Effects of Transthoracic Echocardiography on the Prognosis of Patients with Acute Respiratory Distress Syndrome: A Propensity Score Matched Analysis of the MIMIC-III Database

Introduction: Acute respiratory distress syndrome (ARDS) has high mortality and is mainly related to the circulatory failure.Therefore, real-time monitoring of cardiac function and structural changes has important clinical significance.Transthoracic echocardiography (TTE) is a simple and noninvasive real-time cardiac examination which is widely used in intensive care unit (ICU) patients.The purpose of this study was to analyze the effect of TTE on the prognosis of ICU patients with ARDS.Methods: The data of ARDS patients were retrieved from the MIMIC-III v1.4 database and patients were divided into the TTE group and non-TTE group. Then, the baseline data were compared between the two groups, and the effect of TTE on the prognosis of ARDS patients was analyzed through multivariate logistic analysis and the propensity score (PS).Results: A total of 1,346 ARDS patients were enrolled, including 519 (38.6%) cases in the TTE group and 827 (61.4%) cases in the non-TTE group. Compared with the non-TTE group, the 28-day mortality of patients in the TTE group was greatly improved (OR=0.64 95%CI: 0.48-0.86, P=0.003). The length of ICU stay in the TTE group was significantly shorter than that in the non-TTE group (17d vs.14d, P=0.0001). The infusion volume in the TTE group was significantly less than that of the non-TTE group (6.2L vs.5.5L on day 1, P=0.0012). Importantly, the patients in the TTE group were weaned ventilators earlier than those in the non-TTE group (ventilator-free days within 28 d: 21 d vs. 19.8 d, respectively, P = 0.071).Conclusion: TTE can lower the risk of 28-d mortality in patients with ARDS.

Relationship between tracheal intubation and the drugs used by patients with drug overdose due to self-harm

Background Tracheal intubation may be performed in patients with drug overdose due to self-harm; however, the details of the causative drug are unknown. The purpose of this study was to clarify the relationship between drugs or its blood levels of patients with drug overdose and the need for tracheal intubation based on the actual measurement results. Methods From October 2018 to March 2020, 132 patients with drug overdose due to self-harm who were transported to the emergency department (ED) were studied. Patient drugs were measured using gas chromatography–mass spectrometry (GC-MS) and were analyzed on the basis of the GC/MS Forensic Toxicological Database. Logistic analysis was performed by combining patient information and GC-MS information. Results The Glasgow Coma Scale (GCS) and Japan Coma Scale (JCS) efficiently predicted tracheal intubation in patients with drug overdose during transport triage; GCS (cut-off value: 12, area under the curve (AUC): 0.81, 95% confidence interval (CI): 0.71–0.88, sensitivity: 0.85, specificity: 0.71, P < 0.05) and JCS (cut-off value: 3, AUC: 0.74, 95% CI: 0.60–0.84, sensitivity: 0.60, specificity: 0.84, P < 0.05). The drugs detected in all patients with drug overdose in order were benzodiazepine receptor agonists (BZs; 43.9%), anticonvulsants (38.6%), antipsychotics (25.0%), and antidepressants (9.8%). In univariate logistic analysis, antipsychotics (odds ratio (OR) 2.46, 95% CI 1.19–5.20, P < 0.05), anticonvulsants (OR 2.71, 95% CI 1.26–5.98, P < 0.05), and anticonvulsants above alert blood levels (OR 27.8, 95% CI 2.92–264.1, P < 0.05) were significantly associated with tracheal intubation in patients with drug overdose, but not BZs and antidepressants. Also, in multivariate logistic analysis, antipsychotics (OR 2.27, 95% CI 1.07–4.83, P < 0.05), anticonvulsants (OR 2.50, 95% CI 1.14–5.64, P < 0.05) and in multivariate logistic analysis of blood levels, anticonvulsants above the alert blood levels (OR 24.9, 95% CI 2.56–241.6, P < 0.05) were significantly associated with tracheal intubation in patients with drug overdose respectively. Conclusions Logistic analysis revealed that the use of anticonvulsants and antipsychotics were significantly associated with an increased OR in the tracheal intubation of patients with drug overdose due to self-harm.

