Relationship of somatomedin-C/insulin-like growth factor I levels to conventional nutritional indices in critically ill patients

Twenty ICU patients, with varying diagnoses and degrees of catabolism, were studied prospectively to determine whether somatomedin-C/insulin-like growth factor I (SMC/IGFI) is related to the conventional nutritional indices, plasma prealbumin, transferrin and albumin, and nitrogen balance (NB) in critical illness. Mean SMC/IGFI concentration in these critically ill patients was below the lower limit of the reference range. SMC/IGFI concentrations correlated with NB for the 24 h before measurement (r = .38, p less than .01) and with cumulative NB for the previous 2 (r = .50, p less than .01), 3 (r = .34, p less than .05), and 5 days (r = .46, p less than .05). Prealbumin correlated with cumulative 5-day NB (r = .39, p less than .05). Plasma albumin and transferrin concentrations did not correlate with NB for any of these time periods. SMC/IGFI concentrations correlated with cumulative protein (r = .59, p less than .01), carbohydrate (r = .63, p less than .01), and energy intake (r = .64, p less than .01). SMC/IGFI was the only index which consistently correlated with NB. We conclude it is a useful index of nutritional status in critically ill patients.     

The Urine Stream Interruption Test and pelvic muscle function.

The Urine Stream Interruption Test (UST) was developed to assess the effectiveness of the pelvic floor muscles in impeding urine flow. In the present study, the repeatability of the UST and its relationship to other measures of pelvic muscle strength were tested. Seventy-five women (25 each nulliparous, primiparous, and secundiparous) were enrolled. Repeatability of the UST was demonstrated by a correlation of r = .83. Stronger pelvic muscle strength, as assessed by the Digital Measure, was correlated with more rapid interruption of the stream of urine, r = -.55 to -.59. Greater parity was associated with decreased ability to stop the flow, F = 10.2 [2, 72], p less than .001), with the UST scores longest in secundiparas (M = 4.4 seconds), next longest in primiparas (M = 3.6 seconds), and shortest in nulliparas (M = 1.96 seconds).     

The circumvaginal musculature: correlation between pressure and physical assessment

This study assessed two recently developed techniques to assess the circumvaginal musculature (CVM), the CVM Rating Scale and the pressure sensitive intravaginal balloon device (IVBD), and correlated results of the two methods. Thirty women volunteers, aged 20 to 42, were studied. CVM Rating Scale total scores and IVBD maximal contraction variables were measured for resting pressure, rate of rise, maximal pressure, rate of return, and time that a submaximal contraction could be sustained (endurance contraction). Age, parity, self-reported orgasm, self-reported Kegel exercises, and self-reported physical exercise were separately correlated with CVM Rating Scale total scores and IVBD maximal pressure results. A positive significant correlation was found between the CVM Rating Scale total scores and the IVBD maximal contraction results for the variables rate of rise, r = .50, p less than .01, maximum pressure, r = .82, p less than .01, and rate of return, r = .44, p less than .01. Self-reported orgasm had a positive significant correlation to the CVM Rating Scale total scores, rho = .34, p less than .05, and to the IVBD maximal pressure results, r = .52, p less than .01. A positive correlation was found between self-reported physical exercise and the CVM Rating Scale total scores, rho = .31, p less than .05. IBVD maximal pressure results were negatively correlated with age, r = -.34, p less than .05, and parity, r = -.34, p less than .05.     

