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In recent years, exome sequencing (ES) has shown great utility in the diagnoses of Mendelian disorders. However, after rigorous filtering, a typical ES analysis still involves the interpretation of hundreds of variants, which greatly hinders the rapid identification of causative genes. Since the interpretations of ES data require comprehensive clinical analyses, taking clinical expertise into consideration can speed the molecular diagnoses of Mendelian disorders. To leverage clinical expertise to prioritize candidate genes, we developed PhenoApt, a phenotype-driven gene prioritization tool that allows users to assign a customized weight to each phenotype, via a machine-learning algorithm. Using the ability to rank causative genes in top-10 lists as an evaluation metric, baseline analysis demonstrated that PhenoApt outperformed previous phenotype-driven gene prioritization tools by a relative increase of 22.7%-140.0% in three independent, real-world, multi-center cohorts (cohort 1, n = 185; cohort 2, n = 784; and cohort 3, n = 208). Additional trials showed that, by adding weights to clinical indications, which should be explained by the causative gene, PhenoApt performance was improved by a relative increase of 37.3% in cohort 2 (n = 471) and 21.4% in cohort 3 (n = 208). Moreover, PhenoApt could assign an intrinsic weight to each phenotype based on the likelihood of its being a Mendelian trait using term frequency-inverse document frequency techniques. When clinical indications were assigned with intrinsic weights, PhenoApt performance was improved by a relative increase of 23.7% in cohort 2 and 15.5% in cohort 3. Selleck LF3 For the integration of PhenoApt into clinical practice, we developed a user-friendly website and a command-line tool.Fruquintinib, also called HMPL-013, was first discovered by Hutchison Whampoa Pharmaceuticals Co. Ltd., Shanghai, China, and it is an oral vascular endothelial growth factor receptor (VEGFR) inhibitor. In clinical trials, fruquintinib has demonstrated a survival benefit in metastatic colorectal cancer (mCRC) patients. The purpose of this study was to retrospectively evaluate the efficacy and toxicity of fruquintinib in real-world patients. We collected data from patients with mCRC treated with oral fruquintinib from 2018 to 2020 in six different institutions. Patients with mCRC initially received 5 mg of oral fruquintinib daily for 3 weeks. Progression-free survival (PFS) was evaluated using the KaplanMeier method. The efficacy and safety of fruquintinib were also assessed. Seventy-five patients were involved in our study, and 29.3% of patients achieved stable disease (SD). Median PFS was 5.4 months (95% CI 4.8415.959). The treatment-emergent adverse events (TEAEs) with fruquintinib were acceptable with grade 3 TEAEs of 6%. The grade 3 TEAEs were handfoot skin reaction (HFSR), fatigue, and stomatitis. The ECOG performance status was associated with PFS. In this real-world study, the clinical activity of fruquintinib was consistent with what has been reported in previous clinical trials. The level of safety was acceptable, and the side effects were manageable.INTRODUCTION This study aimed to evaluate whether a short familiarization session is sufficient for individuals with no prior experience of sonography to both reliably and consistently evaluate the prevalence of venous gas emboli (VGE) from precordial ultrasonic videos.METHODS A total of 10 adults with no prior experience of sonography were introduced to the Eftedal-Brubakk 6-grade scale and were shown 6 video sequences, each of a maximum of 10 heartbeats, representing each grading level. Thereafter, they independently evaluated the prevalence of VGE in 70 ultrasonic videos before and after a 14-d interval (test-retest; intra-rater), with these being compared to an experienced sonographer's grading (inter-rater).RESULTS A significant inter-rater level of agreement was found between the naïve and experienced sonographers' bubble grading both during the first (W = 0.945) and second (W = 0.952) round of bubble evaluation. The naïve observers' evaluations were on average 79% (range 61-95%) and 75% (range 48-95%) in complete agreement with the experienced sonographer's gradings, while the level of agreement was 99% and 98% within 1 grade unit. There was a significant intra-rater level of agreement (κ = 0.845) during the test-retest series, with a mean percentage level of agreement of 87% (range 72-93%).CONCLUSION This study demonstrates that a short familiarization session enables individuals with no prior sonography experience to consistently evaluate VGE prevalence from precordial ultrasonic videos.Elia A, Ånell R, Eiken O, Grönkvist M, Gennser M. Inter- and intra-rater level of agreement in ultrasonic video grading of venous gas emboli. Aerosp Med Hum Perform. 2022; 93(1)54-57.OBJECTIVES Airline cabin crew experience high levels of fatigue and sleepiness. Whether these are solely related to their work schedules/jetlag or are in part related to individual factors is unknown. The COVID-19 pandemic has significantly disrupted the aviation industry and many cabin crew have been grounded. This provides a unique opportunity to assess the causes of fatigue and sleepiness in this population.METHODS An online anonymous survey was distributed in April-June 2020 to cabin crew who were 1) flying, 2) grounded but doing alternative work, and 3) grounded, not working, or unemployed. The survey measured fatigue, sleepiness, and mental health. It also screened their risk for insomnia, depression, and shift work disorder and assessed drug and caffeine use.RESULTS Collected were 409 valid responses 45 currently flying; 35 grounded but doing alternate work; and 329 not working. On average, all three groups experienced normal levels of fatigue and sleepiness. The risk for major depressive disorder was 27.4%, with 59.5% of individuals reporting abnormal levels of anxiety. Caffeine intake and the use of drugs and alcohol to facilitate sleep were common, although not different between those currently flying vs. grounded.CONCLUSIONS With reduced workloads or not flying, cabin crew reported lowered fatigue and sleepiness compared to prepandemic findings, along with reduced risk for major depressive disorder. However, a high occurrence of negative emotional states were reported, potentially related to the uncertainty surrounding the pandemic. This study suggests fatigue and sleepiness is primarily related to airline operational rather than personal variables.Wen CC-Y, Nicholas CL, Howard ME, Trinder J, Jordan AS. Understanding sleepiness and fatigue in cabin crew using COVID-19 to dissociate causative factors. Aerosp Med Hum Perform. 