐binding protein 1), IGFBP‐7, MMP‐2 (matrix metalloproteinase 2), and vWF (von Willebrand factor) were assessed in blood at 9.6 (7.1–12.1) years after Fontan completion. After this baseline study measurement, follow‐up information was collected on the incidence of adverse cardiac events, including cardiac death, out of hospital cardiac arrest, heart transplantation (listing), cardiac reintervention (severe events), hospitalization, and cardioversion/ablation for arrhythmias was collected and the relation with blood biomarkers was assessed by Cox proportional hazard analyses. The correlation between biomarkers and other clinical parameters was evaluated. We included 133 patients who have undergone the Fontan procedure, median age 13.2 (25th, 75th percentile 10.4–15.9) years, median age at Fontan 3.2 (2.5–3.9) years. After a median follow‐up of 6.2 (4.9–6.9) years, 36 (27.1%) patients experienced an event of whom 13 (9.8%) had a severe event. NT‐proBNP was associated with (all) events during follow‐up and remained predictive after correction for age, sex, and dominant ventricle (hazard ratio, 1.89; CI, 1.32–2.68). The severe event‐free survival was better in patients with low levels of GDF‐15 ( P =0.005) and vWF ( P =0.008) and high levels of DLK‐1 ( P =0.041). There was a positive correlation (β=0.33, P =0.003) between DLK‐1 and stress cardiac magnetic resonance imaging functional reserve. Conclusions NT‐proBNP, GDF‐15, vWF, DLK‐1, ST‐2 FABP‐4, and IGFBP‐7 levels relate to long‐term outcome in young patients who have undergone the Fontan procedure.

PREVENT: A Randomized, Placebo-Controlled Crossover Trial of Avexitide for Treatment of Post-Bariatric Hypoglycemia

Context Post-bariatric hypoglycemia (PBH), characterized by enteroinsular axis overstimulation and hyperinsulinemic hypoglycemia, is a complication of bariatric surgery for which there is no approved therapy. Objective To evaluate efficacy and safety of avexitide [exendin(9-39)], a GLP-1 antagonist, for treatment of PBH. Design Phase II, randomized, placebo-controlled crossover study (PREVENT). Setting Multicenter. Participants Eighteen female patients with PBH. Intervention Placebo for 14 days followed by avexitide 30 mg BID and 60 mg QD, each for 14 days in random order. Main Outcome Measures Glucose nadir and insulin peak during mixed-meal tolerance testing (MMTT) and hypoglycemic events captured by self-monitoring of blood glucose (SMBG), electronic diary, and blinded continuous glucose monitor (CGM). Results Compared to placebo, avexitide 30 mg BID and 60 mg QD raised the glucose nadir by 21% (p=0.001) and 26% (p=0.0002) and lowered the insulin peak by 23% (p=0.029) and 21% (p=0.042), corresponding to 50% and 75% fewer participants requiring rescue during MMTT, respectively. Significant reductions in rates of Levels 1-3 hypoglycemia were observed, defined, respectively, as SMBG<70 mg/dL, SMBG<54 mg/dL, and a severe event characterized by altered mental and/or physical function requiring assistance. CGM demonstrated reductions in hypoglycemia without induction of clinically-relevant hyperglycemia. Avexitide was well-tolerated, with no increase in adverse events. Conclusions Avexitide administered for 28 days was well-tolerated and resulted in robust and consistent improvements across multiple clinical and metabolic parameters, reinforcing the targeted therapeutic approach and demonstrating durability of effect. Avexitide may represent a first promising treatment for patients with severe PBH.

