Influencing factors of noninvasive positive pressure ventilation in the treatment of respiratory failure: a 10-year study in one single center

Background The utilization of noninvasive positive pressure ventilation (NPPV) is becoming more and more common, especially in patients with acute or chronic respiratory failure. The purpose of our study is to analyze the factors that influence the efficacy of NPPV in the treatment of respiratory failure caused by a variety of etiology. Methods From May 2011 to April 2020, patients treated with NPPV during hospitalization in the First Affiliated Hospital of Soochow University were enrolled. According to the clinical outcome of NPPV treatment and whether converted to invasive mechanical ventilation, patients were divided into the success group and the failure group. The clinical data and the characteristics of NPPV application were compared between the two groups. Results A total of 3312 patients were enrolled, including 2025 patients in the success group and 1287 patients in the failure group. Univariate analysis suggested that there were no statistical differences in patients' age, gender, use of analgesia and/or sedation, complicated with barotrauma, inspiratory positive airway pressure and expiratory positive airway pressure between the success and failure groups (P > 0.05). However, there were statistically significant differences in serum albumin levels, Ca2+ concentration, blood glucose levels, duration of NPPV treatment and length of hospital stay between the success and failure groups (P < 0.05). Multivariate logistic regression analysis indicated that serum albumin levels and duration of NPPV treatment had statistical significance on the therapeutic effect of NPPV (P < 0.05). Conclusion Serum albumin levels and duration of NPPV treatment were independent risk factors for the efficacy of NPPV treatment in respiratory failure.

Efficacy of the Flow Re-direction Endoluminal Device for cerebral aneurysms and causes of failed deployment

Purpose The Flow Re-direction Endoluminal Device (FRED) has recently become available for flow diversion in Japan. We have encountered cases that failed to deploy the FRED. In this study, we report our initial experience with the FRED for cerebral aneurysms and clarify the causes of failed FRED deployment. Methods A retrospective data analysis was performed to identify patients treated with the FRED between June 2020 and March 2021. Follow-up digital subtraction angiography was performed at 3 and 6 months and assessed using the O’Kelly-Marotta (OKM) grading scale. Results Thirty-nine aneurysms in 36 patients (average age: 54.4 years) were treated with the FRED. The average sizes of the dome and neck were 9.9 mm and 5.2 mm, respectively. In nine patients, additional coiling was performed. In one patient (2.6%), proximal vessel injury caused direct carotid-cavernous fistula during deployment. Ischaemic complications were encountered in one patient (2.6%) with transient symptoms. Angiographic follow-up at 6 months revealed OKM grade C or D in 86.6% of patients. FRED deployment was successful in 35 (92.1%) procedures. In the failure group, the differences between the FRED and the minimum vessel diameter (P = 0.04) and the rate of the parent vessel having an S-shaped curve (P = 0.04) were greater than those in the success group. Conclusions Flow diversion using the FRED is effective and safe for treating cerebral aneurysms. The use of the FRED for patients with an S-shaped curve in the parent vessel and oversizing of more than 2 mm should be considered carefully.

Cigarette Smoking is Associated with Difficulties in the Use of Reappraisal for Emotion Regulation

Background: Negative emotions can promote smoking relapse during a quit attempt. The use of cognitive reappraisal to self-regulate these emotions may therefore aid smoking cessation. Determining whether smokers exhibit difficulties in the use of reappraisal, and which factors are associated with such difficulties, may aid smoking cessations.Methods: 50 smokers and 50 non-smokers completed an online reappraisal task in which they either reappraised or naturally experienced emotions induced by negatively- and neutrally-valenced images that presented situations in either the 1st-person or 3rd-person perspective. Participants also completed the Difficulties in Emotion Regulation Scale (DERS).Results: Compared to non-smokers, smokers were less successful in using reappraisal to self-regulate emotions elicited by negatively-valenced images (but not neutrally-valenced images). Importantly, this effect was only true for images that were presented in the 1st-person (but not 3rd-person) perspective. Contrary to predictions, there were no group differences in DERS scores. However, exploratory analyses showed that when smokers were split into those who exhibited low vs. high reappraisal success on the reappraisal task (via median split), the low success group exhibited an association between lower reappraisal success and a greater lack of emotional clarity on the DERS, whereas no such association was observed in the high success group.Conclusions: This study provides evidence that smokers may experience difficulties in the use of reappraisal to self-regulate negative emotions induced by situations that appear to be occurring to themselves, and that this deficit may be related to difficulties in understanding the nature and/or valence of the emotion experienced.