Severity of illness correlates with alterations in energy metabolism in the pediatric intensive care unit

OBJECTIVE: To evaluate the correlations between severity of illness scoring systems and biochemical markers of physiologic stress. SETTING: Tertiary care pediatric ICU in a university hospital. DESIGN: A prospective, clinical study. PATIENTS: Twelve patients aged 2 to 120 months (four patients aged less than 12 months) with varying diagnoses including sepsis, cardiovascular surgery, respiratory failure. INTERVENTIONS: Oxygen consumption (VO2), daily total urinary nitrogen, and the branch chain to aromatic amino acid ratio were correlated with the Physiologic Stability Index, Pediatric Risk of Mortality score, and Therapeutic Intervention Scoring System. Linear regression analysis and multivariate stepwise regression analysis were used to analyze the data. MEASUREMENTS AND MAIN RESULTS: Pediatric Risk of Mortality score and Physiologic Stability Index correlated with VO2 (r2 = .69, p less than .001 and r2 = .52, p less than .01, respectively) and with daily total urinary nitrogen excretion (r2 = .66, p less than .001 and r2 = .62, p less than .01, respectively). The Therapeutic Intervention Scoring System correlated with the total urinary nitrogen excretion (r2 = .69, p less than .001) and branch chain to aromatic amino acid ratio (r2 = .49, p less than .01). Correlations existed between Pediatric Risk of Mortality score and Physiologic Stability Index (r2 = .88, p less than .001) and Pediatric Risk of Mortality score and Therapeutic Intervention Scoring System (r2 = .48, p less than .01). CONCLUSIONS: The correlations were independent of diagnostic category, suggesting that the alterations in biochemical variables were most directly related to the overall severity of illness as measured by the scoring system.     

Predictive validity of Rappaport's Disability Rating Scale in subjects with acute brain dysfunction

We implemented a correlational study to evaluate the effectiveness of Rappaport's Disability Rating Scale in predicting length of hospital stay and discharge status. We evaluated 128 patients who had had cerebrovascular accidents or head injuries using Rappaport's Disability Rating Scale and documented their lengths of stay and discharge dispositions. Significant correlations were obtained between initial Disability Rating scores and lengths of hospital stay (r = .50, p less than .01), discharge Disability Rating scores (r = .66, p less than .01), and discharge status (r = .40, p less than .01). Higher initial ratings of disability were associated with higher discharge ratings and longer terms of hospitalization. Higher ratings of disability were also associated with discharge to another treatment facility rather than home. Despite this evidence supporting the predictive validity of Rappaport's Disability Rating Scale, accurate prediction of length of hospitalization remains difficult because of extreme sample variability. Areas of further investigation are considered.     

Effects of acute illness on selenium homeostasis

Biochemical evidence of selenium (Se) deficiency is frequent in patients with chronic malnutrition. However, the incidence of Se deficiency in acutely ill patients is unknown. In 175 consecutive ICU patients, plasma Se measured during the first week of ICU admission was 0.66 +/- 0.21 mumol/L (mean +/- SD) and was less than that measured in 57 healthy blood donors (1.05 +/- 0.21 mumol/L, p less than .001). Sixty-eight percent of plasma Se concentrations fell below the lower limit of the reference range. Plasma Se decreased with the number of weeks in the ICU (r = .33, p less than .01) with values decreasing to 0.49 +/- 0.20 mumol/L during the fourth week. Urinary Se excretion measured in a subgroup of 20 patients was related to plasma Se concentration (r = .38, p less than .05), and inversely related to N balance (r = .50, p less than .01). We conclude that decreased plasma Se concentrations are common in ICU patients and that catabolic states are associated with increased Se losses. These losses are unlikely to account for the marked reductions in plasma Se concentrations, and the findings suggest there may be significant changes in the distribution of body Se during critical illness.     

Elevated pulmonary artery systolic storage volume associated with redistribution of pulmonary perfusion

