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What We Already Know About This Topic: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: The authors tested the hypothesis that deep neural networks trained on intraoperative features can predict postoperative in-hospital mortality.Methods: The data used to train and validate the algorithm consists of 59,985 patients with 87 features extracted at the end of surgery. Feed-forward networks with a logistic output were trained using stochastic gradient descent with momentum. The deep neural networks were trained on 80% of the data, with 20% reserved for testing. The authors assessed improvement of the deep neural network by adding American Society of Anesthesiologists (ASA) Physical Status Classification and robustness of the deep neural network to a reduced feature set. The networks were then compared to ASA Physical Status, logistic regression, and other published clinical scores including the Surgical Apgar, Preoperative Score to Predict Postoperative Mortality, Risk Quantification Index, and the Risk Stratification Index.Results: In-hospital mortality in the training and test sets were 0.81% and 0.73%. The deep neural network with a reduced feature set and ASA Physical Status classification had the highest area under the receiver operating characteristics curve, 0.91 (95% CI, 0.88 to 0.93). The highest logistic regression area under the curve was found with a reduced feature set and ASA Physical Status (0.90, 95% CI, 0.87 to 0.93). The Risk Stratification Index had the highest area under the receiver operating characteristics curve, at 0.97 (95% CI, 0.94 to 0.99).Conclusions: Deep neural networks can predict in-hospital mortality based on automatically extractable intraoperative data, but are not (yet) superior to existing methods. [ABSTRACT FROM AUTHOR]

Summary: Background: Data on oral vancomycin for primary sclerosing cholangitis (PSC)‐associated inflammatory bowel disease (IBD) are limited. Aims: Using data from the Paediatric PSC Consortium, to examine the effect of vancomycin on IBD activity. Methods: In this retrospective multi‐centre cohort study, we matched vancomycin‐treated and untreated patients (1:3) based on IBD duration at the time of primary outcome assessment. The primary outcome was Physician Global Assessment (PGA) of IBD clinical activity after 1 year (±6 months) of vancomycin. We used generalised estimating equations (GEE) to examine the association between vancomycin and PGA remission, adjusting for IBD type, severity and medication exposures. Secondary outcomes included serum labs and endoscopic remission (global rating of no activity) among those with available data and also analysed with GEE. Results: 113 PSC‐IBD patients received vancomycin (median age 12.7 years, 63% male). The matched cohort included 70 vancomycin‐treated and 210 untreated patients. Vancomycin was associated with greater odds of IBD clinical remission (odds ratio [OR] 3.52, 95% CI 1.97–6.31; adjusted OR [aOR] 5.24, 95% CI 2.68–10.22). Benefit was maintained in sensitivity analyses restricted to non‐transplanted patients and those with baseline moderate–severe PGA. Vancomycin was associated with increased odds of endoscopic remission (aOR 2.76, 95% CI 1.002–7.62; N = 101 with data), and with lower CRP (p = 0.03) and higher haemoglobin and albumin (both p < 0.01). Conclusion: Vancomycin was associated with greater odds of IBD clinical and endoscopic remission. Additional, preferably randomised, controlled studies are needed to characterise efficacy using objective markers of mucosal inflammation, and to examine safety and define optimal dosing. [ABSTRACT FROM AUTHOR]

This paper estimates the sampling error variances of gridded monthly U.S. Historical Climatology Network, version 2 (USHCN V2), time-of-observation-biases (TOB)-adjusted data. The analysis of mean surface air temperature (SAT) assesses uncertainties, trends, and the rankings of the hottest and coldest years for the contiguous United States in the period of 1895-2008. Data from the USHCN stations are aggregated onto a 2.5° × 3.5° latitude-longitude grid by an arithmetic mean of the stations inside a grid box. The sampling error variances of the gridded monthly data are estimated for every month and every grid box with data. The gridded data and their sampling error variances are used to calculate the contiguous U.S. averages and their trends and associated uncertainties. The sampling error variances are smaller (mostly less than 0.2°C2) over the eastern United States, where the station density is greater and larger (with values of 1.3°C2 for some grid boxes in the earlier period) over mountain and coastal areas. In the period of 1895-2008, every month from January to December has a positive linear trend. February has the largest trend of 0.162°C (10 yr)−1, and September has the smallest trend at 0.020°C (10 yr)−1. The three hottest (coldest) years measured by the mean SAT over the United States were ranked as 1998, 2006, and 1934 (1917, 1895, and 1912). [ABSTRACT FROM AUTHOR]

