Midwifeled continuity models compared to additional models of care for childbearing women

We conducted a retrospective observational study including 31 eyes of 20 patients in order to investigate the efficacy of 25-gauge vitrectomy for vitreous opacity with minimal conjunctival invasion and subsequent management of intraocular pressure (IOP) secondary to hereditary transthyretin amyloidosis. We followed up these patients for an average of 44.7 ± 32.6 months. The primary outcome was best corrected visual acuity (BCVA) at 1 month after surgery and at the final follow-up visit, with management of subsequent IOP elevation. Secondary outcomes included the post-vitrectomy IOP survival rate, to determine the frequency of IOP elevation requiring glaucoma surgery. Mean age at vitrectomy was 55.4 ± 9.1 years. Logarithm of the Minimum Angle of Resolution (LogMAR) BCVA showed immediate improvement from 0.73 ± 0.62 to 0.00 ± 0.22 at 1 month (p = 4.1 × 10-7), an improvement that was maintained up to the final follow-up visit, when IOP was maintained at 13.1 ± 5.2 mmHg. The survival rate of post-vitrectomy IOP control was 0.51, 0.38, and 0.23 at 12, 24, and 60 months, respectively. A poor post-vitrectomy IOP survival rate suggests that removing vitreous amyloid via 25-gauge vitrectomy is not sufficient to guarantee good visual function; subsequent careful follow-up and proper glaucoma management is also required in order to achieve this goal.Breakthroughs in the development of high-throughput technologies for profiling transcriptomes at the single-cell level have helped biologists to understand the heterogeneity of cell populations, disease states and developmental lineages. However, these single-cell RNA sequencing (scRNA-seq) technologies generate an extraordinary amount of data, which creates analysis and interpretation challenges. Additionally, scRNA-seq datasets often contain technical sources of noise owing to incomplete RNA capture, PCR amplification biases and/or batch effects specific to the patient or sample. If not addressed, this technical noise can bias the analysis and interpretation of the data. In response to these challenges, a suite of computational tools has been developed to process, analyse and visualize scRNA-seq datasets. Although the specific steps of any given scRNA-seq analysis might differ depending on the biological questions being asked, a core workflow is used in most analyses. Typically, raw sequencing reads are processed into a gene expression matrix that is then normalized and scaled to remove technical noise. Next, cells are grouped according to similarities in their patterns of gene expression, which can be summarized in two or three dimensions for visualization on a scatterplot. These data can then be further analysed to provide an in-depth view of the cell types or developmental trajectories in the sample of interest.BACKGROUND Mercaptopurine-induced neutropenia can interrupt chemotherapy and expose patients to infection during childhood acute lymphoblastic leukemia (ALL) treatment. Previously, six candidate gene variants associated with mercaptopurine intolerance were reported. Herein, we investigated the association between the mean tolerable dose of mercaptopurine and these genetic variants in Taiwanese patients. METHODS In total, 294 children with ALL were treated at the National Taiwan University Hospital from April 1997 to December 2017. Germline variants were analyzed for NUDT15, SUCLA2, TPMT, ITPA, PACSIN2, and MRP4. Mean daily tolerable doses of mercaptopurine in the continuation phase of treatment were correlated with these genetic variants. RESULTS Mercaptopurine intolerance was significantly associated with polymorphisms in NUDT15 (P value less then 0.0001). Patients with SUCLA2 variants received lower mercaptopurine doses (P value = 0.0119). The mean mercaptopurine doses did not differ among patients with TPMT, ITPA, MRP4, and PACSIN2 polymorphisms (P value = 0.9461, 0.5818, and 0.7951, respectively). After multivariable linear regression analysis, only NUDT15 variants retained their clinically significant correlation with mercaptopurine intolerance (P value less then 0.0001). CONCLUSION In this cohort, the major genetic determinant of mercaptopurine intolerance was NUDT15 in Taiwanese patients. selleck inhibitor IMPACT NUDT15 causes mercaptopurine intolerance in children with ALL.The NUDT15 variant is a stronger predictor of mercaptopurine intolerance than TPMT in a Taiwanese cohort. This finding is similar with studies performed on Asian populations rather than Caucasians.Pre-emptive genotyping of the patients' NUDT15 before administering mercaptopurine may be more helpful than genotyping TPMT in Asians.BACKGROUND Genomic assessment previously took months to result and was unable to impact clinical care in the pediatric intensive care unit (PICU). The advent of rapid exome sequencing potentially changes this. We investigated the impact of rapid exome sequencing in a pilot study on pediatric patients admitted to a single PICU with new-onset metabolic/neurologic disease. METHODS Rapid exome sequencing (7 days to verbal result) was performed on (n = 10) PICU patients age  less then  6 years admitted with new-onset metabolic/neurologic disease. The primary outcome of interest was inpatient LOS, which served as a proxy for inpatient cost. RESULTS A significant reduction in median LOS was identified when comparing PICU patients who underwent rapid exome sequencing to historical controls. From those patients who underwent rapid sequencing, five had likely pathogenic variants. In three cases with diagnostic genetic results, there was a modification to clinical care attributable to information provided by exome sequeo do in a PICU. Genetic results can be returned quickly enough to impact critical care decision-making. When done in a carefully selected subset of pediatric patients, rapid exome sequencing can potentially decrease hospital LOS.The next phase of clinical trials in neonatal encephalopathy (NE) focuses on hypothermia adjuvant therapies targeting alternative recovery mechanisms during the process of hypoxic brain injury. Identifying infants eligible for neuroprotective therapies begins with the clinical detection of brain injury and classification of severity. Combining a variety of biomarkers (serum, clinical exam, EEG, movement patterns) with innovative clinical trial design and analyses will help target infants with the most appropriate and timely treatments. The timing of magnetic resonance imaging (MRI) and MR spectroscopy after NE both assists in identifying the acute perinatal nature of the injury (days 3-7) and evaluates the full extent and evolution of the injury (days 10-21). Early, intermediate outcome of neuroprotective interventions may be best defined by the 21-day neuroimaging, with recognition that the full neurodevelopmental trajectory is not yet defined. An initial evaluation of each new therapy at this time point may allow higher-throughput selection of promising therapies for more extensive investigation.