The possibility that an increased pulmonary arterial systolic storage volume (PASSV) correlates with a significant redistribution of pulmonary perfusion was examined in 30 surgical patients. Right ventricular stroke work index (RVSWI) was used as an index of distribution of pulmonary perfusion. The systolic storage volume was calculated from the pulmonary arterial compliance and mean pulmonary arterial distending pressure. Pulmonary arteriolar pressures were computed by Fourier analysis. Pulmonary arterial compliance was derived from the pulmonary arterial time constant and pulmonary arterial resistance. There was a linear relationship between PASSV and RVSWI (r = .81, p less than .001). Also, a direct correlation was found between RVSWI and pulmonary arterial time constant (r = .45, p less than .01). When the patients were divided into three groups according to the severity of pre-existing disease, linear relationships between PASSV and RVSWI were present in all groups, and the slopes were not different among the three groups. The patients were also divided into two groups based on a storage volume fraction of stroke volume index, to evaluate the effect of other hemodynamic data on the PASSV. Comparison of the two groups revealed that pulmonary arterial pressure and pulmonary arterial compliance were significantly higher in the group with a high storage volume fraction (p = .05 and p = .01, respectively). RVSWI and time constant were also significantly different between the groups (p less than .01 and p less than .01, respectively). We conclude that the pressure work generated by the right ventricle improved the distribution of pulmonary perfusion by increasing PASSV.     

Digital measurement of pelvic muscle strength in childbearing women

Fourteen primigravidas were evaluated at 32 and 36 weeks antepartum (AP) and 6 weeks postpartum (PP) to test the reliability and validity of a digital measure of pelvic muscle strength using urine control as the criterion. Interrater reliabilities ranged from .67 to .77. Convergent validity was shown by negative correlations between clinical muscle scores and time required to interrupt urine flow at 32 weeks AP (r = -.41), 36 weeks AP (r = -.64) and 6 weeks PP (r = -.71). Validity was also demonstrated in a pattern of lower scores in women who had urine loss during coughing or reported incontinence as compared with those who did not. Women who had cesarean births had higher postpartum pelvic muscle scores with progressively lower scores demonstrated by those who gave birth vaginally without laceration, with episiotomy, and with laceration, F(3, 10) = 5.40, p = .02.     

Correlation between measured and calculated colloid osmotic pressure

We examined the relationship between measured colloid osmotic pressure (COP), and COP calculated from serum total protein concentration (TP). Serum COP and TP were measured in 40 patients with severe abdominal sepsis. Measured COP values were not significantly different from values calculated using three separate formulas. The correlation rate between measured COP and TP (r = .83, p less than .01) was lower than that between calculated COP and TP (r = .99, p less than .01). All three formulas were fairly reliable. Alternatively, a table of predicted COP values may be useful in severely ill patients.     

The cutaneous R-pulse interval: its application as a clinical measure of neonatal cardiovascular function

The time interval from the onset of the R wave of the ECG to the onset of the cutaneous capillary pulse wave, i.e., cutaneous R-pulse interval or RPIc, was evaluated in 21 full-term and 22 preterm infants as a measure of cardiovascular function. RPIc showed a significant linear relationship with birth weight (r = .58, p less than .001) and gestational age (r = .62, p less than .001) for healthy infants. At similar gestational ages, the sick infants showed a significant prolongation of RPIc when compared to their healthy counterparts (mean prolongation 18.5 msec, p less than .01). The infusion of calcium gluconate, an inotropic agent, consistently and significantly shortened the RPIc from its preinfusion value (p less than .01). In 7 infants, simultaneous measurement of intra-aortic R-pulse interval accompanied parallel changes in RPIc. These preliminary observations suggest that continuous monitoring of RPIc may provide a reliable noninvasive measure of neonatal cardiovascular function.     

Running addiction and dyadic adjustment

Running motivated by an addictive mechanism may overpower the sensible, beneficial approach to exercise. Neglect of family responsibilities and relationships may occur as a result of this addiction. Thirty-five marathon runners and their spouses were studied; 22 of the runners were women and 13 were men. Each runner and spouse completed the dyadic adjustment (DAS) and running addiction (RAS) scales; the spouses were asked to rate their own dyadic adjustment and the runners' addiction. Findings indicated little relationship between the runners' RAS and DAS scores; however, there was a significant negative relationship between spouses' rating of the runners' RAS and their own DAS, (r = -.59, p less than .001). The relationship between higher perceived levels of running addiction in the spouse and lower DAS scores was stronger in those spouses who did not run; (r = -.61, p less than .01) and for male spouses of female runners; (r = -.67, p less than .01).     

