Objective:
After traumatic brain injury (TBI), continuous electroencephalography (cEEG) is widely used to detect electrographic seizures (ESz). With the development of standardized cEEG terminology, we aimed to describe the prevalence and burden of ictal-interictal patterns and ESz after moderate-to-severe TBI and to correlate cEEG features with functional outcome.
Design:
Post-hoc analysis of the prospective, randomized controlled phase 2 multicenter INTREPID2566 study (ClinicalTrials.gov: ). cEEG was initiated upon admission to the ICU. The primary outcome was the 3-month Glasgow Outcome Scale-Extended (GOSE). Consensus EEG reviews were performed by raters certified in standardized cEEG terminology blinded to clinical data. Rhythmic, periodic, or ictal patterns were referred to as ictal-interictal continuum (IIC); severe IIC was defined as ≥1.5 Hz lateralized rhythmic delta activity or generalized periodic discharges, and any lateralized periodic discharges or ESz.
Setting:
20 US Level I trauma centers
Patients:
Patients with non-penetrating TBI and post-resuscitation GCS 4–12 were included.
Interventions:
None.
Measurements and Main Results:
Among 152 patients with cEEG (age 34 ± 14 years; 88% male), 22 (14%) had severe IIC including ESz in 4 (2.6%). Severe IIC correlated with initial prognostic score (International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT)) (r=0.51, p=0.01) and Injury Severity Score (ISS) (r=0.49, p=0.01), but not with functional outcome. After controlling clinical covariates, unfavorable outcome was independently associated with: absence of posterior dominant rhythm (common odds ratio 3.38; 95% CI 1.30–9.09), absence of N2 sleep transients (3.69; 1.69–8.20), predominant delta activity (2.82; 1.32–6.10) and discontinuous background (5.33; 2.28–12.96).
Conclusions:
Severe IIC patterns, including ESz, were associated with clinical markers of injury severity but not functional outcome in this prospective cohort of patients with moderate-to-severe TBI. Importantly, cEEG background features were independently associated with functional outcome and improved the area-under-the-curve of existing, validated predictive models.
By surveying extensive epidemiological behavioural and sexual risk factors in a Korean twin cohort, risk factors for human papillomavirus (HPV) infection were investigated in South Korea. A total of 912 vaginal specimens were collected from the Healthy Twin Study, consisting of twins and their families. A range of epidemiological, behavioural, and sexual activity characteristics were evaluated using multivariate logistic regression analyses of family and twin relationships, adjusted to elucidate the risk factors for HPV infection. Of the various epidemiological characteristics, the possibility of extramarital affairs [odds ratio (OR) 2·48, 95% confidence interval (CI) 1·02-6·02] significantly increased the prevalence of HPV infection. Our multivariate regression analysis indicated that oral contraceptive use (OR 40·64, 95% CI 0·99-1670·7) and history of sexually transmitted disease (OR 2·56, 95% CI 0·93-7·10) were strongly associated with an increase in HPV infection. On the other hand, more frequent vaginal douching (OR 0·32, 95% CI 0·13-0·77) significantly decreased the prevalence of HPV infection. Our results suggested that HPV infection is associated with both biological and behavioural factors.
These methods, however, have two limitations. First, the communication cost for network construction is considerably high. Second, they do not support data integrity. There are two methods for supporting data integrity, iCPDA and iPDA. But they have high communication cost due to additional integrity checking messages. To resolve this problem, we propose a novel Hilbert-curve based data aggregation scheme that enforces data privacy and data integrity for WSNs. To minimize communication cost, we utilize a tree-based network structure for constructing networks and aggregating data. To preserve data privacy, we make use of both a seed exchange algorithm and Hilbert-curve based data encryption. To support data integrity, we use an integrity checking algorithm based on the PIR technique by directly communicating between parent and child nodes. Finally, through a performance analysis, we show that our scheme outperforms the existing methods in terms of both energy efficiency and privacy preservation.
Among our adult patients with febrile UTI, age, systolic blood pressure, body temperature, and procalcitonin were significantly associated with bacteremia. We therefore suggest that these factors should be considered when deciding upon treatment options for febrile UTI patients at the ED.
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