Sample records for acute physiology scores

  1. External validation of Acute Physiology and Chronic Health Evaluation IV in Dutch intensive care units and comparison with Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score II

    S. Brinkman; F. Bakhshi-Raiez; A. Abu-Hanna; E. de Jonge; R.J. Bosman; L. Peelen; N.F. de Keizer


    Purpose: The aim of this study was to validate and compare the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) IV in the Dutch intensive care unit (ICU) population to the APACHE II and Simplified Acute Physiology Score (SAPS) II. Materials and Methods: This is a prospectiv

  2. Predictive Performance of the Simplified Acute Physiology Score (SAPS) II and the Initial Sequential Organ Failure Assessment (SOFA) Score in Acutely Ill Intensive Care Patients

    Granholm, Anders; Møller, Morten Hylander; Krag, Mette;


    PURPOSE: Severity scores including the Simplified Acute Physiology Score (SAPS) II and the Sequential Organ Failure Assessment (SOFA) score are used in intensive care units (ICUs) to assess disease severity, predict mortality and in research. We aimed to assess the predictive performance of SAPS II...... compared the discrimination of SAPS II and initial SOFA scores, compared the discrimination of SAPS II in our cohort with the original cohort, assessed the calibration of SAPS II customised to our cohort, and compared the discrimination for 90-day mortality vs. in-hospital mortality for both scores....... Discrimination was evaluated using areas under the receiver operating characteristics curves (AUROC). Calibration was evaluated using Hosmer-Lemeshow's goodness-of-fit Ĉ-statistic. RESULTS: AUROC for in-hospital mortality was 0.80 (95% confidence interval (CI) 0.77-0.83) for SAPS II and 0.73 (95% CI 0...

  3. Acute physiology, age, and chronic health evaluation (APACHE) III score is an alternative efficient predictor of mortality in burn patients.

    Tanaka, Yohei; Shimizu, Mikio; Hirabayashi, Hidemitsu


    The present study was performed to evaluate the prognostic value of the acute physiology, age, chronic health evaluation (APACHE) III score in burn patients. We hypothesised that APACHE III score efficiently predicts mortality of burn patients as it reflects the physiological changes in the acute phase and the severity of the underlying illness. Data such as age, gender, inhalation injury, total burn surface area (TBSA), burn index (BI), prognostic burn index (PBI), APACHE III score and outcome of 105 hospitalised patients were analysed retrospectively. TBSA, BI, PBI, and APACHE III score in the mortality group were significantly higher than those of surviving group. The mean scores of surviving versus mortality groups were as follows: TBSA, 19.2+/-17.8% versus 69.1+/-28.4%, pAPACHE III score, 28.4+/-22.2% versus 71.3+/-32.1%, pAPACHE III score showed marked associations between higher scores and higher mortality. APACHE III score showed a significant correlation with PBI (pAPACHE III score could be used as an alternative efficient predictor of mortality in burn patients.

  4. Increased Resistin Levels in Intra-abdominal Sepsis: Correlation with proinflammatory cytokines & Acute Physiology & Chronic Health Evaluation II scores

    Tonguç U. Yilmaz


    Full Text Available Objectives: Resistin, a hormone secreted from adipocytes and considered to be a likely cause of insulin resistance, has recently been accepted as a proinflammatory cytokine. This study aimed to determine the correlation between resistin levels in patients with intra-abdominal sepsis and mortality. Methods: Of 45 patients with intraabdominal sepsis, a total of 35 adult patients were included in the study. This study was undertaken from December 2011 to December 2012 and included patients who had no history of diabetes mellitus and who were admitted to the general surgery intensive care units of Gazi University and Bülent Ecevit University School of Medicine, Turkey. Evaluations were performed on 12 patients with sepsis, 10 patients with severe sepsis, 13 patients with septic shock and 15 healthy controls. The patients’ plasma resistin, interleukin-6 (IL-6, tumour necrosis factor alpha (TNF-α, interleukin-1 beta (IL-1β, procalcitonin, lactate and glucose levels and Acute Physiology and Chronic Health Evaluation (APACHE II scores were studied daily for the first five days after admission. A correlation analysis of serum resistin levels with cytokine levels and APACHE II scores was performed. Results: Serum resistin levels in patients with sepsis were significantly higher than in the healthy controls (P <0.001. A significant correlation was found between serum resistin levels and APACHE II scores, serum IL-6, IL-1β, TNF-α, procalcitonin, lactate and glucose levels. Furthermore, a significant correlation was found between serum resistin levels and all-cause mortality (P = 0.02. Conclusion: The levels of resistin were significantly positively correlated with the severity of disease and were a possible mediator of a prolonged inflammatory state in patients with intra-abdominal sepsis.

  5. Score for neonatal acute physiology-II and neonatal pain predict corticospinal tract development in premature newborns.

    Zwicker, Jill G; Grunau, Ruth E; Adams, Elysia; Chau, Vann; Brant, Rollin; Poskitt, Kenneth J; Synnes, Anne; Miller, Steven P


    Premature infants are at risk for adverse motor outcomes, including cerebral palsy and developmental coordination disorder. The purpose of this study was to examine the relationship of antenatal, perinatal, and postnatal risk factors for abnormal development of the corticospinal tract, the major voluntary motor pathway, during the neonatal period. In a prospective cohort study, 126 premature neonates (24-32 weeks' gestational age) underwent serial brain imaging near birth and at term-equivalent age. With diffusion tensor tractography, mean diffusivity and fractional anisotropy of the corticospinal tract were measured to reflect microstructural development. Generalized estimating equation models examined associations of risk factors on corticospinal tract development. The perinatal risk factor of greater early illness severity (as measured by the Score for Neonatal Acute Physiology-II [SNAP-II]) was associated with a slower rise in fractional anisotropy of the corticospinal tract (P = 0.02), even after correcting for gestational age at birth and postnatal risk factors (P = 0.009). Consistent with previous findings, neonatal pain adjusted for morphine and postnatal infection were also associated with a slower rise in fractional anisotropy of the corticospinal tract (P = 0.03 and 0.02, respectively). Lessening illness severity in the first hours of life might offer potential to improve motor pathway development in premature newborns.

  6. Association of serum interleukin-6, interleukin-8, and Acute Physiology and Chronic Health Evaluation II score with clinical outcome in patients with acute respiratory distress syndrome

    Swaroopa, Deme; Bhaskar, Kakarla; Mahathi, T.; Katkam, Shivakrishna; Raju, Y. Satyanarayana; Chandra, Naval; Kutala, Vijay Kumar


    Background and Aim: Studies on potential biomarkers in experimental models of acute lung injury (ALI) and clinical samples from patients with ALI have provided evidence to the pathophysiology of the mechanisms of lung injury and predictor of clinical outcome. Because of the high mortality and substantial variability in outcomes in patients with acute respiratory distress syndrome (ARDS), identification of biomarkers such as cytokines is important to determine prognosis and guide clinical decision-making. Materials and Methods: In this study, we have included thirty patients admitted to Intensive Care Unit diagnosed with ARDS, and serum samples were collected on day 1 and 7 and were analyzed for serum interleukin-6 (IL-6) and IL-8 by ELISA method, and Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring was done on day 1. Results: The mortality in the patients observed with ARDS was 34%. APACHE II score was significantly higher in nonsurvivors as compared to survivors. There were no significant differences in gender and biochemical and hematological parameters among the survivors and nonsurvivors. Serum IL-6 and IL-8 levels on day 1 were significantly higher in all the ARDS patients as compared to healthy controls and these levels were returned to near-normal basal levels on day 7. The serum IL-6 and IL-8 levels measured on day 7 were of survivors. As compared to survivors, the IL-6 and IL-8 levels were significantly higher in nonsurvivors measured on day 1. Spearman's rank correlation analysis indicated a significant positive correlation of APACHE II with IL-8. By using APACHE II score, IL-6, and IL-8, the receiver operating characteristic curve was plotted and the provided predictable accuracy of mortality (outcome) was 94%. Conclusion: The present study highlighted the importance of measuring the cytokines such as IL-6 and IL-8 in patients with ARDS in predicting the clinical outcome. PMID:27688627

  7. Cardiac power index, mean arterial pressure, and Simplified Acute Physiology Score II are strong predictors of survival and response to revascularization in cardiogenic shock.

    Popovic, Batric; Fay, Renaud; Cravoisy-Popovic, Aurelie; Levy, Bruno


    Short-term prognostic factors in patients with cardiogenic shock (CS) have previously been established using only hemodynamic parameters without taking into account classic intensive care unit (ICU) severity score or organ failure/support. The aim of this study was to assess early predictors of in-hospital mortality of a monocentric cohort of patients with ST-elevation myocardial infarction complicated by early CS. We retrospectively studied 85 consecutive patients with CS complicating acute myocardial infarction and Thrombolysis in Myocardial Infarction flow grade 3 after percutaneous coronary revascularization. All patients were managed according to the following algorithm: initial resuscitation by a mobile medical unit or in-hospital critical care physician unit followed by percutaneous coronary revascularization and CS management in the ICU. Prehospital CS was diagnosed in 69% of cases, initially complicated by an out-of-hospital cardiac arrest in 64% of cases. All patients were treated with vasopressors, 82% were ventilated, and 22% underwent extrarenal epuration. The 28-day mortality rate was 39%. Under multivariate analysis, initial cardiac power index, mean arterial pressure of less than 75 mmHg at hour 6 of ICU management, and Simplified Acute Physiology Score II were independent predictive factors of in-hospital mortality. In conclusion, parameters directly related to cardiac performance and vascular response to vasopressors and admission Simplified Acute Physiology Score II are strong predictors of in-hospital mortality.

  8. Evaluation of neuro-intensive care unit performance in China:predicting outcomes of Simplified Acute Physiology Score Ⅱ or Glasgow Coma Scale

    ZHAO Xiao-xia; SU Ying-ying; WANG Miao; ZHANG Yan; YE Hong; FENG Huan-huan; ZHANG Yun-zhou


    Background Severity scoring systems are useful tools for measuring the severity of the disease and its outcome.This pilot study was to verify and compare the prognostic performance of the Simplified Acute Physiology Score Ⅱ (SAPS Ⅱ)and Glasgow Coma Scale (GCS) in neuro-intensive care unit (N-ICU) patients.Methods A total of 1684 patients consecutively admitted to the N-ICU at Xuanwu Hospital between January 1,2005and December 31,2011 were enrolled in this study.The data-base included admission data,at 24-,48-,and 72-hour SAPS Ⅱ and GCS.Repeated measure data analysis of variance,Logistic regression analysis,the Hosmer-Lemeshow goodness-of-fit statistic,and the area under the receiver operating characteristic were used to evaluate the performance.Results There was a significant difference between the SAPS Ⅱ or GCS score at four time points (F=16.110,P=0.000or F=8.108,P=0.000).The SAPS Ⅱ scores or GCS score at four time points interacted with the outcomes with significant difference (F=116.771,P=0.000 or F=65.316,P=0.000).Calibration of the SAPS Ⅱ or GCS score at each time point on all patients was good.The percentage of a risk estimate prediction corresponding to observed mortality was also good.The 72-hour score have the greatest consistency.Discriminations of the SAPS Ⅱ or GCS score at each time were all satisfactory.The 72-hour score had the greatest discriminative power.The cut-off value was 33 (sensitivity of 85.2% and specificity of 74.3%) and 6 (sensitivity of 70.6% and specificity of 65.0%).The SAPS Ⅱ at each time point on all patients showed better calibration,consistency and discrimination than GCS.The binary Logistic regression analysis identified physiological variables,GCS,age,and disease category as significant independent risk factors of death.After the two variables including underlying disease and type of admission were excluded,we built the simplified SAPS Ⅱ model.A correlation was suggested between the simplified SAPS

  9. Quadratic function between arterial partial oxygen pressure and mortality risk in sepsis patients: an interaction with simplified acute physiology score.

    Zhang, Zhongheng; Ji, Xuqing


    Oxygen therapy is widely used in emergency and critical care settings, while there is little evidence on its real therapeutic effect. The study aimed to explore the impact of arterial oxygen partial pressure (PaO2) on clinical outcomes in patients with sepsis. A large clinical database was employed for the study. Subjects meeting the diagnostic criteria of sepsis were eligible for the study. All measurements of PaO2 were extracted. The primary endpoint was death from any causes during hospital stay. Survey data analysis was performed by using individual ICU admission as the primary sampling unit. Quadratic function was assumed for PaO2 and its interaction with other covariates were explored. A total of 199,125 PaO2 samples were identified for 11,002 ICU admissions. Each ICU stay comprised 18 PaO2 samples in average. The fitted multivariable model supported our hypothesis that the effect of PaO2 on mortality risk was in quadratic form. There was significant interaction between PaO2 and SAPS-I (p = 0.007). Furthermore, the main effect of PaO2 on SOFA score was nonlinear. The study shows that the effect of PaO2 on mortality risk is in quadratic function form, and there is significant interaction between PaO2 and severity of illness.


    Cucuteanu, B; Prelipcean, Cristina Cijevschi; Mihai, Cătălina; Dranga, Mihaela; Negru, D


    Acute pancreatitis (AP) is a frequent presentation to the emergency departments with a rising incidence and a great variability in clinical severity and outcome. The aim of this review is to offer a succinct presentation on acute pancreatitis scoring systems and the use of different imaging methods in severity prediction: Ranson criteria, Glasgow criteria, Hong Kong Score, Acute Physiology and Chronic Health Evaluation II (APACHE II), computed tomography scoring systems, Bedside Index of Severity in Acute Pancreatitis (BISAP) score, Panc 3, Japanese Severity Score (JSS), Harmless Acute Pancreatitis Score (HAPS), Pancreatitis Outcome Prediction (POP), Sequential Organ Failure Assessment (SOFA). This article also describes the Revised Atlanta Classification of AP (2012) and the correlation with computed tomography.

  11. Retrospective study on prognostic importance of serum procalcitonin and amino - terminal pro - brain natriuretic peptide levels as compared to Acute Physiology and Chronic Health Evaluation IV Score on Intensive Care Unit admission, in a mixed Intensive Care Unit population

    Chitra Mehta


    Full Text Available Background: Timely decision making in Intensive Care Unit (ICU is very essential to improve the outcome of critically sick patients. Conventional scores like Acute Physiology and Chronic Health Evaluation (APACHE IV are quite cumbersome with calculations and take minimum 24 hours. Procalcitonin has shown to have prognostic value in ICU/Emergency department (ED in disease states like pneumonia, sepsis etc. NTproBNP has demonstrated excellent diagnostic and prognostic importance in cardiac diseases. It has also been found elevated in non-cardiac diseases. We chose to study the prognostic utility of these markers on ICU admission. Settings and Design: Retrospective observational study. Materials and Methods: A Retrospective analysis of 100 eligible patients was done who had undergone PCT and NTproBNP measurements on ICU admission. Their correlations with all cause mortality, length of hospital stay, need for ventilator support, need for vasopressors were performed. Results: Among 100 randomly selected ICU patients, 28 were non-survivors. NTproBNP values on admission significantly correlated with all cause mortality (P = 0.036, AUC = 0.643 and morbidity (P = 0.000, AUC = 0.763, comparable to that of APACHE-IV score. PCT values on admission did not show significant association with mortality, but correlated well with morbidity and prolonged hospital length of stay (AUC = 0.616, P = 0.045. Conclusion: The current study demonstrated a good predictive value of NTproBNP, in terms of mortality and morbidity comparable to that of APACHE-IV score. Procalcitonin, however, was found to have doubtful prognostic importance. These findings need to be confirmed in a prospective larger study.

  12. Retrospective study on prognostic importance of serum procalcitonin and amino-terminal pro-brain natriuretic peptide levels as compared to Acute Physiology and Chronic Health Evaluation IV Score on Intensive Care Unit admission, in a mixed Intensive Care Unit population


    Background: Timely decision making in Intensive Care Unit (ICU) is very essential to improve the outcome of critically sick patients. Conventional scores like Acute Physiology and Chronic Health Evaluation (APACHE IV) are quite cumbersome with calculations and take minimum 24 hours. Procalcitonin has shown to have prognostic value in ICU/Emergency department (ED) in disease states like pneumonia, sepsis etc. NTproBNP has demonstrated excellent diagnostic and prognostic importance in cardiac d...

  13. Prediction of Pressure Ulcer by Combination of Braden Scale Score and Acute Physiology and Chronic Health EvaluationⅡ Score%Braden 量表评分联合急性生理学与慢性健康状况评分系统Ⅱ评分预测压疮发生的价值

    郝娜; 张建波; 高冰洁; 周平


    Background Pressure ulcer assessment is a crucial step in the nursing of pressure ulcer. Braden Scale is a widely used evaluation tool in current assessment of pressure ulcer,but there are limitations in the risk prediction of pressure ulcer in clinic. Objective To evaluate the value of Braden Scale score combined with acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score in pressure ulcer prediction. Methods 310 patients reported by clinic departments(including ICU,CCU,Department of Cardiovascular Disease, Liver Disease, Oncology, Nephrology, Orthopaedics, Emergency, etc. ) from Traditional Chinese Medicine Hospital in Chongqing from June 2014 to June 2015 were selected as the research objects. Patients'scores of Braden Scale and APACHE Ⅱ were collected. The patients scored not more than 12 in Braden Scale were predicted as high - risk pressure ulcer,while those who scored greater than 12 were low - risk pressure ulcer;the patients scored not more than 12 in Braden Scale and not less than 15 in APACHE Ⅱ were predicted as high - risk pressure ulcer,otherwise they would be taken as low - risk pressure ulcer. The receiver operating characteristic(ROC)curve was predicted by Braden Scale or Braden Scale score combined with APACHE Ⅱ score. The areas under curve ( AUC) of ROC,sensibility,specificity,positive predictive value and negative predictive value were also calculated. Results 57 patients developed pressure ulcer,and 253 patients didn't among the 310 inpatients. The 310 patients were predicted as high - risk pressure ulcer and 0 patients were low -risk pressure ulcer by Braden Scale score. The AUC of the occurrence of pressure ulcer predicted by Braden Scale score was 0. 326,95% CI( 0. 241,0. 410 );with 12 as the critical value,the sensitivity,specificity,positive predictive value, negative predictive value,and Youden's index of predicting the occurrence of pressure ulcer were 100% ,0,18. 4% ,0, 18. 4% ,0,and 0 respectively. 63 high - risk

  14. Severity assessment of acute pancreatitis: applying Marshall scoring system

    André Lanza Carioca


    Full Text Available Objective: To analyze the effectiveness of the Marshall scoring system to evaluate the severity of acute pancreatitis (AP. Methods : We performed a prospective, observational study in 39 patients with AP evaluated by the Marshall scoring system and the Ranson criteria (admission and 48 hours. We assessed the progression of the disease for seven days and compared the data of the two criteria. Results : Seven patients died during the observation period and one died afterwards. All deaths had shown failure of at least one system by the Marshall method. Conclusion : The Marshall scoring system may be used as an effective and simplified application method to assess the severity of acute pancreatitis.

  15. MR imaging of acute pancreatitis: Correlation of abdominal wall edema with severity scores

    Yang, Ru, E-mail: [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Jing, Zong Lin, E-mail: [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Zhang, Xiao Ming, E-mail: [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Tang, Wei, E-mail: [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Xiao, Bo, E-mail: [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Huang, Xiao Hua, E-mail: [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Yang, Lin, E-mail: [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Feng, Zhi Song, E-mail: [Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China)


    Objective: To study MRI findings of abdominal wall edema (AWE) in acute pancreatitis as well as correlations between AWE and the severity of acute pancreatitis according to the MR severity index (MRSI) and the Acute Physiology And Chronic Healthy Evaluation III (APACHE III) scoring system. Materials and methods: A total of 160 patients with AP admitted to our institution between December 2009 and March 2011 were included in this study. MRI was performed within 48 h after admission. MRI findings of acute pancreatitis were noted, including AWE on the MRI. The abdominal wall area was divided into quarters, and each area involved was recorded as 1 point to score the severity of AWE. The severity of acute pancreatitis was studied using both the MRSI and the APACHE III scoring system. Spearman correlation of AWE with the MRSI and the APACHE III scoring system was analyzed. Results: In 160 patients with acute pancreatitis, 53.8% had AWE on MRI. The average AWE score was 1.2 {+-} 1.4 points. The prevalence of AWE was 30.5%, 64.5% and 100% in mild, moderate and severe AP, respectively, according to MRSI. AWE on MRI was correlated with MRSI scores (r = 0.441, p = 0.000). According to APACHE III scores, the averages were 2.0 {+-} 1.1 and 2.6 {+-} 1.1 points in mild AP and severe AP, respectively (P = 0.016). AWE was slightly correlated with the APACHE III scores (r = 0.222, p = 0.005). Conclusion: AWE on MRI in acute pancreatitis is common, which may be a supplementary indicator in determining the severity of AP.

  16. [Validation of a diagnostic scoring system (Ohmann score) in acute appendicitis].

    Zielke, A; Sitter, H; Rampp, T A; Schäfer, E; Hasse, C; Lorenz, W; Rothmund, M


    A diagnostic scoring system, recently published by Ohmann et al. in this journal, was validated by analyzing the clinicopathological data of a consecutive series of 2,359 patients, admitted for suspicion of acute appendicitis. The results of the scoring system were compared to the results of clinical evaluation by junior (provisional) and senior surgeons (final clinical diagnosis). To assess the diagnostic ability of the score, the accuracy and positive predictive value were defined as the major diagnostic performance parameters; the rate of theoretical negative laparotomies and that of diagnostic errors served as the major procedural performance parameters. Of 2,359 patients admitted for suspected acute appendicitis, 662 were proven to have acute appendicitis by histology, for a prevalence of 28%. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the provisional clinical diagnosis were 0.50, 0.94, 0.77, 0.83, and 0.82; 0.93, for the score 0.63, 0.93, 0.77, 0.86 and 0.84, and for the final clinical diagnosis 0.90, 0.94, 0.85, 0.96, and 0.93, respectively. Of the main diagnostic performance parameter, the accuracy of the score was significantly better than that of provisional clinical diagnosis (P apendicitis, the score demonstrated a superior performance, with only 6 cases missed (0.9%). However, the number of patients with acute appendicitis, including those with perforated disease, who were not identified by the score, was almost four times that of the final clinical diagnosis (245 vs 63). With regard to the main procedural performance parameter, the score resulted in a significantly smaller number of diagnostic errors than the provisional clinical investigator (P < 0.05, chi 2 test). The results of this study indicate that the diagnostic scoring system might be helpful when experienced investigators or additional diagnostic modalities such as ultrasonography are not available. It may therefore be of value

  17. Worthing Physiological Score vs Revised Trauma Score in Outcome Prediction of Trauma patients; a Comparative Study

    Nakhjavan-Shahraki, Babak; Yousefifard, Mahmoud; Hajighanbari, Mohammad Javad; Karimi, Parviz; Baikpour, Masoud; Mirzay Razaz, Jalaledin; Yaseri, Mehdi; Shahsavari, Kavous; Mahdizadeh, Fatemeh; Hosseini, Mostafa


    Introduction: Awareness about the outcome of trauma patients in the emergency department (ED) has become a topic of interest. Accordingly, the present study aimed to compare the rapid trauma score (RTS) and worthing physiological scoring system (WPSS) in predicting in-hospital mortality and poor outcome of trauma patients. Methods: In this comparative study trauma patients brought to five EDs in different cities of Iran during the year 2016 were included. After data collection, discriminatory power and calibration of the models were assessed and compared using STATA 11. Results: 2148 patients with the mean age of 39.50±17.27 years were included (75.56% males). The AUC of RTS and WPSS models for prediction of mortality were 0.86 (95% CI: 0.82-0.90) and 0.91 (95% CI: 0.87-0.94), respectively (p=0.006). RTS had a sensitivity of 71.54 (95% CI: 62.59-79.13) and a specificity of 97.38 (95% CI: 96.56-98.01) in prediction of mortality. These measures for the WPSS were 87.80 (95% CI: 80.38-92.78) and 83.45 (95% CI: 81.75-85.04), respectively. The AUC of RTS and WPSS in predicting poor outcome were 0.81 (95% CI: 0.77-0.85) and 0.89 (95% CI: 0.85-0.92), respectively (p<0.0001). Conclusion: The findings showed a higher prognostic value for the WPSS model in predicting mortality and severe disabilities in trauma patients compared to the RTS model. Both models had good overall performance in prediction of mortality and poor outcome. PMID:28286838

  18. Eccentric Exercise: Physiological Characteristics and Acute Responses.

    Douglas, Jamie; Pearson, Simon; Ross, Angus; McGuigan, Mike


    An eccentric contraction involves the active lengthening of muscle under an external load. The molecular and neural mechanisms underpinning eccentric contractions differ from those of concentric and isometric contractions and remain less understood. A number of molecular theories have been put forth to explain the unexplained observations during eccentric contractions that deviate from the predictions of the established theories of muscle contraction. Postulated mechanisms include a strain-induced modulation of actin-myosin interactions at the level of the cross-bridge, the activation of the structural protein titin, and the winding of titin on actin. Accordingly, neural strategies controlling eccentric contractions also differ with a greater, and possibly distinct, cortical activation observed despite an apparently lower activation at the level of the motor unit. The characteristics of eccentric contractions are associated with several acute physiological responses to eccentrically-emphasised exercise. Differences in neuromuscular, metabolic, hormonal and anabolic signalling responses during, and following, an eccentric exercise bout have frequently been observed in comparison to concentric exercise. Subsequently, the high levels of muscular strain with such exercise can induce muscle damage which is rarely observed with other contraction types. The net result of these eccentric contraction characteristics and responses appears to be a novel adaptive signal within the neuromuscular system.

  19. Early warning score predicts acute mortality in stroke patients

    Liljehult, J; Christensen, T


    was to investigate whether the aggregate weighted track and trigger system early warning score (EWS) can be used as a simple observational tool to identify patients at risk and predict mortality in a population of patients with acute stroke. MATERIALS AND METHODS: Patients admitted with acute stroke...... at the Copenhagen University Hospital, Nordsjaellands Hospital, Denmark, from May to September 2012 were enrolled in a retrospective cohort study (n = 274). Vital signs were measured immediately after admission and consistently during the hospitalization period. Based on the vital signs, a single composite EWS...... the EWS at admission (AUROC 0.856; 95% CI 0.760-0.951; P-value score is a simple and valid...

  20. Procalcitonin and BISAP score versus c-reactive protein and APACHE II score in early assessment of severity and outcome of acute pancreatitis

    Bezmarević Mihailo


    Full Text Available Background/Aim. Early assessment of severity and continuous monitoring of patients are the key factors for adequate treatment of acute pancreatitis (AP. The aim of this study was to determine the value of procalcitonin (PCT and Bedside Index for Severity in Acute Pancreatitis (BISAP scoring system as prognostic markers in early stages of AP with comparison to other established indicators such as Creactive protein (CRP and Acute Physiology and Chronic Health Evaluation (APACHE II score. Methods. This prospective study included 51 patients (29 with severe AP. In the first 24 h of admission in all patients the APACHE II score and BISAP score, CRP and PCT serum concentrations were determined. The values of PCT serum concentrations and BISAP score were compared with values of CRP serum concentrations and APACHE II score, in relation to the severity and outcome of the disease. Results. Values of PCT, CRP, BISAP score and APACHE II score, measured at 24 h of admission, were significantly elevated in patients with severe form of the disease. In predicting severity of AP at 24 h of admission, sensitivity and specificity of the BISAP score were 74% and 59%, respectively, APACHE II score 89% and 69%, respectively, CRP 75% and 86%, respectively, and PCT 86% and 63%, respectively. It was found that PCT is highly significant predictor of the disease outcome (p < 0,001. Conclusion. In early assessment of AP severity, PCT has better predictive value than CRP, and similar to the APACHE II score. APACHE II score is a stronger predictor of the disease severity than BISAP score. PCT is a good predictor of AP outcome.

  1. Relationship among triple acid-base disturbance and acute physiology and chronic health evaluation Ⅲ score and prognosis in patients with chronic obstructive pulmonary disease acute exacerbation%慢性阻塞性肺疾病急性加重期三重酸碱失衡与急性生理学和慢性健康状况评分Ⅲ评分及预后的关系

    殷波; 惠复新; 赵寅滢


    Objective To investigate the relationship among triple acid-base disturbance , acute physiology and chronic health evaluation ( APACHE) Ⅲ score and prognosis in patients with chronic obstructive pulmonary disease( COPD) acute ex acerbation. Methods Seventy-nine patients with COPD acute exacerbation were divided into two groups,thirty-six patients with triple acid-base disturbance as observation group and forty-three patients with one or double acid-base disturbance as con trol group. Age, chronic healthy condition, neurology, physiology and acid-base disturbance were scored and death risk rates were predicted according to the standard of APACHE Ⅲ system. Results The anions' interspace and potential HCO3 - of pa tients in observation group were significantly higher than those in control group ( P < 0.01 ) . The neurology. physiology, acid base disturbance and total scores of APACHE Ⅲ of patients in obsenration group were significantly higher than those in control group (P <0.01). The predictive death risk rate of patients in observation group was (17.32 ±12.65)% and that of control group was (4.27±2.44) % ,while,the factual death risk rate of patients in observation group was 19.44% and control group 6.98% . Obviously , the rate of patients in observation group was higher than that in control group (P < 0.01 ) . Conclusion Besides the scores of APACHE Ⅲ are increased, other scores of physiological index, the total scores of APACHE Ⅲ and the predictive death risk rate were also increased.%目的 探讨慢性阻塞性肺疾病(COPD)急性加重期三重酸碱失衡与急性生理学和慢性健康状况评分(APACHE)Ⅲ及预后的关系.方法 选择COPD急性加重期住院患者共79例,其中符合三重酸碱失衡的36例作为观察组,同期单纯或二重酸碱失衡43例作为对照组.按照APACHEⅢ系统评分标准分别就年龄、慢性健康状况、神经学、生理学、酸碱失衡评分并预计死亡风险率.结果

  2. Breast cancer acute radiotherapy morbidity evaluated by different scoring systems.

    López, Escarlata; Núñez, M Isabel; Guerrero, M Rosario; del Moral, Rosario; de Dios Luna, Juan; del Mar Rodríguez, M; Valenzuela, M Teresa; Villalobos, Mercedes; Ruiz de Almodóvar, José Mariano


    Reporting of the outcome of radiotherapy is not satisfactory without a description of the treatment-related side effects. The purposes of this paper were: (1) to evaluate the frequency and the severity of collateral skin reactions in a group of breast cancer patients; (2) to report the acute reactions using some current scoring systems and to compare the application of them, and (3) to investigate the variation between intra- and interobservers using these different scales. We studied 108 breast cancer patients who, after surgical treatment, received adjuvant radiotherapy. Clinical skin evaluation was always performed by the same radiotherapist the last day of treatment, and the collateral radiation effects were photographed at that moment to facilitate later evaluations by another two expert doctors. Normal tissue damage was scored according to the Radiation Therapy Oncology Group/The European Organisation for Research, and Treatment of Cancer/ (RTOG/EORTC), the Danish, the European, and the Biomed2 side-effect scales. The most frequent acute complications found were erythema (91.7%), dry desquamation (29.6%) and moist desquamation (35.2%). The reactions were classified as severe in 13.9, 23, 18.5 and 13% of the patients with each of the different systems used, respectively. The concordance between the scoring of radiation-induced side effects on the skin assessed by direct observation of the patients or by examination of the photographic document was sufficient. This is a warrant of accuracy in the evaluation of acute normal tissue lesions. Our results allow us to state the advantage of the RTOG system over the others in terms of evaluating the acute effects produced by radiotherapy of women with breast cancer.

  3. Bernard Organ Failure Score in estimation of most severe forms of acute pancreatitis

    Glišić Tijana


    Full Text Available Introduction. Despite intensive research, efforts and clinical investigations on pathogenesis of acute pancreatitis (AP and system morbidity during the illness onset, mortality is still very high in the group of severe forms. A significantly high number of patients show moderate, self-limited forms of illness, with a minimal degree of systemic or local complications, with full recovery. However, some of them have a severe form, followed by a high percent of morbidity and mortality, and system organ failure. The distinction between mild and severe forms of AP within 24-48 hours of hospital admission is very important for the treatment of these patients. The usage of multifactorial scoring systems holds a lot of promise, reaching reliability in the disease severity estimation of approximately 70-80%. Objective. The main purpose of this prospective study was to assess the correlation of the Acute Physiology and Chronic Health Evaluation II (APACHE II and the Bernard Organ Failure Score (BOFS scoring systems in estimation of disease severity and outcome prediction. Methods. Sixty patients with AP participated in the study, all of them scored with the APACHE II and BOFS scores. The results were used for integration of laboratory and clinical parameters. Results. In our study, we had a highly significant correlation between the APACHE II and BOFS scores from the disease onset until the end of treatment. There was a highly significant correlation between these two scores and the serum C-reactive protein concentration level. Conclusion. The concept of the BOFS score has more advantages than the APACHE II score in the patients with severe forms of AP with organ dysfunction.

  4. Retrospective study on prognostic importance of serum procalcitonin and amino-terminal pro-brain natriuretic peptide levels as compared to Acute Physiology and Chronic Health Evaluation IV Score on Intensive Care Unit admission, in a mixed Intensive Care Unit population

    Mehta, Chitra; Dara, Babita; Mehta, Yatin; Tariq, Ali M.; Joby, George V.; Singh, Manish K.


    Background: Timely decision making in Intensive Care Unit (ICU) is very essential to improve the outcome of critically sick patients. Conventional scores like Acute Physiology and Chronic Health Evaluation (APACHE IV) are quite cumbersome with calculations and take minimum 24 hours. Procalcitonin has shown to have prognostic value in ICU/Emergency department (ED) in disease states like pneumonia, sepsis etc. NTproBNP has demonstrated excellent diagnostic and prognostic importance in cardiac diseases. It has also been found elevated in non-cardiac diseases. We chose to study the prognostic utility of these markers on ICU admission. Settings and Design: Retrospective observational study. Materials and Methods: A Retrospective analysis of 100 eligible patients was done who had undergone PCT and NTproBNP measurements on ICU admission. Their correlations with all cause mortality, length of hospital stay, need for ventilator support, need for vasopressors were performed. Results: Among 100 randomly selected ICU patients, 28 were non-survivors. NTproBNP values on admission significantly correlated with all cause mortality (P = 0.036, AUC = 0.643) and morbidity (P = 0.000, AUC = 0.763), comparable to that of APACHE-IV score. PCT values on admission did not show significant association with mortality, but correlated well with morbidity and prolonged hospital length of stay (AUC = 0.616, P = 0.045). Conclusion: The current study demonstrated a good predictive value of NTproBNP, in terms of mortality and morbidity comparable to that of APACHE-IV score. Procalcitonin, however, was found to have doubtful prognostic importance. These findings need to be confirmed in a prospective larger study. PMID:27052066

  5. A useful new coma scale in acute stroke patients: FOUR score.

    Kocak, Yusuf; Ozturk, Serefnur; Ege, Fahrettin; Ekmekci, Hakan


    Assessment of the severity of unconsciousness in patients with impaired consciousness, prediction of mortality and prognosis are currently the most studied subjects in intensive care. The aim of this study was to investigate the usefulness of the Full Outline of UnResponsiveness (FOUR) score in intensive care unit patients with stroke and the associations of FOUR score with the clinical outcome and with other coma scales (Glasgow [GCS] and Acute Physiology and Chronic Health Evaluation II). One hundred acute stroke patients (44 male, 56 female), who were followed in a neurology intensive care unit, were included in this prospective study. The mean age of the patients was 70.49 ± 12.42 years. Lesion types were determined as haemorrhagic in 30 and ischaemic in 70 patients. FOUR scores on the day of admission and the first, third and 10th days of patients who died within 15 days were lower when compared to scores of patients who survived (P=0.005, P=0.000, P=0.000 and P=0.000 respectively). Receiver operating characteristic curve analysis showed significant trending with both FOUR score and GCS for prognosis; the area under curve ranged from 0.675 (95% confidence interval 0.565 to 0.786) when measurements had been made on day 3 to 0.922 (95% confidence interval 0.867 to 0.977) and 0.981 (95% confidence interval 0.947 to 1.015) for day 10. We suggest that FOUR score is a useful scale for evaluation of acute stroke patients in the intensive care unit as a homogeneous group, with respect to the outcome estimation.

  6. Correlation of serum cholinesterase and acute physiology and chronic health evaluation Ⅱscore and multiple organ dysfunction syndrome score in patients with severe pneumonia%重症肺炎患者血清胆碱酯酶含量变化及其与急性病生理学和长期健康评价Ⅱ评分、多器官功能障碍综合征评分的相关性研究

    莫新; 梁艳冰; 陈志斌; 李振宇; 杨冰玉; 马中富


    Objective To observe the change of serum cholinesterase (S-ChE) levels in patients with severe pneumonia and its correlativity with acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score and multiple organ dysfunction syndrome (MODS) score. Methods A total of 86 patients with severe pneumonia were enrolled in this study as the severe pneumonia group, and divided into the survival group (46 cases) and death group (40 cases). And 100 patients with common pneumonia (common pneumonia group) and 124 people with health examination normal (control group) were served as control. The S-ChE levels were collected and APACHE Ⅱ score and MODS score were calculated after the patients were hospitalized in ICU within 24 hours. The Pearson correlation was used to analyze the association between S-ChE level and APACHE Ⅱ score as well as MODS score. Results The S-ChE levels in the severe pneumonia group, common pneumonia group and control group were (3 679 ± 1 433) U/L, (5 142 ± 1 884) U/L, (8 469 ± 1 377) U / L, respectively, and the S-ChE levels in the severe pneumonia group were much lower than those in the common pneumonia group and control group (all P<0.05). Meanwhile, the S-ChE levels in the death group [(2 748 ± 826) U/L vs. (4 489 ± 1 360) U/L, t=7.041, P<0.001] were much lower, whereas the APACHEⅡscores (26 ± 5 vs. 16 ± 5, t=8.540, P<0.001) and MODS scores (8.15 ± 2.49 vs. 4.35 ± 2.01,t=7.832, P<0.001) were higher than those in the survival group. The Pearson correlation showed that the S-ChE levels were negative related with APACHEⅡscore (r=-0.437, P<0.05) and MODS score (r=-0.337, P<0.05). Conclusion The S-ChE levels in patients with severe pneumonia decrease remarkedly, which can reflect the severity of severe pneumonia and have negative correlation with APACHE Ⅱscore or MODS score.%目的探讨重症肺炎患者血清胆碱酯酶(S-ChE)含量的变化及其与急性病生理学和长期健康评价Ⅱ(APACHEⅡ)评分、多器

  7. SAPS 3, APACHE IV or GRACE: which score to choose for acute coronary syndrome patients in intensive care units?

    Nassar Junior, Antonio Paulo; Mocelin, Amilcar Oshiro; Andrade, Fabio Moreira; Brauer, Leonardo; Giannini, Fabio Poianas; Nunes, Andre Luiz Baptiston; Dias, Carlos Augusto


    CONTEXT AND OBJECTIVE Acute coronary syndromes (ACS) are a common cause of intensive care unit (ICU) admission. Specific prognostic scores have been developed and validated for ACS patients and, among them, GRACE (Global Registry of Acute Coronary Events) has had the best performance. However, intensive care clinicians generally use prognostic scores developed from heterogeneous populations of critically ill patients, such as APACHE IV (Acute Physiologic and Chronic Health Evaluation IV) and SAPS 3 (Simplified Acute Physiology Score 3). The aim of this study was to evaluate and compare the performance of these three scores in a non-selected population of ACS cases. DESIGN AND SETTING Retrospective observational study to evaluate three prognostic scores in a population of ACS patients admitted to three general ICUs in private hospitals in São Paulo. METHODS All patients with ACS admitted from July 2008 to December 2009 were considered for inclusion in the study. Score calibration and discrimination were evaluated in relation to predicting hospital mortality. RESULTS A total of 1065 patients were included. The calibration was appropriate for APACHE IV and GRACE but not for SAPS 3. The discrimination was very good for all scores (area under curve of 0.862 for GRACE, 0.860 for APACHE IV and 0.804 for SAPS 3). CONCLUSIONS In this population of ACS patients admitted to ICUs, GRACE and APACHE IV were adequately calibrated, but SAPS 3 was not. All three scores had very good discrimination. GRACE and APACHE IV may be used for predicting mortality risk among ACS patients.

