Role of central venous-arterial PCO2 difference in prediction of clinical outcome in ICU septic patients

Aims/Objectives/BackgroundVP shunts are used to drain CSF from the cranial vault because of a wide range of pathologies and, like any piece of hardware, can fail. Traditionally investigations include SSR and CT. This project examines the role of SSR in evaluating children with suspected VP shunt failure.Primary outcome: Sensitivity and specificity of SSR in children presenting to the CED with concern for shunt failure.Methods/DesignConducted in a single centre, tertiary CED of the national Irish Neurosurgical(NS) referral centre (ED attendance:>50,000 patients/year). 100 sequential SSR requested by the CED were reviewed. Clinical information was extracted from electronic requests. Shunt failure was defined by the need for NS intervention(Revision).Abstract 332 Figure 1Abstract 332 Figure 2Results/ConclusionsSensitivity and specificity is presented in figure 1 (two by two table).100 radiographs performed in 84 children.22% shunts revised (see flow diagram).7 SSR’s were abnormal.85% (n=6) shunts revised. [5 following abnormal CT].Of the normal SSR’s; 16 had abnormal CT and revised.85/100 received CT.64 of 85 CT’s (75%) were normal.□6 of the 64 had focal shunt concern.SSR’s shouldn’t be used in isolation. NPV&PPV, Sensitivity&Specificity is low.SSR’s are beneficial where there’s concern over focal shunt problems (injury/pain/swelling) or following abnormal CT.VP shunt failure is not well investigated with SSR alone.SSR’s could be omitted where there is no focal shunt concern/after normal CT (without impacting clinical outcome) reducing radiation exposure and reduce impact on CED’s.59 SSR’s could have been avoided without adverse clinical outcome.

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Role of Doppler ultrasonography in the evaluation of hemodialysis arteriovenous access maturation and influencing factors

The Journal of Vascular Access ◽

10.1177/1129729820965064 ◽

2021 ◽

pp. 112972982096506

Author(s):

Eva Chytilova ◽

Tamara Jemcov ◽

Jan Malik ◽

Jernej Pajek ◽

Branko Fila ◽

...

Keyword(s):

Vascular Access ◽

Doppler Ultrasonography ◽

Arteriovenous Graft ◽

Central Venous ◽

Preoperative Mapping ◽

High Incidence ◽

Arteriovenous Access ◽

Ultrasound Parameters ◽

Fistula Maturation

The goal of vascular access creation is to achieve a functioning arteriovenous fistula (AVF) or arteriovenous graft (AVG). An autologous fistula has been shown to be superior to AVG or to central venous catheters (CVCs) with lowest rate of re-intervention, but vessel obstruction or immaturity accounts for 20 % to 54% of cases with primary failure of AVF. This review is focused on the factors influencing maturation; indication and timing of preoperative mapping/creation of vascular access; ultrasound parameters for creation AVF/AVG; early postoperative complications following creation of a vascular access; ultrasound determinants of fistula maturation and endovascular intervention in vascular access with maturation failure. However, vascular accesses that fail to develop, have a high incidence of correctable abnormalities, and these need to be promptly recognized by ultrasonography and managed effectively if a high success rate is to be expected. We review approaches to promoting fistula maturation and duplex ultrasonography (DUS) of evaluating vascular access maturation.

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Androgen receptor gain in circulating free DNA and splicing variant 7 in exosomes predict clinical outcome in CRPC patients treated with abiraterone and enzalutamide

Prostate Cancer and Prostatic Diseases ◽

10.1038/s41391-020-00309-w ◽

2021 ◽

Author(s):

M. Del Re ◽

V. Conteduca ◽

S. Crucitta ◽

G. Gurioli ◽

C. Casadei ◽

...

