The Full Outline of UnResponsiveness (FOUR) Score and Its Use in Outcome Prediction: A Scoping Systematic Review of the Adult Literature.

BACKGROUND: The Full Outline of UnResponsivness (FOUR) score is a neurological assessment score. Its theoretical benefit over preexisting scores is its evaluation of brainstem reflexes and respiratory pattern which may allow better assessment of patients with severe neurologic impairment. OBJECTIVE: Our goal was to perform a scoping systematic review on the available literature for FOUR score and outcome prediction in critically ill patients. The primary outcome of interest was patient global outcome, as assessed by any of: mortality, modified Rankin Score, Glasgow Outcome Score, or any other functional or neuropsychiatric outcome. Information on interobserver reliability was also extracted. METHODS: MEDLINE and five other databases were searched. Inclusion criteria were: humans, adults, and children; prospective randomized controlled trial; prospective cohort, cohort/control, case series, prospective, and retrospective studies. Two reviewers independently screened the results. Full texts for citations passing this initial screen were obtained. Inclusion and exclusion criteria were applied to each article to obtain final articles for review. Results on adult populations are presented here. Data are reported following the preferred reporting items for systematic reviews and meta-analyses guidelines. RESULTS: The initial search yielded 1709 citations. Of those used, 49 were based on adult and 6 on pediatric populations. All but 8 retrospective adult studies were performed prospectively. Patient categories included traumatic brain injury, intraventricular hemorrhage, intracerebral hemorrhage, subarachnoid hemorrhage, ischemic stroke, general/combined neurology and neurosurgery, post-cardiac arrest, medicine/general critical illness, and patients in the emergency department. A total of 9092 adult patients were studied. Fourteen studies demonstrated good interobserver reliability of the FOUR score. Nine studies demonstrated prognostic value of the FOUR score in predicting mortality and functional outcomes. Thirty-two studies demonstrated equivalency or superiority of the FOUR score compared to Glasgow Coma Score in prediction of mortality and functional outcomes. CONCLUSIONS: The FOUR score has been shown to be a useful outcome predictor in many patients with depressed level of consciousness. It displays good inter-rater reliability among physicians and nurses.

Managing Semi-Arid Rangelands for Carbon Storage: Grazing and Woody Encroachment Effects on Soil Carbon and Nitrogen.

High grazing intensity and wide-spread woody encroachment may strongly alter soil carbon (C) and nitrogen (N) pools. However, the direction and quantity of these changes have rarely been quantified in East African savanna ecosystem. As shifts in soil C and N pools might further potentially influence climate change mitigation, we quantified and compared soil organic carbon (SOC) and total soil nitrogen (TSN) content in enclosures and communal grazing lands across varying woody cover i.e. woody encroachment levels. Estimated mean SOC and TSN stocks at 0-40 cm depth varied across grazing regimes and among woody encroachment levels. The open grazing land at the heavily encroached site on sandy loam soil contained the least SOC (30 ± 2.1 Mg ha-1) and TSN (5 ± 0.57 Mg ha-1) while the enclosure at the least encroached site on sandy clay soil had the greatest mean SOC (81.0 ± 10.6 Mg ha-1) and TSN (9.2 ± 1.48 Mg ha-1). Soil OC and TSN did not differ with grazing exclusion at heavily encroached sites, but were twice as high inside enclosure compared to open grazing soils at low encroached sites. Mean SOC and TSN in soils of 0-20 cm depth were up to 120% higher than that of the 21-40 cm soil layer. Soil OC was positively related to TSN, cation exchange capacity (CEC), but negatively related to sand content. Our results show that soil OC and TSN stocks are affected by grazing, but the magnitude is largely influenced by woody encroachment and soil texture. We suggest that improving the herbaceous layer cover through a reduction in grazing and woody encroachment restriction are the key strategies for reducing SOC and TSN losses and, hence, for climate change mitigation in semi-arid rangelands.

Methylthioadenosine phosphorylase expression in cutaneous squamous cell carcinoma.

The methylthioadenosine phosphorylase (MTAP) gene is a tumour suppressor gene, located on chromosome 9p21, 100 kb telomeric of the p15 and p16 genes, which are often deleted in tumor cells. The role of MTAP protein expression in the genesis of cutaneous squamous cell carcinoma (SCC) is currently not known. In a previous study we have shown the frequent occurrence of allelic imbalance/loss of heterozygosity (AI/LOH) in cutaneous SCCs using AI/LOH markers flanking the p15, p16, and MTAP genes and demonstrated reduction in p15 and p16 protein expression in comparison to normal human skin. The present study is a continuation to our previous studies, aimed at determining possible roles played by MTAP protein expression in the genesis of cutaneous SCC. The expression of MTAP protein was detected using immunohistochemical approach in 109 micro array cutaneous SCC and 20 normal human skin tissue samples. The expression of MTAP was not significantly different in the cutaneous SCC cases as compared with normal human skin. This may indicate that MTAP protein expression does not contribute to the genesis of cutaneous SCC.