  8. SAPS 3, APACHE IV or GRACE: which score to choose for acute coronary syndrome patients in intensive care units?

    Antonio Paulo Nassar Junior

    Full Text Available CONTEXT AND OBJECTIVE Acute coronary syndromes (ACS are a common cause of intensive care unit (ICU admission. Specific prognostic scores have been developed and validated for ACS patients and, among them, GRACE (Global Registry of Acute Coronary Events has had the best performance. However, intensive care clinicians generally use prognostic scores developed from heterogeneous populations of critically ill patients, such as APACHE IV (Acute Physiologic and Chronic Health Evaluation IV and SAPS 3 (Simplified Acute Physiology Score 3. The aim of this study was to evaluate and compare the performance of these three scores in a non-selected population of ACS cases. DESIGN AND SETTING Retrospective observational study to evaluate three prognostic scores in a population of ACS patients admitted to three general ICUs in private hospitals in São Paulo. METHODS All patients with ACS admitted from July 2008 to December 2009 were considered for inclusion in the study. Score calibration and discrimination were evaluated in relation to predicting hospital mortality. RESULTS A total of 1065 patients were included. The calibration was appropriate for APACHE IV and GRACE but not for SAPS 3. The discrimination was very good for all scores (area under curve of 0.862 for GRACE, 0.860 for APACHE IV and 0.804 for SAPS 3. CONCLUSIONS In this population of ACS patients admitted to ICUs, GRACE and APACHE IV were adequately calibrated, but SAPS 3 was not. All three scores had very good discrimination. GRACE and APACHE IV may be used for predicting mortality risk among ACS patients.

  9. QT dispersion and prognostication of the outcome in acute cardiotoxicities: A comparison with SAPS II and APACHE II scoring systems.

    Hassanian-Moghaddam, Hossein; Amiri, Hassan; Zamani, Nasim; Rahimi, Mitra; Shadnia, Shahin; Taherkhani, Maryam


    We aimed to evaluate the efficacy of QT dispersion (QTD) in determining the outcome of the patients poisoned by cardiotoxic medications and toxins. Patients who referred to our emergency department (ED) due to acute toxicity with any cardiotoxic medication or toxin and were admitted to medical toxicology intensive care unit (MTICU) were enrolled into the study. A questionnaire containing the demographic characteristics, vital signs, laboratory tests, electrocardiographic (ECG) parameters of the first ECG taken on MTICU or ED admission, simplified acute physiology score (SAPS), and acute physiology and chronic health evaluation (APACHE) score was filled for every single patient. QTD was manually calculated. The patients were divided into two groups of survivors and non-survivors and compared. Although QTD was not significantly different between the survivors and non-survivors (P = 0.8), SAPS II and APACHE II score were so. SAPS and APACHE had the highest sensitivity and specificity in determining the patients' mortality, respectively. SAPS had the highest sensitivity, and QTD had the highest specificity in predicting the later development of the complications. SAPS II and APACHE II scoring systems are the best systems for prognostication of death in patients with acute cardiotoxic medication-induced poisonings. QTD can be successfully used for the prediction of complications.

  10. Physiological-Social Scores in Predicting Outcomes of Prehospital Internal Patients

    Abbasali Ebrahimian


    Full Text Available The physiological-social modified early warning score system is a newly developed instrument for the identification of patients at risk. The aim of this study was to investigate the feasibility of using the physiological-social modified early warning score system for the identification of patients that needed prehospital emergency care. This prospective cohort study was conducted with 2157 patients. This instrument was used as a measure to detect critical illness in patients hospitalised in internal wards. Judgment by an emergency medicine specialist was used as a measure of standard. Data were analyzed by using receiver operating characteristics curves and the area under the curve with 95% confidence interval. The mean score of the physiological-social modified early warning score system was 2.71 ± 3.55. Moreover, 97.6% patients with the score ≥ 4 needed prehospital emergency services. The area under receiver operating characteristic curve was 0.738 (95% CI = 0.708–0.767. Emergency medical staffs can use PMEWS ≥ 4 to identify those patients hospitalised in the internal ward as at risk patients. The physiological-social modified early warning score system is suggested to be used for decision-making of emergency staff about internal patients’ wards in EMS situations.

  11. Physiological-social scores in predicting outcomes of prehospital internal patients.

    Ebrahimian, Abbasali; Seyedin, Hesam; Jamshidi-Orak, Roohangiz; Masoumi, Gholamreza


    The physiological-social modified early warning score system is a newly developed instrument for the identification of patients at risk. The aim of this study was to investigate the feasibility of using the physiological-social modified early warning score system for the identification of patients that needed prehospital emergency care. This prospective cohort study was conducted with 2157 patients. This instrument was used as a measure to detect critical illness in patients hospitalised in internal wards. Judgment by an emergency medicine specialist was used as a measure of standard. Data were analyzed by using receiver operating characteristics curves and the area under the curve with 95% confidence interval. The mean score of the physiological-social modified early warning score system was 2.71 ± 3.55. Moreover, 97.6% patients with the score ≥ 4 needed prehospital emergency services. The area under receiver operating characteristic curve was 0.738 (95% CI = 0.708-0.767). Emergency medical staffs can use PMEWS ≥ 4 to identify those patients hospitalised in the internal ward as at risk patients. The physiological-social modified early warning score system is suggested to be used for decision-making of emergency staff about internal patients' wards in EMS situations.

  12. 改良急性生理学与慢性健康状况评分系统Ⅱ评分在急诊危重患者中的建立和应用%The use and establishment of modified acute physiology and chronic health evaluation Ⅱ score in emergency patients

    叶舟; 陶玲; 范兆普; 吴锦萍; 王英


    目的 将急性生理学与慢性健康状况评分系统I(APACHE I)进行改良,使之更简便、实用.方法 回顾2003年1月-2005年10月全院重症加强治疗病房(ICU)死亡患者,选择各项生理指标数据齐全、且符合改良APACHE I评分标准者为试验组(153例),对照组选择同期监护室生存患者进行1:1配对,以患者24 h内最差生理指标为标准并填表,然后将患者是否死亡与改良APACHE I评分进行拟合检验及建立回归模型,将其应用于2006年1-10月的急诊抢救患者,评价其预报准确性.结果 应用Lemeshow-Hosmet拟合优度检验,预计死亡与实际死亡情况比较.X2=8.853.P=0.335,拟合度良好.改良APACHE I评分以界点16分为预报值,急诊抢救室患者现场预测死亡的敏感度为86.8%,特异性为81.6%,准确性为81.8%.改良ApACHE I评分低者缓解回家及留观的比例较高;随分数增高,入院、死亡的比例也随之增高.结论 APACHE I评分方便、实用于急诊领域.%Objective To simplify the acute physiology and chronic health evaluation I(APACHE I)score to make it more suitable for emergency patients.Methods Medical records of all the dead patients in the intensive care unit(ICU)from January 2003 to October 2005 were retrospectively analyzed.Those dead patients whose clinical data were completed for study were chosen as the experimental group(153 cases).Patients who survived in the same ICU at the same period were chosen as cohort for comparison.The worst scores within 24 hours of admission were selected for comparison between survivors and non-survivors to establish the modified APACHE I by linear regression.Then the new score was tested in the emergency patients who needed medical care from January to October 2006,and the accuracy of the prognostic value was evaluated.Results Tested by the Lemeshow-Hosmer C-statistic and calibration curve analysis,the modified APACHE I score showed a good clustering data and the high calibration of the

  13. 应用简化急性生理评分Ⅱ预测危重神经疾病患者死亡概率%Predicting possibility of mortality in critically ill patients with neurological diseases by using Simplified Acute Physiology Score

    马联胜; 宿英英; 李霞; 刘甜甜; 陈卫碧


    Objective To evaluate feasibility and reliability of using Simplified Acute Physiology Score Ⅱ (SAPS Ⅱ)in predicting mortality in critically ill patients with neurological diseases.Methods All 653 patients hospitalized in neurological intensive care unit (N-ICU) from Jan 2005 to Dec 2007 were retrospectively studied.SAPSⅡ scores were scaled upon admission at 24,48 and 72 h,and possibility of hospital mortality (PHM) was calculated based on SAPS Ⅱ score.Neurological diseases diagnosis made initially at time of hospitalization was classified into five categories:intracranial hemorrhage,cerebral infarction,neurologic infection,neuromuscular diseases and other neurologic diseases.At each of four time points,the SAPSⅡscores were compared between the survival group and death group,and the relationship of SAPS Ⅱ score and prognosis were analyzed.The calibration of the SAPS Ⅱ were accessed with the Hosmer-Lemeshow goodness-of-fit chi-squared statistic and the discrimination with area under the receiver operating characteristic curve (AUROC).Multivariate logistic regression was used to analyze the relationship between disease category and prognosis.Results SAPS Ⅱ scores in the death group (46.53±12.22,47.28±13.84,48.58±14.18 and 49.06±14.61)at each time point were significantly higher than those in the survival group (34.70±11.78,30.28±12.24,29.79±12.36 and 29.69±12.96;t=11.12,14.02,14.43 and 13.49 at 0,24,48 and 72 h,respectively,P<0.01).Furthermore,univariate logistic regression analyses demonstrated that SAPS Ⅱ score was correlated with prognosis (OR=1.080,1.100,1.109,1.100 at 0,24,48 and 72 h,respectively,P<0.01).The scores at 48 and 72 h were more accurate in predicting mortality.SAPS Ⅱ had good calibration at each time points (x2=5.305,7.557,6.369 and 8.540,P>0.05),however,the consistency of expected mortality with observed mortality was satisfactory only at 48 and 72 h(82.6%,83.4%),so was the discrimination ( AUROC=0

  14. Neurointerventional Treatment in Acute Stroke. Whom to Treat? (Endovascular Treatment for Acute Stroke: Utility of THRIVE Score and HIAT Score for Patient Selection)

    Fjetland, Lars, E-mail:; Roy, Sumit, E-mail:; Kurz, Kathinka D., E-mail: [Stavanger University Hospital, Department of Radiology (Norway); Solbakken, Tore, E-mail: [Stavanger University Hospital, Department of Neurology (Norway); Larsen, Jan Petter, E-mail:; Kurz, Martin W., E-mail: [The Norwegian Center for Movement Disorders, Stavanger University Hospital (Norway)


    Purpose: Intra-arterial therapy (IAT) is used increasingly as a treatment option for acute stroke caused by central large vessel occlusions. Despite high rates of recanalization, the clinical outcome is highly variable. The authors evaluated the Houston IAT (HIAT) and the totaled health risks in vascular events (THRIVE) score, two predicting scores designed to identify patients likely to benefit from IAT. Methods: Fifty-two patients treated at the Stavanger University Hospital with IAT from May 2009 to June 2012 were included in this study. We combined the scores in an additional analysis. We also performed an additional analysis according to high age and evaluated the scores in respect of technical efficacy. Results: Fifty-two patients were evaluated by the THRIVE score and 51 by the HIAT score. We found a strong correlation between the level of predicted risk and the actual clinical outcome (THRIVE p = 0.002, HIAT p = 0.003). The correlations were limited to patients successfully recanalized and to patients <80 years. By combining the scores additional 14.3 % of the patients could be identified as poor candidates for IAT. Both scores were insufficient to identify patients with a good clinical outcome. Conclusions: Both scores showed a strong correlation to poor clinical outcome in patients <80 years. The specificity of the scores could be enhanced by combining them. Both scores were insufficient to identify patients with a good clinical outcome and showed no association to clinical outcome in patients aged {>=}80 years.




    Full Text Available BACKGROUND: Alvarado score is simple and can be instituted easily as this scoring is clinical, non-invasive and can be used to support diagnosis of acute appendicitis. Alvarado system combined with ultrasound can be used as a cheap and inexpensive way to confirming acute appendicitis and reducing negative appendicectomy rate. METHODS: The patients on admission were evaluated on the basis of Alvarado scoring. In this study we used a slightly modified version of Alvarado score by excluding one lab finding – shift to the neutrophils maturation. (Score 1, instead patients were subjected to ultrasonography of abdomen. CONCLUSION: Alvarado scoring system is dynamic allowing observation and critical reevaluation of evolution of clinical picture.

  16. Physiological responses to an acute bout of sprint interval cycling.

    Freese, Eric C; Gist, Nicholas H; Cureton, Kirk J


    Sprint interval training has been shown to improve skeletal muscle oxidative capacity, V[Combining Dot Above]O2max, and health outcomes. However, the acute physiological responses to 4-7 maximal effort intervals have not been determined. To determine the V[Combining Dot Above]O2, cardiorespiratory responses, and energy expenditure during an acute bout of sprint interval cycling (SIC), health, college-aged subjects, 6 men and 6 women, completed 2 SIC sessions with at least 7 days between trials. Sprint interval cycling was performed on a cycle ergometer and involved a 5-minute warm-up followed by four 30-second all-out sprints with 4-minute active recovery. Peak oxygen uptake (ml·kg·min) during the 4 sprints were 35.3 ± 8.2, 38.8 ± 10.1, 38.8 ± 10.6, and 36.8 ± 9.3, and peak heart rate (b·min) were 164 ± 17, 172 ± 10, 177 ± 12, and 175 ± 22. We conclude that an acute bout of SIC elicits submaximal V[Combining Dot Above]O2 and cardiorespiratory responses during each interval that are above 80% of estimated maximal values. Although the duration of exercise in SIC is very short, the high level of V[Combining Dot Above]O2 and cardiorespiratory responses are sufficient to potentially elicit adaptations to training associated with elevated aerobic energy demand.

  17. Acute hyperhydration reduces athlete biological passport OFF-hr score

    Bejder Rasmussen, Jacob; Hoffmann, M F; Ashenden, M


    Anecdotal evidence suggests that athletes hyperhydrate to mask prohibited substances in urine and potentially counteract suspicious fluctuations in blood parameters in the athlete biological passport (ABP). It is examined if acute hyperhydration changes parameters included in the ABP. Twenty...... subjects received recombinant human erythropoietin (rhEPO) for 3 weeks. After 10 days of rhEPO washout, 10 subjects ingested normal amount of water (∼ 270 mL), whereas the remaining 10 ingested a 1000 mL bolus of water. Blood variables were measured 20, 40, 60, and 80 min after ingestion. Three days later...... with atypical blood profiles (99% specificity level) before drinking 1000 mL of water, whereas 11% (n = 18), 10% and 11% (n = 18) were identified 40, 60, and 80 min, respectively, after ingestion. This was different (P 

  18. Quantification of clinical scores through physiological recordings in low-responsive patients: a feasibility study

    Wieser Martin


    Full Text Available Abstract Clinical scores represent the gold standard in characterizing the clinical condition of patients in vegetative or minimally conscious state. However, they suffer from problems of sensitivity, specificity, subjectivity and inter-rater reliability. In this feasibility study, objective measures including physiological and neurophysiological signals are used to quantify the clinical state of 13 low-responsive patients. A linear regression method was applied in nine patients to obtain fixed regression coefficients for the description of the clinical state. The statistical model was extended and evaluated with four patients of another hospital. A linear mixed models approach was introduced to handle the challenges of data sets obtained from different locations. Using linear backward regression 12 variables were sufficient to explain 74.4% of the variability in the change of the clinical scores. Variables based on event-related potentials and electrocardiogram account for most of the variability. These preliminary results are promising considering that this is the first attempt to describe the clinical state of low-responsive patients in such a global and quantitative way. This new model could complement the clinical scores based on objective measurements in order to increase diagnostic reliability. Nevertheless, more patients are necessary to prove the conclusions of a statistical model with 12 variables.

  19. Integrative prognostic risk score in acute myeloid leukemia with normal karyotype

    F. Damm (Frederik); M. Heuser (Michael); H.M. Morgan (Helen); K. Wagner (Katharina); K. Görlich (Kerstin); A. Großhennig (Anika); I. Hamwi (Iyas); F. Thol (Felicitas); E. Surdziel (Ewa); W. Fiedler (Walter); M. Lübbert (Michael); L. Kanz (Lothar); C. Reuter (Christoph); G. Heil (Gerhard); H.R. Delwel (Ruud); B. Löwenberg (Bob); P.J.M. Valk (Peter); J. Krauter; A. Ganser (Arnold)


    textabstractTo integrate available clinical and molecular information for cytogenetically normal acute myeloid leukemia (CN-AML) patients into one risk score, 275 CN-AML patients from multicenter treatment trials AML SHG Hannover 0199 and 0295 and 131 patients from HOVON/SAKK protocols as external c

  20. Physiologically based toxicokinetic modeling of secondary acute myelolytic leukemia.

    Mukhopadhyay, Manas Kumar; Nath, Debjani


    Benzene, designated as environmental and occupational carcinogen and hematotoxin, has been associated with secondary leukemia. To develop a toxicokinetic model of AML, benzene can be used as leukemogenic agent. The aim of the present study was to optimize the dose, period and time of cumulative benzene exposure of Swiss Albino mice and to analyze survival rate; alteration in cell cycle regulation and other clinical manifestations in mice exposed to benzene vapour at a dose 300 ppm × 6 h/day × 5 days/week for 2 weeks, i.e., 9000(a)ppm cumulative dose. Analyzing physiological parameters like plasma enzyme profile, complete hematology (Hb %, RBC indices and WBC differentials), hematopoietic cells morphology, expression of cell cycle regulatory proteins, tissue histology and analysis of DNA fragmentation, optimum conditions were established. Down regulation of p53 and p21 and up regulation of CDK2, CDK4, CDK6, cyclin D1 and E in this exposed group were marked as the optimum conditions of cellular deregulation for the development of secondary AML. Elevated level of Plasma AST/ALT with corresponding changes in liver histology showing extended sinusoids within the hepatocytic cell cords in optimally exposed animals also confirmed the toxicokinetic relation of benzene with leukemia. It can be concluded from the above observations that the 9000(a)ppm exposed animals can serve as the induced laboratory model of secondary acute myeloid leukemia.

  1. A new pathological scoring method for adrenal injury in rats with severe acute pancreatitis.

    Deng, Wenhong; Hui, Yuanjian; Yu, Jia; Wang, Weixing; Xu, Sheng; Chen, Chen; Xiong, Xincheng


    These studies investigated the appearance and function of adrenal glands in rats with severe acute pancreatitis (SAP) and established a new histopathological score to evaluate adrenal histopathological changes. Severe acute pancreatitis relied on retrograde infusion of 5% sodium taurocholate into the bile-pancreatic duct. The damage of SAP was estimated by serum amylase, secretory phospholipase A2 and pancreatic histopathology. Light and electron microscopy of adrenal gland, and the levels of serum corticosterone were investigated. These results showed that the generally ascending trend of adrenal pathological score was inversely proportional to the generally descending trend of serum corticosterone levels, but parallel with the changes of pancreatic histopathology. Herein, the new adrenal histopathological score was effective in the evaluation of adrenal injury following SAP. It may indirectly reflect the variation of serum cortisol levels and the severity of pancreatitis to a certain extent.

  2. Personality and physiological reactions to acute psychological stress.

    Bibbey, Adam; Carroll, Douglas; Roseboom, Tessa J; Phillips, Anna C; de Rooij, Susanne R


    Stable personality traits have long been presumed to have biological substrates, although the evidence relating personality to biological stress reactivity is inconclusive. The present study examined, in a large middle aged cohort (N=352), the relationship between key personality traits and both cortisol and cardiovascular reactions to acute psychological stress. Salivary cortisol and cardiovascular activity were measured at rest and in response to a psychological stress protocol comprising 5min each of a Stroop task, mirror tracing, and a speech task. Participants subsequently completed the Big Five Inventory to assess neuroticism, agreeableness, openness to experience, extraversion, and conscientiousness. Those with higher neuroticism scores exhibited smaller cortisol and cardiovascular stress reactions, whereas participants who were less agreeable and less open had smaller cortisol and cardiac reactions to stress. These associations remained statistically significant following adjustment for a range of potential confounding variables. Thus, a negative personality disposition would appear to be linked to diminished stress reactivity. These findings further support a growing body of evidence which suggests that blunted stress reactivity may be maladaptive.

  3. Acute ischemic stroke prognostication, comparison between Glasgow Coma Score, NIHS Scale and Full Outline of UnResponsiveness Score in intensive care unit

    Ossama Y. Mansour


    Conclusions: The GCS and the FOUR score are accurate predictors of mortality after acute ischemic stroke, and are equal in prediction to the NIHSS. The NIHSS is more accurate than the GCS and the FOUR score in predicting poor neurologic outcome.

  4. Prehospital score for acute disease: a community-based observational study in Japan

    Fujiwara Hidekazu


    Full Text Available Abstract Background Ambulance usage in Japan has increased consistently because it is free under the national health insurance system. The introduction of refusal for ambulance transfer is being debated nationally. The purpose of the present study was to investigate the relationship between prehospital data and hospitalization outcome for acute disease patients, and to develop a simple prehospital evaluation tool using prehospital data for Japan's emergency medical service system. Methods The subjects were 9,160 consecutive acute disease patients aged ≥ 15 years who were transferred to hospital by Kishiwada City Fire Department ambulance between July 2004 and March 2006. The relationship between prehospital data (age, systolic blood pressure, pulse rate, respiration rate, level of consciousness, SpO2 level and ability to walk and outcome (hospitalization or non-hospitalization was analyzed using logistic regression models. The prehospital score component of each item of prehospital data was determined by beta coefficients. Eligible patients were scored retrospectively and the distribution of outcome was examined. For patients transported to the two main hospitals, outcome after hospitalization was also confirmed. Results A total of 8,330 (91% patients were retrospectively evaluated using a prehospital score with a maximum value of 14. The percentage of patients requiring hospitalization rose from 9% with score = 0 to 100% with score = 14. With a cut-off point score ≥ 2, the sensitivity, specificity, positive predictive value and negative predictive value were 97%, 16%, 39% and 89%, respectively. Among the 6,498 patients transported to the two main hospitals, there were no deaths at scores ≤ 1 and the proportion of non-hospitalization was over 90%. The proportion of deaths increased rapidly at scores ≥ 11. Conclusion The prehospital score could be a useful tool for deciding the refusal of ambulance transfer in Japan's emergency medical

  5. Balthazar computed tomography severity index is superior to Ranson criteria and APACHE Ⅱ scoring system in predicting acute pancreatitis outcome

    Ting-Kai Leung; Chi-Ming Lee; Shyr-Yi Lin; Hsin-Chi Chen; Hung-Jung Wang; Li-Kuo Shen; Ya-Yen Chen


    AIM: Acute pancreatitis (AP) is a process with variable involvement of regional tissues or organ systems.Multifactorial scales included the Ranson, Acute Physiology and Chronic Health Evaluation (APACHE Ⅱ) systems and Balthazar computed tomography severity index (CTSI).The purpose of this review study was to assess the accuracy of CTSI, Ranson score, and APACHE Ⅱ score in course and outcome prediction of AP.METHODS: We reviewed 121 patients who underwent helical CT within 48 h after onset of symptoms of a first episode of AP between 1999 and 2003. Fourteen inappropriate subjects were excluded; we reviewed the 107 contrastenhanced CT images to calculate the CTSI. We also reviewed their Ranson and APACHE Ⅱ score. In addition, complications,duration of hospitalization, mortality rate, and other pathology history also were our comparison parameters.RESULTS: We classified 85 patients (79%) as having mild AP (CTSI <5) and 22 patients (21%) as having severe AP (CTSI ≥5). In mild group, the mean APACHE Ⅱ score and Ranson score was 8.6±1.9 and 2.4±1.2, and those of severe group was 10.2±2.1 and 3.1±0.8, respectively. The most common complication was pseudocyst and abscess and it presented in 21 (20%) patients and their CTSI was 5.9±1.4. A CTSI ≥5 significantly correlated with death,complication present, and prolonged length of stay.Patients with a CTSI ≥5 were 15 times to die than those CTSI <5, and the prolonged length of stay and complications present were 17 times and 8 times than that in CTSI <5,respectively.CONCLUSION: CTSI is a useful tool in assessing the severity and outcome of AP and the CTSI ≥5 is an index in our study. Although Ranson score and APACHE Ⅱ score also are choices to be the predictors for complications,mortality and the length of stay of AP, the sensitivity of them are lower than CTSI.

  6. Evaluation of modified Alvarado score in the diagnosis of acute appendicitis

    Abhinandan B. Vandakudri


    Results: The result of the study showed that high scores in men and children (7-9 had a sensitivity of 92.3% and 83.3% respectively, whereas in females it had a sensitivity of 72.7%. The score (5-6 in males and females had a sensitivity of 57% and 50% respectively. Conclusions: The high scores in modified Alvarado score is dependable aid in the early diagnosis of acute appendicitis in men and children but it's not true as far as women are considered. Ultrasonography of abdomen is a useful tool in avoiding negative appendicectomy rates particularly in females. [Int J Res Med Sci 2016; 4(1.000: 84-88




    Full Text Available BACKGROUND & OBJECTIVES: Numerous asthma scoring systems have been devised which combine a number of physical signs to estimate the severity of an acute asthma exacerbation. Although more than 16 scoring systems exist, many are difficult to use. The pulmonary score was developed to provide ‘‘user-friendly’’ measure of asthma severity for children with acute asthma exacerbation. The objective of the study is to study the efficacy of pulmonary score in assessing the severity of acute exacerbation of asthma in comparison to peak expiratory flow rate. METHODS: The study sampled 50 children, aged 5–18 years, with mild to moderate acute exacerbation of asthma. The PEFR (best of three attempts and the PS were measured before and after treatment at 5, 10 and 15 minutes. The PS includes respiratory rate, wheezing, and retractions, each rated on a 0–3 scale. Pre- and post-treatment PEFR and PS score were compared using paired t-tests to establish construct validity. Correlation of pre- and post-treatment PSs with PEFRs was measured to establish criterion validity. RESULTS: The mean predicted PEFR improved with treatment by 21.2% (from 50.8% to 72.0% of predicted (p <0.0001 at 15 minutes. The mean PS improved by 2.8 (from 4.8 to 2 (p < 0.0001 at 15 minutes. Pre- and post-treatment PSs were significantly correlated with PEFRs. The correlation of pre-treatment PEFR and PS is r = -0.497 (p = 0.000, that for post treatment at 15 minutes is r = -0.589 (p = 0.000. INTERPRETATION & CONCLUSION: These data support the construct and criterion validities of the PS as a measure of asthma severity among children. The PS is a practical substitute to estimate airway obstruction in children who are too young or too sick to obtain PEFRs.

  8. Comparison of Existing Clinical Scoring Systems in Predicting Severity and Prognoses of Hyperlipidemic Acute Pancreatitis in Chinese Patients

    Qiu, Lei; Sun, Rui Qing; Jia, Rong Rong; Ma, Xiu Ying; Cheng, Li; Tang, Mao Chun; Zhao, Yan


    Abstract It is important to identify the severity of acute pancreatitis (AP) in the early course of the disease. Clinical scoring systems may be helpful to predict the prognosis of patients with early AP; however, few analysts have forecast the accuracy of scoring systems for the prognosis in hyperlipidemic acute pancreatitis (HLAP). The purpose of this study was to summarize the clinical characteristics of HLAP and compare the accuracy of conventional scoring systems in predicting the progno...

  9. Differences Between the "Chinese AMS Score" and the Lake Louise Score in the Diagnosis of Acute Mountain Sickness.

    Wu, Jialin; Gu, Haoran; Luo, Yongjun


    The Chinese AMS score (CAS) is used in clinical medicine and research to diagnosis acute mountain sickness (AMS). However, the Lake Louise Score (LLS) is the well-accepted standard for diagnosing AMS. The difference between the CAS and LLS questionnaires is that the CAS considers more nonspecific symptoms. The aim of the present study was to evaluate differences in AMS prevalence according to the LLS and CAS criteria. We surveyed 58 males who traveled from Chongqing (300 m) to Lhasa (3658 m) via the Qinghai-Tibet train. Cases of AMS were diagnosed using LLS and CAS questionnaires in a few railway stations at different evaluation areas along the road. We subsequently evaluated discrepancies in values related to the prevalence of AMS determined using the 2 types of questionnaires (CAS and LLS). The prevalence of CAS-diagnosed AMS indicated that the percentage of AMS cases among the 58 young men was 29.3% in Golmud, 60.3% in Tanggula, 63.8% in Lhasa, 22.4% on the first day after arrival in Lhasa, 27.6% on the second day, 24.1% on the third day, and 12.1% on the fourth day. The prevalence of LLS-diagnosed AMS in Golmud was 10.3%, 38% in Lhasa, and 6.9% on day 1, the prevalence in each station was lower than that as assessed by the CAS. Our experimental data indicate that AMS diagnoses ascertained using the CAS indicate a higher AMS prevalence than those ascertained using the LLS. Through statistical analysis, the CAS seems capable of effectively diagnosing AMS as validated by LLS (sensitivity 61.8%, specificity 92.7%).

  10. Red cell distribution width and neurological scoring systems in acute stroke patients

    Kara H


    Full Text Available Hasan Kara,1 Selim Degirmenci,1 Aysegul Bayir,1 Ahmet Ak,1 Murat Akinci,1 Ali Dogru,1 Fikret Akyurek,2 Seyit Ali Kayis3 1Department of Emergency Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey; 2Department of Biochemistry, Faculty of Medicine, Selcuk University, Konya, Turkey; 3Department of Biostatistics, Faculty of Medicine, Karabuk University, Karabuk, Turkey Objectives: The purpose of the present study was to evaluate the association between the red blood cell distribution width (RDW and the Glasgow Coma Scale (GCS, Canadian Neurological Scale (CNS, and National Institutes of Health Stroke Scale (NIHSS scores in patients who had acute ischemic stroke. Methods: This prospective observational cohort study included 88 patients who have had acute ischemic stroke and a control group of 40 patients who were evaluated in the Emergency Department for disorders other than acute ischemic stroke. All subjects had RDW determined, and stroke patients had scoring with the GCS, CNS, and NIHSS scores. The GCS, CNS, and NIHSS scores of the patients were rated as mild, moderate, or severe and compared with RDW. Results: Stroke patients had significantly higher median RDW than control subjects. The median RDW values were significantly elevated in patients who had more severe rather than milder strokes rated with all three scoring systems (GCS, CNS, and NIHSS. The median RDW values were significantly elevated for patients who had moderate rather than mild strokes rated by GCS and CNS and for patients who had severe rather than mild strokes rated by NIHSS. The area under the receiver operating characteristic curve was 0.760 (95% confidence interval, 0.676–0.844. Separation of stroke patients and control groups was optimal with RDW 14% (sensitivity, 71.6%; specificity, 67.5%; accuracy, 70.3%. Conclusion: In stroke patients who have symptoms <24 hours, the RDW may be useful in predicting the severity and functional outcomes of the stroke

  11. Yellow flag scores in a compensable New Zealand cohort suffering acute low back pain

    Karen Grimmer-Somers


    Full Text Available Karen Grimmer-Somers1, Mathew Prior1, Jim Robertson21Centre for Allied Health Evidence, University of South Australia, City East Campus, North Tce, Adelaide, South Australia, Australia; 2New Zealand Accident Compensation Corporation, Auckland, New ZealandBackground: Despite its high prevalence, most acute low back pain (ALBP is nonspecific, self-limiting with no definable pathology. Recurrence is prevalent, as is resultant chronicity. Psychosocial factors (yellow flags comprising depression and anxiety, negative pain beliefs, job dissatisfaction are associated with the development of chronic LBP.Methods: A national insurer (Accident Compensation Corporation, New Zealand [NZ], in conjunction with a NZ primary health organization, piloted a strategy for more effective management of patients with ALBP, by following the NZ ALBP Guideline. The guidelines recommend the use of a psychosocial screening instrument (Yellow Flags Screening Instrument, a derivative of Örebro Musculoskeletal Pain Questionnaire. This instrument was recommended for administration on the second visit to a general medical practitioner (GP. This paper tests whether published cut-points of yellow flag scores to predict LBP claims length and costs were valid in this cohort.Results: Data was available for 902 claimants appropriately enrolled into the pilot. 25% claimants consulted the GP once only, and thus were not requested to provide a yellow flag score. Yellow flag scores were provided by 48% claimants who consumed two or more GP services. Approximately 60% LBP presentations resolved within five GP visits. Yellow flag scores were significantly and positively associated with treatment costs and service use, although the association was nonlinear. Claimants with moderate yellow flag scores were similarly likely to incur lengthy claims as claimants with at-risk scores.Discussion: Capturing data on psychosocial factors for compensable patients with ALBP has merit in predicting

  12. Acute and phase-shifting effects of ocular and extraocular light in human circadian physiology

    Ruger, M; Gordijn, MCM; Beersma, DGM; de Vries, B; Daan, S


    Light can influence physiology and performance of humans in two distinct ways. It can acutely change the level of physiological and behavioral parameters, and it can induce a phase shift in the circadian oscillators underlying variations in these levels. Until recently, both effects were thought to

  13. Acute ischemic stroke prognostication, comparison between Glasgow Coma Score, NIHS Scale and Full Outline of UnResponsiveness Score in intensive care unit

    Ossama Y. Mansour; Mohamed M. Megahed; Eman H.S. Abd Elghany


    Background: Stroke is the second most common cause of death worldwide and a frequent cause of adult disability in developed countries. No single outcome measure can describe or predict all dimensions of recovery and disability after acute stroke. Several scales have proven reliability and validity in stroke trials. Objectives: The aim of the work was to evaluate the FOUR score predictability for outcome of patients with acute ischemic stroke in comparison with the NIHSS and the GCS. Met...

  14. The role of THRIVE score in prediction of outcomes of acute ischemic stroke patients with atrial fibrillation



    Objective To study whether the total health risks in vascular events(THRIVE)score could predict the prognosis in the acute ischemic stroke patients with atrial fibrillation.Methods A total of 169 patients were enrolled in the study,with NIH Stroke Scale(NIHSS)score,THRIVE score and CHADS2score given to each patients at admission and modified Rankin Scale(mRS)given at3 months follow up.All patients were divided into the

  15. Human physiological responses to cold exposure: Acute responses and acclimatization to prolonged exposure.

    Castellani, John W; Young, Andrew J


    Cold exposure in humans causes specific acute and chronic physiological responses. This paper will review both the acute and long-term physiological responses and external factors that impact these physiological responses. Acute physiological responses to cold exposure include cutaneous vasoconstriction and shivering thermogenesis which, respectively, decrease heat loss and increase metabolic heat production. Vasoconstriction is elicited through reflex and local cooling. In combination, vasoconstriction and shivering operate to maintain thermal balance when the body is losing heat. Factors (anthropometry, sex, race, fitness, thermoregulatory fatigue) that influence the acute physiological responses to cold exposure are also reviewed. The physiological responses to chronic cold exposure, also known as cold acclimation/acclimatization, are also presented. Three primary patterns of cold acclimatization have been observed, a) habituation, b) metabolic adjustment, and c) insulative adjustment. Habituation is characterized by physiological adjustments in which the response is attenuated compared to an unacclimatized state. Metabolic acclimatization is characterized by an increased thermogenesis, whereas insulative acclimatization is characterized by enhancing the mechanisms that conserve body heat. The pattern of acclimatization is dependent on changes in skin and core temperature and the exposure duration.

  16. Computational Issues Associated with Automatic Calculation of Acute Myocardial Infarction Scores

    Destro-Filho, J. B.; Machado, S. J. S.; Fonseca, G. T.


    This paper presents a comparison among the three principal acute myocardial infarction (AMI) scores (Selvester, Aldrich, Anderson-Wilkins) as they are automatically estimated from digital electrocardiographic (ECG) files, in terms of memory occupation and processing time. Theoretical algorithm complexity is also provided. Our simulation study supposes that the ECG signal is already digitized and available within a computer platform. We perform 1000 000 Monte Carlo experiments using the same input files, leading to average results that point out drawbacks and advantages of each score. Since all these calculations do not require either large memory occupation or long processing, automatic estimation is compatible with real-time requirements associated with AMI urgency and with telemedicine systems, being faster than manual calculation, even in the case of simple costless personal microcomputers.

  17. Comparison of ACUITY and CRUSADE Scores in Predicting Major Bleeding during Acute Coronary Syndrome

    Luis C. L. Correia


    Full Text Available Background:The ACUITY and CRUSADE scores are validated models for prediction of major bleeding events in acute coronary syndrome (ACS. However, the comparative performances of these scores are not known.Objective:To compare the accuracy of ACUITY and CRUSADE in predicting major bleeding events during ACS.Methods:This study included 519 patients consecutively admitted for unstable angina, non-ST-elevation or ST-elevation myocardial infarction. The scores were calculated based on admission data. We considered major bleeding events during hospitalization and not related to cardiac surgery, according to the Bleeding Academic Research Consortium (BARC criteria (type 3 or 5: hemodynamic instability, need for transfusion, drop in hemoglobin ≥ 3 g, and intracranial, intraocular or fatal bleeding.Results:Major bleeding was observed in 31 patients (23 caused by femoral puncture, 5 digestive, 3 in other sites, an incidence of 6%. While both scores were associated with bleeding, ACUITY demonstrated better C-statistics (0.73, 95% CI = 0.63 - 0.82 as compared with CRUSADE (0.62, 95% CI = 0.53 - 0.71; p = 0.04. The best performance of ACUITY was also reflected by a net reclassification improvement of + 0.19 (p = 0.02 over CRUSADE’s definition of low or high risk. Exploratory analysis suggested that the presence of the variables ‘age’ and ‘type of ACS’ in ACUITY was the main reason for its superiority.Conclusion:The ACUITY Score is a better predictor of major bleeding when compared with the CRUSADE Score in patients hospitalized for ACS.

  18. Risk stratification in non-ST elevation acute coronary syndromes: Risk scores, biomarkers and clinical judgment

    David Corcoran


    Clinical guidelines recommend an early invasive strategy in higher risk NSTE-ACS. The Global Registry of Acute Coronary Events (GRACE risk score is a validated risk stratification tool which has incremental prognostic value for risk stratification compared with clinical assessment or troponin testing alone. In emergency medicine, there has been a limited adoption of the GRACE score in some countries (e.g. United Kingdom, in part related to a delay in obtaining timely blood biochemistry results. Age makes an exponential contribution to the GRACE score, and on an individual patient basis, the risk of younger patients with a flow-limiting culprit coronary artery lesion may be underestimated. The future incorporation of novel cardiac biomarkers into this diagnostic pathway may allow for earlier treatment stratification. The cost-effectiveness of the new diagnostic pathways based on high-sensitivity troponin and copeptin must also be established. Finally, diagnostic tests and risk scores may optimize patient care but they cannot replace patient-focused good clinical judgment.

  19. Physiological Responses to Acute Exercise-Heat Stress


    environment is the most primitive of the thermoregulatory responses. and is seen in all vertebrates, including fish and reptiles which, given the... thermoregulation involves conscious willed activity, it is more complex than physiological temperature regulation. and is less well characterized. Thermal...sensation and thermal discomfort presumably represent the motivation for behavioral thermoregulation . and in human subjects. can be measured by

  20. Prehospital electrocardiographic acuteness score of ischemia is inversely associated with neurohormonal activation in STEMI patients with severe ischemia

    Fakhri, Yama; Schoos, Mikkel Malby; Sejersten-Ripa, Maria;


    BACKGROUND: Elevated levels of N-terminal pro brain natriuretic peptide (NT-proBNP) are associated with adverse cardiovascular outcome after ST elevation myocardial infarction (STEMI). We hypothesized that decreasing acuteness-score (based on the electrocardiographic score by Anderson-Wilkins acu...

  1. Alvarado score: A valuable clinical tool for diagnosis of acute appendicitis –a retros-pective study

    Swagata Brahmachari1 and Ashwini B. Jajee2


    Full Text Available Appendicitis is a common surgical emergency and diagnosis is still a great challenge. Accurate diagnosis and timely intervention re-duces morbidity and mortality. The present study was conducted to evaluate Alvarado scoring system for diagnosis of acute appen-dicitis in Indian set up. The study was carried out on 200 patients admitted in Surgery ward between January 2009 and December 2010 with right lower quadrant abdominal pain. Alvarado score was calculated and all patients were divided in three groups. Mean age of presentation was 29.12 years and male to female ratio was 1.27:1. Higher the Alvarado score, more is the sensitivity. So pa-tients having score 7 or above had sensitivity of 66%. We con-clude that Alvarado score is unique since it incorporates signs, symptoms and laboratory findings of suspicious patients. Alvarado score can be utilized safely for diagnosis of acute appendicitis.

