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1.
SASHA versus ShMOLLI: a comparison of T1 mapping methods in health and dilated cardiomyopathy at 3 T
Benedict T. Costello Fabian Springer James L. Hare Andre La Gerche Leah Iles Andris H. Ellims Benjamin Schmitt Andrew J. Taylor 《The international journal of cardiovascular imaging》2017,33(10):1551-1560
Cardiac Magnetic Resonance derived T1 mapping parameters are a non-invasive method of estimating diffuse myocardial fibrosis. This study aims to to determine the native T1 time, post contrast T1 time and extracellular volume (ECV) derived from T1 mapping and to evaluate the ability of T1 mapping techniques to discriminate healthy myocardium from dilated cardiomyopathy. Seventy-nine participants underwent cardiac magnetic resonance imaging at the Baker Heart and Diabetes Institute, Melbourne, Australia. Fifty-seven healthy volunteers and twenty-two patients with Dilated cardiomyopathy were included in the study. Each participant had T1 mapping sequences performed at 3 T in the mid short axis slice—both SASHA and ShMOLLI T1 mapping were performed. Native T1, post contrast T1 and ECV values were compared in health and dilated cardiomyopathy. Native T1, post contrast T1 and ECV differed significantly between SASHA and ShMOLLI techniques (P?<?0.001). All T1 parameters had similar ability to discriminate normal from abnormal myocardium (ROC AUC 0.691 to 0.830). Converting T1 values to Z scores significantly improved the agreement between SASHA and ShMOLLI techniques, particularly for post contrast T1 (ICC 0.19 to 0.895) and ECV (ICC 0.461 to 0.880). T1 mapping values from SASHA and ShMOLLI show strong correlation for post contrast measures, though with a consistent offset for all measures in health and dilated cardiomyopathy. All measures obtained using SASHA and ShMOLLI allow good discrimination between dilated cardiomyopathy and normal myocardium. 相似文献
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Arun K. Baranwal Jagdish P. Meena Sunit C. Singhi Jayashree Muralidharan 《Intensive care medicine》2014,40(9):1285-1294
Purpose
Multidose steroid pretreatment is effective in preventing postextubation airway obstruction (PEAO) in adults, however controversy continues for children. This study was designed as a randomized, placebo-controlled, double-blind trial to compare the effect of 24-h pretreatment with dexamethasone (24hPD) versus 6-h pretreatment (6hPD) on PEAO and reintubation in children at a tertiary care hospital in a developing economy.Methods
Hundred twenty-four children (3 months to 12 years) intubated for ≥48 h and planned to have extubation during next 24 h were randomized to receive 24hPD (0.5 mg/kg/dose, q6h, total of six doses; n = 66) or 6hPD (total of three doses; n = 58). Patients with preexistent upper airway conditions, chronic respiratory diseases, steroid therapy in last 7 days, gastrointestinal bleeding, hypertension, and hyperglycemia and those likely to have poor airway reflexes were excluded.Results
The two groups were similar at baseline. 24hPD reduced the incidence of PEAO (43/66 versus 48/58; p = 0.027) with absolute risk reduction of 17 %. It also reduced the incidence of reintubation, though nonsignificantly, by half [5/61 versus 9/58; relative risk (RR), 1.09; 95 % confidence interval (CI), 0.96–1.25]. Time to recovery from PEAO among non-reintubated patients was shorter among 24hPD patients (p = 0.016). No adverse event was noted with dexamethasone use. Intubation duration >7 days and cuffed tracheal tubes were found to be independent risk factors for PEAO (odds ratio 6 and 3.12, respectively).Conclusions
24-h pretreatment with multidose dexamethasone reduced the incidence of PEAO and the time to recover from it. 24hPD should be considered for high-risk children intubated for >48 h in the study setting. Further studies with larger sample size from different socioeconomic background are desirable to validate these findings. 相似文献4.
