scholarly journals Timing Assessment of Response to Fluid Challenge in Patients with Septic Shock

2021 ◽  
Author(s):  
Hui-bin Huang ◽  
Biao Xu ◽  
Guang-Yun Liu ◽  
Bin Du
Keyword(s):  
Septic Shock ◽  
Repeated Measures ◽  
Time Course ◽  
Fluid Challenge ◽  
Time Points ◽  
Initial Resuscitation ◽  
Hemodynamic Variables ◽  
Assessment Time ◽  
Recorded Data ◽  
Time Courses

Abstract Objectives: Fluid challenge (FC) is most commonly used for fluid responsiveness (FR) evaluation, with a wide divergence in assessment time choices. Therefore, we aimed to explore the optimal assessment time for FC in patients with septic shock. Methods: A prospective cohort study was conducted. Septic shock patients who had experienced initial resuscitation and required an FC with 500 mL 4% gelatin or normal saline (NS) over 5-10 min were included. FR was defined by an increase in cardiac index (CI) >10%. FR and other predefined variables were recorded at baseline (Tb), immediately (T0), and at 10 (T1), 30 (T2), 45 (T3), 60 (T4), 90 (T5), and 120 (T6) min after FC. The incidence of FR and hemodynamic variables at predefined time points were recorded. Data were analyzed by repeated measures of analysis of variance. Results: 63 patients were enrolled, with 43 in the gelatin group and 20 in the NS group. Among the 45/63 (71%) responders, 31 were responded at T0 (ER), while 14 responded at T1 or later (LR). The proportion of NR, ER and LR was comparable between gelatin and NS groups. After FC, the time course of FR status was slightly different between gelatin and NS groups. In the gelatin group, FC induced most responders (69%, 31/45) and frequency of CI maximum (35%, 11/31) at T2 and sustained a positive FR status until T4; while in the NS group, FC induced most responders (55%, 11/20) and frequency of CI maximum (64%, 9/14) at T1, and sustained FR status until T1. Conclusions: Different time courses of FR were found between gelatin and NS group patients undergoing FC. Thus, when NS is used, FR should be performed within 10 min, while it is better to extend the assessment time to 30 min after FC when gelatin is used.

scholarly journals Does Prior Surgery Affect Total Ankle Complication and Failure Rates?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0034
Author(s):  
Luigi Manzi ◽  
Federico Giuseppe Usuelli ◽  
Alexander Caughman ◽  
Christopher E. Gross
Keyword(s):  
Functional Outcome ◽  
Repeated Measures ◽  
Functional Outcomes ◽  
Time Course ◽  
Temporal Evolution ◽  
Consecutive Series ◽  
Exact Test ◽  
Time Points ◽  
Significant Difference ◽  
Pain Outcomes

Category: Ankle Arthritis; Ankle Introduction/Purpose: Given that most ankle replacements are post-traumatic in origin, it is important to investigate if prior interventions can affect a patient’s functional outcome or the possibility of having a complication. Prior surgeries create scar, incisions, and possible affect bone health that could interfere with healing. The purpose of the study is to assess the pain and functional temporal outcomes of patients with and without prior surgeries in the ipsilateral ankle. We hypothesize that those with a previous ipsilateral ankle procedure will not have an increased complication rate or worse functional outcomes. Methods: We retrospectively identified a consecutive series of 100 primary TARs with a prior procedure who were followed for a minimum of 3 years. The follow-up time points considered were 0, 6, 12, and 36 months. Outcomes were measured using AOFAS, VAS, SF12, and range of motion scores. The mean patient age was 56.5 +- 13.4 years. Sixty-four patients had previous interventions which included osteosynthesis (49), arthroscopy (11), hardware removal (25), arthrodesis (3), prosthesis (1), open fracture (9), and other open surgery (12). Within-group comparisons were performed using one-way repeated-measures ANOVA (1-w rANOVA), analyzing temporal course of clinical data (comparisons between different time points) between the groups. To compare the time course of clinical measures between the two groups, 2-w rANOVAs were performed. Data and statistical analysis were conducted using Matlab (MathWorks, Natick, MA). Results: For each type of intervention, every outcome was compared to test whether presurgery interventions have an influence on the temporal evolution of the outcomes. The two groups did not show any difference on the temporal evolution of the outcomes. The type of intervention did have a weak effect on outcomes. Treatment of previous open fractures was the only pre- surgical intervention that showed a statistically significant difference in temporal evolution of functional and pain outcomes between intervention and non-intervention groups. No significant correlations were found between all outcomes and the time between the last intervention and prosthesis. Using Fisher’s-exact test, there was not a significant association between the those who had previous surgery and those who did not and the rate of complication and revision (p =0.10). Conclusion: A pre-operative discussion should center on potential complications and predicted functional outcomes. The presence, type, and timing of an intervention prior to an ankle replacement does not strongly affect the temporal outcomes of pain and functional outcome scores. Furthermore, the complication or revision rate is not affected by prior surgeries.