  2. 改良早期预警评分和急性生理和慢性健康评分Ⅱ对急诊多发伤患者伤情评价及预后预测的作用%Value of modified early warning score and acute physiology and chronic health evaluation Ⅱ in evaluation of severity and prognosis of polytrauma patients in emergency department

    尼加提江·艾比不拉; 阿力木江·阿布力米提; 帕尔哈提·拜合提; 亚力坤·赛来


    Objective To access the effectiveness of modified early warning score (MEWS) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) in predicting the degree of injury and outcome for emergently admitted polytrauma patients.Methods In this single-center prospective study,266 polytrauma patients hospitalized from June 2012 to January 2013 were enrolled.MEWS and APACHE Ⅱ score were collected and compared for the rate of ICU admission,high dependency unit admission,outpatient therapy,death,and discharge within 30 days.Diagnostic and predictive performance of MEWS and APACHE Ⅱ were assessed by the receiver operating characteristic curve (ROC).Results A higher values in MEWS and APACHE Ⅱ were linked to much severe injury,increased likelihood of admission to the ICU or high dependency unit and high mortality.Patients with MEWS value ≥5 had increased risk of death as compared with those with MEWS value < 5 (x2 =90.749,P <0.01).MEWS =5,for injury severity evaluation,showed a sensitivity of 85.7% and specificity of 84.8%.MEWS value≥5 predicted ICU admission with a sensitivity of 80.0% and specificity of 91.1% and high dependency unit admission with a sensitivity of 67.9% and specificity of 79.9%.APACHE Ⅱ score ≥ 21 was associated with increased rate of death,with significant difference from that among patients with APACHE Ⅱ score < 21 (x2 =73.518,P < 0.01).APACHE Ⅱ score =21,for injury severity evaluation,showed a sensitivity of 90.5% and specificity of 79.5%.APACHE Ⅱ score ≥ 21 predicted ICU admission with a sensitivity of 95.0% and specificity of 73.6% and high dependency unit admission with a sensitivity of 88.2% and specificity of 72.8%.In prediction of prognosis,ICU admission and high dependency unit admission,area under the ROC curve with 95% CI for NEWS was 0.889 (0.830-0.948),0.937 (0.900-0.975) and 0.946 (0.916-0.977) respectively and for APACHE Ⅱ was 0.939 (0.898-0.979),0.761 (0.677-0.845) and 0

  3. Evaluation of diagnostic findings and scoring systems in outcome prediction in acute pancreatitis

    Ekrem Kaya; Adem Dervi(s)o(g)lu; Cafer Polat


    AIM: To determine factors related to disease severity, mortality and morbidity in acute pancreatitis.METHODS: One hundred and ninety-nine consecutive patients were admitted with the diagnosis of acute pancreatitis (AP) in a 5-year period (1998-2002). In a prospective design, demographic data, etiology, mean hospital admission time, clinical, radiological, biochemical findings, treatment modalities, mortality and morbidity were recorded. Endocrine insufficiency was investigated with oral glucose tolerance test. The relations between these parameters, scoring systems (Ranson, Imrie and APACHE n) and patients' outcome were determined by using invariable tests and the receiver operating characteristics curve.RESULTS: One hundred patients were men and 99 were women; the mean age was 55 years. Biliary pancreatitis was the most common form, followed by idiopathic pancreatitis (53% and 26%, respectively). Sixty-three patients had severe pancreatitis and 136 had mild disease. Respiratory rate > 20/min, pulse rate> 90/min, increased C-reactive protein (CRP), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) levels, organ necrosis > 30% on computed tomography (CT) and leukocytosis were associated with severe disease. The rate of glucose intolerance, morbidity and mortality were 24.1%, 24.8% and 13.6%, respectively. CRP > 142 mg/L, BUN > 22 mg/dL, LDH> 667 U/L, base excess > -5, CT severity index > 3 and APACHE score > 8 were related to morbidity and mortality.CONCLUSION: APACHE n score, LDH, base excess and CT severity index have prognostic value and CRP is a reliable marker for predicting both mortality and morbidity.

  4. [Development and clinical testing of the Russian version of the Acute Cystitis Symptom Score - ACSS].

    Alidjanov, J F; Abdufattaev, U A; Makhmudov, D Kh; Mirkhamidov, D Kh; Khadzhikhanov, F A; Azgamov, A V; Pilatz, A; Naber, K G; Wagenlehner, F M; Akilov, F A


    The Acute Cystitis Symptom Score - ACSS was originally developed in the Uzbek language and has demonstrated high reliability and validity. The study was aimed to develop a Russian version of the ACSS questionnaire and evaluate its psychometric properties. Translation and adaptation of the ACSS questionnaire containing 18 questions, 6 of them - for the typical symptoms of acute cystitis (AC), 4 - for the differential diagnosis; 3 - for the quality of life, and 5 - for the conditions that may affect the choice of treatment, were performed according to the recommendations developed by the Mapi Research Institute. Study involved 83 Russian-speaking women (mean age, 35.6 ±13.7 years); 38 (45.8%) patients were in the main group (patients with AC), and 45 (54.2%) - in the control group (without AC). Medical examination and appropriate treatment of the respondents were conducted in accordance with approved standards. After completing the course of therapy, 19 (50%) patients of the main group came for the control examination. There was statistically significant difference in the scores obtained in the two groups. Score profiles positively correlated with the results of laboratory tests (rho = 0.26-0.48). Cronbach's alpha for the Russian version of the questionnaire was 0.86 (95% CI, 0.81-0.91), area under the curve in the ROC analysis was 0.96. The results of testing the Russian version correspond to those of the original version. The Russian version of the ACSS questionnaire has high. reliability and validity, and can be recommended for clinical research and diagnosis of primary AC, and dynamic monitoring of the effectiveness of the treatment of the Russian-speaking population of patients.

  5. Efficiency of unenhanced MRI in the diagnosis of acute appendicitis: Comparison with Alvarado scoring system and histopathological results

    Inci, Ercan, E-mail: [Department of Radiology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Incirli-Bakirkoy, Istanbul (Turkey); Hocaoglu, Elif; Aydin, Sibel; Palabiyik, Figen; Cimilli, Tan [Department of Radiology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Incirli-Bakirkoy, Istanbul (Turkey); Turhan, Ahmet Nuray; Ayguen, Ersan [Department of Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul (Turkey)


    Purpose: The purpose of this study was to assess the diagnostic value of unenhanced magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis and compare with Alvarado scores and histopathological results. Materials and methods: The study included 85 consecutive patients (mean age, 26.5 {+-} 11.3 years) who were clinically suspected of having acute appendicitis. Each patients Alvarado scores were recorded and unenhanced MRI was performed, consisting of T1-weighted, T2-weighted and fat-suppressed T2-weighted fast spin-echo sequences. The MR images were prospectively reviewed in consensus for the presence of acute appendicitis by two radiologists who were blinded to the results of the Alvarado scores. The study population were divided into three subgroups based on the MRI findings: Group I: definitely not appendicitis, Group II: probably appendicitis, Group III: definitely appendicitis. All patients were divided into two subgroups according to Alvarado scores as Group A (low: 1-6), and Group B (high: 7-10). MR findings were compared with Alvarado scores and histopathological findings. Results: Sixty-six (77.6%) of the 85 patients with clinically suspected acute appendicitis, had undergone surgery. The diagnosis of appendicitis could be correctly achieved with MRI in 55 (83.3%) of 57 (86.4%) patients with histopathologically proven acute appendicitis. The sensitivity, specificity, positive predictive value and negative predictive value of MRI examination and Alvarado scoring system in the diagnosis of acute appendicitis were 96.49%, 66.67%, 94.83%, 75.0% and 84.21%, 66.67%, 94.12%, 40.0%, respectively. Conclusions: MRI is a valuable technique for detecting acute appendicitis even in the cases with low Alvarado scores. To increase the diagnostic accuracy and preventing unnecessary laparotomies for suspected appendicitis, shorter and cheaper unenhanced basic MRI may be performed.

  6. Does C-reactive Protein Add Prognostic Value to GRACE Score in Acute Coronary Syndromes?

    Correia, Luis Cláudio Lemos, E-mail:; Vasconcelos, Isis; Garcia, Guilherme; Kalil, Felipe; Ferreira, Felipe; Silva, André; Oliveira, Ruan; Carvalhal, Manuela; Freitas, Caio; Noya-Rabelo, Márcia Maria [Escola Bahiana de Medicina e Saúde Pública, Salvador, BA (Brazil); Hospital São Rafael, Salvador, BA (Brazil)


    The incremental prognostic value of plasma levels of C-reactive protein (CRP) in relation to GRACE score has not been established in patients with acute coronary syndrome (ACS) with non-ST segment elevation. To test the hypothesis that CRP measurements at admission increases the prognostic value of GRACE score in patients with ACS. A total of 290 subjects, consecutively admitted for ACS, with plasma material obtained upon admission CRP measurement using a high-sensitivity method (nephelometry) were studied. Cardiovascular outcomes during hospitalization were defined by the combination of death, nonfatal myocardial infarction or nonfatal refractory angina. The incidence of cardiovascular events during hospitalization was 15% (18 deaths, 11 myocardial infarctions, 13 angina episodes) with CRP showing C-statistics of 0.60 (95% CI = 0.51-0.70, p = 0.034) in predicting these outcomes. After adjustment for the GRACE score, elevated CRP (defined as the best cutoff point) tended to be associated with hospital events (OR = 1.89, 95% CI = 0.92 to 3.88, p = 0.08). However, the addition of the variable elevated CRP in the GRACE model did not result in significant increase in C-statistics, which ranged from 0.705 to 0.718 (p = 0.46). Similarly, there was no significant reclassification of risk with the addition of CRP in the predictor model (net reclassification = 5.7 %, p = 0.15). Although CRP is associated with hospital outcomes, this inflammatory marker does not increase the prognostic value of the GRACE score.

  7. A 17-gene stemness score for rapid determination of risk in acute leukaemia.

    Ng, Stanley W K; Mitchell, Amanda; Kennedy, James A; Chen, Weihsu C; McLeod, Jessica; Ibrahimova, Narmin; Arruda, Andrea; Popescu, Andreea; Gupta, Vikas; Schimmer, Aaron D; Schuh, Andre C; Yee, Karen W; Bullinger, Lars; Herold, Tobias; Görlich, Dennis; Büchner, Thomas; Hiddemann, Wolfgang; Berdel, Wolfgang E; Wörmann, Bernhard; Cheok, Meyling; Preudhomme, Claude; Dombret, Herve; Metzeler, Klaus; Buske, Christian; Löwenberg, Bob; Valk, Peter J M; Zandstra, Peter W; Minden, Mark D; Dick, John E; Wang, Jean C Y


    Refractoriness to induction chemotherapy and relapse after achievement of remission are the main obstacles to cure in acute myeloid leukaemia (AML). After standard induction chemotherapy, patients are assigned to different post-remission strategies on the basis of cytogenetic and molecular abnormalities that broadly define adverse, intermediate and favourable risk categories. However, some patients do not respond to induction therapy and another subset will eventually relapse despite the lack of adverse risk factors. There is an urgent need for better biomarkers to identify these high-risk patients before starting induction chemotherapy, to enable testing of alternative induction strategies in clinical trials. The high rate of relapse in AML has been attributed to the persistence of leukaemia stem cells (LSCs), which possess a number of stem cell properties, including quiescence, that are linked to therapy resistance. Here, to develop predictive and/or prognostic biomarkers related to stemness, we generated a list of genes that are differentially expressed between 138 LSC(+) and 89 LSC(-) cell fractions from 78 AML patients validated by xenotransplantation. To extract the core transcriptional components of stemness relevant to clinical outcomes, we performed sparse regression analysis of LSC gene expression against survival in a large training cohort, generating a 17-gene LSC score (LSC17). The LSC17 score was highly prognostic in five independent cohorts comprising patients of diverse AML subtypes (n = 908) and contributed greatly to accurate prediction of initial therapy resistance. Patients with high LSC17 scores had poor outcomes with current treatments including allogeneic stem cell transplantation. The LSC17 score provides clinicians with a rapid and powerful tool to identify AML patients who do not benefit from standard therapy and who should be enrolled in trials evaluating novel upfront or post-remission strategies.

  8. Modified physiological and operative score for the enumeration of mortality and morbidity risk assessment model in general surgery


    AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy.METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results,endocrine function, central nervous system function,hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated.RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function,hepatic function, renal function, blood test results,endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.

  9. Correlation of continuous electroencephalogram with clinical assessment scores in acute stroke patients

    Xiyan Xin; Ying Gao; Hua Zhang; Kegang Cao; Yongmei Shi


    Objective To compare electroencephalogram (EEG) symmetry values between stroke patients with different 28-day outcomes,and to assess correlations between clinical characteristics and 28-day outcomes.Methods Twentytwo patients presenting with acute ischemic stroke and persistent neurological deficits at EEG recording were incrementally included.At 28 days after admission,the modified Rankin scale (mRS) was used to evaluate the outcomes,based on which the patients were divided into two a posteriori groups,mRS =6 and mRS <6.Student's t-test was used to compare these two groups in terms of brain symmetry index (BSI),National Institutes of Health stroke scale (NIHSS),Glasgow coma scale (GCS) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) assessed at admission.Then EEG parameters,NIHSS,GCS and APACHE Ⅱ were correlated with the mRS.Results There were significant differences in BSI,NIHSS,GCS,and APACHE Ⅱ between the two groups.Survivors had lower BSI,NIHSS and APACHE Ⅱ,and higher GCS values,compared with patients who died within 28 days after admission.Besides,BSI at admission had a positive correlation with mRS at 28 days (r =0.441,P =0.040).NIHSS and APACHE Ⅱ were also correlated with mRS (r =0.736,P <0.000 1;r =0.667,P =0.001,respectively).GCS at admission had a negative correlation with mRS (r =-0.656,P =0.001).Conclusion A higher BSI predicts a poorer short-term prognosis for stroke patients.Acute EEG monitoring may be of prognostic value for 28-day outcomes.The early prediction of functional outcomes after stroke may enhance clinical management and minimize short-term mortality.




    Full Text Available NEED FOR STUDY The present study is to use a simple bedside tool as a scoring system to assess the severity of acute pancreatitis and to predict its risks for morbidity and mortality. The main criteria of this study is to highlight the ease of using this tool to identify the severity of acute pancreatitis as early as possible in order to reduce the complications, risks and to improve the outcome and overall survival. MATERIALS AND METHODS Our study is a single centre, prospective observational study conducted at Rajarajeshwari Medical College Hospital, Bangalore, India from September 2014 to September 2015. Forty six patients, both males and females presenting within 24 hours of onset of symptoms diagnosed with acute pancreatitis were included in the study. Informed consents were obtained from all patients. Cases of chronic pancreatitis and acute on chronic pancreatitis were excluded. Pediatric patients of age less than 14 years and geriatric patients more than 70 years were excluded. RESULTS We observed that biliary pancreatitis was the most common with male population more affected than females. Pain abdomen was the most common presentation in the entire study population. Necrotizing pancreatitis was most commonly associated with ICU admission and prolonged hospital stay. Patients with organ failure and BISAP score more than 3 were found to have prolonged hospital stay. SIRS was the most common component of BISAP scoring system seen in 91.3%. Elderly patients with age more than 60 years (6 pts. had high BISAP score (5. All patients with shock had BISAP score of >3. A BISAP score of ≥3 was associated with higher morbidity than scores of <3. CONCLUSION BISAP is a simple and a quick tool over other scoring systems and is similar to other scoring systems to predict the severity and prognosis of acute pancreatitis. In summary we have studied the ease of BISAP scoring system and its advantage in early recognition of acute pancreatitis, thus taking

  11. External Validation of the Simple Clinical Score and the HOTEL Score, Two Scores for Predicting Short-Term Mortality after Admission to an Acute Medical Unit

    Stræde, Mia; Brabrand, Mikkel


    with the objective of validating the Simple Clinical Score (SCS) and the HOTEL score, two existing risk stratification systems that predict mortality for medical patients based solely on clinical information, but not only vital signs. METHODS: Pre-planned prospective observational cohort study. SETTING: Danish 460.......932 to 0.988) for 24-hours mortality and 0.826 (95% CI, 0.774-0.879) for 30-day mortality, and goodness-of-fit test, χ2 = 2.68 (10 degrees of freedom), P = 0.998 and χ2 = 4.00, P = 0.947, respectively. We included 1470 patients when calculating the HOTEL score. Discriminatory power (AUROC) was 0.931 (95......% CI, 0.901-0.962) for 24-hours mortality and goodness-of-fit test, χ2 = 5.56 (10 degrees of freedom), P = 0.234. CONCLUSION: We find that both the SCS and HOTEL scores showed an excellent to outstanding ability in identifying patients at high risk of dying with good or acceptable precision....

  12. Investigation of the degree of organisational influence on patient experience scores in acute medical admission units in all acute hospitals in England using multilevel hierarchical regression modelling

    Sullivan, Paul


    Objectives Previous studies found that hospital and specialty have limited influence on patient experience scores, and patient level factors are more important. This could be due to heterogeneity of experience delivery across subunits within organisations. We aimed to determine whether organisation level factors have greater impact if scores for the same subspecialty microsystem are analysed in each hospital. Setting Acute medical admission units in all NHS Acute Trusts in England. Participants We analysed patient experience data from the English Adult Inpatient Survey which is administered to 850 patients annually in each acute NHS Trusts in England. We selected all 8753 patients who returned the survey and who were emergency medical admissions and stayed in their admission unit for 1–2 nights, so as to isolate the experience delivered during the acute admission process. Primary and secondary outcome measures We used multilevel logistic regression to determine the apportioned influence of host organisation and of organisation level factors (size and teaching status), and patient level factors (demographics, presence of long-term conditions and disabilities). We selected ‘being treated with respect and dignity’ and ‘pain control’ as primary outcome parameters. Other Picker Domain question scores were analysed as secondary parameters. Results The proportion of overall variance attributable at organisational level was small; 0.5% (NS) for respect and dignity, 0.4% (NS) for pain control. Long-standing conditions and consequent disabilities were associated with low scores. Other item scores also showed that most influence was from patient level factors. Conclusions When a single microsystem, the acute medical admission process, is isolated, variance in experience scores is mainly explainable by patient level factors with limited organisational level influence. This has implications for the use of generic patient experience surveys for comparison between

  13. Capillary Index Score and Correlation with Outcomes in Acute Ischemic Stroke: A Meta-analysis

    Jagani, Manoj; Brinjikji, Waleed; Murad, Mohammad H.; Rabinstein, Alejandro A.; Cloft, Harry J.; Kallmes, David F.


    Background and Purpose The capillary index score (CIS) has been recently introduced as a metric for rating the collateral circulation of ischemic stroke patients. Multiple studies in the last five years have evaluated the correlation of good CIS with clinical outcomes and suggested the use of CIS in selecting patients for endovascular treatment. We performed a meta-analysis of these studies comparing CIS with clinical outcomes. Methods We conducted a computerized search of three databases from January 2011 to November 2015 for studies related to CIS and outcomes. A CIS = 0 or 1 is considered poor (pCIS) and a CIS = 2 or 3 is considered favorable (fCIS). Using random-effect meta-analysis, we evaluated the relationship of CIS to neurological outcome (modified Rankin scale score ≤ 2), recanalization, and post-treatment hemorrhage. Meta-regression analysis of good neurological outcome was performed for adjusting baseline National Institutes of Health Stroke Scale (NIHSS) between groups. Results Six studies totaling 338 patients (212 with fCISs and 126 with pCISs) were included in the analysis. Patients with fCIS had higher likelihood of good neurological outcome [relative risk (RR) = 3.03; confidence interval (CI) = 95%, 2.05–4.47; p < 0.001] and lower risk of post-treatment hemorrhage (RR = 0.38; CI = 95%, 0.19–0.93; p = 0.04) as compared with patients in the pCIS group. When adjusting for baseline NIHSS, patients with fCIS had higher RR of good neurological outcome when compared with those with pCIS (RR = 2.94; CI = 95%, 1.23–7, p < 0.0001). Favorable CIS was not associated with higher rates of recanalization. Conclusions Observational evidence suggests that acute ischemic stroke patients with fCIS may have higher rates of good neurological outcomes compared with patients with pCIS, independent of baseline NIHSS. CIS may be used as another tool to select patients for endovascular treatment of acute ischemic stroke.

  14. Poisoning severity score, Glasgow coma scale, corrected QT interval in acute organophosphate poisoning.

    Akdur, Okhan; Durukan, Polat; Ozkan, Seda; Avsarogullari, Levent; Vardar, Alper; Kavalci, Cemil; Ikizceli, Ibrahim


    The aim of this study was to investigate effectiveness of the poisoning severity score (PSS), Glasgow coma scale (GCS), and corrected QT (QTc) interval in predicting outcomes in acute organophosphates (OP) poisoning. Over a period of 2 years, 62 patients with OP poisoning were admitted to emergency department (ED) of Erciyes University Medical School Hospital. The age, sex, cause of contact, compound involved, time elapsed between exposure and admission to the ED, duration of hospital stay, and cardiac manifestations at the time of presentation were recorded. GCS and poisoning severity score (PSS) was calculated for each patient. Electrocardiogram (ECG) analysis included the rate, rhythm, ST-T abnormalities, conduction defects, and measurement of PR and QT intervals. Sixty-two patients with OP poisoning presented to our ED from January 2007 to December 2008 from which 54 patients were included in the study. The mean age was 34.1 +/- 14.8 years. Of the cases, 53.7% were female. Twenty-six patients had a prolonged QTc interval. Mean PSS of men and women was 1.8 +/- 1.0. No statistically significant correlation was found between the PSS and QTc intervals of the cases. A significant correlation was determined between the GCS and PSS of grade 3 and grade 4 cases. GCS is a parameter that helps clinician to identify advanced grade OP poisoning patients in the initial assessment in the ED. However, ECG findings, such as prolonged QTc interval, are not effective in determination of short-term prognosis and show no relationship with PSS.

  15. The association between glucocorticoid therapy and BMI z-score changes in children with acute lymphoblastic leukemia

    Arpe, Marie-Louise Hyre; Rørvig, Sascha; Kok, Karin Bott;


    PURPOSE: Few studies have addressed the common issue of weight gain in children with acute lymphoblastic leukemia (ALL) during early phases of treatment, and even fewer have used the appropriate measure for weight fluctuation in children, BMI-for-age z-scores (BAZs). The purpose of this study...

  16. External validation of the APPS, a new and simple outcome prediction score in patients with the acute respiratory distress syndrome

    Bos, Lieuwe D; Schouten, Laura R; Cremer, Olaf L; Ong, David S Y; Schultz, Marcus J


    BACKGROUND: A recently developed prediction score based on age, arterial oxygen partial pressure to fractional inspired oxygen ratio (PaO2/FiO2) and plateau pressure (abbreviated as 'APPS') was shown to accurately predict mortality in patients diagnosed with the acute respiratory distress syndrome (

  17. Tuberculosis and risk of acute myocardial infarction: a propensity score-matched analysis.

    Huaman, M A; Kryscio, R J; Fichtenbaum, C J; Henson, D; Salt, E; Sterling, T R; Garvy, B A


    Several pathogens have been associated with increased cardiovascular disease (CVD) risk. Whether this occurs with Mycobacterium tuberculosis infection is unclear. We assessed if tuberculosis disease increased the risk of acute myocardial infarction (AMI). We identified patients with tuberculosis index claims from a large de-identified database of ~15 million adults enrolled in a U.S. commercial insurance policy between 2008 and 2010. Tuberculosis patients were 1:1 matched to patients without tuberculosis claims using propensity scores. We compared the occurrence of index AMI claims between the tuberculosis and non-tuberculosis cohorts using Kaplan-Meier curves and Cox Proportional Hazard models. Data on 2026 patients with tuberculosis and 2026 propensity-matched patients without tuberculosis were included. AMI was more frequent in the tuberculosis cohort compared with the non-tuberculosis cohort, 67 (3·3%) vs. 32 (1·6%) AMI cases, respectively, P < 0·01. Tuberculosis was associated with an increased risk of AMI (adjusted hazard ratio (HR) 1·98, 95% confidence intervals (CI) 1·3-3·0). The results were similar when the analysis was restricted to pulmonary tuberculosis (adjusted HR 2·43, 95% CI 1·5-4·1). Tuberculosis was associated with an increased risk of AMI. CVD risk assessment should be considered in tuberculosis patients. Mechanistic studies of tuberculosis and CVD are warranted.

  18. A modified HEART risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome

    Chun-Peng MA; Xiao WANG; Qing-Sheng WANG; Xiao-Li LIU; Xiao-Nan HE; Shao-Ping NIE


    ObjectiveTo validate a modified HEART [History, Electrocardiograph (ECG), Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in the emergency department (ED).Methods This retrospective cohort study used a prospectively acquired database and chest pain patients admitted to the emergency department with suspected NSTE-ACS were enrolled. Data recorded on arrival at the ED were used. The serum sample of high-sensitivity cardiac Troponin I other than conventional cardiac Troponin I used in the HEART risk score was tested. The modified HEART risk score was calculated. The end point was the occurrence of major adverse cardiac events (MACE) defined as a composite of acute myocardial infarction (AMI), percu-taneous intervention (PCI), coronary artery bypass graft (CABG), or all-cause death, within three months after initial presentation.Results A total of 1,300 patients were enrolled. A total of 606 patients (46.6%) had a MACE within three months: 205 patients (15.8%) were diag-nosed with AMI, 465 patients (35.8%) underwent PCI, and 119 patients (9.2%) underwent CABG. There were 10 (0.8%) deaths. A progres-sive, significant pattern of increasing event rate was observed as the score increased (P < 0.001 byχ2 for trend). The area under the receiver operating characteristic curve was 0.84. All patients were classified into three groups: low risk (score 0–2), intermediate risk (score 3–4), and high risk (score 5–10). Event rates were 1.1%, 18.5%, and 67.0%, respectively (P < 0.001).ConclusionsThe modified HEART risk score was validated in chest pain patients with suspected NSTE-ACS and may complement MACE risk assessment and patients triage in the ED. A prospective study of the score is warranted.

  19. Detection of acute deterioration in health status visit among COPD patients by monitoring COPD assessment test score

    Pothirat C


    Full Text Available Chaicharn Pothirat, Warawut Chaiwong, Atikun Limsukon, Athavudh Deesomchok, Chalerm Liwsrisakun, Chaiwat Bumroongkit, Theerakorn Theerakittikul, Nittaya PhetsukDivision of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailandBackground: The Chronic Obstructive Pulmonary Disease Assessment Test (CAT could play a role in detecting acute deterioration in health status during monitoring visits in routine clinical practice.Objective: To evaluate the discriminative property of a change in CAT score from a stable baseline visit for detecting acute deterioration in health status visits of chronic obstructive pulmonary disease (COPD patients.Methods: The CAT questionnaire was administered to stable COPD patients routinely attending the chest clinic of Chiang Mai University Hospital who were monitored using the CAT score every 1–3 months for 15 months. Acute deterioration in health status was defined as worsening or exacerbation. CAT scores at baseline, and subsequent visits with acute deterioration in health status were analyzed using the t-test. The receiver operating characteristic curve was performed to evaluate the discriminative property of change in CAT score for detecting acute deterioration during a health status visit.Results: A total of 354 follow-up visits were made by 140 patients, aged 71.1±8.4 years, with a forced expiratory volume in 1 second of 47.49%±18.2% predicted, who were monitored for 15 months. The mean CAT score change between stable baseline visits, by patients’ and physicians’ global assessments, were 0.05 (95% confidence interval [CI], -0.37–0.46 and 0.18 (95% CI, -0.23–0.60, respectively. At worsening visits, as assessed by patients, there was significant increase in CAT score (6.07; 95% CI, 4.95–7.19. There were also significant increases in CAT scores at visits with mild and moderate exacerbation (5.51 [95% CI, 4.39–6

  20. Comparison of Existing Clinical Scoring Systems in Predicting Severity and Prognoses of Hyperlipidemic Acute Pancreatitis in Chinese Patients

    Qiu, Lei; Sun, Rui Qing; Jia, Rong Rong; Ma, Xiu Ying; Cheng, Li; Tang, Mao Chun; Zhao, Yan


    Abstract It is important to identify the severity of acute pancreatitis (AP) in the early course of the disease. Clinical scoring systems may be helpful to predict the prognosis of patients with early AP; however, few analysts have forecast the accuracy of scoring systems for the prognosis in hyperlipidemic acute pancreatitis (HLAP). The purpose of this study was to summarize the clinical characteristics of HLAP and compare the accuracy of conventional scoring systems in predicting the prognosis of HLAP. This study retrospectively analyzed all consecutively diagnosed AP patients between September 2008 and March 2014. We compared the clinical characteristics between HLAP and nonhyperlipidemic acute pancreatitis. The bedside index for severity of acute pancreatitis (BISAP), Ranson, computed tomography severity index (CTSI), and systemic inflammatory response syndrome (SIRS) scores were applied within 48 hours following admission. Of 909 AP patients, 129 (14.2%) had HLAP, 20 were classified as severe acute pancreatitis (SAP), 8 had pseudocysts, 9 had pancreatic necrosis, 30 had pleural effusions, 33 had SIRS, 14 had persistent organ failure, and there was 1 death. Among the HLAP patients, the area under curves for BISAP, Ranson, SIRS, and CTSI in predicting SAP were 0.905, 0.938, 0.812, and 0.834, 0.874, 0.726, 0.668, and 0.848 for local complications, and 0.904, 0.917, 0.758, and 0.849 for organ failure, respectively. HLAP patients were characterized by younger age at onset, higher recurrence rate, and being more prone to pancreatic necrosis, organ failure, and SAP. BISAP, Ranson, SIRS, and CTSI all have accuracy in predicting the prognosis of HLAP patients, but each has different strengths and weaknesses. PMID:26061329

  1. Acute ischemic stroke treatment, part 2: TreatmentRoles of Capillary Index Score, Revascularization and Time

    Firas eAL-ALI


    Full Text Available Due to recent results from clinical intra-arterial treatment for acute ischemic stroke (IAT-AIS trials such as the Interventional Management of Stroke (IMS III, IAT-AIS and the merit of revascularization have been contested. Even though intra-arterial treatment (IAT has been shown to improve revascularization rates, a corresponding increase in good outcomes has only recently been noted. Even though a significant percentage of patients achieve good revascularization in a timely manner, results do not translate into good clinical outcomes (GCOs. Based on a review of the literature, the authors suspect limited good clinical outcomes following timely and successful revascularization are due to poor patient selection that led to futile and possibly even harmful revascularization. The Capillary Index Score (CIS is a simple angiography-based scale that can potentially be used to improve patient selection to prevent revascularization being performed on patients who are unlikely to benefit from treatment. The CIS characterizes presence of capillary blush related to collateral flow as a marker of residual viable tissue, with absence of blush indicating the tissue is no longer viable due to ischemia. By only selecting patients with a favorable CIS for IAT, the rate of GCOs should consistently approach 80-90%. Current methods of patient selection are primarily dependent on time from ischemia. Time from cerebral ischemia to irreversible tissue damage seems to vary from patient to patient, however, so focusing on viable tissue based on the CIS rather than relying on an artificial time window seems to be a more appropriate approach to patient selection.

  2. Some physiological and biochemical methods for acute and chronic stress evaluation in dairy cows

    Giuseppe Bertoni


    Full Text Available Stress factors are so numerous and so diverse in their strength and duration that the consequences on animal welfare can be quite varied. The first important distinction concerns the characterization of acute and chronic stress conditions. Acute stress is a short-lived negative situation that allows a quick and quite complete recovery of the physiological balance (adaptation, while chronic stress is a long lasting condition from which the subject cannot fully recover (maladaptation. In the latter case, the direct effects of the stress factors (heat, low energy, anxiety, suffering etc., as well as the indirect ones (changes occurring at endocrinological, immune system or function level can be responsible for pre-pathological or pathological consequences which reduce animal welfare. To evaluate the possible chronic stress conditions in single animals or on a farm (in particular a farm of dairy cows, some parameters of the direct or indirect effects can be utilised. They are physiological (mainly hormone changes: cortisol, β-endorphin, behavioural (depression, biochemical (metabolites, acute phase proteins, glycated proteins etc., as well as performance parameters (growing rate, milk yield, fertility, etc.. Special attention has been paid to the interpretation of cortisol levels and to its changes after an ACTH challenge. Despite fervent efforts, well established and accepted indices of chronic stress (distress are currently lacking; but without this objective evaluation, the assessment of animal welfare and, therefore, the optimization of the livestock production, could prove more difficult.

  3. Physiology

    Kay, Ian


    Underlying recent developments in health care and new treatments for disease are advances in basic medical sciences. This edition of "Webwatch" focuses on sites dealing with basic medical sciences, with particular attention given to physiology. There is a vast amount of information on the web related to physiology. The sites that are included here…

  4. Principles of exercise physiology: responses to acute exercise and long-term adaptations to training.

    Rivera-Brown, Anita M; Frontera, Walter R


    Physical activity and fitness are associated with a lower prevalence of chronic diseases, such as heart disease, cancer, high blood pressure, and diabetes. This review discusses the body's response to an acute bout of exercise and long-term physiological adaptations to exercise training with an emphasis on endurance exercise. An overview is provided of skeletal muscle actions, muscle fiber types, and the major metabolic pathways involved in energy production. The importance of adequate fluid intake during exercise sessions to prevent impairments induced by dehydration on endurance exercise, muscular power, and strength is discussed. Physiological adaptations that result from regular exercise training such as increases in cardiorespiratory capacity and strength are mentioned. The review emphasizes the cardiovascular and metabolic adaptations that lead to improvements in maximal oxygen capacity.

  5. A new Leukemia Prognostic Scoring System for refractory/relapsed adult acute myelogeneous leukaemia patients: a GOELAMS study.

    Chevallier, P; Labopin, M; Turlure, P; Prebet, T; Pigneux, A; Hunault, M; Filanovsky, K; Cornillet-Lefebvre, P; Luquet, I; Lode, L; Richebourg, S; Blanchet, O; Gachard, N; Vey, N; Ifrah, N; Milpied, N; Harousseau, J-L; Bene, M-C; Mohty, M; Delaunay, J


    A simplified prognostic score is presented based on the multivariate analysis of 138 refractory/relapsed acute myeloid leukaemia (AML) patients (median age 55 years, range: 19-70) receiving a combination of intensive chemotherapy+Gemtuzumab as salvage regimen. Overall, 2-year event-free survival (EFS) and overall survival (OS) were 29±4% and 36±4%, respectively. Disease status (relapse Leukemia Prognostic Scoring System was then validated on an independent cohort of 111 refractory/relapsed AML patients. This new simplified prognostic score, using three clinical and biological parameters routinely applied, allow to discriminate around two third of the patients who should benefit from a salvage intensive regimen in the setting of refractory/relapsed AML patients. The other one third of the patients should receive investigational therapy.

  6. Prediction scores or gastroenterologists' Gut Feeling for triaging patients that present with acute upper gastrointestinal bleeding

    Groot, N.; Oijen, M.G. van; Kessels, K.; Hemmink, M.; Weusten, B.; Timmer, R.; Hazen, W.; Lelyveld, N. van; Vermeijden, J.R.; Curvers, W.; Baak, L.; Verburg, R.; Bosman, J.; Wijkerslooth, L. de; Rooij, J van; Venneman, N.; Pennings, M.C.P.; Hee, K. van; Scheffer, R.; Eijk, R. van; Meiland, R.; Siersema, P.; Bredenoord, A.


    INTRODUCTION: Several prediction scores for triaging patients with upper gastrointestinal (GI) bleeding have been developed, yet these scores have never been compared to the current gold standard, which is the clinical evaluation by a gastroenterologist. The aim of this study was to assess the added

  7. Infusion of glucose and lipids at physiological rates causes acute endoplasmic reticulum stress in rat liver.

    Boden, Guenther; Song, Weiwei; Duan, Xunbao; Cheung, Peter; Kresge, Karen; Barrero, Carlos; Merali, Salim


    Endoplasmic reticulum (ER) stress has recently been implicated as a cause for obesity-related insulin resistance; however, what causes ER stress in obesity has remained uncertain. Here, we have tested the hypothesis that macronutrients can cause acute (ER) stress in rat liver. Examined were the effects of intravenously infused glucose and/or lipids on proximal ER stress sensor activation (PERK, eIF2-α, ATF4, Xbox protein 1 (XBP1s)), unfolded protein response (UPR) proteins (GRP78, calnexin, calreticulin, protein disulphide isomerase (PDI), stress kinases (JNK, p38 MAPK) and insulin signaling (insulin/receptor substrate (IRS) 1/2 associated phosphoinositol-3-kinase (PI3K)) in rat liver. Glucose and/or lipid infusions, ranging from 23.8 to 69.5 kJ/4 h (equivalent to between ~17% and ~50% of normal daily energy intake), activated the proximal ER stress sensor PERK and ATF6 increased the protein abundance of calnexin, calreticulin and PDI and increased two GRP78 isoforms. Glucose and glucose plus lipid infusions induced comparable degrees of ER stress, but only infusions containing lipid activated stress kinases (JNK and p38 MAPK) and inhibited insulin signaling (PI3K). In summary, physiologic amounts of both glucose and lipids acutely increased ER stress in livers 12-h fasted rats and dependent on the presence of fat, caused insulin resistance. We conclude that this type of acute ER stress is likely to occur during normal daily nutrient intake.

  8. Serious acute pyelonephritis: a predictive score for evaluation of deterioration of treatment based on clinical and radiologic findings using CT

    Kim, See Hyung; Kim, Young Whan; Lee, Hee Jung (Department of Radiology, Keimyung University, Dongsan Hospital, Daegu (Korea, Republic of)), Email:


    Background. Acute pyelonephritis (APN) requires prompt diagnosis and immediate treatment. Purpose To develop a simple score to assist in diagnosing treatment deterioration in patients with serious APN. Material and Methods. Using data from a retrospective cohort of 193 patients with APN, we developed scores based on multivariate logistic regression after the jackknife procedure. We validated the scores in a prospective cohort of 40 patients. Results. Nine criteria were independently associated with our investigation: Abscess (adjusted odds ratio [OR], 19.8; 95% confidence interval [95% CI] 4.5-72.1), pyonephrosis with or without stone (18.3; 4.8-70.9), pelvicalyceal air (15.5; 3.2-26.9), poor global excretion of contrast (12.3; 2.9-68.5), tachycardia or hypotension (10.1; 2.5-28.0), obliteration of the renal sinus (9.6; 2.5-45.2), persistent fever or pyuria (9.8; 1.9-25.8), diabetes (9.4; 2.0-31.8), and global renal enlargement (7.5; 2.1-35.8). The APN score was based on these nine criteria. Low-risk and high-risk groups were derived from the score (probability, 3.5% [95% CI 0-7.5] and 67% [51-83]). Application of these criteria to the prospective cohort confirmed the diagnostic accuracy of the score (probability 0% [0-15] and 71% [25-100] in the low-risk and high-risk groups, respectively). Conclusion. This easy-to-calculate score may prove useful for diagnosing patients with serious APN who deteriorate with treatment

  9. The acute physiological and mood effects of tea and coffee: the role of caffeine level.

    Quinlan, P T; Lane, J; Moore, K L; Aspen, J; Rycroft, J A; O'Brien, D C


    The objective of this study was to determine the effect of caffeine level in tea and coffee on acute physiological responses and mood. Randomised full crossover design in subjects after overnight caffeine abstention was studied. In study 1 (n = 17) the caffeine level was manipulated naturalistically by preparing tea and coffee at different strengths (1 or 2 cups equivalent). Caffeine levels were 37.5 and 75 mg in tea, 75 and 150 mg in coffee, with water and no-drink controls. In study 2 (n = 15) caffeine level alone was manipulated (water, decaffeinated tea, plus 0, 25, 50, 100, and 200 mg caffeine). Beverage volume and temperature (55 degrees C) were constant. SBP, DBP, heart rate, skin temperature, skin conductance, and mood were monitored over each 3-h study session. In study 1, tea and coffee produced mild autonomic stimulation and an elevation in mood. There were no effects of tea vs. coffee or caffeine dose, despite a fourfold variation in the latter. Increasing beverage strength was associated with greater increases in DBP and energetic arousal. In study 2, caffeinated beverages increased SBP, DBP, and skin conductance and lowered heart rate and skin temperature compared to water. Significant dose-response relationships to caffeine were seen only for SBP, heart rate, and skin temperature. There were significant effects of caffeine on energetic arousal but no consistent dose-response effects. Caffeinated beverages acutely stimulate the autonomic nervous system and increase alertness. Although caffeine can exert dose-dependent effects on a number of acute autonomic responses, caffeine level is not an important factor. Factors besides caffeine may contribute to these acute effects.