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Fabiana Madotto Tài Pham Giacomo Bellani Lieuwe D. Bos Fabienne D. Simonis Eddy Fan Antonio Artigas Laurent Brochard Marcus J. Schultz John G. Laffey LUNG SAFE Investigators the ESICM Trials Group 《Intensive care medicine》2018,44(5):564-577
Purpose
To evaluate patients with resolved versus confirmed ARDS, identify subgroups with substantial mortality risk, and to determine the utility of day 2 ARDS reclassification.Methods
Our primary objective, in this secondary LUNG SAFE analysis, was to compare outcome in patients with resolved versus confirmed ARDS after 24 h. Secondary objectives included identifying factors associated with ARDS persistence and mortality, and the utility of day 2 ARDS reclassification.Results
Of 2377 patients fulfilling the ARDS definition on the first day of ARDS (day 1) and receiving invasive mechanical ventilation, 503 (24%) no longer fulfilled the ARDS definition the next day, 52% of whom initially had moderate or severe ARDS. Higher tidal volume on day 1 of ARDS was associated with confirmed ARDS [OR 1.07 (CI 1.01–1.13), P?=?0.035]. Hospital mortality was 38% overall, ranging from 31% in resolved ARDS to 41% in confirmed ARDS, and 57% in confirmed severe ARDS at day 2. In both resolved and confirmed ARDS, age, non-respiratory SOFA score, lower PEEP and P/F ratio, higher peak pressure and respiratory rate were each associated with mortality. In confirmed ARDS, pH and the presence of immunosuppression or neoplasm were also associated with mortality. The increase in area under the receiver operating curve for ARDS reclassification on day 2 was marginal.Conclusions
ARDS, whether resolved or confirmed at day 2, has a high mortality rate. ARDS reclassification at day 2 has limited predictive value for mortality. The substantial mortality risk in severe confirmed ARDS suggests that complex interventions might best be tested in this population.Trial Registration
ClinicalTrials.gov NCT02010073.6.
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Time of Incubation for Antifungal Susceptibility Testing of Aspergillus fumigatus: Can MIC Values Be Obtained at 24 Hours? 下载免费PDF全文
Rodriguez-Tudela JL Alcazar-Fuoli L Alastruey-Izquierdo A Monzon A Mellado E Cuenca-Estrella M 《Antimicrobial agents and chemotherapy》2007,51(12):4502-4504
A collection of Aspergillus fumigatus isolates was used to check if MICs can be read at 24 h. At 24 h, the geometric mean MIC of itraconazole for resistant isolates was determined to be 5.11 mg/liter, but the MIC was read as 16 mg/liter at 48 h. At 24 h, MICs for 51.5% of resistant strains were determined to be 相似文献
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For the past decade extracorporeal shock wave therapy has been applied to a wide range of musculoskeletal disorders. The many promising results and the introduction of shock wave generators that are less expensive and easier to handle has added to the growing interest. Based on their nature of propagation, shock waves can be divided into two types: focused and unfocused. Although several physical differences between these different types of shock waves have been described, very little is known about the clinical outcome using these different modalities. The aim of the present review is to investigate differences in outcome in select orthopaedic applications using focused and unfocused shock waves. 相似文献
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Trzeciak S McCoy JV Phillip Dellinger R Arnold RC Rizzuto M Abate NL Shapiro NI Parrillo JE Hollenberg SM;Microcirculatory Alterations in Resuscitation Shock 《Intensive care medicine》2008,34(12):2210-2217
Objective Sepsis mortality is closely linked to multi-organ failure, and impaired microcirculatory blood flow is thought to be pivotal
in the pathogenesis of sepsis-induced organ failure. We hypothesized that changes in microcirculatory flow during resuscitation
are associated with changes in organ failure over the first 24 h of sepsis therapy.
Design Prospective observational study.
Setting Emergency Department and Intensive Care Unit.
Participants Septic patients with systolic blood pressure <90 mmHg despite intravenous fluids or lactate ≥4.0 mM/L treated with early goal-directed
therapy (EGDT).
Measurements and results We performed Sidestream Dark Field (SDF) videomicroscopy of the sublingual microcirculation <3 h from EGDT initiation and
again within a 3–6 h time window after initial. We imaged five sites and determined the mean microcirculatory flow index (MFI)
(0 no flow to 3 normal) blinded to all clinical data. We calculated the Sequential Organ Failure Assessment (SOFA) score at
0 and 24 h, and defined improved SOFA a priori as a decrease ≥2 points. Of 33 subjects; 48% improved SOFA over 0–24 h. Age,
APACHE II, and global hemodynamics did not differ significantly between organ failure groups. Among SOFA improvers, 88% increased
MFI during EGDT, compared to 47% for non-improvers (P = 0.03). Median change in MFI was 0.23 for SOFA improvers versus −0.05 for non-improvers (P = 0.04).