scholarly journals A Metabolomics Approach to the Identification of Urinary Biomarkers of Pea Intake

Nutrients ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 1911 ◽  
Author(s):  
Pedapati S.C. Sri Harsha ◽  
Roshaida Abdul Wahab ◽  
Catalina Cuparencu ◽  
Lars Dragsted ◽  
Lorraine Brennan
Keyword(s):  
Mass Spectrometry ◽  
Repeated Measures ◽  
Time Course ◽  
Intervention Study ◽  
Random Order ◽  
Ultra Performance Liquid Chromatography ◽  
Nutritional Epidemiology ◽  
Dependent Manner ◽  
Time Points ◽  
Control Food

A significant body of evidence demonstrates that isoflavone metabolites are good markers of soy intake, while research is lacking on specific markers of other leguminous sources such as peas. In this context, the objective of our current study was to identify biomarkers of pea intake using an untargeted metabolomics approach. A randomized cross-over acute intervention study was conducted on eleven participants who consumed peas and couscous (control food) in random order. The urine samples were collected in fasting state and postprandially at regular intervals and were further analysed by ultra-performance liquid chromatography coupled to quadrupole time of flight mass spectrometry (UPLC-QTOF-MS). Multivariate statistical analysis resulted in robust Partial least squares Discriminant Analysis (PLS-DA) models obtained for comparison of fasting against the postprandial time points (0 h vs. 4 h, (R2X = 0.41, Q2 = 0.4); 0 h vs. 6 h, ((R2X = 0.517, Q2 = 0.495)). Variables with variable importance of projection (VIP) scores ≥1.5 obtained from the PLS-DA plot were considered discriminant between the two time points. Repeated measures analysis of variance (ANOVA) was performed to identify features with a significant time effect. Assessment of the time course profile revealed that ten features displayed a differential time course following peas consumption compared to the control food. The interesting features were tentatively identified using accurate mass data and confirmed by tandem mass spectrometry (MS using commercial spectral databases and authentic standards. 2-Isopropylmalic acid, asparaginyl valine and N-carbamoyl-2-amino-2-(4-hydroxyphenyl) acetic acid were identified as markers reflecting pea intake. The three markers also increased in a dose-dependent manner in a randomized intervention study and were further confirmed in an independent intervention study. Overall, key validation criteria were met for the successfully identified pea biomarkers. Future work will examine their use in nutritional epidemiology studies.

Prediction of headache severity (density and functional impact) after traumatic brain injury: A longitudinal multicenter study

Cephalalgia ◽  
2013 ◽  
Vol 33 (12) ◽  
pp. 998-1008 ◽  
Author(s):  
William C Walker ◽  
Jennifer H Marwitz ◽  
Amber R Wilk ◽  
Jessica M Ketchum ◽  
Jeanne M Hoffman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Repeated Measures ◽  
Time Course ◽  
Time Points ◽  
Female Sex ◽  
Severe Tbi ◽  
Generalized Linear Mixed Effects ◽  
Prospective Longitudinal

Background: Headache (HA) following traumatic brain injury (TBI) is common, but predictors and time course are not well established, particularly after moderate to severe TBI. Methods: A prospective, longitudinal cohort study of HA severity post-TBI was conducted on 450 participants at seven participating rehabilitation centers. Generalized linear mixed-effects models (GLMMs) were used to model repeated measures (months 3, 6, and 12 post-TBI) of two outcomes: HA density (a composite of frequency, duration, and intensity) and HA disruptions to activities of daily living (ADL). Results: Although HA density and ADL disruptions were nominally highest during the first three months post-TBI, neither showed significant changes over time. At all time points, history of pre-injury migraine was by far the strongest predictor of both HA density and ADL disruptions (odds ratio (OR) = 8.0 and OR = 7.2, averaged across time points, respectively). Furthermore, pre-injury non-migraine HA (at three and six months post-TBI), penetrating-type TBI (at six months post-TBI), and female sex (at six and 12 months post-TBI) were each associated with an increase in the odds of a more severe HA density. Severity of TBI (post-traumatic amnesia (PTA) duration) was not associated with either outcome. Conclusion: Individuals with HA at three months after moderate-severe TBI do not improve over the ensuing nine months with respect to HA density or ADL disruptions. Those with pre-injury HA, particularly of migraine type, are at greatest risk for HA post-TBI. Other independent risk factors are penetrating-type TBI and, to a lesser degree and post-acutely only, female sex. Individuals with these risk factors should be monitored and considered for aggressive early intervention.

scholarly journals Mortality Prediction Model of Septic Shock Patients Based on Routinely Recorded Data