  10. Algorithm for the automatic computation of the modified Anderson-Wilkins acuteness score of ischemia from the pre-hospital ECG in ST-segment elevation myocardial infarction

    Fakhri, Yama; Sejersten, Maria; Schoos, Mikkel Malby


    BACKGROUND: The acuteness score (based on the modified Anderson-Wilkins score) estimates the acuteness of ischemia based on ST-segment, Q-wave and T-wave measurements obtained from the electrocardiogram (ECG) in patients with ST Elevation Myocardial Infarction (STEMI). The score (range 1 (least...... the acuteness score. METHODS: We scored 50 pre-hospital ECGs from STEMI patients, manually and by the automated algorithm. We assessed the reliability test between the manual and automated algorithm by interclass correlation coefficient (ICC) and Bland-Altman plot. RESULTS: The ICC was 0.84 (95% CI 0.......72-0.91), PECGs, all within the upper (1.46) and lower (-1.12) limits...

  11. Severity of acute pulmonary embolism: evaluation of a new spiral CT angiographic score in correlation with echocardiographic data

    Mastora, Ioana; Remy-Jardin, Martine; Masson, Pascal; Remy, Jacques [Department of Radiology, University Center Hospital Calmette, Boulevard Jules Leclerc, 59037 Lille Cedex (France); Medical Research Group ' ' Equipe d' Accueil no. 2682' ' , Boulevard Jules Leclerc, 59037 Lille Cedex (France); Galland, Eric; Bauchart, Jean-Jacques [Department of Cardiology, University Center Cardiology Hospital; Boulevard Jules Leclerc, 59037 Lille Cedex (France); Delannoy, Valerie [Department of Medical Statistics, University of Lille, Place de Verdun, 59037 Lille Cedex (France)


    The purpose of this study was to investigate whether the severity of acute pulmonary embolism (PE) could be quantitatively assessed with spiral CT angiography (SCTA). Thirty-six consecutive patients without underlying cardiopulmonary disease and high clinical suspicion of PE underwent prospectively thin-collimation SCTA and echocardiography at the time of the initial diagnosis (T0) and after initial therapy (T1; mean interval of time T1-T2: 32 days). The CT severity score was based on the percentage of obstructed surface of each central and peripheral pulmonary arterial section using a 5-point scale (1: <25%; 2: 25-49%; 3: 50-74%; 4: 75-99%; 5: 100%). The sum of the detailed scores attributed to 5 mediastinal, 6 lobar and 20 segmental arteries per patient led to the determination of central, peripheral and global CT severity scores and subsequent determination of percentages of obstruction of the pulmonary circulation. Echocardiographic severity criteria included the presence of signs of acute cor pulmonale and/or systolic pulmonary hypertension (>40 mm Hg). The SCTA depicted acute PE in all patients at T0 with complete resolution of endovascular clots in 10 patients at T1. At T0, the mean percentage of obstruction of the pulmonary arterial bed was significantly higher in the 22 patients with echocardiographic signs of severity (56{+-}13 vs 28{+-}32%; p<0.001). A significant reduction in the mean percentage of pulmonary artery obstruction was observed in the 19 patients with resolution of echocardiographic criteria of severity between T0 and T1 T0: 57{+-}14%; T1: 7{+-}11%; p<0.001. The threshold value for severe PE on CT angiograms was 49% (sensitivity: 0.773; specificity: 0.214). The mean ({+-}SD) pulmonary artery pressure was significantly higher in the 26 patients with more than 50% obstruction of the pulmonary artery bed (45{+-}15 mm Hg) than in the 10 patients with less than 50% obstruction of pulmonary artery bed at T0 (31{+-}11 mm Hg; p<0.01). The CT

  12. Usefulness of Serum Albumin Concentration to Predict High Coronary SYNTAX Score and In-Hospital Mortality in Patients With Acute Coronary Syndrome.

    Kurtul, Alparslan; Murat, Sani Namik; Yarlioglues, Mikail; Duran, Mustafa; Ocek, Adil Hakan; Koseoglu, Cemal; Celık, Ibrahim Etem; Kilic, Alparslan; Aksoy, Ozlem


    High SYNTAX score is a predictor of adverse cardiovascular events, including mortality, in acute coronary syndromes (ACSs). Decreased serum albumin (SA) concentration is associated with an increased risk of cardiovascular events. We aimed to investigate whether SA levels at admission are associated with high SYNTAX score and in-hospital mortality in patients with ACS. The study included 1303 patients with ACS who underwent coronary angiography (CA). The patients were divided into 2 groups as high SYNTAX score (≥33) and lower SYNTAX score (≤32). Baseline SA levels were significantly lower in patients with high SYNTAX score than with lower SYNTAX score (3.46 ± 0.42 mg/dL vs 3.97±0.37 mg/dL, respectively; P SYNTAX score (odds ratio 4.329, 95% confidence interval 2.028-8.264; P SYNTAX score, and SA (SYNTAX score and in-hospital mortality in ACS.

  13. The Association between Stress Measured by Allostatic Load Score and Physiologic Dysregulation in African Immigrants: The Africans in America Study

    Brianna A Bingham


    Full Text Available Introduction: Allostatic load score (ALS summarizes the physiological effect of stress on cardiovascular, metabolic and immune systems. As immigration is stressful, ALS could be affected.Objective: Associations of age of immigration, reason for immigration and unhealthy assimilation behavior with ALS were determined in 238 African immigrants to the United States (US (age 40±10, mean±SD, range 21-64y. Methods: ALS was calculated using ten variables from three domains; cardiovascular (SBP, DBP, cholesterol, triglyceride, homocysteine, metabolic (BMI, A1C, albumin, eGFR and immunological (hsCRP. Variables were divided into sex-specific quartiles with high-risk defined as the highest quartile for each variable except for albumin and eGFR which used the lowest quartile. One point was assigned if the variable was in the high-risk range and zero if not. Unhealthy assimilation behavior was defined by a higher prevalence of smoking, alcohol consumption or sedentary activity in immigrants who lived in the US for ≥10y compare to <10y.Results: Sixteen percent of the immigrants arrived in the US as children (age<18y; 84% arrived as adults (age≥18y. Compared to adulthood immigrants, childhood immigrants were younger (30±7 vs. 42±9, P<0.01, but had lived in the US longer (20±8 vs. 12±9y, P<0.01. Age-adjusted ALS were similar in childhood and adulthood immigrants (2.78±1.83 vs. 2.73±1.69, P=0.87. For adulthood immigrants, multiple regression analysis (adjR2=0.20 revealed older age at immigration and more years in the US were associated with higher ALS (both P<0.05; whereas current age, education, income and gender had no significant influence (all P≥0.4. The prevalence of smoking, alcohol intake and physical activity did not differ in adulthood immigrants living in the US for ≥10y vs. <10y (all P≥0.2. Reason for immigration was available for 77 participants. The reasons included: family reunification, lottery, marriage, work, education and

  14. [Correlation between dental pulp demyelination degree and pain visual analogue scale scores data under acute and chronic pulpitis].

    Korsantiia, N B; Davarashvili, X T; Gogiashvili, L E; Mamaladze, M T; Tsagareli, Z G; Melikadze, E B


    The aim of study is the analysis of pulp nerve fibers demyelination degree and its relationship with Visual Analogue Scale (VAS) score that may be measured as objective criteria. Material and methods of study. Step I: electron micrografs of dental pulp simples with special interest of myelin structural changes detected in 3 scores system, obtained from 80 patients, displays in 4 groups: 1) acute and 2) chronic pulpitis without and with accompined systemic deseases, 20 patients in each group. Dental care was realized in Kutaisi N1 Dental clinic. Step II - self-reported VAS used for describing dental pain. All data were performed by SPSS 10,0 version statistics including Spearmen-rank and Mann-Whitny coefficients for examine the validity between pulp demyelination degree and pain intensity in verbal, numbered and box scales. Researched Data were shown that damaged myelin as focal decomposition of membranes and Schwann cells hyperthrophia correspond with acute dental pain intensity as Spearman index reported in VAS numbered Scales, myelin and axoplasm degeneration as part of chronic gangrenous pulpitis disorders are in direct correlation with VAS in verbal, numbered and behavioral Rating Scales. In fact, all morphological and subjective data, including psychomotoric assessment of dental painin pulpitis may be used in dental practice for evaluation of pain syndrome considered personal story.

  15. Predicting Unsuccessful Electrical Cardioversion for Acute Atrial Fibrillation (from the AF-CVS Score)

    Jaakkola, Samuli; Lip, Gregory Y H; Biancari, Fausto;


    Electrical cardioversion (ECV) is the standard treatment for acute atrial fibrillation (AF), but identification of patients with increased risk of ECV failure or early AF recurrence is of importance for rational clinical decision-making. The objective of this study was to derive and validate...... a clinical risk stratification tool for identifying patients at high risk for unsuccessful outcome after ECV for acute AF. Data on 2,868 patients undergoing 5,713 ECVs of acute AF in 3 Finnish hospitals from 2003 through 2010 (the FinCV study data) were included in the analysis. Patients from western (n = 3......-measures model in the derivation data set. A multivariate analysis for prediction of the composite end point resulted in identification of 5 clinical variables for increased risk: Age (odds ratio [OR] 1.31, confidence interval [CI] 1.13 to 1.52), not the First AF (OR 1.55, CI 1.19 to 2.02), Cardiac failure (OR 1...

  16. Setting safe acute exposure limits for halon replacement chemicals using physiologically based pharmacokinetic modeling.

    Vinegar, A; Jepson, G W; Cisneros, M; Rubenstein, R; Brock, W J


    Most proposed replacements for Halon 1301 as a fire suppressant are halogenated hydrocarbons. The acute toxic endpoint of concern for these agents is cardiac sensitization. An approach is described that links the cardiac endpoint as assessed in dogs to a target arterial concentration in humans. Linkage was made using a physiologically based pharmacokinetic (PBPK) model. Monte Carlo simulations, which account for population variability, were used to establish safe exposure times at different exposure concentrations for Halon 1301 (bromotrifluoromethane), CF(3)I (trifluoroiodomethane), HFC-125 (pentafluoroethane), HFC-227ea (1,1,1,2,3,3,3-heptafluoropropane), and HFC-236fa (1,1,1,3,3,3-hexafluoropropane). Application of the modeling technique described here not only makes use of the conservative cardiac sensitization endpoint, but also uses an understanding of the pharmacokinetics of the chemical agents to better establish standards for safe exposure. The combined application of cardiac sensitization data and physiologically based modeling provides a quantitative approach, which can facilitate the selection and effective use of halon replacement candidates.

  17. OmniGen-AF supplementation modulated the physiological and acute phase responses of Brahman heifers to an endotoxin challenge

    This study examined the effect of feeding OmniGen-AF (OG; Prince Agri Products) on the physiological and acute phase responses (APR) of newly-weaned heifers to an endotoxin (lipopolysaccharide; LPS) challenge. Brahman heifers (n=24; 183±5 kilograms) from the Texas AgriLife Research Center in Overton...

  18. The effect of yeast cell wall supplementation on the physiological and acute phase responses of crossbred heifers to endotoxin challenge

    A study was conducted to determine the effect of feeding yeast cell wall (YCW) products on the physiological and acute phase responses of crossbred newly-received heifers to endotoxin (lipopolysaccharide; LPS) challenge. Heifers (n=24; 218.9+/-2.4 kg) were obtained from commercial sale barns and tra...

  19. Yeast cell wall supplementation alters the physiological and acute phase responses of crossbred heifers to an endotoxin challenge

    A study was conducted to determine the effect of feeding yeast cell wall (YCW) products on the physiological and acute phase responses of crossbred newly-received heifers to an endotoxin challenge. Heifers (n = 24; 219 ± 2.4 kg) were separated into treatment groups receiving a Control diet (n = 8), ...

  20. Dried citrus pulp modulates the physiological and acute phase responses of crossbred heifers to an endotoxin challenge

    This study examined the effect of feeding dried citrus pulp (CP) pellets on the physiological and acute phase responses (APR) of newly-received crossbred heifers to an endotoxin (lipopolysaccharide; LPS) challenge. Heifers (n=24; 218.3±2.4 kg) were obtained from commercial sale barns and transported...

  1. Effects of multiple acute stressors on the predator avoidance ability and physiology of juvenile Chinook salmon

    Mesa, Matthew G.


    Northern squaw fish Ptychocheilus oregonensis are the predominant predators of juvenile Pacific salmonids Oncorhynchus spp. in the Columbia River, and their predation rates are greatest just below dams. Because juvenile salmonids are commonly subjected to multiple stressors at dams in the course of their seaward migration, high predation rates below dams may be due in part to an increase in the vulnerability of stressed fish. I conducted laboratory experiments to examine the predator avoidance ability and physiological stress responses of juvenile chinook salmon O. tshawytscha subjected to treatments (stressors) designed to simulate routine hatchery practices (multiple handlings) or dam passage (multiple agitations). Both stressors resulted in lethargic behavior in the fish, and agitation also caused disorieniation and occasional injury. When equal numbers of stressed and unstressed fish were exposed to northern squawfish for up to 1 h, significantly more stressed fish were eaten, but this effect was not evident during longer exposures. The lack of differential predation in trials lasting up to 24 h can be explained by the rapid development of schooling behavior in the prey, but other possibilities exist, such as changing ratios of stressed and unstressed prey over time. Concentrations of plasma cortisol, glucose, and lactate in fish subjected to multiple stressors were similar and sometimes cumulative, returned to prestress levels within 6-24 h, and correlated poorly with predator avoidance ability. My results suggest that juvenile salmonids are capable of avoiding predators within 1 h after being subjected to multiple acute stressors even though physiological homeostasis may be altered for up to 24 h. Therefore, because juvenile salmonids typically reside in lailrace areas for only a short time after dam passage, measures aimed at reducing physical stress or protecting them as they migrate through dam tailraces may help alleviate the relatively intense predation

  2. Predicting the severity of acute bronchiolitis in infants: should we use a clinical score or a biomarker?

    Amat, Flore; Henquell, Cécile; Verdan, Matthieu; Roszyk, Laurence; Mulliez, Aurélien; Labbé, André


    Krebs von den Lungen 6 antigen (KL-6) has been shown to be a useful biomarker of the severity of Respiratory syncytial virus bronchiolitis. To assess the correlation between the clinical severity of acute bronchiolitis, serum KL-6, and the causative viruses, 222 infants with acute bronchiolitis presenting at the Pediatric Emergency Department of Estaing University Hospital, Clermont-Ferrand, France, were prospectively enrolled from October 2011 to May 2012. Disease severity was assessed with a score calculated from oxygen saturation, respiratory rate, and respiratory effort. A nasopharyngeal aspirate was collected to screen for a panel of 20 respiratory viruses. Serum was assessed and compared with a control group of 38 bronchiolitis-free infants. No significant difference in KL-6 levels was found between the children with bronchiolitis (mean 231 IU/mL ± 106) and those without (230 IU/mL ± 102), or between children who were hospitalized or not, or between the types of virus. No correlation was found between serum KL-6 levels and the disease severity score. The absence of Human Rhinovirus was a predictive factor for hospitalization (OR 3.4 [1.4-7.9]; P = 0.006). Older age and a higher oxygen saturation were protective factors (OR 0.65[0.55-0.77]; P bronchiolitis for the first time, clinical outcome depends more on the adaptive capacities of the host than on epithelial dysfunction intensity. Many of the features of bronchiolitis are affected by underlying disease and by treatment.


    Basavaraj R


    Full Text Available BACKGROUND AND OBJECTIVES: Organophosphorus compound poisoning is the most common medico toxic emergency in India the increase in pesticide use in agriculture has paralleled the increase in the use of these products for deliberate self-warm. Respiratory failure is the most common complication of OP poisoning leading to death. Early recognition and prompt ventilator support may improve survival. Owing to limited availability of resources, all OP poisoning patients are not managed in ICUs in Indian setup. It is therefore important that clinical features and criteria to predict the need for ventilator support be identified at initial examination. Hence this study was undertaken to assess the severity of organophosphorus compound poisoning both clinically by using Peradeniya scoring and by estimating serum choline esterase levels. METHODS: Cross sectional study was done at basaveswar teaching and general hospital attached to MR Medical College. Cases with history of exposure to organophosphorus compound within previous 24 hours were chosen after applying inclusion and exclusion criteria. Patients were evaluated for Peradeniya OP poisoning scale and serum cholinesterase levels for assessment of severity of poisoning. Serum cholinesterase levels and Peradeniya OP poisoning scale were studied to predict the need for ventilator support. The results were analyzed using Chi-square test. STATISTICAL ANALYSIS: It was done using pearson’s chi square test. RESULTS: In this study requirement of ventilator support was seen in 36% of patients. Mortality in our study was 18%. Only 15.6% of patients with mild grade of poisoning according to Peradeniya OP poisoning scale required ventilator support, whereas 84.4% did not require ventilator support. Most of patients with moderate (70.6% and severe poisoning (100% according to Peradeniya OP poisoning scale required ventilator support. 93.7% of patients with serum cholinesterase levels more than 50% did not require

  4. Predicting postoperative acute respiratory failure in critical care using nursing notes and physiological signals.

    Huddar, Vijay; Rajan, Vaibhav; Bhattacharya, Sakyajit; Roy, Shourya


    Postoperative Acute Respiratory Failure (ARF) is a serious complication in critical care affecting patient morbidity and mortality. In this paper we investigate a novel approach to predicting ARF in critically ill patients. We study the use of two disparate sources of information – semi-structured text contained in nursing notes and investigative reports that are regularly recorded and the respiration rate, a physiological signal that is continuously monitored during a patient's ICU stay. Unlike previous works that retrospectively analyze complications, we exclude discharge summaries from our analysis envisaging a real time system that predicts ARF during the ICU stay. Our experiments, on more than 800 patient records from the MIMIC II database, demonstrate that text sources within the ICU contain strong signals for distinguishing between patients who are at risk for ARF from those who are not at risk. These results suggest that large scale systems using both structured and unstructured data recorded in critical care can be effectively used to predict complications, which in turn can lead to preemptive care with potentially improved outcomes, mortality rates and decreased length of stay and cost.

  5. Acute kidney injury after orthotopic liver transplantation using living donor versus deceased donor grafts: A propensity score-matched analysis.

    Hilmi, Ibtesam A; Damian, Daniela; Al-Khafaji, Ali; Sakai, Tetsuro; Donaldson, Joseph; Winger, Daniel G; Kellum, John A


    Acute kidney injury (AKI) is a common complication after liver transplantation (LT). Few studies investigating the incidence and risk factors for AKI after living donor liver transplantation (LDLT) have been published. LDLT recipients have a lower risk for post-LT AKI than deceased donor liver transplantation (DDLT) recipients because of higher quality liver grafts. We retrospectively reviewed LDLTs and DDLTs performed at the University of Pittsburgh Medical Center between January 2006 and December 2011. AKI was defined as a 50% increase in serum creatinine (SCr) from baseline (preoperative) values within 48 hours. One hundred LDLT and 424 DDLT recipients were included in the propensity score matching logistic model on the basis of age, sex, Model for End-Stage Liver Disease score, Child-Pugh score, pretransplant SCr, and preexisting diabetes mellitus. Eighty-six pairs were created after 1-to-1 propensity matching. The binary outcome of AKI was analyzed using mixed effects logistic regression, incorporating the main exposure of interest (LDLT versus DDLT) with the aforementioned matching criteria and postreperfusion syndrome, number of units of packed red blood cells, and donor age as fixed effects. In the corresponding matched data set, the incidence of AKI at 72 hours was 23.3% in the LDLT group, significantly lower than the 44.2% in the DDLT group (P = 0.004). Multivariate mixed effects logistic regression showed that living donor liver allografts were significantly associated with reduced odds of AKI at 72 hours after LT (P = 0.047; odds ratio, 0.31; 95% confidence interval, 0.096-0.984). The matched patients had lower body weights, better preserved liver functions, and more stable intraoperative hemodynamic parameters. The donors were also younger for the matched patients than for the unmatched patients. In conclusion, receiving a graft from a living donor has a protective effect against early post-LT AKI.

  6. [Defense mechanism to prevent ectopic activation of pancreatic digestive enzymes under physiological conditions and its breakdown in acute pancreatitis].

    Kaku, Midori; Otsuko, Makoto


    Independent of the etiology, acute pancreatitis is associated with significant morbidity and the potential for mortality. In most patients, acute pancreatitis follows an uncomplicated or mild course. Recent studies in hereditary pancreatitis have clearly revealed that trypsin is the key enzyme at the onset of pancreatitis. However, there are several defense mechanisms to prevent ectopic activation of trypsin under physiological conditions. If the defense mechanisms failed or activation of trypsin occurred over defense ability, trypsin would activate other digestive enzymes and self-digestion of the pancreas would occur.

  7. Audit of preoperative fluid resuscitation in perforation peritonitis patients using Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity

    Kumar, Sunil


    Context: Debate continues regarding fluid (crystalloid vs. colloid) of choice for resuscitation. Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity (POSSUM) may be used to compare the benefits of preoperative fluid resuscitation with crystalloids and colloids in peritonitis patients. Aims: The aim of this study is to compare crystalloid and colloid for preoperative resuscitation using morbidity, mortality, length of hospital stay (LOS), and time taken to resuscitate as the outcome parameters. Settings and Design: This was a prospective randomized clinical trial. Subjects and Methods: One hundred and seven peritonitis patients were prospectively randomized to fluid resuscitation by crystalloid (Group A) and colloid (Group B) solutions. Physiological score component of POSSUM was recorded before and after fluid resuscitation; operative score component was recorded at discharge/death. These scores were then used to calculate the predicted morbidity and mortality before and after the fluid resuscitation. Statistical Analysis Used: Effect on morbidity and mortality were compared by repeated measure analysis of variance, and its significance was tested by Tukey's test. LOS and time taken to resuscitate were compared using unpaired t-test. Significance was taken at 5%. Results: Fluid resuscitation improved mean predicted morbidity by 0.095 and 0.137 in Group A and Group B, respectively. Similarly, fluid resuscitation improved predicted mortality by 0.145 and 0.185 in Group A and Group B, respectively. These changes were statistically significant. Improvement in morbidity and mortality appeared greater in Group B. No difference was found in the two groups for LOS and time to resuscitate. Conclusions: Preoperative fluid resuscitation using either crystalloid or colloidal solutions decreases morbidity as well as mortality in peritonitis patients.

  8. Genetic influences on the neural and physiological bases of acute threat: A research domain criteria (RDoC) perspective.

    Sumner, Jennifer A; Powers, Abigail; Jovanovic, Tanja; Koenen, Karestan C


    The NIMH Research Domain Criteria (RDoC) initiative aims to describe key dimensional constructs underlying mental function across multiple units of analysis-from genes to observable behaviors-in order to better understand psychopathology. The acute threat ("fear") construct of the RDoC Negative Valence System has been studied extensively from a translational perspective, and is highly pertinent to numerous psychiatric conditions, including anxiety and trauma-related disorders. We examined genetic contributions to the construct of acute threat at two units of analysis within the RDoC framework: (1) neural circuits and (2) physiology. Specifically, we focused on genetic influences on activation patterns of frontolimbic neural circuitry and on startle, skin conductance, and heart rate responses. Research on the heritability of activation in threat-related frontolimbic neural circuitry is lacking, but physiological indicators of acute threat have been found to be moderately heritable (35-50%). Genetic studies of the neural circuitry and physiology of acute threat have almost exclusively relied on the candidate gene method and, as in the broader psychiatric genetics literature, most findings have failed to replicate. The most robust support has been demonstrated for associations between variation in the serotonin transporter (SLC6A4) and catechol-O-methyltransferase (COMT) genes with threat-related neural activation and physiological responses. However, unbiased genome-wide approaches using very large samples are needed for gene discovery, and these can be accomplished with collaborative consortium-based research efforts, such as those of the Psychiatric Genomics Consortium (PGC) and Enhancing Neuro Imaging Genetics through Meta-Analysis (ENIGMA) Consortium.

  9. Dissociable Behavioral, Physiological and Neural Effects of Acute Glucose and Fructose Ingestion: A Pilot Study.

    Bettina Karin Wölnerhanssen

    Full Text Available Previous research has revealed that glucose and fructose ingestion differentially modulate release of satiation hormones. Recent studies have begun to elucidate brain-gut interactions with neuroimaging approaches such as magnetic resonance imaging (MRI, but the neural mechanism underlying different behavioral and physiological effects of glucose and fructose are unclear. In this paper, we have used resting state functional MRI to explore whether acute glucose and fructose ingestion also induced dissociable effects in the neural system. Using a cross-over, double-blind, placebo-controlled design, we compared resting state functional connectivity (rsFC strengths within the basal ganglia/limbic network in 12 healthy lean males. Each subject was administered fructose, glucose and placebo on three separate occasions. Subsequent correlation analysis was used to examine relations between rsFC findings and plasma concentrations of satiation hormones and subjective feelings of appetite. Glucose ingestion induced significantly greater elevations in plasma glucose, insulin, GLP-1 and GIP, while feelings of fullness increased and prospective food consumption decreased relative to fructose. Furthermore, glucose increased rsFC of the left caudatus and putamen, precuneus and lingual gyrus more than fructose, whereas within the basal ganglia/limbic network, fructose increased rsFC of the left amygdala, left hippocampus, right parahippocampus, orbitofrontal cortex and precentral gyrus more than glucose. Moreover, compared to fructose, the increased rsFC after glucose positively correlated with the glucose-induced increase in insulin. Our findings suggest that glucose and fructose induce dissociable effects on rsFC within the basal ganglia/limbic network, which are probably mediated by different insulin levels. A larger study would be recommended in order to confirm these findings.

  10. Prediction of Upper Limb Recovery, General Disability, and Rehabilitation Status by Activity Measurements Assessed by Accelerometers or the Fugl-Meyer Score in Acute Stroke

    Gebruers, Nick; Truijen, Steven; Engelborghs, Sebastiaan; De Deyn, Peter P.


    Objective This study investigated the clinical predictive value of the Fugl-Meyer Assessment (FMA) arm score and the upper limb activity assessed by accelerometers in patients with hemiparesis after acute stroke. Design The prospective cohort (n = 129) was recruited from a general hospital; activity

  11. Comparison of infarct size changes with delayed contrast-enhanced magnetic resonance imaging and electrocardiogram QRS scoring during the 6 months after acutely reperfused myocardial infarction

    Bang, L.E.; Ripa, R.S.; Grande, P.


    that has infarcted. There are no comparison of serial changes on ECG and DE-MRI measuring infarct size. AIM: The general aim of this study was to describe the acute, healing, and chronic phases of the changes in infarct size estimated by the ECG and DE-MRI. The specific aim was to compare estimates......INTRODUCTION: Magnetic resonance imaging using the delayed contrast-enhanced (DE-MRI) method can be used for characterizing and quantifying myocardial infarction (MI). Electrocardiogram (ECG) score after the acute phase of MI can be used to estimate the portion of left ventricular myocardium...... of the Selvester QRS scoring system and DE-MRI to identify the difference between the extent of left ventricle occupied by infarction in the acute and chronic phases. METHODS: In 31 patients (26 men, age 56 +/- 9) with reperfused ST-elevation MI (11 anterior, 20 inferior), standard 12-lead ECG and DE-MRI were...

  12. Effects of LI4 Acupressure on length of delivery time, some of physiologic responseEffects of LI4 Acupressure on Length of Delivery Time, Mothers’ Physiologic Physiologic Responses and Newborn’s Apgar Scores s and Apgar scores in women during of labor

    azam hamidzade


    Full Text Available Introduction: Prolonged labor has been associated with cesarean delivery and low Ph cord blood. Furthermore, hemorrhage and infection, which are strongly associated with long labor, are leading causes of maternal death. Due to the importance of duration of labor, this study investigates the effects of Hego (LI4 acupressure on length of delivery time, mothers’ physiological responses i.e., respiration and pulse rates of mothers, and Apgar scores of newborns. Methods: In this randomized clinical trial study, 100 pregnant women, who were at the beginning of active phase of labor (dilatation 5-3and had referred to Fatemiye educational and research clinic in Shahroud, were randomly assigned to either the LI4 acupressure (n=50 or LI4 touch control (n=50 group. The experimental group received LI4 acupressure at the onset of the active phase for duration of each uterine contraction over a period of 20 minutes but the control group received only LI4 touch. Length of delivery time was calculated in two stages: from 3-5 cm cervical dilation to full cervical dilation and full cervical dilation to the delivery. Pulse and respiration rates were measured before intervention, immediately after intervention, 20, 60 minutes after intervention and then each hour until delivery. One-minute and five-minute Apgar scores were also registered. Results: There were significant differences between the groups in length of delivery time. The total labor (3-5 dilation to delivery was significantly shorter in the LI4 acupressure intervention group (P=0.038. Maternal pulse and respiration rates weren’t significantly different between the groups (P=0.711, P=0.108. There were no significant differences between two groups for neonatal Apgar scores at one and five minutes. (P= 0.2, P= 0.3. Conclusion: These finding showed that LI4 acupressure was effective for shortening the length of delivery time and had no side effects on mothers’ pulse and respiration rate or no

  13. Lung Injury Prediction Score Is Useful in Predicting Acute Respiratory Distress Syndrome and Mortality in Surgical Critical Care Patients

    Zachary M. Bauman


    Full Text Available Background. Lung injury prediction score (LIPS is valuable for early recognition of ventilated patients at high risk for developing acute respiratory distress syndrome (ARDS. This study analyzes the value of LIPS in predicting ARDS and mortality among ventilated surgical patients. Methods. IRB approved, prospective observational study including all ventilated patients admitted to the surgical intensive care unit at a single tertiary center over 6 months. ARDS was defined using the Berlin criteria. LIPS were calculated for all patients and analyzed. Logistic regression models evaluated the ability of LIPS to predict development of ARDS and mortality. A receiver operator characteristic (ROC curve demonstrated the optimal LIPS value to statistically predict development of ARDS. Results. 268 ventilated patients were observed; 141 developed ARDS and 127 did not. The average LIPS for patients who developed ARDS was 8.8±2.8 versus 5.4±2.8 for those who did not (p<0.001. An ROC area under the curve of 0.79 demonstrates LIPS is statistically powerful for predicting ARDS development. Furthermore, for every 1-unit increase in LIPS, the odds of developing ARDS increase by 1.50 (p<0.001 and odds of ICU mortality increase by 1.22 (p<0.001. Conclusion. LIPS is reliable for predicting development of ARDS and predicting mortality in critically ill surgical patients.

  14. Ocean Acidification Portends Acute Habitat Compression for Atlantic Cod (Gadus morhua) in a Physiologically-informed Metabolic Rate Model

    Del Raye, G.; Weng, K.


    Ocean acidification affects organisms on a biochemical scale, yet its societal impacts manifest from changes that propagate through entire populations. Successful forecasting of the effects of ocean acidification therefore depends on at least two steps: (1) deducing systemic physiology based on subcellular stresses and (2) scaling individual physiology up to ecosystem processes. Predictions that are based on known biological processes (process-based models) may fare better than purely statistical models in both these steps because the latter are less robust to novel environmental conditions. Here we present a process-based model that uses temperature, pO2, and pCO2 to predict maximal aerobic scope in Atlantic cod. Using this model, we show that (i) experimentally-derived physiological parameters are sufficient to capture the response of cod aerobic scope to temperature and oxygen, and (ii) subcellular pH effects can be used to predict the systemic physiological response of cod to an acidified ocean. We predict that acute pH stress (on a scale of hours) could limit the mobility of Atlantic cod during diel vertical migration across a pCO2 gradient, promoting habitat compression. Finally, we use a global sensitivity analysis to identify opportunities for the improvement of model uncertainty as well as some physiological adaptations that could mitigate climate stresses on cod in the future.

  15. Effects of resting ischemia assessed by thallium scintigraphy on QRS scoring system for estimating left ventricular function quantified by radionuclide angiography in acute myocardial infarction patients

    DePace, N.L.; Hakki, A.H.; Iskandrian, A.S.


    The purpose of this study was to determine whether resting ischemia limits the usefulness of the QRS scoring system in predicting left ventricular (LV) ejection fraction (EF) in patients with acute infarction. We studied 48 patients after acute infarction by means of 12-lead ECG, thallium-201 scintigraphy, and radionuclide angiography. The thallium-201 scintigrams showed fixed defects in 25 patients, perfusion defects with partial or complete redistribution in the delayed images in 19 patients, and normal images in the remaining four patients. In the 48 patients there was a significant correlation between the QRS score and LVEF (r . -0.67; p less than 0.001). Patients with fixed defects showed a better correlation than patients with resting ischemia (r . -0.77 vs r . -0.60). A QRS score of 3 or less was used to separate patients with LVEF of 40% or greater from those with lower LVEF in patients with fixed defects (p . 0.0005), but this cutoff did not categorize patients with resting ischemia as to LVEF. Thus the presence of rest ischemia in patients with acute infarction may affect the correlation between QRS score and LVEF.

  16. Effects of resting ischemia assessed by thallium scintigraphy on QRS scoring system for estimating left ventricular function quantified by radionuclide angiography in acute myocardial infarction patients.

    DePace, N L; Hakki, A H; Iskandrian, A S


    The purpose of this study was to determine whether resting ischemia limits the usefulness of the QRS scoring system in predicting left ventricular (LV) ejection fraction (EF) in patients with acute infarction. We studied 48 patients after acute infarction by means of 12-lead ECG, thallium-201 scintigraphy, and radionuclide angiography. The thallium-201 scintigrams showed fixed defects in 25 patients, perfusion defects with partial or complete redistribution in the delayed images in 19 patients, and normal images in the remaining four patients. In the 48 patients there was a significant correlation between the QRS score and LVEF (r = -0.67; p less than 0.001). Patients with fixed defects showed a better correlation than patients with resting ischemia (r = -0.77 vs r = -0.60). A QRS score of 3 or less was used to separate patients with LVEF of 40% or greater from those with lower LVEF in patients with fixed defects (p = 0.0005), but this cutoff did not categorize patients with resting ischemia as to LVEF. Thus the presence of rest ischemia in patients with acute infarction may affect the correlation between QRS score and LVEF.

  17. Comparison of Existing Clinical Scoring Systems in Predicting Severity and Prognoses of Hyperlipidemic Acute Pancreatitis in Chinese Patients: A Retrospective Study.

    Qiu, Lei; Sun, Rui Qing; Jia, Rong Rong; Ma, Xiu Ying; Cheng, Li; Tang, Mao Chun; Zhao, Yan


    It is important to identify the severity of acute pancreatitis (AP) in the early course of the disease. Clinical scoring systems may be helpful to predict the prognosis of patients with early AP; however, few analysts have forecast the accuracy of scoring systems for the prognosis in hyperlipidemic acute pancreatitis (HLAP). The purpose of this study was to summarize the clinical characteristics of HLAP and compare the accuracy of conventional scoring systems in predicting the prognosis of HLAP. This study retrospectively analyzed all consecutively diagnosed AP patients between September 2008 and March 2014. We compared the clinical characteristics between HLAP and nonhyperlipidemic acute pancreatitis. The bedside index for severity of acute pancreatitis (BISAP), Ranson, computed tomography severity index (CTSI), and systemic inflammatory response syndrome (SIRS) scores were applied within 48 hours following admission. Of 909 AP patients, 129 (14.2%) had HLAP, 20 were classified as severe acute pancreatitis (SAP), 8 had pseudocysts, 9 had pancreatic necrosis, 30 had pleural effusions, 33 had SIRS, 14 had persistent organ failure, and there was 1 death. Among the HLAP patients, the area under curves for BISAP, Ranson, SIRS, and CTSI in predicting SAP were 0.905, 0.938, 0.812, and 0.834, 0.874, 0.726, 0.668, and 0.848 for local complications, and 0.904, 0.917, 0.758, and 0.849 for organ failure, respectively. HLAP patients were characterized by younger age at onset, higher recurrence rate, and being more prone to pancreatic necrosis, organ failure, and SAP. BISAP, Ranson, SIRS, and CTSI all have accuracy in predicting the prognosis of HLAP patients, but each has different strengths and weaknesses.

  18. Valor prognóstico do Escore de Risco GRACE versus Escore de Risco TIMI em síndromes coronarianas agudas Valor pronóstico del score de riesgo GRACE versus score de riesgo TIMI en síndromes coronarios agudos Prognostic Value of GRACE Scores versus TIMI Score in acute coronary syndromes

    Luis C. L. Correia


    ótesis de que el Score de Riesgo GRACE tiene superior valor pronóstico hospitalario, comparado con el Score TIMI en pacientes ingresados con SCA. MÉTODOS: Fueron incluidos individuos con angina inestable o infarto de miocardio sin supradesnivel del segmento ST, consecutivamente internados en Unidad Coronaria entre agosto de 2007 y enero de 2009. RESULTADOS: Fueron estudiados 154 pacientes, edad 71 ± 13 años, el 56% del sexo femenino, mediana de GRACE de 117 y mediana de TIMI de 3. Durante el período de internación, la incidencia de eventos fue del 8,4% (12 fallecimientos y 1 infarto no fatal. El test de Hosmer-Lemeshow aplicado al Score GRACE presentó χ² de 5,3 (P = 0,72, mientras que el Score TIMI presentó χ² de 1,85 (P = 0,60. De esta forma, ambos scores presentaron buena calibración. En cuanto al análisis de discriminación, el Score GRACE presentó estadística-C de 0,91 (95% IC = 0,86 - 0,97, significativamente superior a la estadística-C de 0,69 del Score TIMI (95% IC = 0,55 - 0,84 - P = 0,02 para diferencia entre los scores. CONCLUSIÓN: Con relación a la predicción de eventos hospitalarios en pacientes con SCA, el Score GRACE tiene capacidad pronóstica superior al compararlo con el Score TIMI.BACKGROUND: Although the TIMI score is the one most frequently used in acute coronary syndromes (ACS without ST-segment elevation, the GRACE score has potential prognostic superiority, as it was created based on an observational registry, part of the variables is treated in a semi-quantitative form and renal function is taken into account in its calculation. OBJECTIVE: To test the hypothesis that the GRACE risk score has superior in-hospital prognostic value, when compared to the TIMI score in patients admitted with ACS. METHODS: Individuals with unstable angina or myocardial infarction without ST-segment elevation, consecutively admitted at the Coronary Unit between August 2007 and January 2009, were included in the study. RESULTS: A total of 154 patients

  19. Quadratic function between arterial partial oxygen pressure and mortality risk in sepsis patients: an interaction with simplified acute physiology score

    Zhongheng Zhang; Xuqing Ji


    Oxygen therapy is widely used in emergency and critical care settings, while there is little evidence on its real therapeutic effect. The study aimed to explore the impact of arterial oxygen partial pressure (PaO2) on clinical outcomes in patients with sepsis. A large clinical database was employed for the study. Subjects meeting the diagnostic criteria of sepsis were eligible for the study. All measurements of PaO2 were extracted. The primary endpoint was death from any causes during hospita...

  20. Reversible acute axonal polyneuropathy associated with Wernicke-Korsakoff syndrome: impaired physiological nerve conduction due to thiamine deficiency?

    Ishibashi, S; Yokota, T; Shiojiri, T; Matunaga, T; Tanaka, H; Nishina, K; Hirota, H; Inaba, A; Yamada, M; Kanda, T; Mizusawa, H


    Acute axonal polyneuropathy and Wernicke-Korsakoff encephalopathy developed simultaneously in three patients. Nerve conduction studies (NCS) detected markedly decreased compound muscle action potentials (CMAPs) and sensory nerve action potentials (SNAPs) with minimal conduction slowing; sympathetic skin responses (SSRs) were also notably decreased. Sural nerve biopsies showed only mild axonal degeneration with scattered myelin ovoid formation. The symptoms of neuropathy lessened within two weeks after an intravenous thiamine infusion. CMAPs, SNAPs, and SSRs also increased considerably. We suggest that this is a new type of peripheral nerve impairment: physiological conduction failure with minimal conduction delay due to thiamine deficiency.

  1. Effect of Serum Growth Differentiation Factor-15 and the Syntax Score on 2-Year Outcomes in Patients With Acute Coronary Syndrome.

    Dominguez-Rodriguez, Alberto; Abreu-Gonzalez, Pedro; Avanzas, Pablo; Consuegra-Sanchez, Luciano


    Growth differentiation factor-15 (GDF-15) is produced by cardiomyocytes and atherosclerotic lesions under stress conditions, but little is known about its relation with severity and complexity of coronary lesions. The aim of this study was to investigate the association between GDF-15 and the syntax score for risk prediction of major adverse cardiovascular events (MACE) at 2-year follow-up in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). This is a prospective cohort study of 502 patients with NSTEACS. The syntax score was calculated from baseline coronary angiography. Blood samples were obtained at study entry for the assessment of GDF-15 and high-sensitivity C reactive protein. One hundred and three patients (20.5%) showed MACE at 2-year follow-up. Patients who developed MACE had greater GDF-15 concentrations and syntax score (p syntax score (ρ = 0.45, p syntax score (p syntax score. In conclusion, in patients with NSTEACS, levels of GDF-15 at admission were correlated with the syntax score and independently associated with an increased risk of MACE during 2-year follow-up.