Six-Year Follow-Up Outcomes of Catheter Ablation of Para-Hisian Accessory Pathways

Background: Ablation of para-hisian accessory pathways (APs) remains challenging due to anatomic characteristics, and a few studies have focused on the causes for recurrence of radiofrequency ablation of para-hisian APs.Objective: This retrospective single center study aimed to explore the risk factors for recurrence of para-hisian APs.Methods: One hundred thirteen patients who had para-hisian AP with an acute success were enrolled in the study. In the 6-year follow-up, 15 cases had a recurrent para-hisian AP. Therefore, 98 patients were classified into the success group, while 15 patients were classified into the recurrence group. Demographic and ablation characteristics were analyzed.Results: Gender difference was similar in two groups. The median age was 36.2 years old and was younger in the recurrence group. Maximum ablation power was significantly higher in the success group (29 ± 7.5 vs. 22.9 ± 7.8, p &lt; 0.01). Ablation time of final target sites was found to be markedly higher in the success group (123.4 ± 53.1 vs. 86.7 ± 58.3, p &lt; 0.05). Ablation time &lt;60 s was detected in 12 (12.2%) cases in the success group and 7 (46.7%) cases in the recurrence group (p &lt; 0.01). Occurrence of junctional rhythm was significantly higher in the recurrence group (25.5% vs. 53.3%, p &lt; 0.05). No severe conduction block, no pacemaker implantation, and no stroke were reported. Junctional rhythm during ablation (OR = 3.833, 95% CI 1.083–13.572, p = 0.037) and ablation time &lt;60 s (OR = 5.487, 95% CI 1.411–21.340, p = 0.014) were independent risk factors for the recurrence of para-hisian AP.Conclusions: With careful and accurate mapping, it is relatively safe to ablate para-hisian AP. If possible, proper extension of ablation time could reduce the recurrence rate of para-hisian APs.

Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen Therapy

Background: Patients with COVID-19 may experience hypoxemic Acute Respiratory Failure (hARF) requiring O2-therapy by High-Flow Nasal Cannula (HFNO). Although Prone Positioning (PP) may improve oxygenation in COVID-19 non-intubated patients, the results on its clinical efficacy are controversial. The present study aims to prospectively investigate whether PP may reduce the need for endotracheal intubation (ETI) in patients with COVID-19 receiving HFNO. Methods: All consecutive unselected adult patients with bilateral lung opacities on chest X-ray receiving HFNO after admission to a SARS-CoV-2 Respiratory Intermediate Care Unit (RICU) were considered eligible. Patients who successfully passed an initial PP trial (success group) underwent PP for periods ≥ 2 h twice a day, while receiving HFNO. The study’s primary endpoint was the intubation rate during the stay in the RICU. Results: Ninety-three patients were included in the study. PP was feasible and safe in 50 (54%) patients. Sixteen (17.2%) patients received ETI and 27 (29%) escalated respiratory support, resulting in a mortality rate of 9/93 (9.7%). The length of hospital stay was 18 (6–75) days. In 41/50 (80%) of subjects who passed the trial and underwent PP, its use was associated with clinical benefit and survival without escalation of therapy. Conclusions: PP is feasible and safe in over 50% of COVID-19 patients receiving HFNO for hARF. Randomized trials are required to confirm that PP has the potential to reduce intubation rate.