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Marta Carrara ◽  
Giuseppe Baselli ◽  
Manuela Ferrario
Keyword(s):  
Septic Shock ◽  
Clinical Information ◽  
Mortality Prediction ◽  
Shock Onset ◽  
The Public ◽  
Hemodynamic Variables ◽  
Mortality Prediction Model ◽  
Critical Care Management ◽  
Recorded Data ◽  
Preliminary Study

We studied the problem of mortality prediction in two datasets, the first composed of 23 septic shock patients and the second composed of 73 septic subjects selected from the public database MIMIC-II. For each patient we derived hemodynamic variables, laboratory results, and clinical information of the first 48 hours after shock onset and we performed univariate and multivariate analyses to predict mortality in the following 7 days. The results show interesting features that individually identify significant differences between survivors and nonsurvivors and features which gain importance only when considered together with the others in a multivariate regression model. This preliminary study on two small septic shock populations represents a novel contribution towards new personalized models for an integration of multiparameter patient information to improve critical care management of shock patients.

scholarly journals Longitudinal Changes of Sensorimotor Resting-State Functional Connectivity Differentiate between Patients with Thalamic Infarction and Pontine Infarction

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Peipei Wang ◽  
Zhenxiang Zang ◽  
Miao Zhang ◽  
Yanxiang Cao ◽  
Zhilian Zhao ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Repeated Measures ◽  
Time Course ◽  
Stroke Onset ◽  
Repeated Measure ◽  
Precentral Gyrus ◽  
Resting State Functional Connectivity ◽  
Time Points ◽  
Thalamic Infarction ◽  
Pontine Infarction

Purpose. We investigated the disparate influence of lesion location on functional damage and reorganization of the sensorimotor brain network in patients with thalamic infarction and pontine infarction. Methods. Fourteen patients with unilateral infarction of the thalamus and 14 patients with unilateral infarction of the pons underwent longitudinal fMRI measurements and motor functional assessment five times during a 6-month period (<7 days, at 2 weeks, 1 month, 3 months, and 6 months after stroke onset). Twenty-five age- and sex-matched controls underwent MRI examination across five consecutive time points in 6 months. Functional images from patients with left hemisphere lesions were first flipped from the left to the right side. The voxel-wise connectivity analyses between the reference time course of each ROI (the contralateral dorsal lateral putamen (dl-putamen), pons, ventral anterior (VA), and ventral lateral (VL) nuclei of the thalamus) and the time course of each voxel in the sensorimotor area were performed for all five measurements. One-way ANOVA was used to identify between-group differences in functional connectivity (FC) at baseline stage (<7 days after stroke onset), with infarction volume included as a nuisance variable. The family-wise error (FWE) method was used to account for multiple comparison issues using SPM software. Post hoc repeated-measure ANOVA was applied to examine longitudinal FC reorganization. Results. At baseline stage, significant differences were detected between the contralateral VA and ipsilateral postcentral gyrus (cl_VA-ip_postcentral), contralateral VL and ipsilateral precentral gyrus (cl_VL-ip_precentral). Repeated measures ANOVA revealed that the FC change of cl_VA-ip_postcentral differ significantly among the three groups over time. The significant changes of FC between cl_VA and ip_postcentral at different time points in the thalamic infarction group showed that compared with 7 days after stroke onset, there was significantly increased FC of cl_VA-ip_postcentral at 1 month, 3 months, and 6 months after stroke onset. Conclusions. The different patterns of sensorimotor functional damage and reorganization in patients with pontine infarction and thalamic infarction may provide insights into the neural mechanisms underlying functional recovery after stroke.

Time Course of Simulator Sickness in Asian Military Pilots

2020 ◽  
Vol 91 (11) ◽  
pp. 892-896
Author(s):  
Janine En Qi Loi ◽  
Magdalene Li Ling Lee ◽  
Benjamin Boon Chuan Tan ◽  
Brian See
Keyword(s):  
Air Force ◽  
Time Course ◽  
Simulator Training ◽  
Simulator Sickness ◽  
Time Points ◽  
True Prevalence ◽  
Subjective Scale ◽  
Significant Difference ◽  
Simulator Sickness Questionnaire ◽  
Military Pilots

