Cough strength,secretions and extubation outcome in burn patients who have passed a spontaneous breathing trial

The aim of this study was to develop a clinical prediction model to inform decisions about the timing of extubation in burn patients who have passed a spontaneous breathing trial (SBT). Rapid shallow breathing index, voluntary cough peak flow (CPF) and endotracheal secretions were measured after each patient had passed a SBT and just prior to extubation. We used multiple logistic regression analysis to identify variables that predict extubation outcome. Seventeen patients failed their first trials of extubation (14%). CPF and endotracheal secretions are strongly associated with extubation outcome (p < 0.0001). Patients with CPF ≤ 60 L/min are 9 times as likely to fail extubation as those with CPF > 60 L/min (risk ratio = 9.1). Patients with abundant endotracheal secretions are 8 times as likely to fail extubation compared to those with no, mild and moderate endotracheal secretions (risk ratio = 8). Our clinical prediction model combining CPF and endotracheal secretions has strong predictive capacity for extubation outcome (area under receiver operating characteristic curve = 0.96, 95% confidence interval 0.91–0.99) and therefore may be useful to predict which patients will succeed or fail extubation after passing a SBT.     

Clinical Comparison of 30-Day Mortalities and 6-Month Functional Recoveries after Spontaneous Intracerebral Hemorrhage in Patients with or without End-Stage Renal Disease

Objective

The aim of this study was to determine 30-day mortality and 6-month functional recovery rates in spontaneous intracerebral hemorrhage (S-ICH) patients undergoing hemodialysis treatment for end-stage renal disease (ESRD), and to compare the outcomes of these patients and S-ICH patients without ESRD.

Methods

The medical records of 1943 S-ICH patients from January 2000 to December 2011 were retrospectively analyzed with focus on demographic, radiological, and laboratory characteristics.

Results

A total of 1558 supratentorial S-ICH patients were included in the present study and 102 (6.5%) were ESRD patients. The 30-day mortality of the S-ICH patients with ESRD was 53.9%, and 29.4% achieved good functional recovery at 6 months post-S-ICH. Multivariate analysis showed that age, Glasgow Coma Scale (GCS) score, pupillary abnormality, ventricular extension of hemorrhage, hemorrhagic volume, hematoma enlargement, anemia, and treatment modality were independently associated with 30-day mortality in S-ICH patients with ESRD (p<0.05), and that GCS score, volume of hemorrhage, conservative treatment, and shorter hemodialysis duration was independently associated with good functional recovery at 6 months post-S-ICH in patients with ESRD (p<0.05).

Conclusion

This retrospective study showed worse outcome after S-ICH in patients with ESRD than those without ESRD; 30-day mortality was four times higher and the functional recovery rate was significantly lower in S-ICH patients with ESRD than in S-ICH patients without ESRD.     

Predictors of outcomes of endoscopic balloon dilatation in strictures after esophageal atresia repair: A retrospective study

BACKGROUND Endoscopic balloon dilatation (EBD) has become the first line of therapy for benign esophageal strictures (ESs);however,there are few publications about the predictive factors for the outcomes of this treatment.AIM To assess the predictive factors for the outcomes of EBD treatment for strictures after esophageal atresia (EA) repair.METHODS Children with anastomotic ES after thoracoscopic esophageal atresia repair treated by EBD from January 2012 to December 2016 were included.All procedures were performed under tracheal intubation and intravenous anesthesia using a three-grade controlled radial expansion balloon with gastroscopy.Outcomes were recorded and predictors of the outcomes were analyzed.RESULTS A total of 64 patients were included in this analysis.The rates of response,complications,and recurrence were 96.77%,8.06%,and 2.33%,respectively.The number of dilatation sessions and complications were significantly higher in patients with a smaller stricture diameter (P=0.013 and 0.023,respectively) and with more than one stricture (P=0.014 and 0.004,respectively).The length of the stricture was significantly associated with complications of EBD (P=0.001).A longer interval between surgery and the first dilatation was related to more sessions and a poorer response (P=0.017 and 0.024,respectively).CONCLUSION The diameter,length,and number of strictures are the most important predictive factors for the clinical outcomes of endoscopic balloon dilatation in pediatric ES.The interval between surgery and the first EBD is another factor affectingresponse and the number of sessions of dilatation.     

Are the leukocyte telomere length attrition and telomerase activity alteration potential predictor biomarkers for sporadic TAA in aged individuals?