2022; 93(1)50-53.INTRODUCTION Hypobaric decompression sickness remains a problem during high-altitude aviation. The prevalence of venous gas emboli (VGE) serves as a marker of decompression stress and has been used as a method in evaluating the safety/risk associated with aviation profiles and/or gas mixtures. However, information is lacking concerning the variability of VGE formation when exposed to the same hypobaric profile on different occasions. In this paper, intra-individual test-retest variation regarding bubble formation during repeated hypobaric exposures is presented. The data can be used to determine the sample size needed for statistical power.METHOD A total of 19 male, nonsmoking subjects volunteered for altitude exposures to 24,000 ft (7315 m). VGE was measured using ultrasound scanning and scored according to the Eftedal-Brubakk (EB) scale. Intraindividual test-retest variation in bubble formation (maximum VGE) was evaluated in subjects exposed more than once to hypobaric pressure. The statistical reliability was examined between paired exposures using the Intraclass Correlation test. G*Power version 3.1.9.6 was used for power calculations.RESULTS During repeated 20-30 and 70-min exposures to 24,000 ft, 42% (N = 19, CI 23-67%) and 29% (N = 7, CI 5-70%) of the subjects varied between maximum EB scores less then 3 and ≥ 3. The sample size needed to properly reject statistical significance of 1 EB step nominal difference between two paired exposures varied between 29-51 subjects.CONCLUSION The large intraindividual test-retest variations in bubble grades during repeated hypobaric exposures highlight the need for relatively large numbers of subjects to reach statistical power when there are no or small differences in decompression stress between the exposures.Ånell R, Grönkvist M, Eiken O, Elia A, Gennser M. Intra-individual test-retest variation regarding venous gas bubble formation during high altitude exposures. Aerosp Med Hum Perform. 2022; 93(1)46-49.INTRODUCTION During spaceflight missions, astronauts work in an extreme environment with several hazards to physical health and performance. Exposure to microgravity results in remarkable deconditioning of several physiological systems, leading to impaired physical condition and human performance, posing a major risk to overall mission success and crew safety. Physical exercise is the cornerstone of strategies to mitigate physical deconditioning during spaceflight. Decades of research have enabled development of more optimal exercise strategies and equipment onboard the International Space Station. However, the effects of microgravity cannot be completely ameliorated with current exercise countermeasures. Moreover, future spaceflight missions deeper into space require a new generation of spacecraft, which will place yet more constraints on the use of exercise by limiting the amount, size, and weight of exercise equipment and the time available for exercise. Space agencies are exploring ways to optimize exercise countermeasures for spaceflight, specifically exercise strategies that are more efficient, require less equipment, and are less time-consuming. Blood flow restriction exercise is a low intensity exercise strategy that requires minimal equipment and can elicit positive training benefits across multiple physiological systems. This method of exercise training has potential as a strategy to optimize exercise countermeasures during spaceflight and reconditioning in terrestrial and partial gravity environments. The possible applications of blood flow restriction exercise during spaceflight are discussed herein.Hughes L, Hackney KJ, Patterson SD. Optimization of exercise countermeasures to spaceflight using blood flow restriction. Aerosp Med Hum Perform. 2021; 93(1)32-45.BACKGROUND Migraine is a common disorder with significant aeromedical implications. The variability and unpredictable nature of occurrences hampers accurate assessment of future risk. This uncertainty results in a necessarily conservative approach to aeromedical recommendations, which unfortunately may lead to over-restrictive dispositions. Limited long-term follow up information is available on migraine outcomes in pilots, particularly assessing for impact of potential modifiable aggravating factors.Methods This retrospective study reviewed 159 U.S. Air Force pilots with migraine who had been granted aeromedical waivers. As a comparison group, 44 U.S. Air Force flight surgeons with migraine who had been granted aeromedical waivers were reviewed.Results Migraine with aura and isolated migraine aura without headache accounted for the majority of migraine subtypes in both male and female subjects. Self-identified triggering factors were identified by 62% of subjects. The most commonly reported triggers were dietary factors, sleep disturbances, stress, caffeine intake, and hormonal factors.
My Website: https://www.selleckchem.com/products/lf3.html
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