Effects of Transthoracic Echocardiography on the Prognosis of Patients with Acute Respiratory Distress Syndrome: a Propensity Score Matched Analysis of the MIMIC-III Database

Introduction: Acute respiratory distress syndrome (ARDS) has high mortality and is mainly related to the circulatory failure.Therefore, real-time monitoring of cardiac function and structural changes has important clinical significance.Transthoracic echocardiography (TTE) is a simple and noninvasive real-time cardiac examination which is widely used in intensive care unit (ICU) patients.The purpose of this study was to analyze the effect of TTE on the prognosis of ICU patients with ARDS.Methods: The data of ARDS patients were retrieved from the MIMIC-III v1.4 database and patients were divided into the TTE group and non-TTE group. Then, the baseline data were compared between the two groups, and the effect of TTE on the prognosis of ARDS patients was analyzed through multivariate logistic analysis and the propensity score (PS).Results: A total of 1,346 ARDS patients were enrolled, including 519 (38.6%) cases in the TTE group and 827 (61.4%) cases in the non-TTE group. Compared with the non-TTE group, the 28-day mortality of patients in the TTE group was greatly improved (OR=0.64 95%CI: 0.48-0.86, P=0.003). The length of ICU stay in the TTE group was significantly shorter than that in the non-TTE group (17d vs.14d, P=0.0001). The infusion volume in the TTE group was significantly less than that of the non-TTE group (6.2L vs.5.5L on day 1, P=0.0012). Importantly, the patients in the TTE group were weaned ventilators earlier than those in the non-TTE group (ventilator-free days within 28 d: 21 d vs. 19.8 d, respectively, P = 0.071).Conclusion: TTE can lower the risk of 28-d mortality in patients with ARDS.

Development and Validation of a Nomogram for Renal Involvement in Primary Sjögren Syndrome Patients: A Retrospective Analysis

Objective To establish and validate a nomogram for individualized prediction of renal involvement in pSS patients. Methods A total of 1293 patients with pSS from the First Affiliated Hospital of Wenzhou Medical University between January 2008 to January 2020 were recruited and further analyzed retrospectively. The patients were randomly divided into a development set (70%, n = 910) and a validation set (30%, n = 383). The univariable and multivariate logistic regression were performed to analyze the risk factors of renal involvement in pSS. Based on the regression β coefficients derived from multivariate logistic analysis, an individualized nomogram prediction model was developed. The prediction model of discrimination and calibration was evaluated with the area under the receiver operating characteristic curves and Calibration plot. Results Multivariate logistic analysis showed that hypertension, anemia, albumin, uric acid, anti-Ro52, hematuria and Chisholm-Mason grade were independent risk factors of renal involvement in pSS. The area under the receiver operating characteristic curves were 0.797 and 0.750 respectively in development set and validation set, indicating the nomogram had a good discrimination capacity. The Calibration plot showed nomogram had a strong concordance performance between the prediction probability and the actual probability. Conclusion The individualized nomogram for pSS patients those who had renal involvement could be used by clinicians to predict the risk of pSS patients developing into renal involvement and improve early screening and intervention.

153 Fragmented QRS in athletes

Aims Fragmented QRS (fQRS), defined as the presence of additional peaks within the QRS complex (&lt;120 ms) in at least two contiguous leads, was considered as a pattern of fibrosis. However, fQRS can also be detected during pre-participation cardiovascular screening. To assess determinants of fQRS in athletes of different sports. Methods and results Retrospective study conducted on 605 non-sedentary subjects undergoing pre-participation cardiovascular screening for competitive activity in six disciplines (athletics, football, cycling, swimming, basketball, and volleyball). All subjects underwent ECG for the search of fQRS and transthoracic echocardiography. Predictors of fQRS were investigated using multivariate logistic analysis adjusted for. fQRS was found in 47 of 605 subjects. On multivariate logistic analysis, fQRS was positively associated with age (OR: 1.03; 95% CI: 1.01–1.05), male sex (OR: 0.35; 95% CI: 0.13–0.94), whereas no association with sport discipline was observed (0.91; 0.73–1.12). When echocardiographic parameters were considered, fQRS was associated with cardiac mass index (OR: 1.02; 95% CI: 1.00–1.03) and E wave (OR: 0.98; 95% CI: 0.96–0.99). Conclusions At pre-participation cardiovascular screening, the fQRS finding increases with age, is more frequent in males, and seems to be independent from practiced sport. Furthermore, fQRS in athletes appears to be associated with parameters of physiological hypertrophy (LV cardiac mass index and diastolic function).

Correlation Analysis of Nodular Sonographic Parameters with Cervical Lymph Node Metastases in Papillary Thyroid Carcinoma

Background Papillary thyroid carcinoma (PTC) is the most common thyroid carcinoma, and is prone to cervical lymph node metastases (CLNM). We aim to analyze the correlation between clinical information, ultrasonic parameters of PTC and CLNM. Methods 1335 patients who had pathologically confirmed unifocal PTC were enrolled. Univariate and multivariate logistic analysis were performed to predict CLNM in PTC patients. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance. Results Univariate analysis showed that gender, age, maximum tumor diameter and volume, cross-sectional and longitudinal aspect ratio were related to CLNM (P<0.05). Multivariate logistic analysis showed that gender, age, maximum tumor diameter and volume were independent correlative factors, cross-sectional aspect ratio had significant difference for PTC2 to predict CLNM. The area under the curve (AUC) of the maximum tumor diameter and volume was 0.738 and 0.733, respectively. Maximum tumor diameter and volume, and cross-sectional and longitudinal aspect ratio were statistically significant following analysis of variance (P < 0.05). Conclusions Younger age, male, and larger tumor were high risk factors for CLNM in patients with unifocal PTC. Cross-sectional aspect ratio had a more effective predictive value for CLNM in patients with larger thyroid tumors.