A large variability in occurrence, complications, and age/gender manifestations characterizes individual susceptibility of sporadic thoracic aortic aneurysms (TAA), even in subjects with the same risk factor profiles. The reasons are poorly understood. On the other hand, TAA pathophysiology mechanisms remain unclear than those involved in abdominal aorta aneurysms. However, recent evidence is suggesting a crucial role of biological ageing in inter-individual risk variation of cardiovascular diseases, including sporadic TAA. Biological age rather than chronological age is a better predictor of vascular risk. Relevant assumptions support this concept. In confirming this evidence and our preliminary data, the mean of blood leukocyte telomere length, through use of terminal restriction fragment assay and in blood samples from sporadic TAA patients and controls, was examined. Telomerase activity was also analyzed in two groups. In addition, we verified the weight of genetic inflammatory variants and the major TAA risk factors in telomere/telomerase impairment. Aorta histopathological abnormalities and systemic inflammatory mediators were ultimately correlated with telomere/telomerase impairment. Data obtained demonstrated shorter telomeres and a reduced telomerase activity in TAA patients significantly associated with a genetic inflammatory risk profile, age, gender, smoking, hypertension, a histopathological phenotype, and higher levels of systemic inflammatory mediators than controls. In conclusion, telomere and telomerase activity’s detection might be used as predictor biomarkers of sporadic TAA. Their impairment also suggests a strong role of vascular ageing in sporadic TAA, evocated by both environmental and genetic inflammatory factors.     

化疗前后CEA水平变化在晚期非小细胞肺癌患者疗效评价和预后判断中的价值

目的：探讨晚期非小细胞肺癌（NSCLC）患者2周期化疗前后CEA水平变化评价影像学肿瘤疾病控制的效能和预后的价值,为2周期后是否调整治疗方案提供依据。方法回顾性分析53例NSCLC患者化疗前、2周期化疗后血液中CEA水平变化;应用ROC曲线评价CEA水平变化对于化疗后影像学疗效达疾病控制（DC）的评价效能;探讨CEA水平变化与预后的关系。结果 CEA水平变化率评价DC的ROC曲线下面积为0.794,CEA水平变化率阈值为-34.0%,此时敏感度和特异度分别为80.0%和87.5%。CEA水平变化与DC呈明显正相关（r=0.526,P＜0.01）。CEA变化阳性的患者肿瘤无疾病进展时间（PFS）明显长于阴性患者（中位值分别为6.87和2.77个月,P＜0.05）。CEA水平变化及化疗周期数、体重变化均是预测PFS的独立预后因子（均P＜0.05）。结论在CEA水平升高的晚期NSCLC患者中,2周期化疗前后CEA水平变化可以有效评价影像学DC和预测PFS,CEA水平变化可作为影像学评价的重要辅助工具,有利于全面评估疗效。     

Values of patients and caregivers for donor site scars: an inter-observer analysis between patients and caregivers and prediction of cosmetic satisfaction

Background

The Patient and Observer Scar Assessment Scale (POSAS) is used to judge scars and involves patients and caregivers. Although the opinions of both are integrated, agreement between them is poorly investigated, especially in donor site scars (DSSs). Furthermore, it is unknown which POSAS-items are mostly associated with overall cosmetic satisfaction with the scar.

Methods

We included 106 DSS-patients. Twelve weeks after wound healing, patients and caregivers rated the DSS in vivo using the POSAS, comprising seven items. They were unaware of each other's judgment. Inter-observer reliability (IOR) was expressed as intra-class correlation coefficients (ICC). Items of the POSAS that best predicted patients’ overall satisfaction were identified using multivariable regression analysis.

Results

Eleven caregivers from different medical centers judged the DSSs. IOR for the POSAS items was ‘moderate’ at best regarding the item ‘overall opinion’ (ICC 0.44; 95% confidence interval 0.27–0.58). IORs regarding other POSAS-items were ‘poor’. Itching and relief best predicted patients’ overall satisfaction (total variance explained, R² = 0.174). For caregivers, pigmentation and pliability were most predictive (R² = 0.318).

Conclusion

Patients and caregivers appreciate different aspects of scar characteristics using the POSAS. This calls for shared decision-making, in which patient opinions are incorporated in the treatment choice.     

Hip abduction with ankle dorsiflexion (HAAD) score and trunk seating control within 72 h after stroke predicts long-term disability: A cohort study

