A Comprehensive Evaluation of the Predictive Abilities of Fetal Electrocardiogram-Derived Parameters during Labor in Newborn Acidemia: Our Institutional Experience

This study aimed to identify cardiotocography patterns that discriminate fetal acidemia newborns by comprehensively evaluating the parameters obtained from Holter monitoring during delivery. Between June 1, 2015, and August 1, 2016, a prospective observational study of 85 patients was conducted using fetal Holter monitoring at the Beijing Obstetrics and Gynecology Hospital, Capital Medical University, China. Umbilical cord blood was sampled immediately after delivery and fetal acidemia was defined as umbilical cord arterial blood pH < 7.20. Fetal electrocardiogram- (FECG-) derived parameters, including basal fetal heart rate (BFHR), short-term variation (STV), large acceleration (LA), deceleration capacity (DC), acceleration capacity (AC), proportion of episodes of high variation (PEHV), and proportion of episodes of low variation (PELV), were compared between 16 fetuses with acidemia and 47 without. The areas under the curve (AUC) of receiver operating characteristics (ROC) were calculated. Although all the computerized parameters showed predictive values for acidemia (all AUC > 0.50), STV (AUC = 0.84, P<0.001), DC (AUC = 0.84, P<0.001), AC (AUC = 0.80, P<0.001), and PELV (AUC = 0.71, P=0.012) were more strongly associated with fetal acidemia. Our institutional experience suggests that FECG-derived parameters from Holter monitoring are beneficial in reducing the incidence of neonatal acidemia.

Download Full-text

Significance of Early Acidosis In Predicting Early Mortality Among Flame Burned Patients In A Kenyan National Hospital

10.21203/rs.3.rs-922053/v1 ◽

2021 ◽

Author(s):

Edward Nandi Mackutwa ◽

Stanley Ominde Khainga ◽

James Muturi Ndung'u ◽

Charles Okwemba Anangwe

Keyword(s):

Survival Curve ◽

Serum Markers ◽

Early Mortality ◽

Base Deficit ◽

Operating Characteristics ◽

Predictive Values ◽

Arterial Blood ◽

Arterial Ph ◽

Level Of Significance ◽

Injured Patients

Abstract Introduction: Burn pathophysiology, fluid therapy and mortality have been assessed by various laboratory parameters including lactate and base deficit serum markers. This study targeted flame injured cohort with an objective to determine the significance of early acidosis, through measurement of three acid base indices at admission in predicting 5-day (early) mortality among the flame burned patients.Methodology: A cohort study. Eighty flame injured patients presenting within 24 hours of incident were assessed for arterial blood pH, lactate and base deficit (BD). Mortality was recorded until day 28. Receiver operating characteristics curves were drawn; area under curve, cut offs, sensitivities and specificities for BD, lactate and pH were determined for 5-day mortality. The cut offs were used to derive contingency tables for calculation of predictive values. Odds ratios were calculated at 95% confidence interval. 28 day survival curve was generated. Level of significance was <0.05.Results: 28-day mortality was 39%. Five-day mortality was 24%. The latter was predicted by a lactate level of 2.36 mmol/L, BD of -10.05 mmol/L and pH of 7.344 with 75%,74% and 95% sensitivities respectively. Odds of patients dying at these levels or worse were 6.3, 11.4 and 36.9 respectively all with significant p-values.Conclusion: Arterial pH, base deficit and lactate are good predictors of 5-day mortality among fire victims.