Multicenter Prospective Cohort on Aortic Valve Stenosis in Japanese Patients With End Stage Kidney Disease in Tokai Region (ASKIT)

Background:The prevalence of aortic valve stenosis (AS) in patients on maintenance dialysis is high and the prognosis is poor. Because only few large cohort studies have analyzed patients with AS on dialysis, the factors that cause AS in such patients remain unclear.Methods:This multicenter, prospective cohort study included 2,786 patients on dialysis who underwent transthoracic echocardiography between July 1, 2017 and June 30, 2018. Patients with a maximum aortic jet velocity (Vmax) ≥2.0 m/s, pressure gradient (PG) between the left ventricle and ascending aorta (mean PG) ≥20 mmHg, or aortic valve area (AVA) ≤1.0 cm2 were categorized into the AS group. Of these, patients with Vmax ≥3.0 m/s, mean PG ≥20 mmHg, or AVA ≤1.0 cm2 were categorized into the severe AS group. The AS and severe AS groups were then compared with the non-AS group to identify the risk factors for AS using multivariate logistic analysis. We also compared the risk factors for AS with and without aortic valve calcification, which is the stage prior to age-related AS.Results:Of the 2,786 patients analyzed, 555 (20.0%) and 139 (6.9%) were categorized into the AS and severe AS groups, respectively. Multivariate logistic analysis revealed that aging, long-term dialysis, and elevated serum phosphorus levels were associated with AS in the AS and severe AS groups (p <0.05). Additional investigation using stratified multivariate analysis revealed that groups with serum phosphorus levels of 5.0–5.9 mg/dL and >6.0 mg/dL had a higher risk of AS than those with serum phosphorus levels of <4.0 mg/dL (odds ratio: 2.24; p = 0.01 and odds ratio: 2.66, p = 0.005, respectively). Aortic valve calcification was associated with aging, long-term dialysis, diabetes mellitus, administration of vitamin D receptor activators, elevated serum calcium levels, and anemia (p <0.05 for all).Conclusions:Dialysis patients had a high prevalence of AS, and AS was associated with aging, long dialysis duration, and elevated serum phosphorus levels.Trial registration: UMIN000026756, Registered on March 29, 2017.

Risk factors for rebleeding in patients with obscure gastrointestinal bleeding from southern China

Background To identify the risk factors associated with rebleeding in obscure gastrointestinal bleeding (OGIB) patients from southern China. Methods This retrospective study involved 229 patients who underwent small bowel endoscopy in our hospital between 1 January 2018 and 1 December 2020. The clinical characteristics and risk factors related to rebleeding were retrospectively evaluated. Results Rebleeding patients were significantly older than non-rebleeding patients (53.0 ± 15.9 vs. 46.2 ± 17.8 years), had lower hemoglobin concentrations (89.2 ± 28.1 vs. 126.2 ± 25.1 g/L), and higher blood urea nitrogen concentrations (5.4 ± 2.6 vs. 4.5 ± 2.2 µmol/L), respectively. A higher percentage of rebleeding patients had diabetes mellitus (13.9% vs. 2.9%) and overt bleeding (70.4% vs. 38.6%), and required blood transfusions (43.1% vs. 8.0%), compared with non-rebleeding patients, respectively. Multivariate logistic analysis indicated that drinking alcohol (odds ratio (OR): 9.27; 95% confidence interval (CI) = 1.35–63.78), anemia (OR: 17.38; 95% CI = 5.48–55.10), and blood transfusion (OR: 3.76; 95% CI = 1.04–13.56) increased the risk of rebleeding in OGIB patients. Conclusion Our data suggested that OGIB patients who drink alcohol, have anemia, and require blood transfusion have an increased risk of rebleeding.

Association between Near Work Time and Depression among Workers in South Korea

Background: The aim of this study was to evaluate the association between near work time and depression. Methods: Data of 1,551 workers aged 19–49 years from the sixth Korea National Health and Nutrition Examination Survey were examined. The Patient Health Questionaire-9 scores were used to screen for depression. Participants who scored a total of 10 or above, which is suggestive of the presence of depression, were classified as the depression group; the rest were classified as normal. The correlation between daily near work time and depression was analyzed using multivariate logistic analysis after adjusting for other sociodemographic and health behavior-related variables. Results: Multivariate logistic analysis found that workers with 3 or more hours of near work were more likely to report depression compared to the reference group who had 2 or fewer hours per day of near work (adjusted odds ratio, 2.471; 95% confidence interval, 1.062–5.747). Conclusion: Longer near work time was associated with depression among South Korea’s workers. Therefore, it is necessary to reduce near work time to prevent depression.