Keyword(s):

Androgen Receptor ◽

Clinical Outcome ◽

Liquid Biopsy ◽

Response To Treatment ◽

First Line ◽

Primary Resistance ◽

Circulating Free Dna ◽

Free Dna ◽

Signaling Inhibitors

Abstract Background Androgen receptor (AR) signaling inhibitors represent the standard treatment in metastatic castration resistance prostate cancer (mCRPC) patients. However, some patients display a primary resistance, and several studies investigated the role of the AR as a predictive biomarker of response to treatment. This study is aimed to evaluate the role of AR in liquid biopsy to predict clinical outcome to AR signaling inhibitors in mCRPC patients. Methods Six milliliters of plasma samples were collected before first-line treatment with abiraterone or enzalutamide. Circulating free DNA (cfDNA) and exosome-RNA were isolated for analysis of AR gain and AR splice variant 7 (AR-V7), respectively, by digital droplet PCR. Results Eighty-four mCRPC patients received abiraterone (n = 40) or enzalutamide (n = 44) as first-line therapy. Twelve patients (14.3%) presented AR gain and 30 (35.7%) AR-V7+ at baseline. Median progression-free survival (PFS) and overall survival (OS) were significantly longer in AR-V7− vs AR-V7+ patients (24.3 vs 5.4 months, p < 0.0001; not reached vs 16.2 months, p = 0.0001, respectively). Patients carrying the AR gain had a median PFS of 4.8 vs 24.3 months for AR normal patients (p < 0.0001). Median OS was significantly longer in AR normal vs patients with AR gain (not reached vs 8.17 months, p < 0.0001). A significant correlation between AR-V7 and AR gain was observed (r = 0.28; p = 0.01). The AR gain/AR-V7 combined analysis confirmed a strong predictive effect for biomarkers combination vs patients without any AR aberration (PFS 3.8 vs 28 month, respectively; OS 6.1 vs not reached, respectively; p < 0.0001). Conclusions The present study demonstrates that cfDNA and exosome-RNA are both a reliable source of AR variants and their combined detection in liquid biopsy predicts resistance to AR signaling inhibitors.

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The microbiological and clinical outcome of guide wire exchanged versus newly inserted antimicrobial surface treated central venous catheters

Critical Care ◽

10.1186/cc12867 ◽

2013 ◽

Vol 17 (5) ◽

pp. R184 ◽

Cited By ~ 6

Author(s):

Nisha Parbat ◽

Norelle Sherry ◽

Rinaldo Bellomo ◽

Antoine G Schneider ◽

Neil J Glassford ◽

...

Keyword(s):

Clinical Outcome ◽

Guide Wire ◽

Central Venous Catheters ◽

Central Venous

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Maximizing the clinical outcome with mTOR inhibitors in the renal transplant recipient: defining the role of calcineurin inhibitors

Transplant International ◽

10.1007/s00147-004-0716-5 ◽

2004 ◽

Vol 17 (6) ◽

Author(s):

Bj�rn Nashan

Keyword(s):

Renal Transplant ◽

Clinical Outcome ◽

Transplant Recipient ◽

Renal Transplant Recipient ◽

Calcineurin Inhibitors ◽

Mtor Inhibitors

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Predominant role of peripheral chemoreceptors in the termination of apnea in maturing newborn lambs

Journal of Applied Physiology ◽

10.1152/jappl.1996.80.3.892 ◽

1996 ◽

Vol 80 (3) ◽

pp. 892-898 ◽

Cited By ~ 11

Author(s):

C. Delacourt ◽

E. Canet ◽

M. A. Bureau

Keyword(s):