Effects of propranolol on resting metabolic rate after severe head injury

Postabsorptive resting metabolic rate (RMR), measured by indirect calorimetry, and the effect of iv propranolol administration were studied in 12 nonseptic patients with severe head injury by means of indirect calorimetry. Before propranolol RMR was moderately increased (126 +/- 10.4% of predicted values) whereas urinary excretion of catecholamines was markedly elevated (p less than .01 vs. normal values). RMR was significantly correlated with both resting heart rate (HR) (r = .72, p less than .01) and 24-h urinary N excretion (r = .85, p less than .001). The administration of iv propranolol (0.1 mg/kg) produced a rapid decrease in HR (-10 +/- 4%, p less than .001) and in RMR (-6.1 +/- 2.3%, p less than .001). Further administration of propranolol produced no additional reduction in either HR or RMR. We conclude that severely head-injured patients are moderately hypermetabolic in resting and postabsorptive conditions, and that acute iv propranolol administration induces a reduction of about one quarter of the resting hypermetabolism.     

Oxygen delivery-dependent oxygen consumption in acute respiratory failure

OBJECTIVE: To investigate whether oxygen consumption (VO2) is dependent on oxygen delivery (DO2) in adult respiratory distress syndrome (ARDS) and non-ARDS acute respiratory failure. DESIGN: Intervention study of a consecutive sample of patients admitted to the ICU with the diagnosis of acute respiratory failure. SETTING: Tertiary care center. PATIENTS: Thirteen consecutive patients with a diagnosis of ARDS and 11 with a diagnosis of respiratory failure not due to ARDS. Patients were monitored with an oximetric pulmonary artery catheter and mechanically ventilated. INTERVENTIONS: DO2 was decreased by the application of positive end-expiratory pressure (PEEP) (20 cm H2O), and subsequently increased by an iv infusion of dobutamine (10 micrograms/kg.min). RESULTS: After the application of PEEP, DO2 decreased significantly in both groups. However, VO2 decreased significantly (p less than .01) only in the ARDS group. When dobutamine was infused, DO2 increased significantly (p less than .01) in both groups, but VO2 increased only in ARDS patients. DO2 correlated significantly with VO2 both in ARDS (r2 = .81, p less than .01) and in non-ARDS (r2 = .38, p less than .05) patients. The correlation coefficient was significantly higher for ARDS than for non-ARDS patients. Comparing the slopes of the regression lines, a stronger dependency of VO2 on DO2 was found in ARDS than in non-ARDS respiratory failure (p less than .001). The oxygen extraction ratio correlated with DO2 in non-ARDS patients (r2 = .49, p less than .05), but not in ARDS patients. CONCLUSIONS: VO2 is dependent on DO2 over a wide range of DO2 values in acute respiratory failure. This dependency phenomenon is much stronger in ARDS than in respiratory failure due to other causes. Due to the abnormal dependency of VO2 on DO2, changes in the oxygenation status may not be reflected by changes in mixed venous oxygen saturation in ARDS.     

A direct relationship between ionized calcium and arterial pressure among patients in an intensive care unit

Serum ionized calcium (Ca+2), creatinine, magnesium, phosphate, and arterial pH were measured in patients on admission to the medical ICU (MICU). Patients were classified into three groups: a) hypotensive (n = 38), those who received vasopressor support for frank hypotension; b) hypertensive (n = 21), those who required vasodilator therapy; and c) normotensive (n = 53), those who required neither vasopressor nor vasodilator therapy. Analysis of variance revealed that only Ca+2, creatinine, and arterial pH differed among the three groups. The difference in Ca+2 persisted when analysis of variance was repeated with creatinine as a covariate. Hypotensive patients had a significantly (p less than .05) lower mean Ca+2 (1.04 +/- 0.13 mmol/L) than normotensive patients (1.13 +/- 0.10 mmol/L), who in turn had a significantly (p less than .05) lower Ca+2 than hypertensive patients (1.18 +/- 0.09 mmol/L). Ca+2 correlated with mean arterial pressure at the time of serum collection (n = 118; r = .43; p less than .01), independent of any other variable. Vasopressor support was required in 41% of hypocalcemic patients in comparison to 14% of normocalcemic patients (p less than .01). Vasodilator therapy was required for 34% of normocalcemic patients, compared to 7.5% of hypocalcemic patients (p less than .01). There appears to be a clinically significant association between hypotension and hypocalcemia. This association may or may not be causal.     