Conclusions Increased microcirculatory flow during resuscitation was associated with reduced organ failure at 24 h without substantial
differences in global hemodynamics. These data support the hypothesis that targeting the microcirculation distinct from the
macrocirculation could potentially improve organ failure in sepsis.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. 相似文献
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Eduard Alentorn-Geli Nathan R. Wanderman Andrew T. Assenmacher Joaquín Sánchez-Sotelo Robert H. Cofield John W. Sperling 《PM & R》2018,10(6):607-615
Background
Wheelchair-dependent patients rely on their upper extremities for mobility and transfers. This entails the heavy use of upper extremities as weight-bearing joints, leading to shoulder overuse with increased prevalence of rotator cuff–related disorders and ultimately to challenging cases for shoulder surgeons when a joint replacement is needed.Objective
To report the outcomes of reverse shoulder arthroplasty (RSA) in wheelchair-dependent patients with arthritis and rotator cuff tears.Design
Retrospective case series/cross-sectional study.Setting
Tertiary university hospital.Patient (participants)
All wheelchair-dependent patients undergoing RSA between 2004 and 2013.Methods/Interventions
Of the 22 wheelchair-dependent patients undergoing RSA, 18 of them had a minimum follow-up of 2 years. There were 9 men and 9 women, with a mean (standard deviation) age and length of follow-up of 68 (8.5) years and 36 (24-63) months. A retrospective chart review and cross-sectional phone calls were conducted to obtain all data.Outcomes
Pain, range of motion, functional scores (Neer scale, simple shoulder test, and American Shoulder and Elbow Society), satisfaction, complications/reoperations, radiographic loosening, and 90-day mortality/morbidity.Results
RSA resulted in a significant improvement in pain (P = .02) and nonsignificant improvements in forward flexion (P = .3) and external rotation (P = .07). There were 3 (16%) excellent, 12 (63%) satisfactory, and 4 (21%) unsatisfactory results. The mean (standard deviation) postoperative American Shoulder and Elbow Society score was 56.5 (16.5). All patients stated that they would undergo RSA again. There were no surgically related complications or reoperations. The 90-day mortality and morbidity rates were 0% and 26%, respectively.Conclusions
RSA is a safe and effective procedure in wheelchair-dependent patients who use their shoulders for weight-bearing purposes. Although functional scores are not optimal and medical complications are not uncommon, 79% of patients had an excellent or satisfactory result.Level of Evidence
III 相似文献11.
Grenouillet-Delacre M Verdoux H Moore N Haramburu F Miremont-Salamé G Etienne G Robinson P Gruson D Hilbert G Gabinski C Bégaud B Molimard M 《Intensive care medicine》2007,33(12):2150-2157
Objective To assess the characteristics of life-threatening adverse drug reactions in patients admitted to medical intensive care unit
and to define those that could facilitate early identification.
Design A prospective 6-month observational study.
Patients Of the 436 admissions to the teaching hospital medical intensive care unit, all patients aged over 15 years and who had received
documented drug treatment were included (n = 405).
Measurements Characteristics of patients [age, gender, underlying diseases, organ failure(s), drugs taken, Severity Acute Physiologic Score
II, length of stay, outcome at discharge] were prospectively collected using a standardised questionnaire. A panel of experts
assessed putative serious adverse drug reaction(s) for each drug taken and each organ failure at admission by using a standardised
causality assessment method. Characteristics of patients with and without serious adverse drug reactions at admission were
compared using univariate and then stepwise descending multivariate logistic regression.
Results Of the 405 patients included, 111 (27.4%) presented an adverse drug reaction leading to organ failure. In 48% of cases adverse
drug reactions were preventable, 23% were undiagnosed and 19% contributed to death. Age over 75 years [odds ratio (OR) 2.25;
95% confidence interval (CI) 1.15–4.38; p = 0.02], having more than three drugs (OR 6.90; 95% CI 1.44–33.00; p = 0.02) and a diagnosis of haematological malignancy (OR 6.19; 95% CI 2.07–18.53; p = 0.001) were independently associated with serious adverse drug reactions.
Conclusions Preventable life-threatening adverse drug reactions were frequently involved in organ failure at admission to medical intensive
care; many of them had not been identified.
Financial disclosures: None
Conflict of interest: None 相似文献
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Ryo Itatani Tomohiro Namimoto Syutaro Atsuji Kazuhiro Katahira Yasuyuki Yamashita 《Abdominal imaging》2016,41(7):1285-1292
Objective
To evaluate and compare the clinical utility of balanced turbo-field-echo (BTFE) magnetic resonance cholangiopancreatography (MRCP) sequences obtained at 3 and 1.5 T.Methods
We acquired three-dimensional (3D) BTFE MRCP scans with a navigator-gated technique at 3 T on a different day after 1.5 T in 39 consecutive patients. Two radiologists independently rated the image quality and visibility of anatomical structures (right and left hepatic duct, cystic duct, gallbladder, common bile duct, and main pancreatic duct) using a four-point scale. For quantitative analysis, the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and acquisition time were evaluated.Results
All visual scores tended to be higher for 1.5 T than 3 T images. There was a significant difference in the image quality and the depiction of the main pancreatic duct (p < 0.01). The image acquisition time was significantly shorter for 3 T than 1.5 T (199.3 ± 40.1 vs. 264.0 ± 86.5 s, p < 0.01). There was no significant difference in SNR and CNR.Conclusions
3D-BTFE MRCP scans acquired at 3 T were of sufficient image quality with respect to the biliary tree. SNR and CNR were comparable on 3 and 1.5 T scans, although the acquisition time was significantly shorter with the 3 T scanner.15.