The specificity of connections made by inhibitory interneurons in the neocortex is not well understood. In this issue of Neuron, use an enhanced version of two-photon glutamate uncaging, which preserves inhibitory synaptic transmission, to demonstrate that somatostatin-positive interneurons form densely convergent connections onto pyramidal cells in layer 2/3 of mouse frontal cortex. [ABSTRACT FROM AUTHOR]

Learning a visuomotor skill involves a distributed network which includes the primary motor cortex (M1). Despite multiple lines of evidence supporting the role of M1 in motor learning and memory, it is unclear whether M1 plays distinct roles in different aspects of learning such as acquisition and retention. Here, we investigated the nature and chronometry of that processing through a temporally specific disruption of M1 activity using single-pulse transcranial magnetic stimulation (TMS). We applied single-pulse TMS to M1 or dorsal premotor cortex (PMd) during adaptation of rapid arm movements (~150 ms duration) to a visuomotor rotation. When M1 was stimulated either immediately after the end of each trial or with a 700 ms delay, subjects exhibited normal adaptation. However, whereas the memory of the subjects who received delayed-TMS showed normal rates of forgetting during deadaptation, the memory of those who received immediate TMS was more fragile: in the deadaptation period, they showed a faster rate of forgetting. Stimulation of PMd with adjusted (reduced) intensity to rule out the possibility of coactivation of this structure caused by the current spread from M1 stimulation did not affect adaptation or retention. The data suggest that, during the short time window after detection of movement errors, neural processing in M1 plays a crucial role in formation of motor memories. This processing in M1 may represent a slow component of motor memory which plays a significant role in retention. [ABSTRACT FROM AUTHOR]

Abstract Background Hepatic steatosis is a common manifestation of CF-related liver disease(CFLD). Controlled attenuation parameter(CAP) measurement during transient elastography(TE) semiquantifies liver steatosis. We examined the relationship between CAP and CFLD severity, clinical factors and liver stiffness measurements(LSM). Methods This is a cross-sectional study of CF patients seen for outpatient care between January 2013–March 2014. CFLD severity was categorized as no CFLD, CFLD without portal hypertension(PHTN) and CFLD with PHTN, based on published criteria. Results 129 patients (median 18.4y; 57% male) had valid CAP. 70(54%) had no CFLD, 44(34%) CFLD without PHTN, and 15(12%) CFLD with PHTN. The median CAP was 210 dB/m (IQR 181–239). Steatosis(CAP ≥230 dB/m) was seen in 27% of subjects without CFLD, 48% in CFLD but no PHTN, and 20% in with CFLD and PHTN(P =.04). CAP was higher for subjects with CFLD without PHTN (P <.05). There was no CAP difference between subjects with no CFLD and those with CFLD and PHTN (P ≥.65). LSM was not different between no CFLD and CFLD without PHTN (P =.07), but each of these groups had lower LSM compared to subjects with CFLD and PHTN(P <.001 for each). Except for direct bilirubin, CAP was not associated with clinical markers of liver disease. Conclusion CAP was normal in 86(67%) of patients with CF and was not associated with standard clinical markers of liver disease. CAP was higher in patients with liver disease, which could possibly reflect the loss of steatosis observed with progression to cirrhosis and portal hypertension. Highlights • CAP is a non-invasive tool to assess liver steatosis. • CAP was normal in a majority of children/young adults with Cystic Fibrosis. • CAP is higher in patients with CFLD without portal hypertension. [ABSTRACT FROM AUTHOR]