Self-reported exercise before age 40: influence on quantitative skeletal ultrasound and fall risk in the elderly

OBJECTIVES: To compare musculoskeletal factors with bone structure, as measured by quantitative ultrasound (QUS) at the calcaneus, and their potential to predict fall risk in geriatric inpatients. DESIGN: Longitudinal. SETTING: Two geriatric hospitals in Switzerland. PARTICIPANTS: A total of 134 of 207 long-stay geriatric patients (96 women, 38 men) who were able to perform the timed up and go (TUG) test. INTERVENTIONS: Five musculoskeletal tests: 2 functional tests (TUG, for mobility; functional reach test, for balance), and 3 muscle strength tests (knee flexor, knee extensor, grip). Falls were monitored prospectively in a subgroup of 94 mobile subjects of 1 geriatric hospital throughout each individual length of stay (median, 31.4wk: interquartile range, 16-56.4wk). MAIN OUTCOME MEASUREMENTS: Functional and strength tests, mobility status, and self-reported exercise before age 40 were musculoskeletal factors to be compared with QUS. RESULTS: QUS was higher in mobile subjects without walking aid (p < .0001) and correlated significantly with muscle strength (knee flexor: r = .36; knee extensor: r = .30) and functional tests (TUG: r = -.25; functional reach: r = .16). Women who reported regular exercise before age 40 had higher QUS (p = .01) and fewer falls (p = .01). Falls were less frequent in subjects with walking aid (p = .03). No single musculoskeletal test, but rather a combination of demographic variables, musculoskeletal factors, and QUS could predict 76% of total variation of fall risk. CONCLUSION: This study showed the important impact of current mobility and muscle strength status on bone structure, as measured by QUS at the calcaneus. In addition, a beneficial effect of former exercise on QUS and fall risk at advanced age could be documented in women. Both findings support life-long engagement in exercise, which might be particularly meaningful for women.     

An instrument to assess the dynamic characteristics of the circumvaginal musculature

This report describes an intravaginal balloon device (IVBD) and an improved method for measuring the dynamic characteristics of circumvaginal muscle (CVM) contractions. The IVBD measurement system may be used in research on women's health problems related to the pelvic floor musculature. The system is independent of examiner judgment and variability, and measurement conditions are carefully controlled. In an initial trial using the device with 20 volunteers, aged 22 to 58 years, the maximal pressure developed during strong CVM contractions was measured with the subjects supine. Subjects were asked to repeat the contraction while they contracted abdominal muscles. The length of time a submaximal contraction could be held was also measured. Test-retest reliability, determined by repeating each experiment, revealed significant correlations in maximal pressure attained, r = .85, p less than .03. A t test demonstrated no significant difference between the variables with and without the use of abdominal muscles, indicating the contraction of abdominal muscles did not affect intravaginal pressure when assessed with the IVBD. A weak correlation between length of time a submaximal contraction could be held and age of subject was found, r = -.44, p less than .06, but no pressure variable was correlated with age or parity, a possible effect of the small sample in this study.     

Effect of tachypnea on oral temperature estimation: a replication

The effect of tachypnea on oral temperature measurement was examined in 53 patients in a medical intensive care unit. This study was a replication of Tandberg and Sklar's (1983) study. The effect on rectal/oral temperature difference exerted by normal respiratory rate (20 or less respirations per minute) versus tachypnea (greater than 20 respirations per minute) was studied. A t test demonstrated that mean rectal/oral temperature difference between the groups was significantly different, t = -3.26, df = 49.45, p less than .01, supporting Tandberg and Sklar's findings. The present study found a positive relationship between the variables, r = .33, p less than .05, as did the previous study, r = .49, p less than .001.     