Download Full-text

Significance of Early Acidosis in Predicting Early Mortality Among Flame Burned Patients in a Kenyan National Hospital

10.21203/rs.3.rs-922053/v2 ◽

2021 ◽

Author(s):

Edward Nandi Mackutwa ◽

Stanley Ominde Khainga ◽

James Muturi Ndung'u ◽

Charles Okwemba Anangwe

Keyword(s):

Survival Curve ◽

Serum Markers ◽

Early Mortality ◽

Base Deficit ◽

Operating Characteristics ◽

Predictive Values ◽

Arterial Blood ◽

Arterial Ph ◽

Level Of Significance ◽

Injured Patients

Abstract Background: Burn pathophysiology, fluid therapy and mortality have been assessed by various laboratory parameters including lactate and base deficit serum markers. This study targeted flame injured cohort with an objective to determine the significance of early acidosis, through measurement of three acid base indices at admission in predicting 5-day (early) mortality among the flame burned patients.Methodology: A cohort study. Eighty flame injured patients presenting within 24 hours of incident were assessed for arterial blood pH, lactate and base deficit (BD). Mortality was recorded until day 28. Receiver operating characteristics curves were drawn; area under curve, cut offs, sensitivities and specificities for BD, lactate and pH were determined for 5-day mortality. The cut offs were used to derive contingency tables for calculation of predictive values. Odds ratios were calculated at 95% confidence interval. 28 day survival curve was generated. Level of significance was <0.05.Results: 28-day mortality was 39%. Five-day mortality was 24%. The latter was predicted by a lactate level of 2.36 mmol/L, BD of -10.05 mmol/L and pH of 7.344 with 75%,74% and 95% sensitivities respectively. Odds of patients dying at these levels or worse were 6.3, 11.4 and 36.9 respectively all with significant p-values.Conclusion: Arterial pH, base deficit and lactate are good predictors of 5-day mortality among fire victims in the Kenyan context.

Download Full-text

Hemodynamic Analysis of Arterial Blood Flow in the Coiled Umbilical Cord

Reproductive Sciences ◽

10.1177/1933719109351596 ◽

2009 ◽

Vol 17 (3) ◽

pp. 258-268 ◽

Cited By ~ 24

Author(s):

Aaron D. Kaplan ◽

Ariel J. Jaffa ◽

Ilan E. Timor ◽

David Elad

Keyword(s):

Blood Flow ◽

Umbilical Cord ◽

Arterial Blood Flow ◽

Arterial Blood

Download Full-text

INTERRELATION BETWEEN POLYFUNCTIONAL MONITORING DATA IN YOUNG MEN WITH PRE- OR MILD HYPERTENSION WITH DIFFERENT BLOOD PRESSURE DAILY PROFILE

Arterial’naya Gipertenziya (Arterial Hypertension) ◽

10.18705/1607-419x-2013-19-1-44-50 ◽

2013 ◽

Vol 19 (1) ◽

pp. 44-50 ◽

Cited By ~ 1

Author(s):

E. N. Kazidaeva ◽

Yu. L. Venevtseva

Keyword(s):