Primary success of electrical cardioversion for new-onset atrial fibrillation and its association with clinical course in non-cardiac critically ill patients: sub-analysis of a multicenter observational study

Background Electrical cardioversion (ECV) is widely used to restore sinus rhythm in critically ill adult patients with atrial fibrillation, although its prognostic value is uncertain. This study aims to elucidate the clinical meaning of successful ECV. Methods This is a sub-analysis of the AFTER-ICU study, a multicenter prospective study with a cohort of 423 adult non-cardiac patients with new-onset atrial fibrillation (AF). Patients that underwent ECV within 7 days after initial onset of AF were included in the sub-analysis. We compared intensive care unit (ICU) and overall hospital mortality, survival time within 30 days, cardiac rhythm at ICU discharge, and the length of ICU and overall hospital stay between patients whose sinus rhythm was restored immediately after the first ECV session (primary success group) and those in whom it was not restored (unsuccessful group). To find the factors related to the primary success of ECV, we also compared patient characteristics, the delivered energy, and pretreatment. Results Sixty-five patients received ECV and were included in this study. Although 35 patients (54%) had primary success, recurrence of AF occurred in 24 of these patients (69%). At ICU discharge, three patients still had AF in the unsuccessful group, but no patients in the primary success group still had AF. ICU mortality was 34% in the primary success group and 17% in the unsuccessful group (P = 0.10). Survival time within 30 days did not differ between the groups. Delivered energy and pretreatment were not associated with primary success of ECV. Conclusions The primary success rate of ECV for new-onset AF in adult non-cardiac ICU population was low, and even if it succeeded, the subsequent recurrence rate was high. Primary success of ECV did not affect the rate of mortality. Pretreatment and delivered energy were not associated with the primary success of ECV. Trial registration UMIN clinical trial registry, the Japanese clinical trial registry (registration number: UMIN000026401, March 31, 2017).

Who Would Benefit from Nasointestinal tube in Small Bowel Obstruction?—A Matched Case-Control Study

Background: Nasointestinal tubes (NITs) have been increasingly used in patients with small bowel obstruction (SBO); However, severe adverse events (SAEs) of NITs might threaten the lives of patients. The indications of NITs need to be identified. This study was designed to explore the indications for the insertion of NITs in patients with SBO and to suggest the optimal strategies for individuals based on the outcomes of SAEs.Methods: After propensity score matching, 68 pairs were included (Success group and failure group). The occurrence of SAEs and the clinical parameters were compared between the SAE group and the non-SAE group. Independent risk factors were evaluated among the subgroups. A novel scoring system was established to detect the subgroups that would benefit from NITs insertion.Results: Successful implementation of NITs could avoid hypochloremia (p=0.010), SAEs (p=0.001), pneumonia (p=0.006). SAEs occurred in 13 of 136 (9.6%) patients who accepted NITs insertion treatment. Risk factors for SAEs included tumors (p=0.002), reduced BMI (p=0.048), reduced hemoglobin (p=0.001), abnormal activated partial thromboplastin time (p=0.015) and elevated white blood cells (p=0.002). A novel risk scoring system consists of hemoglobin before NITs insertion (95% CI: 0.685, 0.893) and bowel obstruction symptoms relieved after NITs insertion (95% CI: 0.575, 0.900) had the highest area under curve (AUC) for predicting the occurrence of SAEs. We divided the risk score system into 3 grades, with the increasing grades, the rates of SAEs surged from 1.3% (1/74) to (6/11) 54.5%.Conclusion: NITs successfully insertion could avoid SAEs occurrence in SBO conservative treatment. SBO patients without anemia and could be relieved after NITs insertion could be the potential benefit group for this therapy.

Electrophysiological Studies of Cognitive Reappraisal Success and Failure in aMCI

Background: Although successful reappraisal relies on cognitive resources, how cognitive impairment affects brain processes related to cognitive reappraisal is not yet clear. Methods: Forty-four amnestic mild cognitive impairment (aMCI) subjects and 72 healthy elderly controls (HECs) were divided into the MCI-Failure (n = 23), MCI-Success (n = 21), HEC-Failure (n = 26), and HEC-Success (n = 46) groups according to changes in self-reported affect using reappraisal. All participants viewed 30 negative and 30 neutral images preceded by straightforward descriptions of these images and 30 negative images preceded by more neutral descriptions. Results: Reappraisal failure was found to be more common in people with MCI. Reappraisal failure is associated with altered neurophysiological indices of negative-reappraisal stimuli processing that are reflected in smaller theta responsivity to negative-reappraisal stimuli between 350–550 ms. The MCI-Success group showed enhanced LPP for negative-reappraisal stimuli from 1200 to 3500 ms, reflecting compensatory effort to complete the reappraisal task, while subjects in other groups showed reduced LPP for negative-reappraisal stimuli from 550 to 1200 ms. Conclusions: These findings deepen our understanding of how cognitive decline impacts reappraisal and informs early diagnosis and interventions for MCI.