Intrinsic Motivation Inventory: translation and validation in Chinese women with urinary incontinence

Female stress urinary incontinence can be treated through surgical, pharmacological and non-surgical approaches. The behavioural intervention such as pelvic floor muscle exercise in the treatment of stress urinary incontinence had been widely studied with a cure rate from 25% to 56%. To date, there is no instrument to measure the intrinsic motivation of Chinese women with stress urinary incontinence engaged in pelvic floor muscle exercise. The aim of the study is to translate the Intrinsic Motivation Inventory (IMI) into Chinese and evaluate the psychometric properties of the Chinese version. Hong Kong Chinese women ( n = 150) attending the pelvic floor muscle exercise programme participated in this study. Test–retest reliability and validity of the C-IMI was assessed. Correlation between the C-IMI and the Chinese version of the Rosenberg self-esteem (C-RES) was used for criterion validity. Construct validity was examined using factor analysis. Cronbach alpha for the IMI-C was 0·79 and test–retest reliability was 0·66. C-IMI was correlated with C-RES score ( r = 0·25, < 0·01). The factor analysis provided five factors and accounted for 60·8% of variance. The C-IMI could be used to help to identify people with low motivation related to adherence to pelvic floor muscle exercise, monitor intervention outcomes and improve exercise behaviour of patients not only with urinary incontinence but also in other patients who require exercise regime as a health-promotion intervention such those undergoing cardiac rehabilitation.     

经会阴超声对自然分娩者产后盆底肌肉锻炼治疗的疗效评估

目的采用经会阴超声检查评估盆底肌肉功能锻炼治疗的疗效,为产后盆底功能恢复提供重要的指导作用。 方法选取2015年6至2016年5月湖南省岳阳市一人民医院30例接受盆底肌肉功能锻炼的产妇组与30例未进行盆底肌肉功能锻炼的对照组的临床资料。采用经会阴超声检查观察2组的盆底基本结构并分别于静息状态及压力状态下进行各参数的测量,可以得到膀胱颈位置（Dr、Ds）、膀胱尿道后角（βr、βs）、膀胱颈旋转角（γ）,研究组与对照组组间年龄、Dr、Ds、βr、βs、γ比较采用t检验（成组设计的两样本均数比较）,2组在产后6周与产后14周Dr、Ds、βr、βs、γ值比较采用t检验（配对设计的均数比较）。 结果（1）第14周研究组与对照组的Dr、Ds参数比较,研究组>对照组,差异有统计学意义（t=4.63、2.14,P均<0.05）;2组βr、βs、γ比较,研究组<对照组,差异有统计学意义（t=3.17、3.83、2.44,P均<0.05）;第6周2组各参数比较,差异无统计学意义（t=1.30、0.40、0.52、0.87、1.21,P均>0.05）。（2）研究组第6周与第14周Dr、Ds参数比较,第14周>第6周,差异有统计学意义（t=11.43、10.00,P均<0.05）;βr、βs、γ参数比较,第14周<第6周,差异有统计学意义（t=11.53、4.84、4.26,P均<0.05）;对照组第6周与第14周的βr、βs、γ参数比较,差异无统计学意义（t=1.94、1.96、1.87,P均>0.05）,而Dr、Ds参数比较,第14周>第6周,差异有统计学意义（t=5.57、10.75,P均<0.05）。 结论盆底肌肉功能锻炼可逐渐改善经阴道分娩者产程中造成的盆底结构及功能的伤害,经会阴超声可客观的评估盆底肌肉功能锻炼治疗的疗效,为临床早期发现盆底功能障碍性疾病和产后恢复提供重要的依据。