Blood Pressure ◽

Power Spectrum ◽

Mild Hypertension ◽

Young Men ◽

Holter Monitoring ◽

Left Ventricular ◽

Total Power ◽

Night Time ◽

Arterial Blood ◽

Functional Features

Objective. To examine the clinical signiﬁ cance of polyfunctional 24-hour Holter monitoring with simultaneous recording of electrocardiogram, blood pressure (BP) and respiratory efforts by respiratory inductance plethysmography (Incart, Russia) and functional features of young men with prehypertension or mild arterial hypertension with different proﬁ le of night arterial blood pressure (BP) decline («dippers», «non-dippers», «over-dippers»).Design and methods. We examined 43 adolescents and young men aged 16–26 years (mean age 19,4 ± 0,5 years). All of them underwent echocardiography («Vivid 7», GE); 48,8 % of patients were overweight or obese (body mass index, BMI > 24,9 kg/m2), and BMI was comparable in all groups. Results. Breathing disturbances (apnea/hypopnea episodes) were found in 86 % patients and were positively related with high frequency (HF) spectrum power of heart rate variability (HRV) at night-time and were not related with BMI, BP or type of night BP decline. The analysis of echocardiography revealed that in «non-dippers» (n = 18) left ventricular myocardial mass index (LVMMI) was higher (94,3 ± 16,6 g/m2) than in «over-dippers» (n = 15; 77,8 ± 10,3 g/m2, р < 0,001). In daytime «non-dippers» had lower HRV (total power spectrum and power in all three groups) and power spectrum of VLF and LF spectrum at night. The frequency of repolarization instability (transient T-wave inversion) and early repolarization syndrome was higher in «over-dippers» (66,7 %, р < 0,01). Circadian index of HR was also higher (150 %) in «over-dippers». The number of sleep apnea in «non-dippers» and «dippers» was higher (39,7 ± 29,7 and 37,1 ± 18,1 episodes per hour of sleep) than in «over-dippers» (22,3 ± 12,0 episodes per hour of sleep, р < 0,05), but the last group had more hypopneas.Conclusion. Breathing disturbances were a frequent, and, probably, physiological, ﬁ nding at polyfunctional 24-hour Holter monitoring in young overweight men with pre- or mild hypertension. There is a relationship between LVMMI and nocturnal BP dipping even in young men. Young «non-dippers» demonstrate the same clinical pattern as the older ones. «Over-dipper» type is characterized predominantly by lower HR at night and ECG repolarization abnormalities.

Download Full-text

Correlation between Intrapartum Cardiotocogram findings and cord blood pH in term and preterm labors

Current Women s Health Reviews ◽

10.2174/1573404817666210811124304 ◽

2021 ◽

Vol 17 ◽

Author(s):

Shubha Rao ◽

Himanshi Jain ◽

Anjali Suneel ◽

Roopa Padavagodu Shivananda ◽

Akhila Vasudeva

Keyword(s):

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Preterm Labor ◽

Fetal Monitoring ◽

Cord Blood Sample ◽

Arterial Blood ◽

Blood Ph ◽

Preterm Group ◽

Fetal Acidosis

Background: The purpose of intrapartum fetal monitoring by cardiotocograph (CTG) is to identify early signs of developing hypoxia so that appropriate action can be taken to improve the perinatal outcome. Although CTG findings are well known to monitor the progress of the labor due to the paucity of recommendations, there has always been a clinical dilemma as the term fetuses respond differently than a preterm fetus. However, umbilical cord blood pH can distinguish the infant at high risk for asphyxia and related sequel. Therefore, because of differences in fetal physiology in term and preterm fetuses, CTG findings vary, and hence the validity of CTG to determine fetal acidosis should be different. Aims and Objectives: This study aimed to correlate abnormal intrapartum CTG findings with umbilical cord blood pH in term and preterm labor and thus evaluate the success of CTG in predicting fetal acidosis during labor. Methods: The present study included 210 women in labor (70 preterm and 140 term) with abnormal intrapartum CTG that was classified as per 2015 revised International Federation of Gynecologists and Obstetrician (FIGO) guidelines. Immediately after delivery 2 ml Umbilical artery cord blood sample was taken in a pre-heparinized syringe for analysis, pH <=7.2 was taken as acidosis and pH >7.2 was taken as normal. The measured data were maternal general characteristics which included gravida status, associated comorbidities, method of induction and character of liquor, the intrapartum CTG tracings recorded the cord arterial blood pH and the neonatal characteristics such as APGAR score and neonatal outcome. Results: Data from 70 preterm labor was compared with 140 term labor. In this study, 20.9 % of the babies had acidosis. Suspicious CTG due to decreased variability were more common in the preterm group than in the term group (21.4% vs. 8.6% p<0.05). Positive predictive value (PPV) of abnormal CTG for fetal acidosis in the preterm group was found to be higher than that in term group, PPV of pathological CTG being even higher than suspicious CTG. Women with suspicious CTG had 82 % less risk of fetal acidosis as compared to pathological CTG. Women with Bradycardia had 5.9 times the risk of fetal acidosis as compared with normal and tachycardia. Conclusion: Abnormal CTG should be managed appropriately without any delay to prevent acidosis and cord blood pH should be done in all labors with abnormal CTG. However, our findings of a higher incidence of lower cord blood pH and suspicious CTG due to decreased variability alone, highlight the limitation of criteria currently used for interpretation of CTG in preterm labors.