  2. The HAS-BLED Score Identifies Patients with Acute Venous Thromboembolism at High Risk of Major Bleeding Complications during the First Six Months of Anticoagulant Treatment.

    Judith Kooiman

    Full Text Available The HAS-BLED score enables a risk estimate of major bleeds in patients with atrial fibrillation on vitamin K-antagonists (VKA treatment, but has not been validated for patients with venous thromboembolism (VTE. We analyzed whether the HAS-BLED score accurately identifies patients at high risk of major bleeds during VKA treatment for acute VTE.Medical records of 537 patients with acute VTE (primary diagnosis pulmonary embolism in 223, deep vein thrombosis in 314 starting VKA treatment between 2006-2007 were searched for items on the HAS-BLED score and the occurrence of major bleeds during the first 180 days of follow-up. The hazard ratio (HR for the occurrence of major bleeds comparing non-high with high-risk patients as defined by a HAS-BLED score ≥ 3 points was calculated using Cox-regression analysis.Major bleeds occurred in 11/537 patients (2.0%, 5.2/100 person years, 95% CI 2.8-9.2. Cumulative incidences of major bleeds were 1.3% (95% CI 0.1-2.5 in the non-high (HAS-BLED < 3 and 9.6% (95%CI 2.2-17.0 in the high-risk group (HAS-BLED ≥ 3, (p <0.0001 by Log-Rank test, with a HR of 8.7 (95% CI 2.7-28.4. Of the items in the HAS-BLED score, abnormal renal function (HR 10.8, 95% CI 1.9-61.7 and a history of bleeding events (HR 10.4, 95% CI 2.5-42.5 were independent predictors of major bleeds during follow-up.Acute VTE patients with a HAS-BLED score ≥ 3 points are at increased risk of major bleeding. These results warrant for correction of the potentially reversible risk factors for major bleeding and careful International Normalized Ratio monitoring in acute VTE patients with a high HAS-BLED score.

  3. International Society of Thrombosis and Hemostasis Scoring System for disseminated intravascular coagulation ≥ 6: a new predictor of hemorrhagic early death in acute promyelocytic leukemia.

    Mitrovic, Mirjana; Suvajdzic, Nada; Bogdanovic, Andrija; Kurtovic, Nada Kraguljac; Sretenovic, Aleksandra; Elezovic, Ivo; Tomin, Dragica


    High-hemorrhagic early death (ED) rate is a major impediment in the managing of acute promyelocytic leukemia (APL). In our group of 56 newly diagnosed APL patients, ED occurred in 12 subjects, due to endocranial bleeding (8/12), differentiation syndrome (2/12), or infection (2/12). Predictors of hemorrhagic ED were as follows: white blood cells count ≥ 20 × 10(9)/L (P = 0.002337), Eastern cooperative oncology group performance status ≥ 3 (P = 0.00173), fibrinogen level disseminated intravascular coagulation (ISTH DIC score) ≥ 6 (P = 0.00741). Multivariate analysis indicated ISTH DIC score ≥ 6 to be the most significant predictor for hemorrhagic ED (P = 0.008). The main finding of this study is that simple coagulation-related tests, performed on hospital admission and combined in the ISTH DIC score, might help to identify patients at high risk for fatal bleeding needing more aggressive supportive measures.

  4. Mindfulness-based stress reduction and physiological activity during acute stress: a randomized controlled trial

    Nyklicek, I.; Mommersteeg, P.M.; Beugen, S. van; Ramakers, C.; Boxtel, G.J. Van


    OBJECTIVE: The aim was to examine the effects of a Mindfulness-Based Stress Reduction (MBSR) intervention on cardiovascular and cortisol activity during acute stress. METHOD: Eighty-eight healthy community-dwelling individuals reporting elevated stress levels were randomly assigned to the MBSR proto

  5. Cognitive and physiological effects of an acute physical activity intervention in elementary school children

    Katja eJäger


    Full Text Available The aim of the present study was to investigate the effects of an acute physical activity intervention including cognitive engagement on executive functions and on cortisol level in young elementary school children. Half of the 104 participating children (6 to 8 years old attended a 20-minute sport sequence, which included cognitively engaging and playful forms of physical activity. The other half was assigned to a resting control condition. Individual differences in children`s updating, inhibition, and shifting performance as well as salivary cortisol were assessed before (pre-test, immediately after (post-test, and 40 minutes after (follow-up the intervention or control condition respectively. Results revealed a significantly stronger improvement in inhibition in the experimental group compared to the control group, while it appeared that acute physical activity had no specific effect on updating and shifting. The intervention effect on inhibition levelled out 40 minutes after physical activity. Salivary cortisol increased significantly more in the experimental compared to the control group between post-test and follow-up and results support partly the assumed inverted U-shaped relationship between cortisol level and cognitive performance. In conclusion, results indicate that acute physical activity including cognitive engagement may have immediate positive effects on inhibition, but not necessarily on updating and shifting in elementary school children. This positive effect may partly be explained trough cortisol elevation after acute physical activity.

  6. Preservation of high glycolytic phenotype by establishing new acute lymphoblastic leukemia cell lines at physiologic oxygen concentration

    Sheard, Michael A., E-mail: [Developmental Therapeutics Program, USC-CHLA Institute for Pediatric Clinical Research, Division of Hematology-Oncology, Children' s Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027 (United States); Ghent, Matthew V., E-mail: [Department of Pathology, Keck School of Medicine, University of Southern California, Health Sciences Campus, Los Angeles, CA 90089 (United States); Cabral, Daniel J., E-mail: [Cancer Center and Departments of Cell Biology & Biochemistry, Pharmacology & Neuroscience, Internal Medicine and Pediatrics, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430 (United States); Lee, Joanne C., E-mail: [Cancer Center and Departments of Cell Biology & Biochemistry, Pharmacology & Neuroscience, Internal Medicine and Pediatrics, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430 (United States); Khankaldyyan, Vazgen, E-mail: [Developmental Therapeutics Program, USC-CHLA Institute for Pediatric Clinical Research, Division of Hematology-Oncology, Children' s Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027 (United States); Ji, Lingyun, E-mail: [Developmental Therapeutics Program, USC-CHLA Institute for Pediatric Clinical Research, Division of Hematology-Oncology, Children' s Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027 (United States); Wu, Samuel Q., E-mail: [Medical Genetics, Children' s Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027 (United States); Kang, Min H., E-mail: [Cancer Center and Departments of Cell Biology & Biochemistry, Pharmacology & Neuroscience, Internal Medicine and Pediatrics, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430 (United States); and others


    Cancer cells typically exhibit increased glycolysis and decreased mitochondrial oxidative phosphorylation, and they continue to exhibit some elevation in glycolysis even under aerobic conditions. However, it is unclear whether cancer cell lines employ a high level of glycolysis comparable to that of the original cancers from which they were derived, even if their culture conditions are changed to physiologically relevant oxygen concentrations. From three childhood acute lymphoblastic leukemia (ALL) patients we established three new pairs of cell lines in both atmospheric (20%) and physiologic (bone marrow level, 5%) oxygen concentrations. Cell lines established in 20% oxygen exhibited lower proliferation, survival, expression of glycolysis genes, glucose consumption, and lactate production. Interestingly, the effects of oxygen concentration used during cell line initiation were only partially reversible when established cell cultures were switched from one oxygen concentration to another for eight weeks. These observations indicate that ALL cell lines established at atmospheric oxygen concentration can exhibit relatively low levels of glycolysis and these levels are semi-permanent, suggesting that physiologic oxygen concentrations may be needed from the time of cell line initiation to preserve the high level of glycolysis commonly exhibited by leukemias in vivo. - Highlights: • Establishing new ALL cell lines in 5% oxygen resulted in higher glycolytic expression and function. • Establishing new ALL cell lines in 5% oxygen resulted in higher proliferation and lower cell death. • The divergent metabolic phenotypes selected in 5% and 20% oxygen are semi-permanent.

  7. Behavioral and physiological effects of a short-term feed restriction in lactating dairy cattle with different body condition scores at calving.

    Schütz, K E; Cox, N R; Macdonald, K A; Roche, J R; Verkerk, G A; Rogers, A R; Tucker, C B; Matthews, L R; Meier, S; Webster, J R


    Body condition score (BCS) around calving, and the typical BCS loss for up to 100 d after parturition, is associated with both production and reproductive performance of dairy cattle. In addition, there is public concern that thin cows may have impaired welfare, particularly in early lactation where feed demand exceeds pasture growth, and a lag exists between peak milk energy requirements and intake. The aim of this experiment was to determine how BCS at calving influences behavioral and physiological responses to a short-term feed restriction at 47 DIM. Body condition score (on a 10-point scale) at calving was manipulated by modifying the diets in the previous lactation of healthy dairy cattle to generate 3 treatment groups: low BCS (3.4; n=17), medium BCS (4.6; n=18), or high BCS (5.4; n=20). Cows were tested in 4 groups for 8 consecutive days; testing consisted of different levels of feed allocation (d 1 and 2: 100%; d 3 and 4: 75%; d 5: 50%; d 6 to 8: 125%), where 100% was 15kg of DM/cow per day. All BCS groups had similar and marked behavioral and physiological responses to feed restriction. For example, they increased vocalization, time spent eating silage and grazing, aggressive behavior, and fat metabolism (as measured by concentrations of β-hydroxybutyrate and nonesterified fatty acids), and reduced milk production. Body condition affected some of these responses. Fewer cows with low BCS engaged in aggressive interactions in a feed competition test (trough filled with silage that could be consumed in 15 min) on the first day of feed restriction (low: 32%; medium: 74%; high: 64%; standard error of difference=15.4%). High BCS cows had greater concentrations of β-hydroxybutyrate and nonesterified fatty acids throughout the experimental period, which suggests more fat mobilization; however, plasma leptin and fecal glucocorticosteroid metabolite concentrations were unaffected by BCS. Whereas cows demonstrated marked responses to feed restriction, the results

  8. A Physiologic-Based Approach to the Treatment of Acute Hyperkalemia

    Shingarev, Roman; Allon, Michael


    Hyperkalemia is a common and potentially lethal disorder. Given its variable presentation clinicians should have a high index of suspicion, especially in patients with chronic kidney disease. The present case highlights key physiological mechanisms in the development of hyperkalemia and provides an outline for emergent treatment. In this context, we discuss specific mechanisms of action of available treatments of hyperkalemia.

  9. Sweat-inducing physiological challenges do not result in acute changes in hair cortisol concentrations.

    Grass, Juliane; Kirschbaum, Clemens; Miller, Robert; Gao, Wei; Steudte-Schmiedgen, Susann; Stalder, Tobias


    Hair cortisol concentrations (HCC) are assumed to provide a stable, integrative marker of long-term systemic cortisol secretion. However, contrary to this assumption, some recent observations have raised the possibility that HCC may be subject to acute influences, potentially related to cortisol incorporation from sweat. Here, we provide a first detailed in vivo investigation of this possibility comprising two independent experimental studies: study I (N=42) used a treadmill challenge to induce sweating together with systemic cortisol reactivity while in study II (N=52) a sauna bathing challenge induced sweating without systemic cortisol changes. In both studies, repeated assessments of HCC, salivary cortisol, cortisol in sweat and individuals' sweating rate (single assessment) were conducted on the experimental day and at a next-day follow-up. Results across the two studies consistently revealed that HCC were not altered by the acute interventions. Further, HCC were found to be unrelated to acute salivary cortisol reactivity, sweat cortisol levels, sweating rate or the time of examination. In line with previous data, cortisol levels in sweat were strongly related to total salivary cortisol output across the examined periods. The present results oppose recent case report data by showing that single sweat-inducing interventions do not result in acute changes in HCC. Our data also tentatively speak against the notion that cortisol in sweat may be a dominant source of HCC. Further, our findings also indicate that HCC are not subject to diurnal variation. This research provides further support for hair cortisol analysis as a marker of integrated long-term systemic cortisol secretion.

  10. Dynamics of the 'acute yellowing' of spruce. Epidemiological and physiological evidences

    Kandler, O.; Miller, W.; Ostner, R.


    Among the numerous different pathological conditions summarised under the popular slogan 'Waldsterben', the 'acute yellowing' of Norway spruce is the best defined syndrom. It is characterised by the yellowing of the older needle seasons, while the youngest shoots remain green until flushing in the following spring. The syndrom is restricted to soils with low Mg supply originating from silicate rocks. In this study, the dynamics of the disease was investigated over a period of 3 years by following the course of the disease in individual about 40 years old trees and by mapping more than thousand young trees in two plots with natural regeneration (Bavarian Forest; Spiegelhuette I and II) which exhibited the onset of the disease followed by a distinct spontaneous recovery of part of the population. The following results were obtained: Yellowing of the needles is accompanied by a decrease in Mg and pigment content. During pigment reduction the normal chlorphyll: carotene ratio remains almost unchanged, thus resembling the metabolically regulated pigment reduction in sun leaves rather than the direct photooxidative pigment destruction involving ozone. The latter would lead to a predominant decrease in carotene. 'Acute yellowing' causes a reduction of annual increment by about 30%, while mortality is low. All phases of 'acute yellowing' - onset, progression, stagnation, regreening - occurred in the same stands at the same time. In some cases, even neighbouring trees with overlapping root systems showed a contrary development of the disease.

  11. Collateral blood vessels in acute ischemic stroke: a physiological window to predict future outcomes

    Heitor Castelo Branco Rodrigues Alves


    Full Text Available ABSTRACT Collateral circulation is a physiologic pathway that protects the brain against ischemic injury and can potentially bypass the effect of a blocked artery, thereby influencing ischemic lesion size and growth. Several recent stroke trials have provided information about the role of collaterals in stroke pathophysiology, and collateral perfusion has been recognized to influence arterial recanalization, reperfusion, hemorrhagic transformation, and neurological outcomes after stroke. Our current aim is to summarize the anatomy and physiology of the collateral circulation and to present and discuss a comprehensible review of the related knowledge, particularly the effects of collateral circulation on the time course of ischemic injury and stroke severity, as well as imaging findings and therapeutic implications.

  12. Combined Value of Red Blood Cell Distribution Width and Global Registry of Acute Coronary Events Risk Score for Predicting Cardiovascular Events in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

    Na Zhao

    Full Text Available Global Registry of Acute Coronary Events (GRACE risk score and red blood cell distribution width (RDW content can both independently predict major adverse cardiac events (MACEs in patients with acute coronary syndrome (ACS. We investigated the combined predictive value of RDW and GRACE risk score for cardiovascular events in patients with ACS undergoing percutaneous coronary intervention (PCI for the first time. We enrolled 480 ACS patients. During a median follow-up time of 37.2 months, 70 (14.58% patients experienced MACEs. Patients were divided into tertiles according to the baseline RDW content (11.30-12.90, 13.00-13.50, 13.60-16.40. GRACE score was positively correlated with RDW content. Multivariate Cox analysis showed that both GRACE score and RDW content were independent predictors of MACEs (hazard ratio 1.039; 95% confidence interval [CI] 1.024-1.055; p < 0.001; 1.699; 1.294-2.232; p < 0.001; respectively. Furthermore, Kaplan-Meier analysis demonstrated that the risk of MACEs increased with increasing RDW content (p < 0.001. For GRACE score alone, the area under the receiver operating characteristic (ROC curve for MACEs was 0.749 (95% CI: 0.707-0.787. The area under the ROC curve for MACEs increased to 0.805 (0.766-0.839, p = 0.034 after adding RDW content. The incremental predictive value of combining RDW content and GRACE risk score was significantly improved, also shown by the net reclassification improvement (NRI = 0.352, p < 0.001 and integrated discrimination improvement (IDI = 0.023, p = 0.002. Combining the predictive value of RDW and GRACE risk score yielded a more accurate predictive value for long-term cardiovascular events in ACS patients who underwent PCI as compared to each measure alone.

  13. Derivation of a T2-weighted MRI total colonic inflammation score (TCIS) for assessment of patients with severe acute inflammatory colitis - a preliminary study

    Hafeez, Rehana; Boulos, Paul [University College London Hospitals NHS Trust, Department of Surgery, London (United Kingdom); Punwani, Shonit; Halligan, Steve [University College London, Centre for Medical Imaging, London (United Kingdom); University College London Hospitals NHS Trust, Department of Specialist X-ray, Level 2 podium, London (United Kingdom); Pendse, Doug [University College London, Centre for Medical Imaging, London (United Kingdom); Bloom, Stuart [University College London Hospitals NHS Trust, Department of Gastroenterology, London (United Kingdom); Taylor, Stuart A. [University College London, Centre for Medical Imaging, London (United Kingdom); University College London Hospitals NHS Trust, Department of Specialist X-ray, Level 2 podium, London (United Kingdom)


    To derive an MRI score for assessing severity, therapeutic response and prognosis in acute severe inflammatory colitis. Twenty-one patients with acute severe colitis underwent colonic MRI after admission and again (n = 16) after median 5 days of treatment. Using T2-weighted images, two radiologists in consensus graded segmental haustral loss, mesenteric and mural oedema, mural thickness, and small bowel and colonic dilatation producing a total colonic inflammatory score (TCIS, range 6-95). Pre- and post-treatment TCIS were compared, and correlated with CRP, stool frequency, and number of inpatient days (therapeutic response marker). Questionnaire assessment of patient worry, satisfaction and discomfort graded 1 (bad) to 7 (good) was administered Admission TCIS correlated significantly with CRP (Kendall's tau=0.45, 95% confidence interval [CI] 0.11-0.79, p = 0.006), and stool frequency (Kendall's tau 0.39, 95% CI 0.14-0.64, p = 0.02). TCIS fell after treatment (median [22 range 15-31]) to median 20 [range 8-25], p = 0.01. Admission TCIS but not CRP or stool frequency was correlated with length of inpatient stay (Kendall's tau 0.40, 95% CI 0.11-0.69, p = 0.02). Patients reported some discomfort (median score 4) during MRI. MRI TCIS falls after therapy, correlates with existing markers of disease severity, and in comparison may better predict therapeutic response. (orig.)

  14. The Achilles tendon total rupture score: a study of responsiveness, internal consistency and convergent validity on patients with acute Achilles tendon ruptures

    Kearney Rebecca S


    Full Text Available Abstract Background The Achilles tendon Total Rupture Score was developed by a research group in 2007 in response to the need for a patient reported outcome measure for this patient population. Beyond this original development paper, no further validation studies have been published. Consequently the purpose of this study was to evaluate internal consistency, convergent validity and responsiveness of this newly developed patient reported outcome measure within patients who have sustained an isolated acute Achilles tendon rupture. Methods Sixty-four eligible patients with an acute rupture of their Achilles tendon completed the Achilles tendon Total Rupture Score alongside two further patient reported outcome measures (Disability Rating Index and EQ 5D. These were completed at baseline, six weeks, three months, six months and nine months post injury. The Achilles tendon Total Rupture Score was evaluated for internal consistency, using Cronbach's alpha, convergent validity, through correlation analysis and responsiveness, by analysing floor and ceiling effects and calculating its relative efficiency in comparison to the Disability Rating Index and EQ 5D scores. Results The Achilles tendon Total Rupture Score demonstrated high internal consistency (Cronbachs alpha > 0.8 and correlated significantly (p Conclusions A universally accepted outcome measure is imperative to allow comparisons to be made across practice. This is the first study to evaluate aspects of validity of this newly developed outcome measure, outside of the developing centre. The ATRS demonstrated high internal consistency and responsiveness, with limited convergent validity. This research provides further support for the use of this outcome measure, however further research is required to advocate its universal use in patients with acute Achilles tendon ruptures. Such areas include inter-rater reliability and research to determine the minimally clinically important difference

  15. Comparative studies of hemolymph physiology response and HIF-1 expression in different strains of Litopenaeus vannamei under acute hypoxia.

    Wei, Lin; Li, Yuhu; Qiu, Liguo; Zhou, Hailong; Han, Qian; Diao, Xiaoping


    Litopenaeus vannamei has a high commercial value and is the primary cultured shellfish species globally. In this study, we have compared the hemolymph physiological responses between two L. vannamei strains under acute hypoxia. The results showed that hemocyanin concentration (HC) of strain A6410 was significantly higher than strain Zhengda; Total hemocyte counts (THC) decreased significantly in both strains under hypoxic stress (p 0.05), but in the gills and hepatopancreas under hypoxia for 12 h (p Litopenaeus vannamei was closely correlated with the expression level of HIF-1, and the higher expression level of HIF-1 to hypoxia, the lower tolerance to hypoxia in the early stage of hypoxia. These results can help to better understand the molecular mechanisms of hypoxic tolerance and speed up the selective breeding process of hypoxia tolerance in L. vannamei.

  16. Acute physiological responses to castration-related pain in piglets: the effect of two local anesthetics with or without meloxicam.

    Bonastre, C; Mitjana, O; Tejedor, M T; Calavia, M; Yuste, A G; Úbeda, J L; Falceto, M V


    Methods to reduce castration-related pain in piglets are still issues of concern and interest for authorities and producers. Our objectives were to estimate the effectiveness of two protocols of local anesthesia (lidocaine and the combination of lidocaine+bupivacaine) as well as the use of meloxicam as a postoperative analgesic in alleviating castration-related pain, measured by acute physiological responses. Eight groups (15 piglets/group) were included in the study: (1) castration without anesthesia or analgesia, without meloxicam (TRAD WITHOUT), (2) castration without anesthesia or analgesia, but with meloxicam (TRAD WITH), (3) handling without meloxicam (SHAM WITHOUT), (4) handling with meloxicam (SHAM WITH), (5) castration after local anesthesia with lidocaine but without meloxicam (LIDO WITHOUT), (6) castration after local anesthesia with lidocaine and meloxicam (LIDO WITH), (7) castration after local anesthesia with lidocaine+bupivacaine without meloxicam (LIDO+BUPI WITHOUT), (8) castration after local anesthesia with lidocaine+bupivacaine and meloxicam (LIDO+BUPI WITH). Acute physiological responses measured included skin surface temperature and serum glucose and cortisol concentrations. On days 4 and 11 post-castration BW was recorded and average daily gain was calculated over this period. Furthermore, piglet mortality was recorded over the 11-day post-castration period. Administration of local anesthetic or meloxicam did not prevent the decrease in skin surface temperature associated with castration. Lidocaine reduced the increase in glucose concentration associated with castration. For castrated pigs, the joint use of lidocaine and meloxicam caused a significant decrease in cortisol concentration; the combination of intratesticular lidocaine and bupivacaine did not seem to be more effective than lidocaine alone. No effect of treatments on mortality and growth were detected.

  17. Acute physiological stress down-regulates mRNA expressions of growth-related genes in coho salmon.

    Toshiki Nakano

    Full Text Available Growth and development in fish are regulated to a major extent by growth-related factors, such as liver-derived insulin-like growth factor (IGF -1 in response to pituitary-secreted growth hormone (GH binding to the GH receptor (GHR. Here, we report on the changes in the expressions of gh, ghr, and igf1 genes and the circulating levels of GH and IGF-1 proteins in juvenile coho salmon (Oncorhynchus kisutch in response to handling as an acute physiological stressor. Plasma GH levels were not significantly different between stressed fish and prestressed control. Plasma IGF-1 concentrations in stressed fish 1.5 h post-stress were the same as in control fish, but levels in stressed fish decreased significantly 16 h post-stress. Real-time quantitative PCR (qPCR analysis showed that ghr mRNA levels in pituitary, liver, and muscle decreased gradually in response to the stressor. After exposure to stress, hepatic igf1 expression transiently increased, whereas levels decreased 16 h post-stress. On the other hand, the pituitary gh mRNA level did not change in response to the stressor. These observations indicate that expression of gh, ghr, and igf1 responded differently to stress. Our results show that acute physiological stress can mainly down-regulate the expressions of growth-related genes in coho salmon in vivo. This study also suggests that a relationship between the neuroendocrine stress response and growth-related factors exists in fish.

  18. A Puzzle of Vestibular Physiology in a Meniere’s Disease Acute Attack

    Marta Martinez-Lopez


    Full Text Available The aim of this paper is to present for the first time the functional evaluation of each of the vestibular receptors in the six semicircular canals in a patient diagnosed with Meniere’s disease during an acute attack. A 54-year-old lady was diagnosed with left Meniere’s disease who during her regular clinic review suffers an acute attack of vertigo, with fullness and an increase of tinnitus in her left ear. Spontaneous nystagmus and the results in the video head-impulse test (vHIT are shown before, during, and after the attack. Nystagmus was initially left beating and a few minutes later an upbeat component was added. No skew deviation was observed. A decrease in the gain of the vestibuloocular reflex (VOR and the presence of overt saccades were observed when the stimuli were in the plane of the left superior semicircular canal. At the end of the crisis nystagmus decreased and vestibuloocular reflex returned to almost normal. A review of the different possibilities to explain these findings points to a hypothetical utricular damage.

  19. Physiological responses to acute experimental hypoxia in the air-breathing Indian catfish, Clarias batrachus (Linnaeus, 1758)

    Ratnesh Kumar Tripathi; Vindhya Mohindra; Akanksha Singh; Rajesh Kumar; Rahasya Mani Mishra; Joy Krushna Jena


    With an aim to study the mechanism of adaptation to acute hypoxic periods by hypoxia-tolerant catfish, Clarias batrachus, the mass-specific metabolic rate (VO2) along with its hematological parameters, metabolic response and antioxidant enzyme activities were studied. During progressive hypoxia, C. batrachus was found to be an oxyconformer and showed a steady decline in its aquatic oxygen consumption rate. When C. batrachus was exposed for different periods at experimental hypoxia level (0.98±0.1 mg/L, DO), hemoglobin and hematocrit concentrations were increased, along with decrease in mean cellular hemoglobin concentration, which reflected a physiological adaptation to enhance oxygen transport capacity. Significant increase in serum glucose and lactate concentration as well as lactate dehydrogenase activity was observed. Antioxidant enzymes were found to operate independently of one another, while total glutathione concentration was unaffected in any of the tissues across treatments. These observations suggested that hypoxia resulted in the development of oxidative stress and C. batrachus was able to respond through increase in the oxygen carrying capacity, metabolic depression and efficient antioxidant defense system to survive periods of acute hypoxia.

  20. Effects of acute thermal stress on the survival, predator avoidance, and physiology of juvenile fall Chinook salmon

    Mesa, M.G.; Weiland, L.K.; Wagner, P.


    We subjected juvenile fall chinook salmon from the Hanford Reach of the Columbia River to acute thermal stressors in the laboratory that were derived from field data. We assessed the effects of thermal stress on: (1) the extent of direct mortality; (2) the vulnerability of fish to predation by smallmouth bass; and (3) some general physiological stress responses and synthesis of heat shock protein 70 (hsp70). Thermally-stressed fish showed little direct mortality and no increases in vulnerability to predation. However, these fish showed transient increases in plasma concentrations of cortisol, glucose, and lactate, and a dramatic (25-fold higher than controls) and persistent (lasting 2 wk) increase in levels of liver hsp70. Our results indicate that exposure of Hanford Reach juvenile fall chinook salmon to such stressors did not lead to significant increases in direct mortality or vulnerability to predation, but did alter physiological homeostasis, which should be of concern to those managing this resource. Because our fish received only a single exposure to one of the stressors we examined, we are also concerned about the consequences of exposing fish to multiple, cumulative stressors - a likely scenario for fish in the wild.

  1. Effects of musical cadence in the acute physiologic adaptations to head-out aquatic exercises.

    Barbosa, Tiago M; Sousa, Vítor F; Silva, António J; Reis, Vítor M; Marinho, Daniel A; Bragada, José A


    The purpose of this study was to analyze the relationships between musical cadence and the physiologic adaptations to basic head-out aquatic exercises. Fifteen young and clinically healthy women performed, immersed to the breast, a cardiovascular aquatic exercise called the "rocking horse." The study design included an intermittent and progressive protocol starting at a 90 b.min(-1) rhythm and increasing every 6 minutes, by 15 b.min(-1), up to 195 b.min(-1) or exhaustion. The rating of perceived effort (RPE) at the maximal heart rate achieved during each bout (HRmax), the percentage of the maximal theoretical heart rate estimated (%HRmax), and the blood lactate concentration ([La-]) were evaluated. The musical cadence was also calculated at 4 mmol.L(-1) of blood lactate (R4), the RPE at R4 (RPE@R4), the HR at R4 (HR@R4), and the %HRmax at R4 (%HRmax@R4). Strong relationships were verified between the musical cadence and the RPE (R2 = 0.85; p musical cadence created an increase in the physiologic response. Therefore, instructors must choose musical cadences according to the goals of the session they are conducting to achieve the desired intensity.

  2. Validación del score de riesgo TIMI para pacientes con síndrome coronario agudo sin elevación del ST TIMI risk score validation for patients with acute coronary syndrome without ST elevation

    Rodrigo H. Bagur


    Full Text Available Los síndromes coronarios agudos sin elevación del segmento ST (SCA-SST son causa frecuente de hospitalización, siendo responsables del 10 al 15% de infartos de miocardio (IM o muertes al año. El objetivo fue evaluar eventos cardiovasculares a 6 meses de seguimiento y validar el score de riesgo TIMI (Thrombolysis in Myocardial Infarction en nuestra población. Se analizaron retrospectivamente pacientes con diagnóstico de SCA-SST. Se realizó seguimiento telefónico a los 6 meses del ingreso. Los puntos finales evaluados fueron la combinación de muerte, internación por síndrome coronario agudo y necesidad de revascularización. Se incluyeron 204 pacientes. El 70.2% eran hombres, edad promedio de 64.5 ± 11.8 años. Luego de la evaluación inicial, se hizo diagnóstico de angina inestable en el 34.6%, IM en 38.9% y el 26.4% fueron catalogados como "dolor no coronario". Al aplicar el score de TIMI, 52 (25.5% pacientes tenían riesgo bajo, 106 (52% riesgo intermedio, y 46 (22.5% riesgo alto. La mortalidad global fue 12.6%. Se encontró un incremento progresivo y significativo en la tasa de eventos combinados a medida que aumentaba el score de TIMI (p Non-ST elevation acute coronary syndromes (NSTE-ACS are frequent cause of hospitalization, being responsible for 10-15% of infarcts or deaths per year. The study was designed to analyze 6 months follow-up of cardiovascular events as well as to validate the Thrombolysis in Myocardial Infarction (TIMI risk score for patients hospitalized for NSTE-ACS. We retrospectively analyzed patients admitted with NSTE-ACS. Telephone follow-up were performed at 6 month. Combination of death, re-admission for acute coronary syndrome and revascularization were considered as end point. Two hundred and four patients were included for the analysis. There were 70.2% males, with a mean age of 64.5 ± 11.8 years. After the initial evaluation, we diagnosed unstable angina in 34.6% of cases, MI in 38.9% of cases, and 26

  3. Canada acute coronary syndrome score was a stronger baseline predictor than age ≥75 years of in-hospital mortality in acute coronary syndrome patients in western Romania

    Pogorevici A


    Full Text Available Antoanela Pogorevici, Ioana Mihaela Citu, Diana Aurora Bordejevic, Florina Caruntu, Mirela Cleopatra TomescuCardiology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, RomaniaBackground: Several risk scores were developed for acute coronary syndrome (ACS patients, but their use is limited by their complexity.Purpose: The purpose of this study was to identify predictors at admission for in-hospital mortality in ACS patients in western Romania, using a simple risk-assessment tool – the new Canada acute coronary syndrome (C-ACS risk score.Patients and methods: The baseline risk of patients admitted with ACS was retrospectively assessed using the C-ACS risk score. The score ranged from 0 to 4; 1 point was assigned for the presence of each of the following parameters: age ≥75 years, Killip class >1, systolic blood pressure <100 mmHg, and heart rate >100 bpm.Results: A total of 960 patients with ACS were included, 409 (43% with ST-segment elevation myocardial infarction (STEMI and 551 (57% with non-ST-segment elevation acute coronary syndrome (NSTE-ACS. The C-ACS score predicted in-hospital mortality in all ACS patients with a C-statistic of 0.95 (95% CI: 0.93–0.96, in STEMI patients with a C-statistic of 0.92 (95% confidence interval [CI]: 0.89–0.94, and in NSTE-ACS patients with a C-statistic of 0.97 (95% CI: 0.95–0.98. Of the 960 patients, 218 (22.7% were aged ≥75 years. The proportion of patients aged ≥75 years was 21.7% in the STEMI subgroup and 23.4% in the NSTE-ACS subgroup (P>0.05. Age ≥75 years was significantly associated with in-hospital mortality in ACS patients (odds ratio [OR]: 3.25, 95% CI: 1.24–8.25 and in the STEMI subgroup (OR >3.99, 95% CI: 1.28–12.44. Female sex was strongly associated with mortality in the NSTE-ACS subgroup (OR: 27.72, 95% CI: 1.83–39.99.Conclusion: We conclude that C-ACS score was the strongest predictor of in-hospital mortality in all ACS patients while

  4. Characterization and scoring of skin changes in severe acute malnutrition in children between 6 months and 5 years of age

    Heilskov, S; Vestergaard, Christian; Babirekere, E


    AND METHODS: At Mulago Hospital, Mwanamugimu (Department of Paediatrics and Child Health), Uganda, 120 children were included over a period of six months and observed when treated for severe acute malnutrition. Skin changes were registered through clinical examination and photo documentation and associated...

  5. Acute physiological stress promotes clustering of synaptic markers and alters spine morphology in the hippocampus.

    Veronica Sebastian

    Full Text Available GluA2-containing AMPA receptors and their association with protein kinase M zeta (PKMζ and post-synaptic density-95 (PSD-95 are important for learning, memory and synaptic plasticity processes. Here we investigated these synaptic markers in the context of an acute 1h platform stress, which can disrupt spatial memory retrieval for a short-term memory on the object placement task and long-term memory retrieval on a well-learned radial arm maze task. Acute stress increased serum corticosterone and elevated the expression of synaptic PKMζ while decreasing synaptic GluA2. Using co-immunoprecipitation, we found that this stressor promotes the clustering of GluA2, PKMζ and PSD-95, which is consistent with effects reported from overexpression of PKMζ in cell culture. Because PKMζ overexpression has also been shown to induce spine maturation in culture, we examined how stress impacts synaptic markers within changing spines across various hippocampal subfields. To achieve this, we employed a new technique combining Golgi staining and immmunohistochemistry to perform 3D reconstruction of tertiary dendrites, which can be analyzed for differences in spine types and the colocalization of synaptic markers within these spines. In CA1, stress increased the densities of long-thin and mushroom spines and the colocalization of GluA2/PSD-95 within these spines. Conversely, in CA3, stress decreased the densities of filopodia and stubby spines, with a concomitant reduction in the colocalization of GluA2/PSD-95 within these spines. In the outer molecular layer (OML of the dentate gyrus (DG, stress increased both stubby and long-thin spines, together with greater GluA2/PSD-95 colocalization. These data reflect the rapid effects of stress on inducing morphological changes within specific hippocampal subfields, highlighting a potential mechanism by which stress can modulate memory consolidation and retrieval.

  6. Clinical study on HAT and SEDAN score scales and related risk factors for predicting hemorrhagic transformation following thrombolysis in acute ischemic stroke

    Heng WEI


    Full Text Available Objective To investigate the value of HAT and SEDAN score scales in predicting hemorrhagic transformation (HT following the recombinant tissue-type plasminogen activator (rt-PA intravenous thrombolysis in acute ischemic stroke patients and risk factors affecting HT.  Methods A total of 143 patients with acute ischemic stroke underwent rt-PA intravenous thrombolysis within 4.50 h of onset and their clinical data were collected. According to head CT after thrombolysis, patients were divided into HT group (18 cases and non-HT group (125 cases. Single factor analysis was used to assess differences in HAT and SEDAN score scales and related risk factors of ischemic stroke in 2 groups, and further Logistic regression analysis was used to investigate independent predictors of HT. Receiver operating characteristic (ROC curve was used to evaluate the sensitivity and specificity of HAT and SEDAN score scales in predicting HT.  Results Univariate Logistic regression analysis showed that history of atrial fibrillation (AF, admission systolic blood pressure (SBP, admission blood glucose level, early low density of head CT, thrombolytic time window, National Institute of Health Stroke Scale (NIHSS, HAT and SEDAN scores were all risk factors for HT after thrombolysis (P < 0.05, for all. Multivariate Logistic regression analysis showed that history of AF (OR = 1.677, 95% CI: 1.332-2.111; P = 0.000, admission SBP (OR = 1.102, 95% CI: 1.009-1.204; P = 0.031, admission blood glucose level (OR = 1.870, 95% CI: 1.119-3.125; P = 0.017, thrombolysis time window (OR = 1.030, 95%CI: 1.009-1.052; P = 0.005, NIHSS score (OR = 1.574, 95%CI: 1.186-2.090; P = 0.002, HAT score (OR = 2.515, 95%CI: 1.273-4.970;P = 0.008 and SEDAN score (OR = 2.413, 95%CI: 1.123-5.185; P = 0.024 were risk factors for HT after thrombolysis. ROC curve analysis showed that HAT score could predict HT with 94.40% sensitivity and 41.60% specificity, and area under curve (AUC was 0.70. SEDAN

  7. Study on Alcoholic Withdrawal Score, with Questionnaire Based Session Conducted on Acute and Chronic Alcoholic Liver Disease Patients

    Bandi Navyatha


    Full Text Available Alcohol liver disease is damage to the Liver and its function due to alcohol abuse. It occurs after years of heavy drinking and by through which cirrhosis can occur and which leads to the final phase of Alcoholic liver disease. It not only occurs in heavy drinkers but also there is a chance of getting liver disease go up the longer of been drinking and more alcohol consumption. A study was observational, prospective and descriptive; and was carried out one hundred and nine patients [n=109] who were with suffering from an Alcoholic liver disease, to determine the alcohol withdrawal score and there symptoms involved after they were kept on alcohol withdrawal therapy. An observational, prospective and randomized study was conducted in the hospital from March 2014-March 2016. Questionnaire based session with 10 scaled questions were framed according to CIWA (assessment and management of alcohol withdrawal and the score was noted with their symptoms occurrence after the alcohol cessation plan. CIWA score with moderate severity were found to be highest. 7 patients out of 33 patients in severe category of CIWA score were admitted in the hospital with alcohol withdrawal syndrome and psychological disturbances. Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA helps clinicians assess and treat potential alcohol withdrawal.

  8. Acute physiological impacts of CO{sub 2} ocean sequestration on marine animals

    Ishimatsu, A.; Hayashi, M.; Lee, K.S.; Murata, K.; Kumagai, E. [Nagasaki Univ., Nagasaki (Japan). Marine Research Inst.; Kikkawa, T. [Marine Ecology Research Inst., Chiba (Japan). Central Laboratory; Kita, J. [Research Inst. of Innovative Technology for the Earth, Kyoto (Japan)


    The biological impacts of ocean carbon dioxide (CO{sub 2}) sequestration must be carefully considered before it is implemented as a mitigation strategy. This paper presented details of a study investigating the effects of high CO{sub 2} concentrations on marine fish, lobster, and octopus. The influence of water temperature on the physiological effects of CO{sub 2} was also discussed. In the first part of the study, eggs and larvae of red seabream were exposed to both CO{sub 2} and HCI-acidified seawater at identical pH levels. Seabream in the CO{sub 2} group showed a much higher mortality rate than fish in the HCI group. Other tests showed that Japanese Flounder died after complete recovery of pH in seawater equilibrated with 5 per cent CO{sub 2}. Cardiac output was rapidly depressed in Yellowtail fish without significant changes in blood oxygen concentrations. Lower temperatures resulted in higher mortality and delayed pH recovery during hypercapnia in all fish. Western rock lobsters were the most tolerant to CO{sub 2} among all species tested. The recovery of hemolymph pH was complete at exposure to CO{sub 2} concentrations of 1 per cent. Changes in hemolymph bicarbonate concentrations indicated that acid-based regulatory mechanisms differed between fish and lobsters. Mortality rates for octopus were significant at CO{sub 2} concentrations of 1 per cent. The results of all tests showed that aquatic animals are more susceptible to increases in ambient CO{sub 2} levels than terrestrial animals. It was concluded that even slight elevations in CO{sub 2} concentration levels adversely affected physiological functioning in the tested species. It was concluded that CO{sub 2} sequestration in deeper, colder waters will have a more pronounced effect on aquatic animals due to the interactions between CO{sub 2} and lower temperatures, as well as the fact that most deep-sea fish are less tolerant to environmental perturbations. 3 refs., 1 tab., 3 figs.