BackgroundThe aim of this study was to determine whether muscle strength of the lower limb and trunk during the acute phase after stroke are predictors of motor function and disability 90 days after hospital discharge.MethodsThis prospective study used a nonconcurrent design to evaluate stroke patients at two time points: a) first 72 h: hip abduction and ankle dorsiflexion (HAAD) score, trunk sitting control, clinical evaluation, demographic profile, and stroke severity using the National Institutes of Health Stroke Scale (NIHSS); b) 90 days after hospital discharge: modified Rankin scale (mRS). The participants were divided into two groups: good outcome (mRS 0–2) and worse outcome (mRS>2), and the differences between them were assessed statistically. Clinical and demographic variables were included in the multiple logistic regression analysis. The ROC curve was used to illustrate the clinical sensitivity and specificity of the HAAD score cutoff for the outcomes.ResultsThirty-seven patients were included: 16 with mRS≤2 and 21 with mRS>2. Patients in the worse outcome group were older (p = 0.02) and presented with higher NIHSS scores (p = 0.002), lower HAAD scores (p < 0.001), higher pain sensation (p = 0.04), greater altered perception (p = 0.008), and no trunk control in the sitting position (p = 0.004). A lower HAAD score (OR = 0.09; 95%CI: 0.14–0.53; p < 0.001) and the absence of trunk control in the sitting position (OR = 0.55; 95%CI:0.54–0.95; p < 0.001) were associated with unsatisfactory outcomes.ConclusionA HAAD score <6 and the absence of trunk control while sitting during the first 72 h are predictors of worse long-term disability in stroke patients.     

Independent risk factors for the development of incontinence-associated dermatitis (category 2) in critically ill patients with fecal incontinence: A cross-sectional observational study in 48 ICU units

BackgroundCritically ill patients suffering from fecal incontinence have a major risk of developing incontinence-associated dermatitis (IAD). The presence of moisture and digestive enzymes (lipase, protease) negatively influences skin barrier function. Additional risk factors will make some patients even more vulnerable than others. In order to provide (cost) effective prevention, this specific patient population should be identified timely.ObjectivesTo identify independent risk factors for the development of IAD category 2 (skin loss) in critically ill patients with fecal incontinence.DesignA cross-sectional observational study.Setting and participantsThe study was performed in 48 ICU wards from 27 Belgian hospitals. Patients of 18 years or older, with fecal incontinence at the moment of data collection, were eligible to participate. Patients with persistent skin redness due to incontinence (IAD category 1) were excluded.MethodsPotential risk factors were carefully determined based on literature and expert consultations. Data were collected over a period of eight months by trained researchers using patient records and observation of skin care practices. At the time a patient was included in the study, all relevant data from the past six days, or since admission at the ICU, were recorded. Simultaneously, direct skin observations were performed and high definition photographs were ratified by an expert IAD researcher. A multiple binary logistic regression model was composed to identify independent risk factors. Variables with P < .25 in single binary logistic regression analyses were added to the multiple model using a forward procedure. A cut-off value of P < .1 was established to retain variables in the final model. Nagelkerke’s R² and Hosmer-Lemeshow statistic were calculated as measures of model fit.ResultsThe sample comprised of 206 patients, of which 95 presented with IAD category 2, and 111 were free of IAD. Seven independent risk factors were identified: liquid stool [odds ratio (OR) 4.69; 95% confidence interval (CI) 2.28–9.62], diabetes (OR 2.89; 95% CI 1.34–6.27), age (OR 1.05; 95% CI 1.02–1.08), smoking (OR 2.67; 95% CI 1.21–5.91), non-use of diapers (OR 2.97; 95% CI 1.39–6.33), fever (OR 2.60; 95% CI 1.23–5.53), and low oxygen saturation (OR 2.15; 95% CI 1.03–4.48). Nagelkerke’s R² was 0.377. The Hosmer-Lemeshow statistic indicated no significant difference between the observed and expected values (p = .301).ConclusionsLiquid stool, diabetes, age, smoking, non-use of diapers, fever, and low oxygen saturation were independently associated with IAD category 2 in critically ill patients with fecal incontinence.     

Visceral adiposity index as a predictor for type 2 diabetes mellitus in Asian population: A systematic review

BackgroundVisceral Adiposity Index (VAI) is a formula to estimate visceral fat accumulation which has been reported to have a better prediction for type 2 diabetes mellitus (T2DM) in Caucasian population. This systematic review is proposed to inquire whether VAI can be used as a predictor of T2DM in Asian population with different body composition compared to the Caucasian.MethodsAll studies performed in Asia and published in English on VAI prediction on the incidence of T2DM were included. The search keywords used in Pubmed and Cochrane database were visceral adiposity index, VAI and T2DM.ResultsSeven included studies, of which six studies were conducted in China and one in Iran. Four studies were prospective cohorts and the other three were cross-sectional. The largest study population were 7639 subjects, while the longest observation period was 15 years. This study found that VAI can be used as a predictor of T2DM in Asian population with better prediction values compared to Caucasian population. The reported odds ratio or hazard ratio ranged from 1.2 to 3.6.ConclusionsVAI is a practical formula used to estimate the accumulation of visceral fat which can be used as a predictor for T2DM in Asian population.