Download Full-text

Abstract 17352: Hand Grip Strength as a Predictor of Exercise Capacity in Coronary Heart Disease

Circulation ◽

10.1161/circ.138.suppl_1.17352 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Cheol Ung Choi ◽

Woohyeun Kim ◽

Se-Hyun Park ◽

Woo-Sub Kim ◽

Won Young Jang ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Grip Strength ◽

Exercise Capacity ◽

Quadriceps Strength ◽

Hand Grip Strength ◽

Operating Characteristics ◽

Predictive Values ◽

Metabolic Equivalents ◽

Hand Grip

Introduction: Exercise capacity is related to the prognosis of coronary heart disease (CHD). Recent study have shown that quadriceps strength can be used to predict exercise capacity levels in patients with CHD. Hypothesis: The aim of this study is to determine whether this relationship between muscular strength and exercise capacity is maintained in hand grip strength (HGS). Methods: We studied 310 participants (Age; 62.1 ± 11.5, Men; 77.4 %) who underwent coronary intervention and participated cardiac rehabilitation. Maximal HGS was expressed as absolute value (kg), and relative to bodyweight (%bodyweight). Logistic regression was used to assess the relationship of maximal HGS, age, sex, type of CHD, diabetes, hypertension, renal insufficiency, ejection fraction, body mass index, body weight, waist to hip ratio, and basal metabolic rate with distance walked on 6-minuite walk test (6MWT) and estimated metabolic equivalents (eMETs). Results: Maximal HGS was significantly related to distance walked on 6 MWT (r = 0.40 for %bodyweight, p < 0.001) and eMETs (r = 0.43 for %bodyweight, p < 0.001). Maximal HGS was the strongest predictor of exercise capacity in each distance walked on 6 MWT category. Receiver operating characteristics curves identified maximal HGS of 35.7, 42.0% bodyweight as the best predictive cut offs for 200, and 400 meters, respectively with positive predictive values of 0.64. They also identified HGS of 38.3, and 44.6% bodyweight as the best predictive cut offs for 6 and 8 eMETs, respectively with positive predictive values of 0.70. Conclusions: Maximal HGS is related with distance on 6 MWT and eMETs levels at exercise test in CHD patients. This result suggests that maximal HGS can be used to predict exercise capacity levels. Based on this result, prospective study investigating the association between HGS and clinical outcome of CHD is needed.

Download Full-text

Clinical Prediction Scores for Pediatric Appendicitis

European Journal of Pediatric Surgery ◽

10.1055/s-0040-1710534 ◽

2020 ◽

Author(s):

Johanna Gudjonsdottir ◽

Emma Marklund ◽

Lars Hagander ◽

Martin Salö

Keyword(s):