  9. Part 2: effect of training surface on acute physiological responses after sport-specific training.

    Binnie, Martyn J; Dawson, Brian; Pinnington, Hugh; Landers, Grant; Peeling, Peter


    This study compared the effect of sand and grass training surfaces during a sport-specific conditioning session in well-trained team sport athletes (n = 10). The participants initially completed a preliminary testing session to gather baseline (BASE) performance data for vertical jump, repeated sprint ability, and 3-km running time trial. Three days subsequent to BASE, all the athletes completed the first sport-specific conditioning session, which was followed by a repeat of the BASE performance tests the following day (24 hours postexercise). Seven days later, the same training session was completed on the opposing surface and was again followed 24 hours later by the BASE performance tests. During each session, blood lactate, ratings of perceived exertion (RPE), and heart rate (HR) were recorded, with player movement patterns also monitored via global positioning system units. Additionally, venous blood was collected preexercise, postexercise, and 24 hours postexercise, and analyzed for serum concentrations of Myoglobin, Haptoglobin, and C-Reactive Protein. Results showed significantly higher HR and RPE responses on SAND (p > 0.05), despite significantly lower distance and velocity outputs for the training session (p > 0.05). There were no differences in 24 hours postexercise performance (p > 0.05), and blood markers of muscle damage, inflammation and hemolysis were also similar between the surfaces (p > 0.05). These results suggest that performing a sport-specific conditioning session on a sand (vs. grass) surface can result in a greater physiological response, without any additional decrement to next-day performance.

  10. Methyl parathion and fenvalerate toxicity in American kestrels: Acute physiological responses and effects of cold

    Rattner, B.A.; Franson, J.C.


    Physiological and toxicological effects of p.o. methyl parathion (0.375-3.0 mg/kg) or fenvalerate (1000-4000 mg/kg) were examined over a 10-h period in American kestrels (Falco sparverius) maintained in thermoneutral (22?C) and cold (-5?C) environments. Methyl parathion was highly toxic (estimated median lethal dose of 3.08 mg/kg, 95% confidence limits of 2.29 -4.14 mg/kg), producing dose-dependent inhibition of brain and plasma cholinesterase activity, hyperglycemia, and elevated plasma corticosterone concentration. Brain and plasma cholinesterase inhibition in excess of 50% was associated with transient but pronounced hypothermia 2 h after intubation, although the magnitude of this response was yariable. Fenvalerate, at doses far exceeding those encountered in the environment, caused mild intoxication and elevated plasma alanine aminotransferase activity. Cold intensified methyl parathion toxicity, but did not affect that of fenvalerate. Thus, it would appear that organophosphorus insecticides pose far greater hazard than pyrethroids to raptorial birds.

  11. A novel Respiratory Health Score (RHS supports a role of acute lung damage and pig breed in the course of an Actinobacillus pleuropneumoniae infection

    Gerlach Gerald F


    Full Text Available Abstract Background Bacterial lung infections are a major cause of economic losses in the pig industry; they are responsible for approximately 50% of the antibiotics used in pigs and, therefore, also present an increasing concern to consumer protection agencies. In response to this changing market we investigated the feasibility of an old approach aimed at the breeding selection of more resistant pigs. As a first step in this direction we applied a new respiratory health score system to study the susceptibility of four different pig breeding lines (German Landrace, Piétrain, Hampshire, Large White towards the respiratory tract pathogen Actinobacillus (A. pleuropneumoniae. Results A controlled experimental aerosol infection with an A. pleuropneumoniae serotype 7 isolate was performed using 106 weaning pigs of defined breeding lines from the breeds German Landrace, Piétrain, Hamphire, and Large White. Pigs were clinically assessed on days 4 and 20 post infection following a novel scoring system, the Respiratory Health Score (RHS, which combines clinical, sonographic and radiographic examination results. The ranking on day 4 was significantly correlated with the ranking based on the pathomorphological Lung Lesion Score (LLS; Spearman Rank Correlation Coefficient of 0.86 [p Conclusion These results demonstrate that the RHS obtained from live pigs shows a highly significant correlation to the lung lesion score considered as a "gold standard". The correlation of the ranking at days 4 and 20 post infection implies that the course of disease is highly dependent on the acute lung damage. The different severity of signs among the tested pig breeding lines clearly suggests a genetic difference in the susceptibility of pigs to A. pleuropneumoniae infection.

  12. Elaboration of a clinical and paraclinical score to estimate the probability of herpes simplex virus encephalitis in patients with febrile, acute neurologic impairment.

    Gennai, S; Rallo, A; Keil, D; Seigneurin, A; Germi, R; Epaulard, O


    Herpes simplex virus (HSV) encephalitis is associated with a high risk of mortality and sequelae, and early diagnosis and treatment in the emergency department are necessary. However, most patients present with non-specific febrile, acute neurologic impairment; this may lead clinicians to overlook the diagnosis of HSV encephalitis. We aimed to identify which data collected in the first hours in a medical setting were associated with the diagnosis of HSV encephalitis. We conducted a multicenter retrospective case-control study in four French public hospitals from 2007 to 2013. The cases were the adult patients who received a confirmed diagnosis of HSV encephalitis. The controls were all the patients who attended the emergency department of Grenoble hospital with a febrile acute neurologic impairment, without HSV detection by polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF), in 2012 and 2013. A multivariable logistic model was elaborated to estimate factors significantly associated with HSV encephalitis. Finally, an HSV probability score was derived from the logistic model. We identified 36 cases and 103 controls. Factors independently associated with HSV encephalitis were the absence of past neurological history (odds ratio [OR] 6.25 [95 % confidence interval (CI): 2.22-16.7]), the occurrence of seizure (OR 8.09 [95 % CI: 2.73-23.94]), a systolic blood pressure ≥140 mmHg (OR 5.11 [95 % CI: 1.77-14.77]), and a C-reactive protein probability score was calculated summing the value attributed to each independent factor. HSV encephalitis diagnosis may benefit from the use of this score based upon some easily accessible data. However, diagnostic evocation and probabilistic treatment must remain the rule.

  13. Alberta Stroke Program Early CT Score applied to CT angiography source images is a strong predictor of futile recanalization in acute ischemic stroke

    Kawiorski, Michal M.; Alonso de Lecinana, Maria [Hospital Universitario La Paz, IdiPAZ, Universidad Autonoma de Madrid, Madrid (Spain); Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala de Henares, Madrid (Spain); Martinez-Sanchez, Patricia; Fuentes, Blanca; Sanz-Cuesta, Borja E.; Marin, Begona; Ruiz-Ares, Gerardo; Diez-Tejedor, Exuperio [Hospital Universitario La Paz, IdiPAZ, Universidad Autonoma de Madrid, Madrid (Spain); Garcia-Pastor, Andres; Diaz-Otero, Fernando [Hospital Universitario Gregorio Maranon, IiSGM, Universidad Complutense de Madrid, Madrid (Spain); Calleja, Patricia [Hospital Universitario 12 de Octubre, Universidad Autonoma de Madrid, Madrid (Spain); Lourido, Daniel; Vicente, Agustina; Fandino, Eduardo [Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala de Henares, Madrid (Spain); Sierra-Hidalgo, Fernando [Hospital Universitario 12 de Octubre, Universidad Autonoma de Madrid, Madrid (Spain); Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid (Spain)


    Reliable predictors of poor clinical outcome despite successful revascularization might help select patients with acute ischemic stroke for thrombectomy. We sought to determine whether baseline Alberta Stroke Program Early CT Score (ASPECTS) applied to CT angiography source images (CTA-SI) is useful in predicting futile recanalization. Data are from the FUN-TPA study registry (; NCT02164357) including patients with acute ischemic stroke due to proximal arterial occlusion in anterior circulation, undergoing reperfusion therapies. Baseline non-contrast CT and CTA-SI-ASPECTS, time-lapse to image acquisition, occurrence, and timing of recanalization were recorded. Outcome measures were NIHSS at 24 h, symptomatic intracranial hemorrhage, modified Rankin scale score, and mortality at 90 days. Futile recanalization was defined when successful recanalization was associated with poor functional outcome (death or disability). Included were 110 patients, baseline NIHSS 17 (IQR 12; 20), treated with intravenous thrombolysis (IVT; 45 %), primary mechanical thrombectomy (MT; 16 %), or combined IVT + MT (39 %). Recanalization rate was 71 %, median delay of 287 min (225; 357). Recanalization was futile in 28 % of cases. In an adjusted model, baseline CTA-SI-ASPECTS was inversely related to the odds of futile recanalization (OR 0.5; 95 % CI 0.3-0.7), whereas NCCT-ASPECTS was not (OR 0.8; 95 % CI 0.5-1.2). A score ≤5 in CTA-SI-ASPECTS was the best cut-off to predict futile recanalization (sensitivity 35 %; specificity 97 %; positive predictive value 86 %; negative predictive value 77 %). CTA-SI-ASPECTS strongly predicts futile recanalization and could be a valuable tool for treatment decisions regarding the indication of revascularization therapies. (orig.)

  14. Intracerebral Hemorrhage; towards physiological imaging of hemorrhage risk in acute and chronic bleeding.

    Raphael eJakubovic


    Full Text Available Despite improvements in management and prevention of intracerebral hemorrhage (ICH, there has been little improvement in mortality over the last 30 years. Hematoma expansion, primarily during the first few hours is highly predictive of neurological deterioration, poor functional outcome and mortality. For each 10% increase in ICH size, there is a 5% increase in mortality and an additional 16% chance of poorer functional outcome. As such, both the identification and prevention of hematoma expansion are attractive therapeutic targets in ICH. Previous studies suggest that contrast extravasation seen on CT Angiography (CTA, MRI, and digital subtraction angiography correlates with hematoma growth, indicating ongoing bleeding. Contrast extravasation on the arterial phase of a CTA has been coined the CTA Spot Sign. These easily identifiable foci of contrast enhancement have been identified as independent predictors of hematoma growth, mortality and clinical outcome in primary ICH. The Spot Sign score, developed to stratify risk of hematoma expansion, has shown high inter-observer agreement. Post-contrast leakage or delayed CTA Spot Sign, on post contrast CT following CTA or delayed CTA respectively are seen in an additional ~8% of patients and explain apparently false negative observations on early CTA imaging in patients subsequently undergoing hematoma expansion. CT perfusion provides an opportunity to acquire dynamic imaging and has been shown to quantify rates of contrast extravasation. Intravenous recombinant factor VIIa(rFVIIa within 4 hours of ICH onset has been shown to significantly reduce hematoma growth. However, clinical efficacy has yet to be proven. There is compelling evidence that cerebral amyloid angiopathy (CAA may precede the radiographic evidence of vascular disease and as such contribute to microbleeding. The interplay between microbleeding, CAA,CTA Spot Sign and genetic composition (ApoE genotype may be crucial in developing a

  15. Dickkopf-1 as a novel predictor is associated with risk stratification by GRACE risk scores for predictive value in patients with acute coronary syndrome: a retrospective research.

    Lin Wang

    Full Text Available OBJECTIVE: Dickkopf-1 (DKK-1, a major regulator of the Wnt pathway, plays an important role in cardiovascular disease. However, no study has evaluated the association of DKK-1 and acute coronary syndrome (ACS. We investigated this association and whether the Global Registry of Acute Coronary Events (GRACE hospital-discharge risk score predicting major adverse cardiac events (MACE can be improved by adding the DKK-1 value. METHODS: We enrolled 291 patients (46 with ST-segment elevation myocardial infarction [STEMI] and 245 with non-ST elevated ACS [NSTE-ACS] who were divided into groups by tertiles of baseline plasma DKK-1 level measured by ELISA. The GRACE risk score was calculated and predictive value alone and together with DKK-1 and/or high-sensitivity C-reactive protein (hs-CRP level were assessed, respectively. RESULTS: Compared with patients with NSTE-ACS, those with STEMI had higher plasma DKK-1 level at baseline (P = 0.006. Plasma DKK-1 level was correlated with hs-CRP level (r = 0.295, P<0.001 and was greater with high than intermediate or low GRACE scores (P = 0.002 and P<0.001, respectively. We found 44 (15.1% MACEs during a median 2-year follow-up. DKK-1 levels were higher for patients with than without events (P<0.001. The rate of MACE increased with increasing DKK-1 level (P<0.001. The area under the receiver operating characteristic curve for GRACE score with MACE was 0.524 and improved to 0.791 with the addition of hs-CRP level, 0.775 with the addition of DKK-1 level and 0.847 with both values added. CONCLUSIONS: DKK-1 is an independent predictor of long-term MACE of patients with ACS. The long-term predictive ability of post-discharge GRACE score may be enhanced by adding DKK-1 level.

  16. Tennis for physical health: acute age- and gender-based physiological responses to cardio tennis.

    Murphy, Alistair P; Duffield, Rob; Reid, Machar


    This study described physiological and perceptual responses to Cardio tennis for "younger" and "older" adult populations of both sexes for health-related outcomes. Thirty-one active participants, each with prior recreational tennis experience (∼2 years) (8 younger and 8 older males, and 7 younger and 8 older females) performed preliminary testing and a 50-minute instructor-led Cardio tennis session. Cardio tennis is a conditioning-based tennis program comprised of warm-up movements, drill-based exercises (set movement and hitting games), and competitive play scenarios. Participants performed the 20-m shuttle run test to determine maximal heart rate (HR) during preliminary testing. Before, after, and 30-minute post Cardio tennis session, HR, blood pressure (BP), rate pressure product (RPP), and capillary blood lactate and glucose were determined. Furthermore, HR and pedometer-derived step counts were measured throughout, while the session was filmed and coded for technical skill. After the session, ratings of perceived exertion, enjoyment, and challenge were obtained. Heart rate, systolic BP, and RPP were significantly increased by Cardio tennis (p ≤ 0.05), though returned to pre-exercise levels after 30 minutes (p > 0.05). Heart rate and BP did not differ between groups pre- or 30-minute postexercise (p > 0.05); however, these were lower in younger males during and higher in younger females postsession (p ≤ 0.05). Lactate and glucose concentrations were increased in all groups (p ≤ 0.05), with lactate being highest in male groups (p ≤ 0.05), without differences in glucose between groups (p > 0.05). Stroke and step counts were not different between groups (p > 0.05). Ratings of perceived exertion and perceived challenge were lowest in the younger male group compared with all other groups (p ≤ 0.05). Cardio tennis presents as an effective stimulus to invoke sufficient cardiovascular and metabolic load to benefit health and fitness, though age- and sex

  17. Use of Renal Replacement Therapy May Influence Graft Outcomes following Liver Transplantation for Acute Liver Failure: A Propensity-Score Matched Population-Based Retrospective Cohort Study.

    Stephen R Knight

    Full Text Available Acute kidney injury is associated with a poor prognosis in acute liver failure but little is known of outcomes in patients undergoing transplantation for acute liver failure who require renal replacement therapy.A retrospective analysis of the United Kingdom Transplant Registry was performed (1 January 2001-31 December 2011 with patient and graft survival determined using Kaplan-Meier methods. Cox proportional hazards models were used together with propensity-score based full matching on renal replacement therapy use.Three-year patient and graft survival for patients receiving renal replacement therapy were 77.7% and 72.6% compared with 85.1% and 79.4% for those not requiring renal replacement therapy (P<0.001 and P = 0.009 respectively, n = 725. In a Cox proportional hazards model, renal replacement therapy was a predictor of both patient death (hazard ratio (HR 1.59, 95% CI 1.01-2.50, P = 0.044 but not graft loss (HR 1.39, 95% CI 0.92-2.10, P = 0.114. In groups fully matched on baseline covariates, those not receiving renal replacement therapy with a serum creatinine greater than 175 μmol/L had a significantly worse risk of graft failure than those receiving renal replacement therapy.In patients being transplanted for acute liver failure, use of renal replacement therapy is a strong predictor of patient death and graft loss. Those not receiving renal replacement therapy with an elevated serum creatinine may be at greater risk of early graft failure than those receiving renal replacement therapy. A low threshold for instituting renal replacement therapy may therefore be beneficial.

  18. In-hospital prognosis in non-ST-segment elevation acute coronary syndrome derived using a new risk score based on electrocardiographic parameters obtained at admission.

    Jiménez-Candil, Javier; González Matas, José Manuel; Cruz González, Ignacio; Hernández Hernández, Jesús; Martín, Ana; Pabón, Pedro; Martín, Francisco; Martín-Luengo, Cándido


    Several electrocardiographic variables are of prognostic value in non-ST-segment elevation acute coronary syndrome (NSTEACS). From observations in 427 patients, we developed a new risk score (the ECG-RS) based on admission ECG findings that can be used to determine the likelihood of death or recurrent ischemia during hospitalization, which occurred in 36% of patients. Logistic regression analysis, which considered seven electrocardiographic variables and variables from the Thrombolysis in Myocardial Infarction (TIMI) risk score, identified the following significant predictors: corrected QT interval (QTc) > or =450 ms (odds ratio 4.2, Psegment depression >0.5 mm (odds ratio 2.7, P or =450 ms, 2 points for ST-segment depression >0.5 mm, and 1 point for left atrial enlargement. When patients were divided into three groups on the basis of their ECG-RSs (i.e. or =4), the risk of death or recurrent ischemia was significantly different between the groups, at 11%, 27% and 58%, respectively (P< .001). In conclusion, the new ECG-RS provides a simple, rapid and accurate means of determining prognosis in patients with NSTEACS.

  19. The Impact of Acute and Chronic Weight Restriction and Weight Regulation practices on Physiological, Osteogenic, Metabolic and Cognitive Function in Elite Jockeys

    Dolan, Eimear


    Horse racing is a weight category sport. One of the key challenges facing jockeys is the pressure of “making weight” throughout the protracted racing season. Aim: The aim of this study was to examine the effect of a chronically weight restrictive lifestyle and acute weight loss practices on aspects of physiological, osteogenic, metabolic and cognitive function in jockeys. Methods: The primary aim was achieved through the completion of four related studies. Study One: The effect of a 4% reduct...

  20. Comparison and combination of a hemodynamics/biomarkers-based model with simplified PESI score for prognostic stratification of acute pulmonary embolism: findings from a real world study

    Luca Masotti


    Full Text Available Background: Prognostic stratification is of utmost importance for management of acute Pulmonary Embolism (PE in clinical practice. Many prognostic models have been proposed, but which is the best prognosticator in real life remains unclear. The aim of our study was to compare and combine the predictive values of the hemodynamics/biomarkers based prognostic model proposed by European Society of Cardiology (ESC in 2008 and simplified PESI score (sPESI. Methods: Data records of 452 patients discharged for acute PE from Internal Medicine wards of Tuscany (Italy were analysed. The ESC model and sPESI were retrospectively calculated and compared by using Areas under Receiver Operating Characteristics (ROC Curves (AUCs and finally the combination of the two models was tested in hemodinamically stable patients. All cause and PE-related in-hospital mortality and fatal or major bleedings were the analyzed endpoints Results: All cause in-hospital mortality was 25% (16.6% PE related in high risk, 8.7% (4.7% in intermediate risk and 3.8% (1.2% in low risk patients according to ESC model. All cause in-hospital mortality was 10.95% (5.75% PE related in patients with sPESI score and #8805;1 and 0% (0% in sPESI score 0. Predictive performance of sPESI was not significantly different compared with 2008 ESC model both for all cause (AUC sPESI 0.711, 95% CI: 0.661-0.758 versus ESC 0.619, 95% CI: 0.567-0.670, difference between AUCs 0.0916, p=0.084 and for PE-related mortality (AUC sPESI 0.764, 95% CI: 0.717-0.808 versus ESC 0.650, 95% CI: 0.598-0.700, difference between AUCs 0.114, p=0.11. Fatal or major bleedings occurred in 4.30% of high risk, 1.60% of intermediate risk and 2.50% of low risk patients according to 2008 ESC model, whereas these occurred in 1.80% of high risk and 1.45% of low risk patients according to sPESI, respectively. Predictive performance for fatal or major bleeding between two models was not significantly different (AUC sPESI 0.658, 95% CI

  1. New Comprehensive Cytogenetic Scoring System for Primary Myelodysplastic Syndromes (MDS) and Oligoblastic Acute Myeloid Leukemia After MDS Derived From an International Database Merge

    Schanz, Julie; Tüchler, Heinz; Solé, Francesc; Mallo, Mar; Luño, Elisa; Cervera, José; Granada, Isabel; Hildebrandt, Barbara; Slovak, Marilyn L.; Ohyashiki, Kazuma; Steidl, Christian; Fonatsch, Christa; Pfeilstöcker, Michael; Nösslinger, Thomas; Valent, Peter; Giagounidis, Aristoteles; Aul, Carlo; Lübbert, Michael; Stauder, Reinhard; Krieger, Otto; Garcia-Manero, Guillermo; Faderl, Stefan; Pierce, Sherry; Le Beau, Michelle M.; Bennett, John M.; Greenberg, Peter; Germing, Ulrich; Haase, Detlef


    Purpose The karyotype is a strong independent prognostic factor in myelodysplastic syndromes (MDS). Since the implementation of the International Prognostic Scoring System (IPSS) in 1997, knowledge concerning the prognostic impact of abnormalities has increased substantially. The present study proposes a new and comprehensive cytogenetic scoring system based on an international data collection of 2,902 patients. Patients and Methods Patients were included from the German-Austrian MDS Study Group (n = 1,193), the International MDS Risk Analysis Workshop (n = 816), the Spanish Hematological Cytogenetics Working Group (n = 849), and the International Working Group on MDS Cytogenetics (n = 44) databases. Patients with primary MDS and oligoblastic acute myeloid leukemia (AML) after MDS treated with supportive care only were evaluated for overall survival (OS) and AML evolution. Internal validation by bootstrap analysis and external validation in an independent patient cohort were performed to confirm the results. Results In total, 19 cytogenetic categories were defined, providing clear prognostic classification in 91% of all patients. The abnormalities were classified into five prognostic subgroups (P < .001): very good (median OS, 61 months; hazard ratio [HR], 0.5; n = 81); good (49 months; HR, 1.0 [reference category]; n = 1,809); intermediate (26 months; HR, 1.6; n = 529); poor (16 months; HR, 2.6; n = 148); and very poor (6 months; HR, 4.2; n = 187). The internal and external validations confirmed the results of the score. Conclusion In conclusion, these data should contribute to the ongoing efforts to update the IPSS by refining the cytogenetic risk categories. PMID:22331955

  2. Propensity score-matched analysis of effects of clinical characteristics and treatment on gender difference in outcomes after acute myocardial infarction.

    Schiele, François; Meneveau, Nicolas; Seronde, Marie-France; Descotes-Genon, Vincent; Chopard, Romain; Janin, Sebastien; Briand, Florent; Guignier, Alexandre; Ecarnot, Fiona; Bassand, Jean-Pierre


    The greater mortality observed in women compared to men after acute myocardial infarction remains unexplained. Using an analysis of pairs, matched on a conditional probability of being male (propensity score), we assessed the effect of the baseline characteristics and management on 30-day mortality. Consecutive patients were included from January 2006 to December 2007. Two propensity scores (for being male) were calculated, 1 from the baseline characteristics and 1 from both the baseline characteristics and treatment. Two matched cohorts were composed using 1:1 matching and computed using the best 8 digits of the propensity score. Paired analyses were performed using conditional regression analysis. During the study period, 3,510 patients were included in the registry; 1,119 (32%) were women. Compared to the men, the women were 10 years older, had more co-morbidities, less often underwent angiography and reperfusion, and received less medical treatment. The 30-day mortality rate was 12.3% (130 of 1,060) for the women and 7.2% (167 of 2,324) for the men (p <0.001). The 2 matched populations represented 1,298 and 1,168 patients. After matching using the baseline characteristics, the only difference in treatment was a lower rate of angiography and reperfusion, with a trend toward greater 30-day mortality in women. After matching using both baseline characteristics and treatment, the 30-day mortality was similar for the men and women, suggesting that the increased use of invasive procedures in women could potentially be beneficial. In conclusion, compared to men, the 30-day mortality is greater in women and explained primarily by differences in baseline characteristics and to a lesser degree by differences in management. The difference in the use of invasive procedures persisted after matching by characteristics. In contrast, after matching using the baseline characteristics and treatment, the 30-day mortality was comparable across the genders.

  3. Glasgow coma scale and APACHE-II scores affect the liver transplantation outcomes in patients with acute liver failure

    Necdet Guler; Omer Unalp; Ayse Guler; Onur Yaprak; Murat Dayangac; Murat Sozbilen; Murat Akyildiz and Yaman Tokat


    BACKGROUND: The timing and selection of patients for liver transplantation in acute liver failure are great challenges. This study  aimed  to  investigate  the  effect  of  Glasgow  coma  scale (GCS) and APACHE-II scores on liver transplantation outcomes in patients with acute liver failure. METHOD: A total of 25 patients with acute liver failure were retrospectively  analyzed  according  to  age,  etiology,  time  to transplantation, coma scores, complications and mortality. RESULTS: Eighteen  patients  received  transplants  from  live donors and 7 had cadaveric whole liver transplants. The mean duration  of  follow-up  after  liver  transplantation  was  39.86± 40.23  months.  Seven  patients  died  within  the  perioperative period and the 1-, 3-, 5-year survival rates of the patients were 72%, 72% and 60%, respectively. The parameters evaluated for the perioperative deaths versus alive were as follows: the mean age of the patients was 33.71 vs 28 years, MELD score was 40 vs 32.66, GCS was 5.57 vs 10.16, APACHE-II score was 23 vs 18.11, serum sodium level was 138.57 vs 138.44 mmol/L, mean waiting time before the operation was 12 vs 5.16 days. Low GCS, high APACHE-II score and longer waiting time before the operation (P CONCLUSION: Lower GCS and higher APACHE-II scores are related to poor outcomes in patients with acute liver failure after liver transplantation.

  4. Additive prognostic value of the SYNTAX score over GRACE, TIMI, ZWOLLE, CADILLAC and PAMI risk scores in patients with acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention.

    Brkovic, Voin; Dobric, Milan; Beleslin, Branko; Giga, Vojislav; Vukcevic, Vladan; Stojkovic, Sinisa; Stankovic, Goran; Nedeljkovic, Milan A; Orlic, Dejan; Tomasevic, Miloje; Stepanovic, Jelena; Ostojic, Miodrag


    This study evaluated additive prognostic value of the SYNTAX score over GRACE, TIMI, ZWOLLE, CADILLAC and PAMI risk scores in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). All six scores were calculated in 209 consecutive STEMI patients undergoing pPCI. Primary end-point was the major adverse cardiovascular event (MACE--composite of cardiovascular mortality, non-fatal myocardial infarction and stroke); secondary end point was cardiovascular mortality. Patients were stratified according to the SYNTAX score tertiles (≤12; between 12 and 19.5; >19.5). The median follow-up was 20 months. Rates of MACE and cardiovascular mortality were highest in the upper tertile of the SYNTAX score (p SYNTAX score was independent multivariable predictor of MACE and cardiovascular mortality when added to GRACE, TIMI, ZWOLLE, and PAMI risk scores. However, the SYNTAX score did not improve the Cox regression models of MACE and cardiovascular mortality when added to the CADILLAC score. The SYNTAX score has predictive value for MACE and cardiovascular mortality in patients with STEMI undergoing primary PCI. Furthermore, SYNTAX score improves prognostic performance of well-established GRACE, TIMI, ZWOLLE and PAMI clinical scores, but not the CADILLAC risk score. Therefore, long-term survival in patients after STEMI depends less on detailed angiographical characterization of coronary lesions, but more on clinical characteristics, myocardial function and basic angiographic findings as provided by the CADILLAC score.

  5. Bedside index for severity in acute pancreatitis:comparison with other scoring systems in predicting severity and organ failure

    Ji Young Park; Tae Joo Jeon; Tae Hwan Ha; Jin Tae Hwang; Dong Hyun Sinn; Tae-Hoon Oh


    BACKGROUND: The  early  identification  of  severe  acute pancreatitis is important for the management and for improving outcomes. The bedside index for severity in acute pancreatitis (BISAP)  has  been  considered  as  an  accurate  method  for  risk stratification  in  patients  with  acute  pancreatitis.  This  study aimed to evaluate the comparative usefulness of the BISAP. METHODS: We  retrospectively  analyzed  303  patients  with acute pancreatitis diagnosed at our hospital from March 2007 to  December  2010.  BISAP,  APACHE-II,  Ranson  criteria,  and CT  severity  index  (CTSI)  of  all  patients  were  calculated.  We stratified  the  number  of  patiants  with  severe  pancreatitis, pancreatic  necrosis,  and  organ  failure  as  well  as  the  number of deaths by BISAP score. We used the area under the receiver-operating  curve  (AUC)  to  compare  BISAP  with  other  scoring systems,  C-reactive  protein  (CRP),  hematocrit,  and  body mass  index  (BMI)  with  regard  to  prediction  of  severe  acute pancreatitis, necrosis, organ failure, and death. RESULTS: Of  the  303  patiants,  31  (10.2%)  were  classified  as having severe acute pancreatitis. Organ failure occurred in 23 (7.6%) patients, pancreatic necrosis in 40 (13.2%), and death in 6 (2.0%). A BISAP score of 2 was a statistically significant cutoff value for the diagnosis of severe acute pancreatitis, organ failure, and mortality. AUCs for BISAP predicting severe pancreatitis and death were 0.80 and 0.86, respectively, which were similar to those for APACHE-II (0

  6. Physiological noise in murine solid tumours using T2*-weighted gradient-echo imaging: a marker of tumour acute hypoxia?

    Baudelet, Christine; Ansiaux, Réginald; Jordan, Bénédicte F.; Havaux, Xavier; Macq, Benoit; Gallez, Bernard


    T2*-weighted gradient-echo magnetic resonance imaging (T2*-weighted GRE MRI) was used to investigate spontaneous fluctuations in tumour vasculature non-invasively. FSa fibrosarcomas, implanted intramuscularly (i.m.) in the legs of mice, were imaged at 4.7 T, over a 30 min or 1 h sampling period. On a voxel-by-voxel basis, time courses of signal intensity were analysed using a power spectrum density (PSD) analysis to isolate voxels for which signal changes did not originate from Gaussian white noise or linear drift. Under baseline conditions, the tumours exhibited spontaneous signal fluctuations showing spatial and temporal heterogeneity over the tumour. Statistically significant fluctuations occurred at frequencies ranging from 1 cycle/3 min to 1 cycle/h. The fluctuations were independent of the scanner instabilities. Two categories of signal fluctuations were reported: (i) true fluctuations (TFV), i.e., sequential signal increase and decrease, and (ii) profound drop in signal intensity with no apparent signal recovery (SDV). No temporal correlation between tumour and contralateral muscle fluctuations was observed. Furthermore, treatments aimed at decreasing perfusion-limited hypoxia, such as carbogen combined with nicotinamide and flunarizine, decreased the incidence of tumour T2*-weighted GRE fluctuations. We also tracked dynamic changes in T2* using multiple GRE imaging. Fluctuations of T2* were observed; however, fluctuation maps using PSD analysis could not be generated reliably. An echo-time dependency of the signal fluctuations was observed, which is typical to physiological noise. Finally, at the end of T2*-weighted GRE MRI acquisition, a dynamic contrast-enhanced MRI was performed to characterize the microenvironment in which tumour signal fluctuations occurred in terms of vessel functionality, vascularity and microvascular permeability. Our data showed that TFV were predominantly located in regions with functional vessels, whereas SDV occurred in regions

  7. Amplitude-integrated electroencephalographic activity is suppressed in preterm infants with high scores on illness severity

    ter Horst, Hendrik J.; Jongbloed-Pereboom, Marjolein; van Eykern, Leo A.; Bos, Arend F.


    Background: The neonatal acute physiology score. SNAP-II, reflects the severity of illness in newborns. In term newborns, amplitude integrated EEG (aEEG), is depressed following asphyxia. In preterm infants aEEG is discontinuous, and therefore more difficult to assess compared to term infants. Aims:

  8. Apgar score

    ... this page: // Apgar score To use the sharing features on this page, ... birth. Virginia Apgar, MD (1909-1974) introduced the Apgar score in 1952. How the Test is Performed The ...

  9. Clinical use of the combined Sclarovsky Birnbaum Severity and Anderson Wilkins Acuteness scores from the pre-hospital ECG in ST-segment elevation myocardial infarction

    Fakhri, Yama; Schoos, Mikkel M; Clemmensen, Peter


    This review summarizes the electrocardiographic changes during an evolving ST segment elevation myocardial infarction and discusses associated electrocardiographic scores and the potential use of these indices in clinical practice, in particular the ECG scores developed by Anderson and Wilkins...

  10. Effect of a Six-Week Preparation Period on Acute Physiological Responses to a Simulated Combat in Young National-Level Taekwondo Athletes

    Nikolaidis Pantelis T.


    Full Text Available The aim of this study was to examine changes in physical attributes, physiological characteristics and responses that occurred in a simulated combat during a six-week preparatory period in young taekwondo athletes. Seven athletes (age 12.17 ±1.11 years were examined before (pre-intervention and after (post-intervention a preparatory period for physical fitness and physiological responses to a 2×90 s simulated bout with a 30 s rest period. The heart rate (HR was monitored during the simulated combat, and handgrip muscle strength (HMS along with the countermovement jump (CMJ were recorded before and after the combat. When compared with pre-intervention values, in post-intervention we observed a decrease in body mass, body fat percentage, and the HR at rest and during recovery after a 3 min step test, and an increase in maximal velocity of the cycle ergometer force-velocity test, the CMJ and mean power during the 30 s continuous jumping test (p<0.05. Furthermore, HR responses to a simulated combat were lower in the post-intervention session (p<0.05. CMJ values increased after the bout in both pre and post-intervention, with higher absolute values in the latter case (p<0.05, whereas there was no difference in HMS. Based on these findings, it can be concluded that the acute physiological responses to a simulated taekwondo combat vary during a season, which might be explained by changes in physical fitness.

  11. Relação entre o escore de comportamento materno e as características fisiológicas de ovelhas Relation between maternal behavior score with physiological characteristics of ewes

    Marta Farias Aita


    Full Text Available Neste estudo objetivou-se avaliar a relação do escore de comportamento materno de ovelhas com os parâmetros fisiológicos relacionados ao seu temperamento. Durante a parição, foram avaliadas 258 ovelhas Corriedale e 50 ovelhas Ideal criadas em campo natural em três fazendas na região sudoeste do estado do Rio Grande do Sul, Brasil. Foram analisados os efeitos propriedade, idade, tipo de parto, escore de comportamento materno e escore de condição corporal antes do parto e ao desmame em relação às frequências cardíaca e respiratória e temperatura corporal dos animais ao desmame. Nas primeiras 24 horas de vida do cordeiro, o escore de comportamento materno foi atribuído à distância de fuga da ovelha em relação ao seu cordeiro: 1 >10 m e não retorna ao cordeiro; 2 >10 m do cordeiro e retorna; 3 5 a 10 m; 4 entre 1 e 3. Ovelhas criadas em Bagé apresentaram os maiores valores de frequência cardíaca e respiratória. Ovelhas com escore de condição corporal antes do parto The objective of this study to assess the relationship between ewe maternal behavior score and physiological parameters related to their temperament. During lambing, 258 Corriedale and 50 Polwarth ewes were evaluated. They were raised on native pasture in the southwest region of Rio Grande do Sul State, Brazil. The effects of farm, age, type of lambing, maternal behavior scores and body condition score before lambing and during the weaning were evaluated in relation to heart rate, respiratory rate and body temperature of animals at weaning. In the first 24 hours after lambing, the maternal behavior score was assigned to the ewe as the distance from its lamb: 1 >10 meters and does not return to the lamb; 2 >10 meters from the lamb, but returns; 3 five to 10 meters; 4 between one and five meters; 5 less than one meter; 6 maintains physical contact. Ewes with maternal behavior score of 3. Sheep raised on the farm in Bagé municipality had higher heart and

  12. RIFLE 评分评价妊娠并发急性肾损伤的发生和预后%The evaluation value of RIFLE scoring for occurance and outcomes of acute kidney injury in pregnancy

    韩云宏; 顾勤; 刘宁


    the ICU of Nanjing Drum Tower Hospital, Nanjing University Medical School from June 1st 2009 to June 1st 2012 was made. All patients were classified into non-AKI group and AKI group according to RIFLE scoring, evaluate the incidence of AKI in pregnancy. Then the patients were divided into three subgroups in AKI group, namely risk(R), injury(I) and failure(F) grade according to the degree of AKI. Compared score of Acute Physiology and Chronic Health Evaluation(APACHEⅡ), the outcome of kidney function,number of patients required renal replacement therapy, days of ICU stay and hospital stay and mortality between three subgroups. Evaluate the relationship between degree of AKI and above clinical prognostic indicators. Results During the 3-year period there were 81 critically ill obstetric patients admitted to the ICU. The incidence of AKI in pregnancy was 23.5%. 10 patients required renal replacement therapy, 11 patients complete recovery of kidney function, 4 patients with partial recovery, and 4 patients not recovery when transferred out of ICU. There were 7 cases of R-grade patients, 6 cases of I-grade patients, 6 cases of F-grade patients in AKI group. None case of patients with R-grade developed to F-grade, 1 cases of I-grade patients finally developed to F-grade. The F-grade patients' APACHE Ⅱ score was significantly higher than the R-grade patients' (14.5±6.72 vs. 6.86±2.79). The outcome of kidney function in three subgroups was significantly difference. The days of ICU stay in F-grade patients was significantly longer than R-grade patients(10.17±5.81 vs. 4.00±4.12). Conclusion The incidence of AKI in pregnancy in critically ill obstetric patients is high, RIFLE classification are related with APACHE Ⅱ score, the outcome of kidney function and the days of ICU stay.

  13. Coronary artery calcium score using electron beam tomography in the patients with acute obstructive coronary arterial disease : comparative study within asymptomatic high-risk group of atherosclerosis and chronic obstructive coronary arterial disease group

    Ryu, Seok Jong; Choi, Byoung Wook; Choe, Kyu Ok [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)


    To compare, through analysis of the coronary artery calcium (CAC) score and the risk factors for atherosclerosis, the characteristics of acute coronary syndrome between an asymptomatic high-risk group of atherosclerosis patients and a chronic coronary arterial obstructive disease(CAOD) group. The CAC scores of an asymptomatic high-risk group of atherosclerosis patients (group I, n=284), a chronic CAOD croup (group II, n=39) and an acute coronary syndrome group (group III, n=21) were measured by electron beam tomography. Forty-seven patients with CAOD from groups II and III underwent coronary angiography, and we scrutinized age, sex and risk factors including diabetes mellitus, hypertension, obesity, smoking, hypercholesterolemia and low high-density lipoproteinemia. The numbers of stenotic coronary arterial branches and degree of stenosis revealed by coronary angiography were also recorded. We determined the differences between the three groups in terms of CAC score and the risk factors, the relationship between CAC score and risk factors, and the characteristic features of each type of CAOD group. The mean CA score of group III (135.1) was not statistically different from that of group I (135.7) or group II (365.8). Among patients aged below 50, the mean CAC score of group III (127.4) was significantly higher than that of group I (6.2), (p=0.0006). The mean CAC score at the sixth decade was also significantly different between group I(81.5) and group II (266.9). The mean age of group III (54.2 years) was significantly lower than that of group I (58.1 years) (p=0.047) and of group II (60.1) (p=0.022). There was significant correlation between the number of stenotic coronary arterial branches and log(CAC +1) (p<.01). The square root of the CAC score and the maximal degree of stenosis was also well correlated (p<.01). There was no difference in the mean number of risk factors among the three groups, though the incidence of smoking in group III was significantly

  14. Physiological study on CT image analysis of acute pulmonary edema by oleic acid and its application to diagnosis of drowning

    Nosaka, Mizuho [Wakayama Medical Coll. (Japan)


    Recently, various investigations are carried out about the relationship between the pathophysiological changes and the images of the destructive extent in acute lung injury. In present paper, we examined, in progression time, the pathophysiological and histological changes basing upon pulmonary edema model made by administration of oleic acid to beagle dogs, and simultaneously took images of the lung by employing high-resolution X-ray CT and analyzed them. In pathophysiological and histological investigation, V{sub A}/Q heterogeneity and lung water volume increased, and decrease of PO{sub 2} in arterial blood was observed, and also filling of the alveoli with exudate, edema of the alveolar interstitium, congestion of the alveoli were observed histologically. In image analysis, the findings, that is enough to reflect the pathophysiological and histological changes, were obtained from mean CT value and the distribution of CT value histogram. Moreover, the same examination as in acute pulmonary edema model was carried out in drowning model with seawater. Consequently, it became evident that presuming of pathophysiological changes in drowning was possible from results of X-ray CT image analysis. The results described above seem to indicate that X-ray CT image analysis in acute lung injury can use as an index of the damage degree, and also is available for elucidation of the pathophysiological changes. (author)

  15. Apgar Scores

    ... Stages Listen Español Text Size Email Print Share Apgar Scores Page Content Article Body As soon as your ... the syringe, but is blue; her one minute Apgar score would be 8—two points off because she ...

