BackgroundPatients with single-ventricle physiology have a significant risk of cardiorespiratory deterioration between their first and second stage palliation surgeries.ObjectivesThe objective of this study is to develop and validate a real-time computer algorithm that can automatically recognize physiological precursors of cardiorespiratory deterioration in children with single-ventricle physiology during their interstage hospitalization.MethodsA retrospective study was conducted from prospectively collected physiological data of subjects with single-ventricle physiology. Deterioration events were defined as a cardiac arrest requiring cardiopulmonary resuscitation or an unplanned intubation. Physiological metrics were derived from the electrocardiogram (heart rate, heart rate variability, ST-segment elevation, and ST-segment variability) and the photoplethysmogram (peripheral oxygen saturation and pleth variability index). A logistic regression model was trained to separate the physiological dynamics of the pre-deterioration phase from all other data generated by study subjects. Data were split 50/50 into model training and validation sets to enable independent model validation.ResultsOur cohort consisted of 238 subjects admitted to the cardiac intensive care unit and stepdown units of Texas Children’s Hospital over a period of 6 years. Approximately 300,000 h of high-resolution physiological waveform and vital sign data were collected using the Sickbay software platform (Medical Informatics Corp., Houston, Texas). A total of 112 cardiorespiratory deterioration events were observed. Seventy-two of the subjects experienced at least 1 deterioration event. The risk index metric generated by our optimized algorithm was found to be both sensitive and specific for detecting impending events 1 to 2 h in advance of overt extremis (receiver-operating characteristic curve area: 0.958; 95% confidence interval: 0.950 to 0.965).ConclusionsOur algorithm can provide 1 to 2 h of advanced warning for 62% of all cardiorespiratory deterioration events in children with single-ventricle physiology during their interstage period, with only 1 alarm being generated at the bedside per patient per day. 相似文献
ObjectivesThis study sought to determine the relationship between the severity of reduced quantitative perfusion parameters and mortality with and without revascularization.BackgroundThe physiological mechanisms for differential mortality risk of coronary flow reserve (CFR) and coronary flow capacity (CFC) before and after revascularization are unknown.MethodsGlobal and regional rest-stress (ml/min/g), CFR, their regional per-pixel combination as CFC, and relative stress in ml/min/g were measured as percent of LV in all serial routine 5,274 diagnostic PET scans with systematic follow-up over 10 years (mean 4.2 ± 2.5 years) for all-cause mortality with and without revascularization.ResultsSeverely reduced CFR of 1.0 to 1.5 and stress perfusion ≤1.0 cc/min/g incurred increasing size-dependent risks that were additive because regional severely reduced CFC (CFCsevere) was associated with the highest major adverse cardiac event rate of 80% (p < 0.0001 vs. either alone) and a mortality risk of 14% (vs. 2.3% for no CFCsevere; p = 0.001). Small regions of CFCsevere ≤0.5% predicted high risk (p < 0.0001 vs. no CFCsevere) related to a wave front of border zones at risk around the small most severe center. By receiver-operating characteristic analysis, relative stress topogram maps of stress (ml/min/g) as a fraction of LV defined these border zones at risk or for mildly reduced CFC (area under the curve [AUC]: 0.69) with a reduced relative tomographic subendocardial-to-subepicardial ratio. CFCsevere incurred the highest mortality risk that was reduced by revascularization (p = 0.005 vs. no revascularization) for artery-specific stenosis not defined by global CFR or stress perfusion alone.ConclusionsCFC is associated with the size-dependent highest mortality risk resulting from the additive risk of CFR and stress (ml/min/g) that is significantly reduced after revascularization, a finding not seen for global CFR. Small regions of CFCsevere ≤0.5% of LV also carry a high risk because of the surrounding border zones at risk defined by relative stress perfusion and a reduced relative subendocardial-to-subepicardial ratio. 相似文献