Steroidogenic Activity in Unresected Adrenals Associated With Surgical Outcomes in Primary Aldosteronism

In patients with primary aldosteronism diagnosed with unilateral lesions through adrenal venous sampling, excess aldosterone occasionally persists after adrenalectomy. We investigated whether aldosterone values from unresected adrenals would be associated with postoperative outcomes. Overall, 102 primary aldosteronism patients, who underwent segmental adrenal venous sampling and unilateral adrenalectomy, were assessed for biochemical success (as outlined in the PASO [Primary Aldosteronism Surgical Outcomes] Study) at 1 year after surgery by using the saline infusion test. We divided patients into the biochemical complete or incomplete success group. Eighty-seven and 15 patients had complete and incomplete biochemical success, respectively. The biochemical incomplete group, compared with the biochemical complete group, had higher maximum aldosterone in tributary veins (11 000 versus 7030 pg/mL, P =0.006), maximum aldosterone/cortisol in tributary veins (18.05 versus 9.13, P <0.001), aldosterone in the central vein (9260 versus 5800 pg/mL, P =0.011), and aldosterone/cortisol in the central vein (13.67 versus 8.08, P <0.001) of the unresected adrenal gland. In logistic regression analyses, maximum aldosterone/cortisol in tributary veins had the highest area under the curve (0.780). Aldosterone/cortisol in the central vein had a nearly equivalent area under the curve (0.775). The lateralization index showed no significant differences between the groups. The clinical incomplete group similarly had higher aldosterone and aldosterone/cortisol in the unresected adrenal gland than did the clinical complete group. Therefore, steroidogenic activity in unresected adrenals (eg, absolute aldosterone value and aldosterone/cortisol) were associated with surgical outcomes. Our results may aid clinicians in determining the surgical application for primary aldosteronism.

11-year follow-up outcomes of catheter ablation of para-hisian accessory pathways

Funding Acknowledgements Type of funding sources: None. Background Ablation of para-hisian accessory pathways (APs) remains challenging due to anatomic characteristics and few studies have focused on the causes for recurrence of radiofrequency ablation of para-hisian APs. Objective This retrospective single center study was aimed to explore the risk factors for recurrence of para-hisian APs. Methods 113 patients who had a para-hisian AP with an acute success were enrolled in the study. In the 11-year follow-up, 15 cases had a recurrent para-hisian AP. Therefore 98 patients were classified into success group while 15 patients were classified into recurrence group. Demographic and ablation characteristics were analyzed. Results Gender difference was similar in two groups. The median age was 36.2 years old and was younger in recurrence group. Maximum ablation power was significantly higher in success group (29 ± 7.5 vs 22.9 ± 7.8, p &lt; 0.01). Ablation time of final target sites was found to be markedly higher in success group (123.4 ± 53.1 vs 86.7 ± 58.3, p &lt; 0.05). Ablation time less than 60 seconds was detected in 12 (12.2%) cases in success group and 7 (46.7%) cases in recurrence group (p &lt; 0.01). Occurrence of junctional rhythm was significantly higher in recurrence group (25.5% vs 53.3%, p &lt; 0.05). No severe conduction block, no pacemaker implantation and no stroke were reported. Junctional rhythm during ablation (OR = 3.833, 95%CI 1.083-13.572, p = 0.037) and ablation time &lt;60s (OR = 5.487, 95%CI 1.411-21.340, p = 0.014) were independent risk factors for the recurrence of para-hisian AP. Conclusions Considering the long-term safety of ablation of para-hisian AP, proper extension of ablation time and increase of ablation power could be applied during operation.