  16. Physiologic benefits of pulsatile perfusion during mechanical circulatory support for the treatment of acute and chronic heart failure in adults.

    Guan, Yulong; Karkhanis, Tushar; Wang, Shigang; Rider, Alan; Koenig, Steven C; Slaughter, Mark S; El Banayosy, Aly; Undar, Akif


    A growing population experiencing heart failure (100,000 patients/year), combined with a shortage of donor organs (less than 2200 hearts/year), has led to increased and expanded use of mechanical circulatory support (MCS) devices. MCS devices have successfully improved clinical outcomes, which are comparable with heart transplantation and result in better 1-year survival than optimal medical management therapies. The quality of perfusion provided during MCS therapy may play an important role in patient outcomes. Despite demonstrated physiologic benefits of pulsatile perfusion, continued use or development of pulsatile MCS devices has been widely abandoned in favor of continuous flow pumps owing to the large size and adverse risks events in the former class, which pose issues of thrombogenic surfaces, percutaneous lead infection, and durability. Next-generation MCS device development should ideally implement designs that offer the benefits of rotary pump technology while providing the physiologic benefits of pulsatile end-organ perfusion.

  17. Association between acute pancreatitis and peptic ulcer disease

    Kang-Moon Lee; Chang-Nyol Paik; Woo Chul Chung; Jin Mo Yang


    AIM:To evaluate the relationship between peptic ulcer disease (PUD) and acute pancreatitis.METHODS:A cohort of 78 patients with acute pancreatitis were included in this study.The presence of PUD and the Helicobacter pylori (H.pylori ) status were assessed by an endoscopic method.The severity of acute pancreatitis was assessed using Ranson's score, the Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score,computed tomography severity index and the clinical data during hospitalization,all of which were compared between the patients with and without PUD.The risk factors for PUD were also evaluated. RESULTS:Among 78 patients,41 patients (52.6%) with acute pancreatitis suffered from PUD,but only 13 (31.7%) patients with PUD were infected by H.pylori .On univariate analysis,male gender,an etiology of alcohol-induced pancreatitis,a history of smoking or alcohol consumption, elevated triglyceride and C-reactive protein levels, and high APACHE Ⅱ score were significantly associated with PUD.However,on multivariate logistic regression analysis,the APACHE Ⅱ score (odds ratio:7.69; 95% confidence interval:1.78-33.33; P < 0.01) was found to be the only independent risk factor for PUD.CONCLUSION:Patients with acute pancreatitis are liable to suffer from PUD.PUD is associated with severe acute pancreatitis according to the APACHE Ⅱ score, and treatment for PUD should be considered for patients with severe acute pancreatitis.

  18. Effects of dietary nitrate supplementation on symptoms of acute mountain sickness and basic physiological responses in a group of male adolescents during ascent to Mount Everest Base Camp.

    Hennis, Philip J; Mitchell, Kay; Gilbert-Kawai, Edward; Bountziouka, Vassiliki; Wade, Angie; Feelisch, Martin; Grocott, Michael P; Martin, Daniel S


    The purpose of this study was to investigate the effects of dietary nitrate supplementation, in the form of beetroot juice, on acute mountain sickness (AMS) symptoms and physiological responses, in a group of young males trekking to Mount Everest Base Camp (EBC). Forty healthy male students (mean age (SD): 16 (1) yrs) trekked to EBC over 11 days. Following an overnight fast, each morning participants completed the Lake Louise AMS questionnaire and underwent a series of physiological tests: resting blood pressure as well as resting and exercising heart rate, respiratory rate, and peripheral oxygen saturation. The exercise test consisted of a standardised 2-min stepping protocol and measurements were taken in the last 10 s. Participants in the intervention arm of the study consumed 140 ml of concentrated beetroot juice daily, containing approximately 10 mmol of nitrate, while those in the control arm consumed 140 ml of concentrated blackcurrant cordial with negligible nitrate content. Drinks were taken for the first seven days at high altitude (days 2-8), in two equal doses; one with breakfast, and one with the evening meal. Mixed modelling revealed no significant between-groups difference in the incidence of AMS (Odds Ratio - nitrate vs.

  19. Evaluation of prognostic factors and scoring system in colonic perforation

    Atsushi Horiuchi; Yuji Watanabe; Takashi Doi; Kouichi Sato; Syungo Yukumi; Motohira Yoshida; Yuji Yamamoto; Hiroki Sugishita; Kanji Kawachi


    AIM: To study the significance of scoring systems assessing severity and prognostic factors in patients with colonic perforation.METHODS: A total of 26 patients (9 men, 17 women;mean age 72.7±11.6 years) underwent emergency operation for colorectal perforation in our institution between 1993 and 2005. Several clinical factors were measured preoperatively and 24 h postoperatively. Acute physiology and chronic health evaluationⅡ (APACHE Ⅱ),Mannheim peritonitis index (MPI) and peritonitis index of Altona (PIA Ⅱ) scores were calculated preoperatively.RESULTS: Overall postoperative mortality rate was 23.1% (6 patients). Compared with survivors, nonsurvivors displayed low blood pressure, low serum protein and high serum creatinine preoperatively, and low blood pressure, low white blood cell count, low pH,low PaO2/FiO2, and high serum creatinine postoperatively.APACHE Ⅱ score was significantly lower in survivors than in non-survivors (10.4±3.84 vs19.3±2.87, P= 0.00003). Non-survivors tended to display high MPI score and low PIA Ⅱ score, but no significant difference was identified.CONCLUSION: Pre- and postoperative blood pressure and serum creatinine level appear related to prognosis of colonic perforation. APACHE Ⅱ score is most associated with prognosis and scores ≥ 20 are associated with significantly increased mortality rate.

  20. Physiological Correlation of Airway Pressure and Transpulmonary Pressure Stress Index on Respiratory Mechanics in Acute Respiratory Failure

    Chun Pan; Lu Chen; Yun-Hang Zhang; Wei Liu; Rosario Urbino; V Marco Ranieri; Hai-Bo Qiu


    Background:Stress index at post-recruitment maneuvers could be a method of positive end-expiratory pressure (PEEP) titration in acute respiratory distress syndrome (ARDS) patients.However,airway pressure (Paw) stress index may not reflect lung mechanics in the patients with high chest wall elastance.This study was to evaluate the Paw stress index on lung mechanics and the correlation between Paw stress index and transpulmonary pressure (PL) stress index in acute respiratory failure (ARF) patients.Methods:Twenty-four ARF patients with mechanical ventilation (MV) were consecutively recruited from July 2011 to April 2013 in Zhongda Hospital,Nanjing,China and Ospedale S.Giovanni Battista-Molinette Hospital,Turin,Italy.All patients underwent MV with volume control (tidal volume 6 ml/kg) for 20 min.PEEP was set according to the ARDSnet study protocol.The patients were divided into two groups according to the chest wall elastance/respiratory system elastance ratio.The high elastance group (H group,n =14) had a ratio ≥30%,and the low elastance group (L group,n =10) had a ratio <30%.Respiratory elastance,gas-exchange,Paw stress index,and PL stress index were measured.Student's t-test,regression analysis,and Bland-Altman analysis were used for statistical analysis.Results:Pneumonia was the major cause of respiratory failure (71.0%).Compared with the L group,PEEP was lower in the H group (5.7 ± 1.7 cmH2O vs.9.0 ± 2.3 cm2O,P < 0.01).Compared with the H group,lung elastance was higher (20.0 ± 7.8 cmH2O/L vs.11.6 ± 3.6 cmH2O/L,P < 0.01),and stress was higher in the L group (7.0 ± 1.9 vs.4.9 ± 1.9,P =0.02).A linear relationship was observed between the Paw stress index and the PL stress index in H group (R2 =0.56,P < 0.01) and L group (R2 =0.85,P < 0.01).Conclusion:In the ARF patients with MV,Paw stress index can substitute for PL to guide ventilator settings.

  1. Score Correlation

    Fabián, Z. (Zdeněk)


    In this paper, we study a distribution-dependent correlation coefficient based on the concept of scalar score. This new measure of association of continuous random variables is compared by means of simulation experiments with the Pearson, Kendall and Spearman correlation coefficients.

  2. Diagnostic Value of the Updated Diamond and Forrester Score to Predict Coronary Artery Disease in Patients with Acute-Onset Chest Pain

    Sørgaard, Mathias; Linde, Jesper James; Kofoed, Klaus Fuglsang;


    compared the diagnostic accuracy of PTP and stress testing assessed by the area under the receiver operating characteristic curve (AUC) to identify significant CAD, defined as at least 1 coronary artery branch with >70% diameter stenosis identified by CCTA. RESULTS: The diagnostic accuracy of PTP......OBJECTIVES: In the recently updated clinical guidelines from the European Society of Cardiology on the management of stable coronary artery disease (CAD), the updated Diamond Forrester score has been included as a pretest probability (PTP) score to select patients for further diagnostic testing. We...... was significantly higher than the stress test (AUC 0.80 vs. 0.69; p = 0.009), but the diagnostic accuracy of the combination of PTP and a stress test did not significantly increase when compared to PTP alone (AUC 0.86 vs. 0.80; p = 0.06). CONCLUSIONS: PTP using the updated Diamond and Forrester Score is a very...

  3. Specific scoring systems to predict survival of patients with high-risk myelodysplastic syndrome (MDS) and de novo acute myeloid leukemia (AML) after intensive antileukemic treatment based on results of the EORTC-GIMEMA AML-10 and intergroup CRIANT studies.

    Oosterveld, Margriet; Suciu, Stefan; Muus, Petra; Germing, Ulrich; Delforge, Michel; Belhabri, Amin; Aul, Carlo; Selleslag, Dominik; Ferrant, Augustin; Marie, Jean-Pierre; Amadori, Sergio; Jehn, Ulrich; Mandelli, Franco; Hess, Uwe; Hellström-Lindberg, Eva; Cakmak-Wollgast, Songuel; Vignetti, Marco; Labar, Boris; Willemze, Roel; de Witte, Theo


    High-risk myelodysplastic syndrome (MDS) patients have usually a less favorable outcome after intensive treatment compared with de novo acute myeloid leukemia (AML) patients. This may reflect different disease-related and patient-related factors. The purpose of this analysis is to identify disease-specific prognostic factors and to develop prognostic scores for both patient groups. A total of 692 patients in the EORTC/GIMEMA AML-10 study and 289 patients in the CRIANT study received identical remission-induction and consolidation treatment. Estimated 5-year survival rate was 34 % in the AML-10 versus 27 % in the CRIANT study, and estimated disease-free survival was 40 % versus 28 %, respectively. In multivariate analysis, cytogenetic characteristics, white blood count, and age appeared prognostic for survival in both studies. French-American-British (FAB) subtype and performance status were prognostic in the AML-10 study only, whereas number of cytopenias and duration of antecedent hematologic disorder >6 months were prognostic in the CRIANT study only. The prognostic scores distinguish three groups with a 5-year survival rate of 54, 38, and 19 % in the AML-10 study versus 69, 37, and 5 % in the CRIANT study. The prognostic value of these scores has been validated on two external series. The new scoring systems form a practical tool to predict the outcome of individual MDS and AML patients treated with intensive antileukemic therapy.

  4. Vascular Physiology according to Clinical Scenario in Patients with Acute Heart Failure: Evaluation using the Cardio-Ankle Vascular Index.

    Goto, Toshihiko; Wakami, Kazuaki; Mori, Kento; Kikuchi, Shohei; Fukuta, Hidekatsu; Ohte, Nobuyuki


    Increased aortic stiffness may be an important cause of acute heart failure (AHF). Clinical scenario (CS), which classifies the pathophysiology of AHF based on the initial systolic blood pressure (sBP), was proposed to provide the most appropriate therapy for AHF patients. In CS, elevated aortic stiffness, vascular failure, has been considered as a feature of patients categorized as CS1 (sBP > 140 mmHg at initial presentation). However, whether elevated aortic stiffness, vascular failure, is present in such patients has not been fully elucidated. Therefore, we assessed aortic stiffness in AHF patients using the cardio-ankle vascular index (CAVI), which is considered to be independent of instantaneous blood pressure. Sixty-four consecutive AHF patients (mean age, 70.6 ± 12.8 years; 39 men) were classified with CS, based on their initial sBP: CS1: sBP > 140 mmHg (n = 29); CS2: sBP 100-140 mmHg (n = 22); and CS3: sBP 100 mmHg (n = 13). There were significant group differences in CAVI (CS1 vs. CS2 vs. CS3: 9.7 ± 1.4 vs. 8.4 ± 1.7 vs. 8.3 ± 1.7, p = 0.006, analysis of variance). CAVI was significantly higher in CS1 than in CS2 (p = 0.02) and CS3 (p = 0.04). CAVI did not significantly correlate with sBP at the time of measurement of CAVI (r = 0.24 and p = 0.06). Aortic stiffness assessed using blood pressure-independent methodology apparently increased in CS1 AHF patients. We conclude that vascular failure is a feature of CS1 AHF initiation.

  5. Age, estimated glomerular filtration rate and ejection fraction score predicts contrast-induced acute kidney injury in patients with diabetes and chronic kidney disease: insight from the TRACK-D study

    Li Jing; Li Yi; Wang Xiaozeng; Yang Shuguang; Gao Chuanyu; Zhang Zheng; Yang Chengming


    Background The occurrence of contrast induced acute kidney injury (CIAKI) has a pronounced impact on morbidity and mortality.The aim of the present study was to appraise the diagnostic efficacy of age,estimated glomerular filtration rate (eGFR) and ejection fraction (AGEF) score (age/EF(%)+1 (if eGFR was <60 ml·min-1·1.73 m2)) as an predictor of CIAKI in patients with diabetes mellitus (DM) and concomitant chronic kidney disease (CKD).Methods The AGEF score was calculated for 2 998 patients with type 2 DM and concomitant CKD who had undergone coronary/peripheral arterial angiography.CIAKI was defined as an increase in sCr concentration of 0.5 mg/dl (44.2 mmol/L) or 25% above baseline at 72 hours after exposure to the contrast medium.Post hoc analysis was performed by stratifying the rate of CIAKI according to AGEF score tertiles.The diagnostic efficacy of the AGEF score for predicting CIAKI was evaluated with receiver operating characteristic (ROC) analysis.Results The AGEF score ranged from 0.49 to 3.09.The AGEF score tertiles were defined as follows:AGEFlow ≤0.92 (n=1 006); 0.92 <AGEFmid ≤1.16 (n=1 000),and ACEFhigh >1.16 (n=992).The incidence of CIAKI was significantly different in patients with low,middle and high AGEF scores (AGEFlow=1.1%,AGEFmid=2.3% and AGEFhigh=5.8%,P <0.001).By multivariate analysis,AGEF score was an independent predictor of CIAKI (odds ratio=4.96,95% CI:2.32-10.58,P <0.01).ROC analysis showed that the area under the curve was 0.70 (95% CI:0.648-0.753,P <0.001).Conclusion The AGEF score is effective for stratifying risk of CIAKI in patients with DM and CKD undergoing coronary/peripheral arterial angiography.

  6. Bone morphogenetic protein-4 and transforming growth factor-beta1 mechanisms in acute valvular response to supra-physiologic hemodynamic stresses

    Ling; Sun; Philippe; Sucosky


    AIM:To explore ex vivo the role of bone morphogenetic protein-4(BMP-4) and transforming growth factorbeta1(TGF-β1) in acute valvular response to fluid shear stress(FSS) abnormalities.METHODS:Porcine valve leaflets were subjected ex vivo to physiologic FSS,supra-physiologic FSS magnitude at normal frequency and supra-physiologic FSS frequency at normal magnitude for 48 h in a double-sided cone-and-plate bioreactor filled with standard culture medium. The role of BMP-4 and TGF-β1 in the valvular response was investigated by promoting or inhibiting the downstream action of those cytokines via culture medium supplementation with BMP-4 or the BMP antagonist noggin,and TGF-β1 or the TGF-β1 inhibitor SB-431542,respectively. Fresh porcine leaflets were used as controls. Each experimental group consisted of six leaflet samples. Immunostaining and immunoblotting were performed to assess endothelial activation in terms of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 expressions,paracrine signaling in terms of BMP-4 and TGF-β1 expressions and extracellular matrix(ECM) remodeling in terms of cathepsin L,cathepsin S,metalloproteinases(MMP)-2 and MMP-9 expressions. Immunostained images were quantified by normalizing the intensities of positively stained regions by the number of cells in each image while immunoblots were quantified by densitometry. R E S U LT S :Regardless of the culture medium,physiologic FSS maintained valvular homeostasis. Tissue exposure to supra-physiologic FSS magnitude in standard medium stimulated paracrine signaling(TGF-β1:467% ± 22% vs 100% ± 6% in freshcontrols,BMP-4:258% ± 22% vs 100% ± 4% in fresh controls; P < 0.05) and ECM degradation(MMP-2:941% ± 90% vs 100% ± 19% in fresh controls,MMP-9:1219% ± 190% vs 100% ± 16% in fresh controls,cathepsin L:1187% ± 175% vs 100% ± 12% in fresh controls,cathepsin S:603% ± 88% vs 100% ± 13% in fresh controls; P < 0.05),while BMP-4 supplementation also promoted fibrosa

  7. Validity of Outcome Prediction Scoring Systems in Korean Patients with Severe Adult Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation Therapy.

    Lee, Seunghyun; Yeo, Hye Ju; Yoon, Seong Hoon; Lee, Seung Eun; Cho, Woo Hyun; Jeon, Doo Soo; Kim, Yun Seong; Son, Bong Soo; Kim, Do Hyung


    Recently, several prognostic scoring systems for patients with severe acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO) have been published. The aim of this study was to validate the established scoring systems for outcome prediction in Korean patients. We retrospectively reviewed the data of 50 patients on ECMO therapy in our center from 2012 to 2014. A calculation of outcome prediction scoring tools was performed and the comparison across various models was conducted. In our study, the overall hospital survival was 46% and successful weaning rate was 58%. The Predicting Death for Severe ARDS on V-V ECMO (PRESERVE) score showed good discrimination of mortality prediction for patients on ECMO with AUC of 0.80 (95% CI 0.66-0.90). The respiratory extracorporeal membrane oxygenation survival prediction (RESP) score and simplified acute physiology score (SAPS) II score also showed fair prediction ability with AUC of 0.79 (95% CI 0.65-0.89) and AUC of 0.78 (95% CI 0.64-0.88), respectively. However, the ECMOnet score failed to predict mortality with AUC of 0.51 (95% CI 0.37-0.66). When evaluating the predictive accuracy according to optimal cut-off point of each scoring system, RESP score had a best specificity of 91.3% and 66.7% of sensitivity, respectively. This study supports the clinical usefulness of the prognostic scoring tools for severe ARDS with ECMO therapy when applying to the Korean patients receiving ECMO.

  8. Who will be sicker in the morning? Changes in the Simple Clinical Score the day after admission and the subsequent outcomes of acutely ill unselected medical patients.

    Kellett, John


    All doctors are haunted by the possibility that a patient they reassured yesterday will return seriously ill tomorrow. We examined changes in the Simple Clinical Score (SCS) the day after admission, factors that might influence these changes and the relationship of these changes to subsequent clinical outcome.

  9. Physiological benefits of being small in a changing world: responses of Coho salmon (Oncorhynchus kisutch to an acute thermal challenge and a simulated capture event.

    Timothy D Clark

    Full Text Available Evidence is building to suggest that both chronic and acute warm temperature exposure, as well as other anthropogenic perturbations, may select for small adult fish within a species. To shed light on this phenomenon, we investigated physiological and anatomical attributes associated with size-specific responses to an acute thermal challenge and a fisheries capture simulation (exercise+air exposure in maturing male coho salmon (Oncorhynchus kisutch. Full-size females were included for a sex-specific comparison. A size-specific response in haematology to an acute thermal challenge (from 7 to 20 °C at 3 °C h(-1 was apparent only for plasma potassium, whereby full-size males exhibited a significant increase in comparison with smaller males ('jacks'. Full-size females exhibited an elevated blood stress response in comparison with full-size males. Metabolic recovery following exhaustive exercise at 7 °C was size-specific, with jacks regaining resting levels of metabolism at 9.3 ± 0.5 h post-exercise in comparison with 12.3 ± 0.4 h for full-size fish of both sexes. Excess post-exercise oxygen consumption scaled with body mass in male fish with an exponent of b = 1.20 ± 0.08. Jacks appeared to regain osmoregulatory homeostasis faster than full-size males, and they had higher ventilation rates at 1 h post-exercise. Peak metabolic rate during post-exercise recovery scaled with body mass with an exponent of b~1, suggesting that the slower metabolic recovery in large fish was not due to limitations in diffusive or convective oxygen transport, but that large fish simply accumulated a greater 'oxygen debt' that took longer to pay back at the size-independent peak metabolic rate of ~6 mg min(-1 kg(-1. Post-exercise recovery of plasma testosterone was faster in jacks compared with full-size males, suggesting less impairment of the maturation trajectory of smaller fish. Supporting previous studies, these findings suggest that environmental change and non

  10. Acute Kidney Injury Classification in Neuro-ICU Patient Group

    Canan Akıncı


    Full Text Available Objective: To investigate the role of acute kidney injury (AKI classification system for kidney injury outcome in neuro-Intensive care unit (ICU patients. Material and Method: Total 432 patients who admitted to ICU between 2005 and 2009 evaluated in this study. All patients’ AKI stage, Acute Physiology and Chronic Health Evaluation (APACHE-II, Sequential Organ Failure Assessment Score (SOFA, Glasgow Coma Score (GCS, Glasgow Outcome Score (GOS, mortality rate, length of ICU stay, need for intubation, and mechanical ventilation were recorded. Results: AKI was found in 24 of all 432 patents’ (5.5%. We found that, patients with AKI had higher APHACE-II score, SOFA score and mortality rates; longer ICU stay, duration of mechanical ventilation and intubation and lower GCS and GOS than without AKI group. Conclusion: Length of ICU stay and mortality rate were higher in AKI positive group.

  11. Does a physiological concentration of taurine increase acute muscle power output, time to fatigue, and recovery in isolated mouse soleus (slow) muscle with or without the presence of caffeine?

    Tallis, Jason; Higgins, Matthew F; Cox, Val M; Duncan, Michael J; James, Rob S


    High concentrations of caffeine and taurine are key constituents of many ergogenic supplements ingested acutely to provide legal enhancements in athlete performance. Despite this, there is little evidence supporting the claims for the performance-enhancing effects of acute taurine supplementation. In-vitro models have demonstrated that a caffeine-induced muscle contracture can be further potentiated when combined with a high concentration of taurine. However, the high concentrations of caffeine used in previous research would be toxic for human consumption. Therefore, this study aimed to investigate whether a physiological dose of caffeine and taurine would directly potentiate skeletal muscle performance. Isolated mouse soleus muscle was used to examine the effects of physiological taurine (TAU), caffeine (CAF), and taurine-caffeine combined (TC) on (i) acute muscle power output; (ii) time to fatigue; and (iii) recovery from fatigue, compared with the untreated controls (CON). Treatment with TAU failed to elicit any significant difference in the measured parameters. Treatment with TC resulted in a significant increase in acute muscle power output and faster time to fatigue. The ergogenic benefit posed by TC was not different from the effects of caffeine alone, suggesting no acute ergogenic benefit of taurine.

  12. The clot burden score, the Boston Acute Stroke Imaging Scale, the cerebral blood volume ASPECTS, and two novel imaging parameters in the prediction of clinical outcome of ischemic stroke patients receiving intravenous thrombolytic therapy

    Sillanpaa, Niko; Hakomaki, Jari; Lahteela, Arto; Dastidar, Prasun; Soimakallio, Seppo [Tampere University Hospital, Medical Imaging Center, Tampere (Finland); Saarinen, Jukka T.; Numminen, Heikki; Elovaara, Irina [Tampere University Hospital, Department of Neurology, Tampere (Finland); Rusanen, Harri [Oulu University Hospital, Department of Neurology, Oulu (Finland)


    Recently two classification methods based on the location and the extent of thrombosis detected with CT angiography have been introduced: the Boston Acute Stroke Imaging Scale (BASIS) and the clot burden score (CBS). We studied the performance of BASIS and CBS in predicting good clinical outcome (mRS {<=}2 at 90 days) in an acute (<3 h) stroke cohort treated with intravenous thrombolytic therapy. Eighty-three consecutive patients who underwent multimodal CT were analyzed. Binary logistic regression model was used to assess how BASIS, CBS, and cerebral blood volume (CBV) ASPECTS predict favorable clinical outcome. Diagnostic sensitivities and specificities were calculated and compared. Patients with low CBS and CBV ASPECTS scores and major strokes according to BASIS had significantly higher admission NIHSS scores, larger perfusion defects, and more often poor clinical outcome. In logistic regression analysis, CBV ASPECTS, CBS and BASIS were significantly associated with the clinical outcome. The performance of BASIS improved when patients with thrombosis of the M2 segment of the middle cerebral artery were classified as having minor stroke (M1-BASIS). In the anterior circulation, the sum of CBS and CBV ASPECTS (CBSV) proved to be the most robust predictor of favorable outcome. CBV ASPECTS and CBS had high sensitivity but moderate to poor specificity while BASIS was only moderately sensitive and specific. CBS, BASIS, and CBV ASPECTS are statistically robust and sensitive but unspecific predictors of good clinical outcome. Two new derived imaging parameters, CBSV and M1-BASIS, share these properties and may have increased prognostic value. (orig.)

  13. 脂肪肝诊断联合APACHE-Ⅱ评分提高预测重症急性胰腺炎的能力%A combination of hepatic steatosis with APACHE-Ⅱ score improves the ability of predicting severe acute pancreatitis

    郝一鸣; 王士琪; 冯全新; 冯向英; 余鹏飞; 白槟; 邱兆岩; 王谦; 赵青川


    目的 明确脂肪肝是否为重症急性胰腺炎的暴露因素,判断脂肪肝诊断联合急性生理学和慢性健康评估(acute physiology and chronic health evaluation,APACHE-Ⅱ)评分预测重症急性胰腺炎的能力.方法 回顾性分析148例急性胰腺炎患者的临床资料,分为重症急性胰腺炎组(41例)和轻症急性胰腺炎组(107例).比较两组患者的一般资料.根据APACHE-Ⅱ评分,进行亚组分析.计算联合预测的敏感性、特异性和ROC曲线下面积.结果 脂肪肝与重症急性胰腺炎呈正相关.合并脂肪肝的患者发生重症急性胰腺炎的概率是未合并脂肪肝的5.33倍(OR =5.33,P=0.003).亚组分析结果表明,入院24 h内APACHE-Ⅱ评分<8分的患者,合并脂肪肝的患者较未合并脂肪肝的患者,重症胰腺炎发生率((34.5%比6.9%,P<0.001)、全身并发症发生率更高(31%比5.7%,P<0.001).入院24 h内APACHE-Ⅱ评分≥8分的患者,合并脂肪肝的患者较未合并脂肪肝的患者,重症胰腺炎发生率(100%比65%,P=0.029)、全身并发症发生率更高(100%比65%,P=0.029).入院24 h内APACHE-Ⅱ评分预测重症急性胰腺炎的敏感性、特异性、ROC曲线下面积分别为61.0% 、93.5%、0.772.脂肪肝预测重症急性胰腺炎的敏感性、特异性、ROC曲线下面积分别为53.7% 、82.2%、0.680.两个指标联合预测重症急性胰腺炎的敏感性、特异性、ROC曲线下面积分别为85.4% 、75.7%、0.861.结论 脂肪肝和重症急性胰腺炎具有相关性.脂肪肝诊断联合APACHE-Ⅱ评分可以提高预测重症急性胰腺炎的能力.%Objective To identify whether hepatic steatosis is the exposure factor of severe acute pancreatitis (SAP) and to investigate the prognostic efficacy of combining hepatic steatosis with APACHE-Ⅱ score in predicting the severity of SAP.Methods Clinicopathological data of 148 patient diagnosed as acute pancreatitis in Xijing Hospital from April 2011 to

  14. Physiological relevance and performance of a minimal lung model – an experimental study in healthy and acute respiratory distress syndrome model piglets

    Chiew Yeong


    Full Text Available Abstract Background Mechanical ventilation (MV is the primary form of support for acute respiratory distress syndrome (ARDS patients. However, intra- and inter- patient-variability reduce the efficacy of general protocols. Model-based approaches to guide MV can be patient-specific. A physiological relevant minimal model and its patient-specific performance are tested to see if it meets this objective above. Methods Healthy anesthetized piglets weighing 24.0 kg [IQR: 21.0-29.6] underwent a step-wise PEEP increase manoeuvre from 5cmH2O to 20cmH2O. They were ventilated under volume control using Engström Care Station (Datex, General Electric, Finland, with pressure, flow and volume profiles recorded. ARDS was then induced using oleic acid. The data were analyzed with a Minimal Model that identifies patient-specific mean threshold opening and closing pressure (TOP and TCP, and standard deviation (SD of these TOP and TCP distributions. The trial and use of data were approved by the Ethics Committee of the Medical Faculty of the University of Liege, Belgium. Results and discussions 3 of the 9 healthy piglets developed ARDS, and these data sets were included in this study. Model fitting error during inflation and deflation, in healthy or ARDS state is less than 5.0% across all subjects, indicating that the model captures the fundamental lung mechanics during PEEP increase. Mean TOP was 42.4cmH2O [IQR: 38.2-44.6] at PEEP = 5cmH2O and decreased with PEEP to 25.0cmH2O [IQR: 21.5-27.1] at PEEP = 20cmH2O. In contrast, TCP sees a reverse trend, increasing from 10.2cmH2O [IQR: 9.0-10.4] to 19.5cmH2O [IQR: 19.0-19.7]. Mean TOP increased from average 21.2-37.4cmH2O to 30.4-55.2cmH2O between healthy and ARDS subjects, reflecting the higher pressure required to recruit collapsed alveoli. Mean TCP was effectively unchanged. Conclusion The minimal model is capable of capturing physiologically relevant TOP, TCP and SD of both healthy and ARDS lungs. The

  15. Comparison of severity of illness scoring systems for patients with nosocomial bloodstream infection due to Pseudomonas aeruginosa

    Wenzel Richard P


    Full Text Available Abstract Background Several acute illness severity scores have been proposed for evaluating patients on admission to intensive care units but these have not been compared for patients with nosocomial bloodstream infection (nBSI. We compared three severity of illness scoring systems for predicting mortality in patients with nBSI due to Pseudomonas aeruginosa. Methods We performed a historical cohort study on 63 adults in intensive care units with P. aeruginosa monomicrobial nBSI. Results The Acute Physiology, Age, Chronic Health Evaluation II (APACHE II, Sequential Organ Failure Assessment (SOFA, and Simplified Acute Physiologic Score (SAPS II, were calculated daily from 2 days prior through 2 days after the first positive blood culture. Calculation of the area under the receiver operating characteristic (ROC curve confirmed that APACHE II and SAPS II at day -1 and SOFA at day +1 were better predictors of outcome than days -2, 0 and day 2 of BSI. By stepwise logistic regression analysis of these three scoring systems, SAPS II (OR: 13.03, CI95% 2.51–70.49 and APACHE II (OR: 12.51, CI95% 3.12–50.09 on day -1 were the best predictors for mortality. Conclusion SAPS II and APACHE II are more accurate than the SOFA score for predicting mortality in this group of patients at day -1 of BSI.

  16. ARDS患者中APACHEⅡ评分及CRP值对呼吸机应用的指导意义%The guide significance of the APACHE Ⅱ score and CRP in acute respiratory distress syndrome to ventilator applications

    杨晓帆; 王君一; 田六九; 黄彩凤; 荣清源; 葛良


    Objective: To investigate the guide significance of APACHE Ⅱ score and CRP in acute respiratory distress syndrome to vertilator applications.Methods: Reviewed the 54 ARDS patients from October 2009 to October 2010 that had been freed from ARDS in the ICU of the First People's Hospital of Anqing City, compared the APACHE Ⅱ score and CRP in 55 ARDS before mechanical ventilation with when freed from ventilators, compared the APACHE Ⅱ score and CRP in male ARDS with in the female, and the APACHE Ⅱ score and CRP in ARDS patients with different etiology; at the same time studied the relations between APACHE Ⅱ score and CRP in ARDS patients.Results: The APACHE Ⅱ score and CRP when freed from ventilator were obviously lower than before mechanical ventilation; there was no statistical meaning in the differenee of APACHE Ⅱ score and CRP between male and female; the APACHE Ⅱ acore and CRP in trauma ARDS patients was lower than in pulmonary infection and aspiration ARDS patients without statistical mearung (P>0.05).There was a positive relation between APACHE Ⅱ score and CRP in ARDS patients (r=0 52).Conclusion: There i8 a great guide significance in the applications of mechanical ventilation through studying the change of APACHE Ⅱ score and CRP in ARDS patients.%目的:探讨APACHEⅡ评分及CRP值对ARDS患者呼吸机应用的指导意义.方法:回顾性分析安庆市第一人民医院ICU 2009年10月~2010年10月以来成功救治的55例ARDS患者,比较机械通气前及脱机时APACHEⅡ评分及CRP值,比较不同性别间ARDS患者APACHEⅡ评分及CRP值,比较不同病因间ARDS患者APACHEⅡ评分及CRP值并分析APACHEⅡ评分和CRP值的关联性.结果:脱机时APACHE评分及CRP值较机械通气前显著降低,不同性别间ARDS患者APACHEⅡ评分及CRP值无差异,外伤性ARDS患者机械通气前APACHEⅡ评分及CRP值均较肺部感染及误吸性ARDS高,但差异无统计学意义(P>0.05).ARDS患者APACHEⅡ评分

  17. Fetal Biophysical Profile Scoring

    H.R. HaghighatKhah


    Full Text Available   "nFetal biophysical profile scoring is a sonographic-based method of fetal assessment first described by Manning and Platt in 1980. "nThe biophysical profile score was developed as a method to integrate real-time observations of the fetus and his/her intrauterine environment in order to more comprehensively assess the fetal condition. These findings must be evaluated in the context of maternal/fetal history (i.e., chronic hypertension, post-dates, intrauterine growth restriction, etc, fetal structural integrity (presence or absence of congenital anomalies, and the functionality of fetal support structures (placental and umbilical cord. For example, acute asphyxia due to placental abruption may result in an absence of the acute variables of the biophysical profile score (fetal breathing movements, fetal movement, fetal tone, and fetal heart rate reactivity with a normal amniotic fluid volume. With post maturity the asphyxial event may be intermittent and chronic resulting in a decrease in amniotic fluid volume, but with the acute variables remaining normal. "nWhile the 5 components of the biophysical profile score have remained unchanged since 1980 (Manning, 1980, the definitions of a normal and abnormal parameter have evolved with increasing experience. "nIn 1984 the definition of oligohydramnios was increased from < 1cm pocket of fluid to < 2.0 x 1.0 cm pocket. Oligohydramnios is now defined as a pocket of amniotic fluid < 2.0 x 2.0 cm (Manning, 1995a "nIf the four ultrasound variables are normal, the accuracy of the biophysical profile score was not found to be significantly improved by adding the non-stress test. As a result, in 1987 the profile score was modified to incorporate the non-stress test only when one of the ultrasound variables was abnormal (Manning 1987. Table 1 outlines the current definitions for quantifying a variable as present or absent. "nEach of the 5 components of the biophysical profile score does not have equal

  18. Performance assessment of the SOFA, APACHE II scoring system, and SAPS II in intensive care unit organophosphate poisoned patients.

    Kim, Yong Hwan; Yeo, Jung Hoon; Kang, Mun Ju; Lee, Jun Ho; Cho, Kwang Won; Hwang, SeongYoun; Hong, Chong Kun; Lee, Young Hwan; Kim, Yang Weon


    This study assessed the ability of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology, Chronic Health Evaluation (APACHE) II scoring systems, as well as the Simplified Acute Physiology Score (SAPS) II method to predict group mortality in intensive care unit (ICU) patients who were poisoned with organophosphate. The medical records of 149 organophosphate poisoned patients admitted to the ICU from September 2006 to December 2012 were retrospectively examined. The SOFA, APACHE II, and SAPS II were calculated based on initial laboratory data in the Emergency Department, and during the first 24 hr of ICU admission. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and SAPS II equations. The ability to predict group mortality by the SOFA score, APACHE II score, and SAPS II method was assessed using two by two decision matrices and receiver operating characteristic (ROC) curve analysis. A total of 131 patients (mean age, 61 yr) were enrolled. The sensitivities, specificities, and accuracies were 86.2%, 82.4%, and 83.2% for the SOFA score, respectively; 65.5%, 68.6%, and 67.9% for the APACHE II scoring system, respectively; and 86.2%, 77.5%, and 79.4% for the SAPS II, respectively. The areas under the curve in the ROC curve analysis for the SOFA score, APACHE II scoring system, and SAPS II were 0.896, 0.716, and 0.852, respectively. In conclusion, the SOFA, APACHE II, and SAPS II have different capability to discriminate and estimate early in-hospital mortality of organophosphate poisoned patients. The SOFA score is more useful in predicting mortality, and easier and simpler than the APACHE II and SAPS II.

  19. GRACE评分和SYNTAX评分对非ST段抬高急性冠状动脉综合征患者的远期预后评估%The Predictive Value for Long-term Prognosis of GRACE Score and SYNTAX Score in Patients With Non-ST Elevation Acute Coronary Syndrome

    张韶辉; 蔺跃栋; 刘立新; 魏广和; 王铁成; 王建军; 安毅; 杨国良; 陈安勇; 郭莹


    目的:明确GRACE评分和SYNTAX评分对非ST段抬高急性冠状动脉综合征(NSTE-ACS)远期预后的评估价值。  方法:回顾性分析2009-01至2014-01住院诊断为NSTE-ACS的患者共784例,其中单纯药物治疗组410例,支架组325例,CABG组49例。计算患者的GRACE评分和SYNTAX评分,按照评分分为低、中、高危三组。GRACE评分和SYNTAX评分的关系采用Pearson相关分析;生存分析采用Kaplan-Meier法;用Cox比例风险模型进行单因素及多因素分析。计算受试者工作特征(ROC)曲线下面积比较预测方法的优劣性。  结果:研究完成随访784例,随访中位时间为47.7个月。Pearson相关分析显示,GRACE评分和SYNTAX评分存在较弱的正相关(r=0.40,P0.05)。Cox回归和ROC分析显示,GRACE评分和SYNTAX评分对NSTE-ACS的长期预后评估均有重要价值。将GRACE评分、SYNTAX评分及GRACE和SYNTAX联合评分进行ROC曲线分析后发现,三者对NSTE-ACS患者远期MACE风险均有良好的预测价值,但三者的95%可信区间明显重叠,预测价值的差异无统计学意义。  结论:GRACE评分和SYNTAX评分存在相关性,二者对NSTE-ACS的远期预后评估均有重要价值,预测价值无明显差异,即使两者联合也并不提高预测价值。利用GRACE评分对NSTE-ACS患者的远期预后进行低、中、高危分层是适宜的。%Objective: To clarify the predictive value for long-term prognosis of GRACE score and SYNTAX score in patients with non-ST elevation acute coronary syndrome (NSTE-ACS). Methods: A total of 784 NSTE-ACS patients treated in our hospital from 2009-01 to 2014-01 were retrospectively studied. According to the treatment, the patients were divided into 3 groups: Medication group,n=410, Stent group,n=325 and CABG group,n=49. Based on 2 scoring systems, the patients were divided into another 3 groups: Low risk group, Medium risk group and High-risk group. The

  20. The Research Progress of Risk Stratification Score for Acute Non-traumatic Chest Pain%急性非创伤性胸痛危险分层评分的研究进展

    周洪峰(综述); 王秀杰(审校)


    Chest pain is one of the most common complaints in the emergency department .Acute coro-nary syndrome is the one of the most common and serious diseases.Using risk stratification score,clinicians can make protocol and evaluate condition more reasonably , which currently plays a positive role in triage , evaluating illness on admission and prognosis.With the emergence of some new biomakers,such as super sen-sitive troponin and fatty acid binding protein,and combined biomarkers scoring,the risk stratification score will be more widely used in clinical .%胸痛是急诊科常见的就诊原因之一。急性冠状动脉综合征是其中最常见、最危重的疾病之一,危险分层评分的应用可以帮助临床医师更加合理地评估病情、制订治疗方案。目前它们在急诊室分诊、入院病情评估及预后评估方面都有一定的积极意义。随着超敏肌钙蛋白、脂肪酸结合蛋白等新兴标志物的出现,以及标志物联合评分的研究,危险评分将进一步得到广泛的临床应用。

  1. Indocyanine green clearance test combined with MELD score in predicting the short-term prognosis of patients with acute liver failure

    Hong-Ling Feng; Qian Li; Lin Wang; Gui-Yu Yuan and Wu-Kui Cao


    BACKGROUND: Acute liver failure (ALF) is an acute severe deterioration of liver function with high mortality. Early and accurate prognostic assessment of patients with ALF is critically important. Although the model for end-stage liver disease (MELD) scores and King's College Hospital (KCH) criteria are well-accepted as predictive tools, their accuracy is unsatisfactory. The indocyanine green (ICG) clearance test (ICGR15, ICG retention rate at the 15 minutes) is a sensitive indicator of liver function. In this study, we investigated the efifcacy of the ICGR15 for the short-term prognosis in patients with ALF. We compared the predictive value of ICGR15 with the MELD scores and KCH criteria. METHODS: Sixty-nine patients who had been diagnosed with ALF were recruited retrospectively. ICGR15 had been performed by ICG pulse spectrophotometry and relevant clinical and laboratory indices were analyzed within 24 hours of diagnosis. In addition, the MELD scores and KCH criteria were calculated. RESULTS: The three-month mortality of all patients was 47.83%. Age,  serum  total  bilirubin  and  creatinine  concentrations, international normalized ratio for prothrombin time, ICGR15, MELD scores and KCH criteria differed signiifcantly between surviving and deceased patients. A positive correlation was observed between ICGR15 and MELD scores (r=0.328, P=0.006). The ICGR15-MELD model, Logit(P)=0.096×ICGR15+0.174 × MELD  score-9.346,  was  constructed  by  logistic  regression analysis. The area under the receiver operating characteristic curve was 0.855.