Age Groups ◽

False Positives ◽

Curve Analysis ◽

Clinical Prediction ◽

Operating Characteristics ◽

Roc Curve Analysis ◽

Alvarado Score ◽

Predictive Values ◽

Decision Curve Analysis ◽

Suspected Appendicitis

Abstract Introduction The rate of misdiagnosis of appendicitis in children is a challenge and clinical prediction scores could be part of the solution. However, the pediatric appendicitis score (PAS) and the Alvarado score have shown disappointing diagnostic accuracy in pediatric validation studies, while the appendicitis inflammatory response (AIR) score and the novel pediatric appendicitis risk calculator (pARC) have not yet been validated thoroughly. Therefore, the aim of the present study was to evaluate these four prediction scores prospectively in children with suspected appendicitis. Materials and Methods A prospective study was conducted over a 2-year period. All patients <15 years with suspected appendicitis were eligible for inclusion. The four prediction scores were compared regarding predictive values, receiver operating characteristics (ROC) curves, decision curve analysis, and clinical outcome. Results Of the 318 patients included, 151 (47 %) patients had appendicitis. The AIR score and the pARC had substantially higher specificity and positive predictive value, and lower rate of false positives (7% and 2%), than the PAS and Alvarado score (36 and 28%, p < 0.001). Across the different gender and age groups, the AIR score and the pARC generally had fewer false positives than the PAS and Alvarado score. There were no significant differences in sensitivity, negative predictive values, rates of missed appendicitis, or ROC curve analysis. In decision curve analysis, the AIR score and the pARC outperformed the PAS and Alvarado score at most threshold probabilities. Conclusion The AIR score and the pARC are superior to the PAS and Alvarado score in diagnosing children with suspected appendicitis.

Download Full-text

Endoscopist’s Judgment Is as Useful as Risk Scores for Predicting Outcome in Peptic Ulcer Bleeding: A Multicenter Study

Journal of Clinical Medicine ◽

10.3390/jcm9020408 ◽

2020 ◽

Vol 9 (2) ◽

pp. 408

Author(s):

Enric Brullet ◽

Pilar Garcia-Iglesias ◽

Xavier Calvet ◽

Michel Papo ◽

Montserrat Planella ◽

...

Keyword(s):

Peptic Ulcer ◽

Roc Curve ◽

Clinical Judgment ◽

Scoring Systems ◽

Subjective Assessment ◽

Risk Scores ◽

Ulcer Bleeding ◽

Operating Characteristics ◽

Peptic Ulcer Bleeding ◽

Predictive Values

Background: Guidelines recommend using prognostic scales for risk stratification in patients with non-variceal upper gastrointestinal bleeding. It remains unclear whether risk scores offer greater accuracy than clinical evaluation. Objective: Compare the diagnostic accuracy of the endoscopist’s judgment against different risk-scoring systems (Rockall, Glasgow–Blatchford, Baylor and the Cedars–Sinai scores) for predicting outcomes in peptic ulcer bleeding (PUB). Methods: Between February 2006 and April 2010 we prospectively recruited 401 patients with peptic ulcer bleeding; 225 received endoscopic treatment. The endoscopist recorded his/her subjective assessment (“endoscopist judgment”) of the risk of rebleeding and death immediately after endoscopy for each patient. Independent evaluators calculated the different scores. Area under the receiver-operating-characteristics (ROC) curve, sensitivity, specificity, positive and negative predictive values were calculated for rebleeding and mortality. Results: The areas under ROC curve of the endoscopist’s clinical judgment for rebleeding (0.67–0.75) and mortality (0.84–0.9) were similar or even superior to the different risk scores in both the whole group and in patients receiving endoscopic therapy. Conclusions: The accuracy of the currently available risk scores for predicting rebleeding and mortality in PUB patients was moderate and not superior to the endoscopist’s judgment. More precise prognostic scales are needed.

Download Full-text

Comparison of Commercial ELISA Kits, a Prototype Multiplex Electrochemoluminescent Assay, and a Multiplex Bead-Based Immunoassay for Detecting a Urine-Based Bladder-Cancer-Associated Diagnostic Signature

Diagnostics ◽

10.3390/diagnostics9040166 ◽

2019 ◽

Vol 9 (4) ◽

pp. 166

Author(s):

Hideki Furuya ◽

Ian Pagano ◽

Keanu Chee ◽

Takashi Kobayashi ◽

Regan S. Wong ◽

...

