Cost comparison of andexanet versus prothrombin complex concentrates for direct factor Xa inhibitor reversal after hemorrhage

Journal of Thrombosis and Thrombolysis - Andexanet-alpha is a specific reversal agent for direct factor Xa inhibitors (dFXaI). We aimed to project utilization rates and cost of andexanet for...     

Acoustic cardiographic recording during ventricular fibrillation

This is the second case report in literature that describes the simultaneous acoustic cardiographic, electrocardiographic, and invasive hemodynamic events that occurred before, during and after ventricular fibrillation that was successfully cardioverted to sinus rhythm. The absence of heart sounds, which are linked to the lack of effective myocardial contractility, correlated well with invasive hemodynamic data, indicating the lack of perfusion during ventricular fibrillation. These observations, coupled with the challenges of pulse detection as a sign of adequate perfusion during resuscitation suggest that acoustic cardiography may be a potentially effective supplemental diagnostic tool during the resuscitation of malignant arrhythmias.     

Extensive phenotype data and machine learning in prediction of mortality in acute coronary syndrome – the MADDEC study

Objective: Investigation of the clinical potential of extensive phenotype data and machine learning (ML) in the prediction of mortality in acute coronary syndrome (ACS).Methods: The value of ML and extensive clinical data was analyzed in a retrospective registry study of 9066 consecutive ACS patients (January 2007 to October 2017). Main outcome was six-month mortality. Prediction models were developed using two ML methods, logistic regression and extreme gradient boosting (xgboost). The models were fitted in training set of patients treated in 2007–2014 and 2017 (81%, n = 7344) and validated in a separate validation set of patients treated in 2015–2016 with full GRACE score data available for comparison of model accuracy (19%, n = 1722).Results: Overall, six-month mortality was 7.3% (n = 660). Several variables were found to be significantly associated with six-month mortality by both ML methods. The xgboost scored the best performance: AUC 0.890 (0.864–0.916). The AUC values for logistic regression and GRACE score were 0.867(0.837–0.897) and 0.822 (0.785–0.859), respectively. The AUC value of xgboost was better when compared to logistic regression (p = .012) and GRACE score (p < .00001).Conclusions: The use of extensive phenotype data and novel machine learning improves prediction of mortality in ACS over traditional GRACE score.

KEY MESSAGES

• The collection of extensive cardiovascular phenotype data from electronic health records as well as from data recorded by physicians can be used highly effectively in prediction of mortality after acute coronary syndrome.
• Supervised machine learning methods such as logistic regression and extreme gradient boosting using extensive phenotype data significantly outperform conventional risk assessment by the current golden standard GRACE score.
• Integration of electronic health records and the use of supervised machine learning methods can be easily applied in a single centre level to model the risk of mortality.

     

无抽搐电休克治疗精神病患者的不良反应分析及护理

目的分析无抽搐电休克(MECT)治疗精神病患者的不良反应并提出护理措施。方法回顾分析了我院82例精神病患者接受MECT治疗共515次中出现的各类不良反应。结果82例精神病患者在接受MECT治疗过程中,出现自主呼吸恢复时间超过6min以上者16例,暂时记忆障碍者5例,颈、胸部大片红疹者9例,呼吸道分泌物过多5例,烦躁不安62例,头痛不适8例。结论MECT治疗过程中的不良反应有一定的危险性,不容忽视。密切观察病情变化、采取及时有效地加压吸氧、侧卧位、适当的约束保护及良好的心理沟通是保证患者安全的重要措施。     

Comparison between intensity normalization techniques for dynamic susceptibility contrast (DSC)-MRI estimates of cerebral blood volume (CBV) in human gliomas

Purpose:

To compare “standardization,” “Gaussian normalization,” and “Z‐score normalization” intensity transformation techniques in dynamic susceptibility contrast magnetic resonance imaging (DSC‐MRI) estimates of cerebral blood volume (CBV) in human gliomas. DSC‐MRI is a well‐established biomarker for CBV in brain tumors; however, DSC‐MRI estimates of CBV are semiquantitative. The use of image intensity transformation algorithms provides a mechanism for obtaining quantitatively similar CBV maps with the same intensity scaling.

Materials and Methods:

The coefficient of variance (CV) in normal‐appearing white matter and relative contrast between tumor regions and normal tissue was compared between the three CBV transformations across five different MR scanners in 96 patients with gliomas.

Results:

The results suggest all normalization techniques improved variability and relative tumor contrast of CBV measurements compared with nonnormalized CBV maps. The results suggest Gaussian normalization of CBV maps provided slightly lower CV in normal white matter and provided slightly higher tumor contrast for glioblastomas (WHO grade IV) compared with other techniques.

Conclusion:

The results suggest Gaussian normalization of leakage‐corrected CBV maps may be the best choice for image intensity correction for use in large‐scale, multicenter clinical trials where MR scanners and protocols vary widely due to ease of implementation, lowest variability, and highest tumor to normal tissue contrast. J. Magn. Reson. Imaging 2012;35:1472–1477. © 2012 Wiley Periodicals, Inc.     

Efficacy and Safety of Orally Administered Intravenous Midazolam Versus a Commercially Prepared Syrup

Background:

Among different categories of sedative agents, benzodiazepines have been prescribed for more than three decades to patients of all ages. The effective and predictable sedative and amnestic effects of benzodiazepines support their use in pediatric patients. Midazolam is one of the most extensively used benzodiazepines in this age group. Oral form of drug is the best accepted route of administration in children.

Objectives:

The purpose of this study was to compare the efficacy and safety of a commercially midazolam syrup versus orally administered IV midazolam in uncooperative dental patients. Second objective was to determine whether differences concerning sedation success can be explained by child‘s behavioral problems and dental fear.

Patients and Methods:

Eighty eight uncooperative dental patients (Frankl Scales 1,2) aged 3 to 6 years, and ASA I participated in this double blind, parallel randomized, controlled clinical trial. Midazolam was administered in a dose of 0.5 mg/kg for children under the age 5 and 0.2 mg/kg in patients over 5 years of age. Physiologic parameters including heart rate, respiratory rate, oxygen saturation and blood pressure were recorded. Behavior assessment was conducted throughout the course of treatment using Houpt Sedation Rating Scale and at critical moments of treatment (injection and cavity preparation) by North Carolina Scale. Dental fear and behavioral problems were evaluated using Child Fear Schedule Survey-Dental Subscale (CFSS-DS), and Strength and Difficulties Questionnaire (SDQ). Independent t-test, Chi-Square, and Pearson correlation were used for statistical analysis.

Results:

Acceptable overall sedation ratings were observed in 90% and 86% of syrup and IV/Oral group respectively; Chi-Square P = 0.5. Other domains of Houpt Scale including: sleep, crying and movement were also not significantly different between groups. Physiological parameters remained in normal limits during study without significant difference between groups.

Conclusions:

“Orally administered IV midazolam” preparation can be used as an alternative for commercially midazolam syrup.