INTRODUCTION: This study sought to determine the incidence, severity, and time-course of simulator sickness (SS) among Asian military pilots following flight simulator training.METHODS: A survey was conducted on Republic of Singapore Air Force pilots undergoing simulator training. Each subject completed a questionnaire immediately after (0H), and at the 3-h (3H) and 6-h (6H) marks. The questionnaire included the simulator sickness questionnaire (SSQ) and a subjective scale to rate their confidence to fly.RESULTS: In this study, 258 pilots with a median age of 31.50 yr (range, 2155 yr) and mean age of 32.61 6.56 yr participated. The prevalence of SS was 48.1% at 0H, 30.8% at 3H, and 16.4% at 6H. Based on a threshold of an SSQ score >10, the prevalence of operationally significant SS was 33.3% at 0H, 13.2% at 3H, and 8.1% at 6H. The most frequent symptoms were fatigue (38.1%), eye strain (29.0%), and fullness of head (19.9%). There was no significant difference in mean scores between rotary and fixed wing pilots. Older, more experienced pilots had greater scores at 0H, but this association did not persist. A correlation was found between SSQ score and self-reported confidence.DISCUSSION: To our knowledge, this study is the first to report the prevalence of operationally significant SS in Asian military pilots over serial time points. Most pilots with SS are able to subjectively judge their fitness to fly. Sensitivity analysis suggests the true prevalence of SS symptoms at 3H and 6H to be closer to 23.8% and 12.0%, respectively.Loi JEQ, Lee MLL, Tan BBC, See B. Time course of simulator sickness in Asian military pilots. Aerosp Med Hum Perform. 2020; 91(11):892896.

scholarly journals Cytotoxicity assessment of different doses of ozonated water on dental pulp cells

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ferdiye Küçük ◽  
Sibel Yıldırım ◽  
Serap Çetiner
Keyword(s):  
Cell Viability ◽  
Repeated Measures ◽  
Dental Pulp ◽  
Control Group ◽  
Dental Pulp Cells ◽  
Time Points ◽  
Significant Difference ◽  
Pulp Cells ◽  
Time Point ◽  
Ozonated Water

Abstract Background The purpose of this study was to assess the cytotoxicity of various concentrations of ozonated water (OW) on human primary dental pulp cells. Methods Human primary dental pulp cells were isolated from exfoliated primary canine teeth of an 11-year-old patient with good systemic and oral health. Afterwards, cells were divided into 6 experimental groups; four groups of OW in concentrations of 2 mg/L, 4 mg/L, 8 mg/L, and 16 mg/L, untreated control group, and cell culture without cells. Cytotoxicity was evaluated after exposure for 5-min exposure using Mosmann’s Tetrazolium Toxicity (MTT) assay at 0 h and 48 h time points. Data were analyzed using a repeated measures analysis of variance and Post-hoc tests were performed using Bonferroni correction for multiple comparisons. Results All experimental groups showed proliferation at 0 h time point. However, all groups also experienced a decrease in overtime at 48 h time point (p < 0.05). At both time points 2 mg/L OW showed the highest cell viability as well as proliferation. At 0 h time point, the increase in cell viability for all experimental groups was found statistically significant when compared to positive control group (p < 0.05). At 48 h time point, although 8 mg/L and 16 mg/L OW showed statistically significant reduction in compare to 0 h time point, 2 mg/L and 4 mg/L OW groups didn’t experience any statistically significant difference (p < 0.05). Conclusion Considering our findings, due to ozonated water's induced a higher proliferation rate of dental pulp cells, indicating their biocompatibility and a possible adjuvant on irrigating agent in regenerative endodontic procedures.

scholarly journals Serial computed tomography findings of Coronavirus disease 2019 (COVID-19) pneumonia treated with favipiravir and steroid therapy: report of 11 cases

2021 ◽  
Vol 45 (1) ◽  
Author(s):  
Naoki Irizato ◽  
Hiroshi Matsuura ◽  
Atsuya Okada ◽  
Ken Ueda ◽  
Hitoshi Yamamura
Keyword(s):  
Computed Tomography ◽  
Mechanical Ventilation ◽  
Steroid Therapy ◽  
Time Course ◽  
Ground Glass ◽  
Time Points ◽  
Ct Findings ◽  
Mixed Pattern ◽  
Bronchial Dilatation

Abstract Background This study evaluated the time course of computed tomography (CT) findings of patients with COVID-19 pneumonia who required mechanical ventilation and were treated with favipiravir and steroid therapy. Results Eleven patients with severe COVID-19 pneumonia were included. CT findings assessed at the three time points showed that all patients had ground-glass opacities (GGO) and consolidation and mixed pattern at intubation. Consolidation and mixed pattern disappeared in most of the patients whereas GGO persisted in all patients at 1-month follow-up. In addition to GGO, a subpleural line and bronchus distortion and bronchial dilatation were frequent findings. The degree of resolution of GGO varied depending on each patient. The GGO score correlated significantly with the time from symptoms onset to initiation of steroid therapy (ρ = 0.707, p = 0.015). Conclusions At 1-month follow-up after discharge, non-GGO lesions were absorbed almost completely, and GGO were a predominant CT manifestation. Starting steroid therapy earlier after onset of symptoms in severe COVID-19 pneumonia may reduce the extent of GGO at 1-month follow-up.

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