Keyword(s):

Bladder Cancer ◽

Matrix Metalloproteinase ◽

Protein Array ◽

Enzyme Linked Immunosorbent Assay ◽

Operating Characteristics ◽

Predictive Values ◽

Multiplex Assays ◽

Diagnostic Signature ◽

Technical Specifications ◽

Multiplex Bead

The ability to accurately measure multiple proteins simultaneously in a single assay has the potential to markedly improve the efficiency of clinical tests composed of multiple biomarkers. We investigated the diagnostic accuracy of the two multiplex protein array platforms for detecting a bladder-cancer-associated diagnostic signature in samples from a cohort of 80 subjects (40 with bladder cancer). Banked urine samples collected from Kyoto and Nara Universities were compared to histologically determined bladder cancer. The concentrations of the 10 proteins (A1AT; apolipoprotein E—APOE; angiogenin—ANG; carbonic anhydrase 9—CA9; interleukin 8—IL-8; matrix metalloproteinase 9—MMP-9; matrix metalloproteinase 10—MMP10; plasminogen activator inhibitor 1—PAI-1; syndecan—SDC1; and vascular endothelial growth factor—VEGF) were monitored using two prototype multiplex array platforms and an enzyme-linked immunosorbent assay (ELISA) according to the manufacturer’s technical specifications. The range for detecting each biomarker was improved in the multiplex assays, even though the lower limit of quantification (LLOQ) was typically lower in the commercial ELISA kits. The area under the receiver operating characteristics (AUROC) of the prototype multiplex assays was reported to be 0.97 for the multiplex bead-based immunoassay (MBA) and 0.86 for the multiplex electrochemoluminescent assay (MEA). The sensitivities and specificities for MBA were 0.93 and 0.95, respectively, and for MEA were 0.85 and 0.80, respectively. Accuracy, positive predictive values (PPV), and negative predictive values (NPV) for MBA were 0.94, 0.95, and 0.93, respectively, and for MEA were 0.83, 0.81, and 0.84, respectively. Based on these encouraging preliminary data, we believe that a multiplex protein array is a viable platform that can be utilized as an efficient and highly accurate tool to quantitate multiple proteins within biologic specimens.

Download Full-text

HIV Viral Load Estimation Using Hematocrit Corrected Dried Blood Spot Results on a BioMerieux NucliSENS® Platform

Diagnostics ◽

10.3390/diagnostics9030086 ◽

2019 ◽

Vol 9 (3) ◽

pp. 86 ◽

Cited By ~ 3

Author(s):

Charles Nyagupe ◽

Hemant Deepak Shewade ◽

Serge Ade ◽

Collins Timire ◽

Hannock Tweya ◽

...

Keyword(s):

Viral Load ◽

Correction Factor ◽

Intraclass Correlation ◽

Dried Blood Spot ◽

Reference Laboratory ◽

Operating Characteristics ◽

Hiv Viral Load ◽

Cross Sectional ◽

Predictive Values ◽

Blood Spot

While reporting human immunodeficiency virus (HIV) viral load (VL) using dried blood spot (DBS) in the BioMerieux NucliSENS platform, application of the hematocrit correction factor has been suggested. In this cross-sectional study from the National Microbiology Reference Laboratory of Zimbabwe, we assessed whether hematocrit correction (individual and/or mean) in DBS results improved the correlation with plasma VL and prediction of VL non-suppression (≥1000 copies per ml in plasma). Of 517 specimens during August–December 2018, 65(12.6%) had non-suppressed plasma VL results. The hematocrit correction factor ranged from 1.3 to 2.0 with a mean of 1.6, standard deviation (SD: 1.5, 1.7). The intraclass correlation (ICC) for mean (0.859, 95% CI: 0.834, 0.880) and individual (0.809, 95% CI: 0.777, 0.837) hematocrit corrected DBS results were not significantly different. The uncorrected DBS results had a significantly lower ICC (0.640, 95% CI: 0.586, 0.688) when compared to corrected DBS results. There were no significant differences in validity, predictive values, and areas under the receiver operating characteristics curves for all three DBS results when predicting VL non-suppression. To conclude, hematocrit correction of DBS VL results improved agreement with the plasma results but did not improve prediction of VL non-suppression. The results were not significantly different for individual and mean corrected results.

Download Full-text