Impact of solid cancer on in-hospital mortality overall and among different subgroups of patients with COVID-19: a nationwide, population-based analysis

BackgroundCancer seems to have an independent adverse prognostic effect on COVID-19-related mortality, but uncertainty exists regarding its effect across different patient subgroups. We report a population-based analysis of patients hospitalised with COVID-19 with prior or current solid cancer versus those without cancer.MethodsWe analysed data of adult patients registered until 24 May 2020 in the Belgian nationwide database of Sciensano. The primary objective was in-hospital mortality within 30 days of COVID-19 diagnosis among patients with solid cancer versus patients without cancer. Severe event occurrence, a composite of intensive care unit admission, invasive ventilation and/or death, was a secondary objective. These endpoints were analysed across different patient subgroups. Multivariable logistic regression models were used to analyse the association between cancer and clinical characteristics (baseline analysis) and the effect of cancer on in-hospital mortality and on severe event occurrence, adjusting for clinical characteristics (in-hospital analysis).ResultsA total of 13 594 patients (of whom 1187 with solid cancer (8.7%)) were evaluable for the baseline analysis and 10 486 (892 with solid cancer (8.5%)) for the in-hospital analysis. Patients with cancer were older and presented with less symptoms/signs and lung imaging alterations. The 30-day in-hospital mortality was higher in patients with solid cancer compared with patients without cancer (31.7% vs 20.0%, respectively; adjusted OR (aOR) 1.34; 95% CI 1.13 to 1.58). The aOR was 3.84 (95% CI 1.94 to 7.59) among younger patients (<60 years) and 2.27 (95% CI 1.41 to 3.64) among patients without other comorbidities. Severe event occurrence was similar in both groups (36.7% vs 28.8%; aOR 1.10; 95% CI 0.95 to 1.29).ConclusionsThis population-based analysis demonstrates that solid cancer is an independent adverse prognostic factor for in-hospital mortality among patients with COVID-19. This adverse effect was more pronounced among younger patients and those without other comorbidities. Patients with solid cancer should be prioritised in vaccination campaigns and in tailored containment measurements.

Development of algorithms for evaluating performance of flood simulation models with satellite-derived flood

Flood inundation simulation models are widely used for simulating severe events of flood, generating hazard maps, risk assessment, and to identify flood vulnerable locations. It is important to assess the degree of accuracy of flood model results as these results may be one of the triggering parameters considered in developing flood hazard maps, flood mitigation policies, and land using planning where multi-criteria analysis is approached. In the present study, an algorithm is developed in order to know the performance of flood models by validating it with flood footprints extracted from synthetic aperture radar (SAR) images using multi-segmentation and Otsu's thresholding technique. Evaluation of the performance of the model is based on two best fit criteria called F1 and F2. For this, HEC-RAS model is used for simulating the severe event of flood witnessed in Mahanadi River in Odisha stretching between Tikarpara and Mundali during September 2008.Three simulations were made by considering three different Manning's roughness for river and floodplain. The model gives appreciable results and best fit F1 = 0.85 and F2 = 0.74 was found for Manning's roughness 0.020.

Posibility to fast react in order to identify the risk and make first claim assesment in case of a severe earthquake in Bucharest

Insurer’s reaction in case of a severe event, in Romania, especially in Bucharest is well known that is more than difficult, mainly due to the existing resources that need to be appointed in a short time to a high number of reported cases. The lack of a clear plan to react, at the national level, by all authorities is showing that Romania is not prepared properly to react in case of an earthquake similar with the one in 1977. Romanian authorities in the insurance industry strive to find a fast and smooth process, to inspect the claims in due time, but the reality shows that this plan is not linked to reality, and, as it is currently described as project by PAID will definitively fail to it purpose. Current legislative framework and procedures shows that the process of handling a claim in case of a big volume of files will be more than difficult even could lead to a blockage in the system. The authors’ research follows the importance that claim inspection, identification of risk and claim file opening should have a total different process even a disruptive one via an online solution or special app. The research is starting from a plan of PAID which is mentioning that all resources available in the insurance companies to be combined and managed through a special command force under PAID supervision. The main finding of the research is that the Romanian insurance market need a totally different approach in order to assess the claims and in the same time the fact that currently discussed project, initiated by PAID cannot be applied in the existing environment due to many conflicts even with the EU legislation. A new modern solution to provide to the clients best services in the promised time is required to exist and to be applied in the moment of the event.