目的分析急性生理与慢性健康状况系统Ⅱ(APACHEⅡ)评分与重度有机磷中毒患者肠道屏障功能的相关性。方法回顾性选取2017年1月至2019年12月安徽理工大学附属亳州市人民医院收治的119例重度有机磷中毒患者。按照患者预后情况,将患者分别纳入存活组80例、病死组39例。记录患者入院即刻及入院48、72、144 h APACHEⅡ评分,并检测其对应时点D-乳酸(D-L)、二胺氧化酶(DAO)、内毒素(LPS)、肠脂肪酸结合蛋白(I-FABP)水平。应用Pearson相关性分析,总结APACHEⅡ评分与患者肠道屏障功能的相关性。结果119例患者中,存活80例,病死39例,病死率32.77%。存活组与病死组入院后48、72、144 h血浆D-L、LPS水平均较入院即刻下降,存活组入院即刻及入院后48、72、144 h血浆D-L、LPS水平均低于病死组同期水平,差异有统计学意义(P<0.05)。存活组与病死组入院后48、72、144 h血浆DAO、I-FABP水平均较入院即刻下降,存活组入院即刻及入院后48、72、144 h血浆DAO、I-FABP水平均低于病死组同期水平,差异有统计学意义(P<0.05)。存活组与病死组入院后48、72、144 h APACHEⅡ评分均较入院即刻下降,存活组入院即刻及入院后48、72、144 h APACHEⅡ评分均低于病死组同期水平,差异有统计学意义(P<0.05)。Pearson相关性分析显示,APACHEⅡ评分与D-L、LPS、DAO、I-FABP均呈正相关(P<0.05)。结论重度有机磷中毒患者肠黏膜通透性的上升与肠黏膜损伤的加剧伴随着APACHEⅡ评分的升高,以及病死风险的增加。 相似文献
So called Caisson's disease of bone is well recognized in the literature. The purpose of this paper is to move away from simply considering the orthopaedic aspects of avascular injury to bones and joints and provide some background physiology and physics to help understand the challenges encountered whilst diving. This is relevant to those working with professional divers. Either commercially or within the military setting, and some guidance will be provided for those involved in the acute care of divers injured or affected by the problems covered within this article. It is recommended that acute units that deal with diving accidents have established protocols to deal with the issues covered, including access to hyperbaric chambers. 相似文献
Introduction: The physiologic importance of fast CO2/HCO3? interconversion in various tissues requires the presence of carbonic anhydrase (CA, EC 4.2.1.1). Fourteen CA isozymes are present in humans, all of them being used as biomarkers.
Area covered: A great number of patents and articles were focused on the use of CA isozymes as biomarkers for various diseases and syndromes in the recent years, in an ascending trend over the last decade. The review highlights the most important studies related with each isozyme and covers the most recent patent literature.
Expert opinion: The CAs biomarker research area expanded significantly in recent years, shifting from the predominant use of CA IX and CA XII in cancer diagnostic, staging, and prognosis towards a wider use of CA isozymes as disease biomarkers. CA isozymes are currently used either alone, in tandem with other CA isozymes and/or in combination with other proteins for the detection, staging, and prognosis of a huge repertoire of human dysfunctions and diseases, ranging from mild transformation of the normal tissues to extreme shifts in tissue organization and function. The techniques used for their detection/quantitation and the state-of-the-art in each clinical application are presented through relevant clinical examples and corresponding statistical data. 相似文献
BackgroundIn planning a skin graft, the texture, color, and size of the recipient and donor site tissues should be considered.ObjectiveWe determined the optimal donor sites for nasal full-thickness skin grafting based on biophysical parameters.MethodsThirty women over the age of 60 were selected for this study. Four recipient sites (nasal root, dorsum, tip, ala) and three donor sites (preauricle, postauricle, forehead) were considered. Biophysical parameters such as transepidermal water loss (TEWL), capacitance, sebum output, erythema/melanin value, and skin replica technique were tested.ResultsThe nasal root was correlated with the forehead in terms of TEWL and sebum output. The nasal dorsum was correlated with the preauricle in terms of TEWL, erythema/melanin value, and skin replica measurements. The nasal tip was correlated with the preauricle in terms of TEWL, sebum output, erythema/melanin value, and skin replica measurements. The ala was correlated with the forehead in terms of TEWL and skin replica measurements.ConclusionThe preauricule is the optimal donor site for resurfacing of the nasal dorsum and tip. The forehead is a good donor site for alar defects. For resurfacing of the nasal root, the forehead and postauricle are good choices. 相似文献