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Stillbirth is a significant global health problem that frequently results in perinatal grief with compound negative psychosocial impact. In low-resource settings with exceedingly high stillbirth rates, such as rural Chhattisgarh, India, it is vital to utilize low-cost, effective interventions. Mindfulness-based stress reduction is an evidence-based intervention utilized for a broad range of physical and mental health problems, and is adaptable to specific populations. The objective of this study was to explore the sustained effectiveness of a shortened, culturally adapted mindfulness-based intervention (MBI) designed to address complex grief after stillbirth. We used an observational, mixed-methods pre-post study design with 6-week and 12-month follow-up assessments among women with a history of stillbirth (N = 22). Analyses explored study outcomes and continued use of mindfulness skills. Pretest results showed elevated psychological symptoms and high levels of perinatal grief. General linear modeling repeated measures was used to explore 6-week and 12-month follow-up changes from baseline, controlling for significantly correlated demographic variables. Longitudinal results indicated significant reductions in perinatal grief and psychological symptoms; four of the five facets of mindfulness changed in the desired direction; and resilience scores indicated thriving. The shortened, culturally adapted, MBI pilot brought about sustained, significant reductions of perinatal grief and mental health symptoms, and participants reported use of mindfulness skills in day-to-day life. This study shows that the significant mental health needs among rural women of various castes and ethnicities in Chhattisgarh following stillbirth were successfully addressed by a promising MBI with potential scalability and sustainability. 相似文献
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Anne M. Muehe Ashok J. Theruvath Lillian Lai Maryam Aghighi Andrew Quon Samantha J. Holdsworth Jia Wang Sandra Luna-Fineman Neyssa Marina Ranjana Advani Jarrett Rosenberg Heike E. Daldrup-Link 《Molecular imaging and biology》2018,20(2):324-335
Purpose
To provide clinically useful gadolinium-free whole-body cancer staging of children and young adults with integrated positron emission tomography/magnetic resonance (PET/MR) imaging in less than 1 h.Procedures
In this prospective clinical trial, 20 children and young adults (11–30 years old, 6 male, 14 female) with solid tumors underwent 2-deoxy-2-[18F]fluoro-d-glucose ([18F]FDG) PET/MR on a 3T PET/MR scanner after intravenous injection of ferumoxytol (5 mg Fe/kg) and [18F]FDG (2–3 MBq/kg). Time needed for patient preparation, PET/MR image acquisition, and data processing was compared before (n = 5) and after (n = 15) time-saving interventions, using a Wilcoxon test. The ferumoxytol-enhanced PET/MR images were compared with clinical standard staging tests regarding radiation exposure and tumor staging results, using Fisher’s exact tests.Results
Tailored workflows significantly reduced scan times from 36 to 24 min for head to mid thigh scans (p < 0.001). These streamlined PET/MR scans were obtained with significantly reduced radiation exposure (mean 3.4 mSv) compared to PET/CT with diagnostic CT (mean 13.1 mSv; p = 0.003). Using the iron supplement ferumoxytol “off label” as an MR contrast agent avoided gadolinium chelate administration. The ferumoxytol-enhanced PET/MR scans provided equal or superior tumor staging results compared to clinical standard tests in 17 out of 20 patients. Compared to PET/CT, PET/MR had comparable detection rates for pulmonary nodules with diameters of equal or greater than 5 mm (94 vs. 100 %), yet detected significantly fewer nodules with diameters of less than 5 mm (20 vs 100 %) (p = 0.03). [18F]FDG-avid nodules were detected with slightly higher sensitivity on the PET of the PET/MR compared to the PET of the PET/CT (59 vs 49 %).Conclusion
Our streamlined ferumoxytol-enhanced PET/MR protocol provided cancer staging of children and young adults in less than 1 h with equivalent or superior clinical information compared to clinical standard staging tests. The detection of small pulmonary nodules with PET/MR needs to be improved.19.
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Winnie K. W. So K. C. Choi Joanne M. T. Chen Carmen W. H. Chan S. Y. Chair Olivia W. M. Fung Rayman W. M. Wan Suzanne S. S. Mak W. M. Ling W. T. Ng Bernice W. L. Yu 《Supportive care in cancer》2014,22(11):2917-2926