Carotid Body ◽

Pco2 Level ◽

Peripheral Chemoreceptor ◽

Arterial Pco2 ◽

Postnatal Maturation ◽

Body Function ◽

Life Threatening ◽

Prolonged Apnea ◽

Arterial Po2

Apneas are very common and normal in newborns but may become life threatening if they are not terminated appropriately. The aim of this study in newborn lambs was to investigate the influence on apnea termination of postnatal maturation, peripheral chemoreceptor function, and hypoxia. Apneas were induced by passive hyperventilation at varying inspired O2 fraction levels. The apnea termination threshold PCO2 (PATTCO2) was defined as the arterial PCO2 value at the first breath after the apnea. Three groups of awake intubated lambs were studied: 1) intact lambs tested at both 1 and 15 days of life, 2) intact 1-day-old lambs with central tissue hypoxia induced by CO inhalation, and 3) 1-day-old lambs with carotid body denervation (CBD). In individual lambs and regardless of age and carotid body function, there was a PO2-PCO2 response curve that was a determinant for the termination of an apnea. PATTCO2 invariably increased when arterial PO2 increased, regardless of age. During hypoxia and normoxia, PATTCO2 was significantly lower in 15-day-old lambs compared with 1-day-old lambs. No difference was seen during hyperoxia. PATTCO2 values were shifted to higher levels after carotid body removal. Finally, hypoxia induced by either a low inspired O2 fraction or CO inhalation consistently failed to induce a depressive effect on the PATTCO2 even in CBD lambs. In conclusion, in awake newborn lambs, the PCO2 level for apnea termination changed with postnatal age, and carotid body function was essential in lowering PATTCO2, thus protecting the lambs against prolonged apnea. Furthermore, hypoxia consistently failed to depress the reinitiation of breathing after apnea, even in CBD lambs.

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Acute Pyelonephritis: Role of Enhanced CT Scan in the Prediction of Clinical Outcome

Journal of the Korean Radiological Society ◽

10.3348/jkrs.1997.36.4.671 ◽

1997 ◽

Vol 36 (4) ◽

pp. 671

Author(s):

Byung June Jo ◽

Ki Whang Kim ◽

Jeong Sik Yu ◽

Jai Keun Kim ◽

Sang Wook Yoon ◽

...

Keyword(s):

Clinical Outcome ◽

Ct Scan ◽

Acute Pyelonephritis ◽

Enhanced Ct

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Role of NO in goat basal cerebral circulation and after vasodilatation to hypercapnia or brief ischemias

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1993.265.6.r1410 ◽

1993 ◽

Vol 265 (6) ◽

pp. R1410-R1415 ◽

Cited By ~ 1

Author(s):

G. Dieguez ◽

J. L. Garcia ◽

N. Fernandez ◽

A. L. Garcia-Villalon ◽

L. Monge ◽

...

Keyword(s):

Nitric Oxide ◽

Heart Rate ◽

Methyl Ester ◽

Cerebral Circulation ◽

Systemic Arterial Pressure ◽

Nitric Oxide Production ◽

Hemodynamic Effects ◽

Arterial Pco2 ◽

Different Levels

The role of nitric oxide (NO) in the cerebral circulation under basal conditions and after vasodilatation to hypercapnia or reactive hyperemias was studied in 17 anesthetized goats. The intravenous administration of NG-nitro-L-arginine methyl ester (L-NAME, 3-4 or 8-10 mg/kg), an inhibitor of nitric oxide production, reduced middle cerebral artery (MCA) flow (electromagnetically measured) by 19 and 30% and increased systemic arterial pressure by 21 and 26%, respectively, whereas heart rate did not significantly change; MCA resistance increased by 48 and 86%, respectively. These hemodynamic effects were reversed by L-arginine (200-300 mg/kg iv; 5 goats). Different levels of hypercapnia (PCO2 of 30-35, 40-45, and 55-65 mmHg) (12 goats) produced arterial PCO2-dependent increases in MCA flow that were similar under control and L-NAME treatment. Graded cerebral hyperemia occurred after 5, 10, and 20 s of MCA occlusion in 5 goats, but its magnitude was decreased during L-NAME treatment. It suggests that, in the cerebral circulation, nitric oxide 1) produces a basal vasodilator tone and 2) is probably not involved in the vasodilatation to hypercapnia but may mediate hyperemic responses after short brain ischemias.

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