  2. Escore de risco Dante Pazzanese para síndrome coronariana aguda sem supradesnivelamento do segmento ST Score de riesgo dante pazzanese para síndrome coronario agudo sin supradesnivel del segmento ST Dante Pazzanese risk score for non-st-segment elevation acute coronary syndrome

    Elizabete Silva dos Santos


    desarrolló para prever el riesgo de muerte o de (reinfarto en 30 días. La exactitud predictiva del modelo fue determinada por el C statistic. RESULTADOS: El evento combinado ocurrió en 54 pacientes (5,3%. El score se creó por la suma aritmética de puntos de los predictores independientes, cuyos puntajes se designaron por las respectivas probabilidades de ocurrencia del evento. Se identificaron las siguientes variables: aumento de la edad (0 a 9 puntos; antecedente de diabetes mellitus (2 puntos o de accidente vascular cerebral (4 puntos; no utilización previa de inhibidor de la enzima conversora de la angiotensina (1 punto; elevación de la creatinina (0 a 10 puntos; y combinación de elevación de la troponina I cardíaca y depresión del segmento ST (0 a 4 puntos. Se definieron cuatro grupos de riesgo: muy bajo (até 5 puntos; bajo (6 a 10 puntos; intermedio (11 a 15 puntos; y alto riesgo (16 a 30 puntos. El C statistic para la probabilidad del evento fue de 0,78 y para el score de riesgo en puntaje de 0,74. CONCLUSIÓN: Se desarrolló un score de riesgo para prever muerte o (reinfarto en 30 días en una población brasileña con SCA sin SST, pudiendo fácilmente se aplicable en el departamento de emergencia.BACKGROUND: The probability of adverse events estimate is crucial in acute coronary syndrome condition. OBJECTIVES: To develop a risk score for the brazilian population presenting non-ST-segment elevation acute coronary syndrome. METHODS: One thousand and twenty seven (1,027 patients were investigated prospectively at a cardiology center in Brazil. A multiple logistic regression model was developed to estimate death or (reinfarction risk within 30 days. Model predictive accuracy was determined by C statistic. RESULTS: Combined event occurred in 54 patients (5.3%. The score was created by the arithmetic sum of independent predictors points. Points were determined by corresponding probabilities of event occurrence. The following variables have been identified: age

  3. Comparison of the screening effects between Wells and revised Geneva scores on suspected acute pulmonary thromboembolism%Wells与修正Geneva评分急诊筛查肺栓塞的比较

    吴伟程; 蔺际; 杨成彬; 吴郁珍; 俞祥玫; 刘加权; 张自立


    Objective To compare the screening effects between Wells and revised Geneva scores on suspected acute pulmonary thromboembolism (APTE),and to explore a optimum screening method for APTE in the emergency department of China.Methods The study was carried out by using random,crossed,prospective methods to compare the screening effects between Wells and revised Geneva scores for 167 suspected APTE patients in the emergency department of the First Affiliated Hospital of Xiamen University.Results The areas under the receiver operating characteristic curve of Wells and revised Geneva scores for screening APTE in the emergency department were (0.917 ± 0.022 ) and (0.927 ± 0.020),respectively ( P < 0.05 ).The diagnostic concordance between the two score systems for predicting APTE was poor (Kappa value =0.276 ). In addition, the difference between their hierarchical discrimination for the possibility of APTE was statistically significant ( P < 0.05 ).Compared with revised Geneva score,fewer patients were diagnosed with low clinical probability of APTE and more patients were diagnosed with intermediate or high clinical probability of APTE through Wells score.The patients with low chnical probability of APTE were excluded from pulmonary embolism in Wells or revised Geneva score.At intermediate clinical probability,the accuracy rate of Wells score for predicting APTE (9.64%) was lower than that (32.84% ) of revised Geneva ( P < 0.05 ).At high clinical probability,there was no significant difference between their accuracy rate [ (67.24% vs.86.21%),P>0.05]. Conclusions Revised Geneva score is more suitable than Wells score in screening suspected APTE patients in the emergency department in our country.%目的 比较Wells与修正Geneva评分筛查急性肺栓塞(acute pulmonary thromboembolism,APTE)效果,寻找适合我国急诊科诊断APTE的策略.方法 对厦门大学附属第一医院急诊部诊治的167例疑似APTE患者采用随机、交叉、前瞻

  4. Nasal Physiology

    ... Caregivers Contact ARS HOME ANATOMY Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure ... Patient Education About this Website Font Size + - Home > ANATOMY > Nasal Physiology Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy ...

  5. Review of acute chemical incidents as a first step in evaluating the usefulness of physiologically based pharmacokinetic models in such incidents

    Hunault, C. C.; Boerleider, R. Z.; Hof, B. G H; Kliest, J. J G; Meijer, M.; Nijhuis, N. J.; De Vries, I.; Meulenbelt, J.


    Context. Acute chemical incidents can have substantial public health consequences in terms of morbidity and mortality. Objective. We aimed to characterize acute chemical incidents and near-misses in the Netherlands and compare the results with previous studies. This review is a first step in evaluat

  6. Obstetrical disseminated intravascular coagulation score.

    Kobayashi, Takao


    Obstetrical disseminated intravascular coagulation (DIC) is usually a very acute, serious complication of pregnancy. The obstetrical DIC score helps with making a prompt diagnosis and starting treatment early. This DIC score, in which higher scores are given for clinical parameters rather than for laboratory parameters, has three components: (i) the underlying diseases; (ii) the clinical symptoms; and (iii) the laboratory findings (coagulation tests). It is justifiably appropriate to initiate therapy for DIC when the obstetrical DIC score reaches 8 points or more before obtaining the results of coagulation tests. Improvement of blood coagulation tests and clinical symptoms are essential to the efficacy evaluation for treatment after a diagnosis of obstetrical DIC. Therefore, the efficacy evaluation criteria for obstetrical DIC are also defined to enable follow-up of the clinical efficacy of DIC therapy.

  7. Escore TIMI no infarto agudo do miocárdio conforme níveis de estratificação de prognóstico Score TIMI en el infarto agudo de miocardio según niveles de estratificación de pronóstico TIMI risk score for acute myocardial infarction according to prognostic stratification

    Jaqueline Locks Pereira


    hospitalaria postinfarto fue de un 17,5%. En el grupo de bajo riesgo no hubo óbito. La mortalidad fue del 8,1% en el grupo de medio riesgo y de un 55,6% en el de alto riesgo. El riesgo de muerte para casos de alto riesgo fue 14,1 veces mayor con relación a los casos de medio y bajo riesgo (IC95% = 4,4 a 44,1 y pBACKGROUND: The TIMI (Thrombolysis in Myocardial Infarction risk score is derived from clinical trial involving patients who are eligible for fibrinolysis. As the risk profiles of these cases differ from those found in non-selected populations, it is important to review the applicability of the score in usual clinical conditions. OBJECTIVES: To evaluate the management and clinical evolution of hospital inpatients with acute myocardial infarction, according to risk stratification by the TIMI score. METHODS: We evaluated, retrospectively, 103 cases of acute myocardial infarction with ST-segment elevation admitted to the Hospital Nossa Senhora da Conceição - Tubarão, in 2004 and 2005. The cases were analyzed in three risk groups according to the TIMI score. RESULTS: The hospital mortality after infarction was 17.5%. In the low-risk group there was no death. The mortality was 8.1% in the medium risk group and 55.6% in the high-risk group. The risk of death in cases of high risk was 14.1 times higher than in the cases of medium and low risk (95% CI = 4.4 to 44.1 and p <0.001. The chance of receiving fibrinolytic was 50% lower in the high-risk group in relation to the low risk group (95% CI = 0.27 to 0.85, p = 0.004. CONCLUSION: There was a progressive increase in mortality and incidence of in-hospital complications according to the stratification by the TIMI score. High risk patients received thrombolytic less frequently than the patients at low risk.

  8. Effects of different types of painful procedures on neonatal pain scores and physiological changes%不同类型致痛性操作对新生儿疼痛的影响

    陈银花; 钱丽冰; 陈梦莹; 曹兆兰; 徐玉香; 程锐; 卢官明; 李晓南


    Objective To assess the effects of different types of painful procedures on neonatal pain scores and physiological changes.Methods A prospective study was conducted in neonatal intensive care unit of Nanjing Children's Hospital from March 1,2009 to May 31,2009.Around-theclock bedside data of all painful procedures performed on 108 neonates (46 premature and 62 termbirth infants) from admission to discharge for diagnosis or treatment were collected through video,along with cardiac monitoring.Neonatal Facial Coding System (NFCS),Neonatal Infant Pain Scale (NIPS),Premature Infant Pain Profile (PIPP) and physiological changes (heart rate and blood oxygen saturation) were used to evaluate the pain that neonates experienced.Data were analyzed by Student-t test,Chi-square test and analysis of variance.Results There were 6966 painful procedures on preterm neonates,among which tracheal aspiration (23.6 %,1645/6966),nasal aspiration (18.3%,1278/6966) and intravenous cannulation (17.2%,1195/6966) were the most frequently used.There were 3667 painful procedures on term neonates,among which,intravenous cannulation (27.0%,989/3667),removal of indwelling needle (20.5%,751/3667) and tape removal (18.4%,675/3667)were the most frequently used painful procedures on term ones.For preterm neonates,both NFCS and PIPP showed that tracheal intubation (7.00± 1.66 and 14.08±3.54),femoral venous puncture (6.52±1.66 and 12.15±3.11) and axillary vein puncture (5.75± 1.89 and 11.75±4.19) caused much more pain than other procedures.For term neonates,both NFCS and NIPS indicated that femoral venous puncture (6.68±1.34 and 5.58±1.32),tape removal (6.00±1.41 and 5.67±0.58)and abdominal wall vein puncture (6.00 ± 0.00 and 5.50 ± 0.71) were the top three painful procedures.No differences were found in heart rate and blood oxygen saturation changes caused by different types of painful procedures in term neonates (F=0.186,P=0.836; F=1.672,P=0.198).Conclusions Better pain

  9. Effects of work-related sleep restriction on acute physiological and psychological stress responses and their interactions: A review among emergency service personnel

    Alexander Wolkow


    Full Text Available Emergency work can expose personnel to sleep restriction. Inadequate amounts of sleep can negatively affect physiological and psychological stress responses. This review critiqued the emergency service literature (e.g., firefighting, police/law enforcement, defense forces, ambulance/paramedic personnel that has investigated the effect of sleep restriction on hormonal, inflammatory and psychological responses. Furthermore, it investigated if a psycho-physiological approach can help contextualize the significance of such responses to assist emergency service agencies monitor the health of their personnel. The available literature suggests that sleep restriction across multiple work days can disrupt cytokine and cortisol levels, deteriorate mood and elicit simultaneous physiological and psychological responses. However, research concerning the interaction between such responses is limited and inconclusive. Therefore, it is unknown if a psycho-physiological relationship exists and as a result, it is currently not feasible for agencies to monitor sleep restriction related stress based on psycho- physiological interactions. Sleep restriction does however, appear to be a major stressor contributing to physiological and psychological responses and thus, warrants further investigation.

  10. Effects of work-related sleep restriction on acute physiological and psychological stress responses and their interactions: A review among emergency service personnel.

    Wolkow, Alexander; Ferguson, Sally; Aisbett, Brad; Main, Luana


    Emergency work can expose personnel to sleep restriction. Inadequate amounts of sleep can negatively affect physiological and psychological stress responses. This review critiqued the emergency service literature (e.g., firefighting, police/law enforcement, defense forces, ambulance/paramedic personnel) that has investigated the effect of sleep restriction on hormonal, inflammatory and psychological responses. Furthermore, it investigated if a psycho-physiological approach can help contextualize the significance of such responses to assist emergency service agencies monitor the health of their personnel. The available literature suggests that sleep restriction across multiple work days can disrupt cytokine and cortisol levels, deteriorate mood and elicit simultaneous physiological and psychological responses. However, research concerning the interaction between such responses is limited and inconclusive. Therefore, it is unknown if a psycho-physiological relationship exists and as a result, it is currently not feasible for agencies to monitor sleep restriction related stress based on psycho- physiological interactions. Sleep restriction does however, appear to be a major stressor contributing to physiological and psychological responses and thus, warrants further investigation.

  11. Earlier application of percutaneous cardiopulmonary support rescues patients from severe cardiopulmonary failure using the APACHE III scoring system.

    Song, Suk-Won; Yang, Hong-Suk; Lee, Sak; Youn, Young-Nam; Yoo, Kyung-Jong


    Percutaneous cardiopulmonary support (PCPS) is a widely accepted treatment for severe cardiopulmonary failure. This system, which uses a percutaneous approach and autopriming devices, can be rapidly applied in emergency situations. We sought to identify the risk factors that could help predict in-hospital mortality, and to assess its outcomes in survivors. During a 2-yr period, 50 patients underwent PCPS for the treatment of severe cardiopulmonary failure, and of those, 22 (44%) were classified as survivors and 28 (56%) as non-survivors. We compared the 2 groups for risk factors of in-hospital mortality and to establish proper PCPS timing. Twenty patients underwent PCPS for acute myocardial infarction, 20 for severe cardiopulmonary failure after cardiac surgery, 7 for acute respiratory distress syndrome, and 3 for acute myocarditis. Multivariate analysis showed that an acute physiology, age, and chronic health evaluation (APACHE) III score >or=50 prior to PCPS was the only significant predictor of in-hospital mortality (P=0.001). Overall 18-month survival was 42.2%. Cox analysis showed patients with APACHE III scores >or=50 had a poor prognosis (P=0.001). Earlier application of PCPS, and other preemptive strategies designed to optimize high-risk patients, may improve patient outcomes. Identifying patients with high APACHE scores at the beginning of PCPS may predict in-hospital mortality. Survivors, particularly those with higher APACHE scores, may require more frequent follow-up to improve overall survival.

  12. Scoring systems for the characterization of sepsis and associated outcomes

    McLymont, Natalie


    Sepsis is responsible for the utilisation of a significant proportion of healthcare resources and has high mortality rates. Early diagnosis and prompt interventions are associated with better outcomes but is impeded by a lack of diagnostic tools and the heterogeneous and enigmatic nature of sepsis. The recently updated definitions of sepsis have moved away from the centrality of inflammation and the systemic inflammatory response syndrome (SIRS) criteria which have been shown to be non-specific. Sepsis is now defined as a “life-threatening organ dysfunction caused by a dysregulated host response to infection”. The Quick (q) Sequential (Sepsis-related) Organ Failure Assessment (SOFA) score is proposed as a surrogate for organ dysfunction and may act as a risk predictor for patients with known or suspected infection, as well as being a prompt for clinicians to consider the diagnosis of sepsis. Early warning scores (EWS) are track and trigger physiological monitoring systems that have become integrated within many healthcare systems for the detection of acutely deteriorating patients. The recent study by Churpek and colleagues sought to compare qSOFA to more established alerting criteria in a population of patients with presumed infection, and compared the ability to predict death or unplanned intensive care unit (ICU) admission. This perspective paper discusses recent advances in the diagnostic criteria for sepsis and how qSOFA may fit into the pre-existing models of acute care and sepsis quality improvement. PMID:28149888

  13. Assessment of the EuroSCORE risk scoring system for patients undergoing coronary artery bypass graft surgery in a group of Iranian patients

    Hamidreza Jamaati


    Full Text Available Background and Aims: Previous studies around the world indicated validity and accuracy of European System for Cardiac Operative Risk Evaluation (EuroSCORE risk scoring system we evaluated the EuroSCORE risk scoring system for patients undergoing coronary artery bypass graft (CABG surgery in a group of Iranian patients. Materials and Methods: In this cohort 2220 patients more than 18 years, who were performed CABG surgery in Massih Daneshvari Hospital, from January 2004 to March 2010 were recruited. Predicted mortality risk scores were calculated using logistic EuroSCORE and Acute Physiology and Chronic Health Evaluation II (APACHE II and compared with observed mortality. Calibration was measured by the Hosmer-Lemeshow (HL test and discrimination by using the receiver operating characteristic (ROC curve area. Results: Of the 2220 patients, in hospital deaths occurred in 270 patients (mortality rate of 12.2%. The accuracy of mortality prediction in the logistic EuroSCORE and APACHE II model was 89.1%; in the local EuroSCORE (logistic was 91.89%; and in the local EuroSCORE support vector machines (SVM was 98.6%. The area under curve for ROC curve, was 0.724 (95% confidence interval [CI]: 0.57-0.88 for logistic EuroSCORE; 0.836 (95% CI: 0.731-0.942 for local EuroSCORE (logistic; 0.978 (95% CI: 0.937-1 for Local EuroSCORE (SVM; and 0.832 (95% CI: 0.723-0.941 for APACHE II model. The HL test showed good calibration for the local EuroSCORE (SVM, APACHE II model and local EuroSCORE (logistic (P = 0.823, P = 0.748 and P = 0.06 respectively; but there was a significant difference between expected and observed mortality according to EuroSCORE model (P = 0.033. Conclusion: We detected logistic EuroSCORE risk model is not applicable on Iranian patients undergoing CABG surgery.

  14. Chronic Psychosocial Factors and Acute Physiological Responses to Laboratory-Induced Stress in Healthy Populations: A Quantitative Review of 30 Years of Investigations

    Chida, Yoichi; Hamer, Mark


    This meta-analysis included 729 studies from 161 articles investigating how acute stress responsivity (including stress reactivity and recovery of hypothalamic-pituitary-adrenal [HPA] axis, autonomic, and cardiovascular systems) changes with various chronic psychosocial exposures (job stress; general life stress; depression or hopelessness;…

  15. Luminal lactate in acute pancreatitis - validation and relation to disease severity

    Pynnönen, Lauri; Minkkinen, Minna; Räty, Sari;


    the physiological validity of the method. Rectal luminal lactate at the hospital admission was not associated with the first day or the highest SOFA score, CRP level, hospital length of stay, length of stay in intensive care or mortality. In this cohort of unselected consecutive patients with acute pancreatitis we...... patients admitted to hospital due to acute pancreatitis to test the hypothesis that a single measurement of rectal luminal lactate predicts the severity of acute pancreatitis, the length of hospital stay, the need of intensive care and ultimately, mortality. We also tested the physiological validity...... and systemic inflammation. In acute pancreatitis (AP) bacterial translocation is considered as the key event leading to infection of necrotic pancreatic tissue and high severity of illness. METHODS: We used rectal luminal equilibration dialysis for the measurement of gut luminal lactate in 30 consecutive...

  16. 生理海水辅助治疗儿童急性分泌性中耳炎的疗效分析%Adjuvant Treatment Efficacy Analysis of Children with Acute Physiological Seawater Secretory Otitis Media

    乔晓丞; 王明辉


    Objective To observe the clinical ef ect of physiological sea water nasal douche therapy on children with acute secretory otitis media. Methods 2011 May -2012 August 100 cases (130 ears) were acute secretory otitis media in children, were randomly divided into physiological sea water nasal lavage combined treatment group (treatment group, 55 cases, 82 ears) and the control group (45 cases, 48 ears), two groups were given conventional systemic drug therapy. Compare the two groups at tenth and twentieth days of treatment ef ect. Results Treatment group 76 ears, 6 ears were inef ective, the total ef iciency of 92.7%; control group, 38 ears and 10 ears of ef ective, inef ective, the total ef iciency of 79.2%; there was significant dif erence between two groups (P < 0.05). Conclusions Physiological sea water therapy on children with acute secretory otitis media is bet er.%目的观察生理海水鼻腔冲洗辅助治疗儿童急性分泌性中耳炎的临床疗效。方法2011年5月~2012年8月收治100例(130耳)急性分泌性中耳炎的儿童,随机分为生理海水鼻腔冲洗联合治疗组(治疗组,55例,82耳)和对照组(45例,48耳),两组同时给予常规全身药物治疗。比较两组在第10d和第20d的治疗效果。结果治疗组有效76耳,无效6耳,总有效率92.7%;对照组有效38耳,无效10耳,总有效率79.2%;两组差异有统计学意义(P<0.05)。结论生理海水辅助治疗儿童急性分泌性中耳炎效果较好。

  17. The physiological responses of the Caspian kutum (Rutilus frisii kutum) fry to the static magnetic fields with different intensities during acute and subacute exposures.

    Loghmannia, Javad; Heidari, Behrooz; Rozati, Seyed Ali; Kazemi, Soodabeh


    In recent years, the application of new technologies producing magnetic fields has widely increased in the aquatic environment. In this study, the effects of variable static magnetic fields on metabolic and immune parameters of the Caspian kutum fry were investigated. The Caspian kutum fry (n=220, body weight 1.78±0.11 g) was exposed to static magnetic fields with different intensities (2.5, 5.0, 7.5 mT) induced by electrical power supply during acute (one week) and subacute (3 weeks) periods. The results showed an increment in the quantity of ALT and AST enzymes (metabolic parameters) with increasing magnetic fields intensities in subacute and acute exposures (p<0.05). The lysozyme level, an immune parameter, showed a significant decrease, especially at intensities higher than 2.5 mT during subacute and acute exposures (p<0.05). It seems that low-intensity static magnetic fields can effect on the metabolism and immunity of the Caspian kutum fry as valuable commercial species.

  18. Acute exercise and physiological insulin induce distinct phosphorylation signatures on TBC1D1 and TBC1D4 in human skeletal muscle

    Treebak, Jonas Thue; Pehmøller, Christian; Kristensen, Jonas Møller


    We investigated the phosphorylation signatures of two Rab GTPase activating proteins TBC1D1 and TBC1D4 in human skeletal muscle in response to physical exercise and physiological insulin levels induced by a carbohydrate rich meal using a paired experimental design. Eight healthy male volunteers...... in response to physiological stimuli in human skeletal muscle and support the idea that Akt and AMPK are upstream kinases. TBC1D1 phosphorylation signatures were comparable between in vitro contracted mouse skeletal muscle and exercised human muscle, and we show that AMPK was regulating phosphorylation...... of these sites in mouse muscle. Contraction and exercise elicited a different phosphorylation pattern of TBC1D4 in mouse compared with human muscle, and although different circumstances in our experimental setup may contribute to this difference, the observation exemplifies that transferring findings between...

  19. Sequential organ failure assessment score in evaluation of the outcome of patients with acute poisoning%序贯器官衰竭评分对急性中毒病情及预后的评价

    刘伟; 马涛; 刘志


    after admission (SOFA ) and then a comparison was made between survivors and victims. Results There was no significant difference in SOFA between survivors and victims ( P = 0.26) , but significant difference in SOFA48 as well as SOFA was shown between survivors and victims (P < 0.01). Multivariate logistic regression analysis indicated that the SOFA48 of renal and nervous systems were the independent predictors with acute poisoning (P = 0.003 and 0.012 respectively). Spearman correlation analysis implicated that ALT,CK-MB, WBC,base excess (BE) and blood glucose (BG) had correlation with SOFAs48. Conclusions SOFA shows its score eorrellated with the prognosis of poisoning with a-cute poisoning and it is a practical method in eveluating the outcome of patients with acute poisoning.

  20. Physiological Networks: towards systems physiology

    Bartsch, Ronny P.; Bashan, Amir; Kantelhardt, Jan W.; Havlin, Shlomo; Ivanov, Plamen Ch.


    The human organism is an integrated network where complex physiologic systems, each with its own regulatory mechanisms, continuously interact, and where failure of one system can trigger a breakdown of the entire network. Identifying and quantifying dynamical networks of diverse systems with different types of interactions is a challenge. Here, we develop a framework to probe interactions among diverse systems, and we identify a physiologic network. We find that each physiologic state is characterized by a specific network structure, demonstrating a robust interplay between network topology and function. Across physiologic states the network undergoes topological transitions associated with fast reorganization of physiologic interactions on time scales of a few minutes, indicating high network flexibility in response to perturbations. The proposed system-wide integrative approach may facilitate new dimensions to the field of systems physiology.

  1. Heat Shock Factor-1 and Nuclear Factor-kappaB Are Systemically Activated in Human Acute Pancreatitis

    Derek A O’Reilly


    Full Text Available Context :Nuclear factor-kappa B (NFkappaB is a transcription factor for a wide range of proinflammatory mediators while heat shock factor-1 (HSF-1 transcribes stress proteins that protect against cellular damage. Both are attractive therapeutic targets, undergoing investigation in other acute inflammatory conditions, such as sepsis. Objective :To evaluate the role of the transcription factors NF-kappaB and HSF-1 in human acute pancreatitis and their relationship to cytokine/chemokine production, disease severity and outcome. Patients :Twenty-four patients with acute pancreatitis and 12 healthy controls. Main outcome measures :Peripheral blood mononuclear cells were isolated. NF-kappaB and HSF-1 were measured by electrophoretic mobility shift assay. Soluble tumor necrosis factor (TNF receptor II and interleukin-8 were measured by ELISA. Acute physiology scores (APS, APACHE II scores and final Atlanta designations of severity were also determined. Results: Systemic NF-kappaB activation occurs in acute pancreatitis compared to healthy controls (P=0.004. However, there was no significant difference between those with mild and severe disease (P=0.685. Systemic activation of HSF-1 was observed in acute pancreatitis compared to healthy controls although this did not reach statistical significance (P=0.053. Activation, however, was greatest in those who had a final Atlanta designation of mild pancreatitis compared to those who had a severe attack of acute pancreatitis (P=0.036. Furthermore, HSF-1 was inversely correlated with acute physiology score (APS; r=-0.49, P=0.019 and APACHE II score (r=-0.47, P=0.026. Conclusions: Both NF-kappaB and HSF-1 are systemically activated in human acute pancreatitis. HSF-1 activation may protect against severity of pancreatitis

  2. Risk prediction score for severe high altitude illness: a cohort study.

    Florence Canouï-Poitrine

    Full Text Available Risk prediction of acute mountain sickness, high altitude (HA pulmonary or cerebral edema is currently based on clinical assessment. Our objective was to develop a risk prediction score of Severe High Altitude Illness (SHAI combining clinical and physiological factors. Study population was 1017 sea-level subjects who performed a hypoxia exercise test before a stay at HA. The outcome was the occurrence of SHAI during HA exposure. Two scores were built, according to the presence (PRE, n = 537 or absence (ABS, n = 480 of previous experience at HA, using multivariate logistic regression. Calibration was evaluated by Hosmer-Lemeshow chisquare test and discrimination by Area Under ROC Curve (AUC and Net Reclassification Index (NRI.The score was a linear combination of history of SHAI, ventilatory and cardiac response to hypoxia at exercise, speed of ascent, desaturation during hypoxic exercise, history of migraine, geographical location, female sex, age under 46 and regular physical activity. In the PRE/ABS groups, the score ranged from 0 to 12/10, a cut-off of 5/5.5 gave a sensitivity of 87%/87% and a specificity of 82%/73%. Adding physiological variables via the hypoxic exercise test improved the discrimination ability of the models: AUC increased by 7% to 0.91 (95%CI: 0.87-0.93 and 17% to 0.89 (95%CI: 0.85-0.91, NRI was 30% and 54% in the PRE and ABS groups respectively. A score computed with ten clinical, environmental and physiological factors accurately predicted the risk of SHAI in a large cohort of sea-level residents visiting HA regions.

  3. Effect of a Six-Week Preparation Period on Acute Physiological Responses to a Simulated Combat in Young National-Level Taekwondo Athletes.

    Nikolaidis, Pantelis T; Chtourou, Hamdi; Torres-Luque, Gema; Tasiopoulos, Ioannis G; Heller, Jan; Padulo, Johnny


    The aim of this study was to examine changes in physical attributes, physiological characteristics and responses that occurred in a simulated combat during a six-week preparatory period in young taekwondo athletes. Seven athletes (age 12.17 ± 1.11 years) were examined before (pre-intervention) and after (post-intervention) a preparatory period for physical fitness and physiological responses to a 2×90 s simulated bout with a 30 s rest period. The heart rate (HR) was monitored during the simulated combat, and handgrip muscle strength (HMS) along with the countermovement jump (CMJ) were recorded before and after the combat. When compared with pre-intervention values, in post-intervention we observed a decrease in body mass, body fat percentage, and the HR at rest and during recovery after a 3 min step test, and an increase in maximal velocity of the cycle ergometer force-velocity test, the CMJ and mean power during the 30 s continuous jumping test (ptaekwondo combat vary during a season, which might be explained by changes in physical fitness.




    Full Text Available INTRODUCTION The pancreas is perhaps the most unforgiving organ in the human body and with its critical endocrine functions and its exocrine portion is a major source of extremely potent digestive enzymes Pancreatic diseases are very complex and acute pancreatitis is associated with high morbidity and mortality rates. Early diagnosis of pancreatitis, its severity evaluation and adequate intensive care are highly essential for the reduction in morbidity and mortality. There are various criteria to assess the severity of acute pancreatitis like Ranson’s criteria, The Acute Physiology and Chronic Health Evaluation II (APACHE II score, Glasgow score etc. Ranson’s criteria is most frequently and accurate method to assess the severity and mortality associated with acute pancreatitis because of its relative easy tabulation and resulting scores well correlated with morbidity and mortality. OBJECTIVES To study the clinical presentation, complications and prognosis of patients with acute pancreatitis during the study period. To study the correlation of Ranson’s criteria in acute pancreatitis with prognosis of the patient. METHODS Prospective study conducted in period ranging from November 2012 to October 2014 who admitted in JSS Hospital, Mysore in the Department of surgery satisfying inclusion criteria were taken into study. RESULTS Patients with low Ranson’s score had shorter hospital duration and majority recovered by the time of discharge. High Ranson’s score predicts long hospital stay and increased morbidity and mortality. In our study it predicted long hospital study but could not predict significant morbidity or mortality. CONCLUSION Ranson’s criteria is the best prognostic tool in assessing the severity of the acute pancreatitis and also defines the need for early aggressive management in acute severe pancreatitis to reduce morbidity and mortality.

  5. Acute effects of electromagnetic fields emitted by GSM mobile phones on subjective well-being and physiological reactions: a meta-analysis.

    Augner, Christoph; Gnambs, Timo; Winker, Robert; Barth, Alfred


    The potential effects of radiofrequency electromagnetic fields (RF-EMF) emitted by GSM mobile phones on subjective symptoms, well-being and physiological parameters have been investigated in many studies. However, the results have been ambiguous. The current meta-analysis aims to clarify whether RF-EMF have an influence on well-being in self-reported sensitive persons, as well as in non-sensitive people. A literature search revealed 17 studies including 1174 participants. The single effects for various subjective and objective outcomes were meta-analytically combined to yield a single population parameter. Dependant variables were subjective (e.g. headaches) and objective parameters (e.g. heart rate variability) of well-being. The results show no significant impact of short-term RF-EMF exposure on any parameter. Future research should focus on the possible effects of long-term exposure.

  6. Evaluation of nosocomial infection risk using APACHE II scores in the neurological intensive care unit.

    Li, Hai-Ying; Li, Shu-Juan; Yang, Nan; Hu, Wen-Li


    To evaluate the feasibility and accuracy of using the Acute Physiology, Age and Chronic Health Evaluation II (APACHE II) scoring system for predicting the risk of nosocomial infection in the neurological intensive care unit (NICU), 216 patients transferred to NICU within 24hours of admission were retrospectively evaluated. Based on admission APACHE II scores, they were classified into three groups, with higher APACHE II scores representing higher infectious risk. The device utilization ratios and device-associated infection ratios of NICU patients were analyzed and compared with published reports on patient outcome. Statistical analysis of nosocomial infection ratios showed obvious differences between the high-risk, middle-risk and low-risk groups (pAPACHE II model in predicting the risk of nosocomial infection was 0.81, which proved to be reliable and consistent with the expectation. In addition, we found statistical differences in the duration of hospital stay (patient-days) and device utilization (device-days) between different risk groups (pAPACHE II scoring system was validated in predicting the risk of nosocomial infection, duration of patient-days and device-days, and providing accurate assessment of patients' condition, so that appropriate prevention strategies can be implemented based on admission APACHE II scores.

  7. The Apgar Score.


    The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed. The Apgar score alone cannot be considered as evidence of, or a consequence of, asphyxia; does not predict individual neonatal mortality or neurologic outcome; and should not be used for that purpose. An Apgar score assigned during resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists encourage use of an expanded Apgar score reporting form that accounts for concurrent resuscitative interventions.

  8. Outcome prediction in a surgical ICU using automatically calculated SAPS II scores.

    Engel, J M; Junger, A; Bottger, S; Benson, M; Michel, A; Rohrig, R; Jost, A; Hempelmann, G


    The objective of this study was to establish a complete computerized calculation of the Simplified Acute Physiology Score (SAPS) II within 24 hours after admission to a surgical intensive care unit (ICU) based only on routine data recorded with a patient data management system (PDMS) without any additional manual data entry. Score calculation programs were developed using SQL scripts (Structured Query Language) to retrospectively compute the SAPS II scores of 524 patients who stayed in ICU for at least 24 hours between April 1, 1999 and March 31, 2000 out of the PDMS database. The main outcome measure was survival status at ICU discharge. Score evaluation was modified in registering missing data as being not pathological and using surrogates of the Glasgow Coma Scale (GCS). Computerized score calculation was possible for all investigated patients. The 459 (87.6%) survivors had a median SAPS II of 28 (interquartile range (IQR) 13) whereas the 65 (12.4%) decreased patients had a median score of 43 (IQR 16; P calculation, bilirubin was missing in 84%, followed by PaO2/FiO2 ratio (34%), and neurological status (34%). Using neurological diagnoses and examinations as surrogates for the GCS, a pathological finding was seen in only 8.8% of all results. The discriminative power of the computerized SAPS II checked with a receiver operating characteristic (ROC) curve was 0.81 (95% confidence interval (CI): 0.74-0.87). The Hosmer-Lemeshow goodness-of-fit statistics showed good calibration (H = 5.55, P = 0.59, 7 degrees of freedom; C = 5.55, P = 0.68, 8 degrees of freedom). The technique used in this study for complete automatic data sampling of the SAPS II score seems to be suitable for predicting mortality rate during stay in a surgical ICU. The advantage of the described method is that no additional manual data recording is required for score calculation.

  9. The prediction of the in-hospital mortality of acutely ill medical patients by electrocardiogram (ECG) dispersion mapping compared with established risk factors and predictive scores--a pilot study.

    Kellett, John


    ECG dispersion mapping (ECG-DM) is a novel technique that analyzes low amplitude ECG oscillations and reports them as the myocardial micro-alternation index (MMI). This study compared the ability of ECG-DM to predict in-hospital mortality with traditional risk factors such as age, vital signs and co-morbid diagnoses, as well as three predictive scores: the Simple Clinical Score (SCS)--based on clinical and ECG findings, and two Medical Admission Risk System scores--one based on vital signs and laboratory data (MARS), and one only on laboratory data (LD).

  10. Matched and mismatched unrelated donor compared to autologous stem cell transplantation for acute myeloid leukemia in first complete remission: a retrospective, propensity score-weighted analysis from the ALWP of the EBMT

    Francesco Saraceni


    Full Text Available Abstract Background Optimal post-remission strategy for patients with acute myeloid leukemia (AML is matter of intense debate. Recent reports have shown stronger anti-leukemic activity but similar survival for allogeneic stem cell transplantation (allo-HSCT from matched sibling donor compared to autologous transplantation (auto-HSCT; however, there is scarcity of literature confronting auto-HSCT with allo-HSCT from unrelated donor (UD-HSCT, especially mismatched UD-HSCT. Methods We retrospectively compared outcome of allogeneic transplantation from matched (10/10 UD-HSCT or mismatched at a single HLA-locus unrelated donor (9/10 UD-HSCT to autologous transplantation in patients with AML in first complete remission (CR1. A total of 2879 patients were included; 1202 patients received auto-HSCT, 1302 10/10 UD-HSCT, and 375 9/10 UD-HSCT. A propensity score-weighted analysis was conducted to control for disease risk imbalances between the groups. Results Matched 10/10 UD-HSCT was associated with the best leukemia-free survival (10/10 UD-HSCT vs auto-HSCT: HR 0.7, p = 0.0016. Leukemia-free survival was not statistically different between auto-HSCT and 9/10 UD-HSCT (9/10 UD-HSCT vs auto-HSCT: HR 0.8, p = 0.2. Overall survival was similar across the groups (10/10 UD-HSCT vs auto-HSCT: HR 0.98, p = 0.84; 9/10 UD-HSCT vs auto-HSCT: HR 1.1, p = 0.49. Notably, in intermediate-risk patients, OS was significantly worse for 9/10 UD-HSCT (9/10 UD-HSCT vs auto-HSCT: HR 1.6, p = 0.049, while it did not differ between auto-HSCT and 10/10 UD-HSCT (HR 0.95, p = 0.88. In favorable risk patients, auto-HSCT resulted in 3-year LFS and OS rates of 59 and 78 %, respectively. Conclusions Our findings suggest that in AML patients in CR1 lacking an HLA-matched sibling donor, 10/10 UD-HSCT significantly improves LFS, but this advantage does not translate in better OS compared to auto-HSCT. In intermediate-risk patients lacking a fully HLA-matched donor

  11. KAMIR评分与GRACE评分预测急性心肌梗死患者一年死亡率的临床研究%Clinical assessment of KAMIR and GRACE scores system on predicting one-year mortality of acute myocardial infarction patients

    高戎; 钱骏; 徐建如


    目的 比较KAMIR评分与GRACE评分预测急性心肌梗死(AMI)患者一年死亡率的价值.方法 对收治128例AMI患者进行回顾性分析,计算KAMIR、GRACE评分,采用受试者工作特征曲线(ROC曲线),计算曲线下面积(AUC);KAMIR和GRACE的评分AUC比较采用Z检验.结果 KAMIR及GRACE评分预测AMI患者一年死亡率的AUC分别为0.880和0.792,两者比较差异有统计学意义(Z=2.524,P=0.0116).结论 KAMIR评分对预测AMI患者一年死亡率有较好的预测价值.%Objective To evaluate the predictive value of KAMIR and GRACE scores system score on predicting one - year mortality of acute myocardial infarction (AMI) patients. Methods One hundred and twenty - eight patients with AMI were retrospectively analyzed. The KAMIR and GRACE scores were calculated. The area under the receiver operating characteristic ( ROC ) curve ( AUC ) was evaluated using ROC curve. KAMIR, GRACE scores and AUC were analyzed by Z test. Results The AUCs of KAMIR and GRACE score for predicting one - year mortality of AMI patients were 0. 880 and 0. 792,respectively, which were significantly different between the two scores system(Z =2. 524,P = 0.0116). Conclusion KAMIR score is a better predictive factor of one - year mortality for AMI patients.

  12. The Perfect Way to Predict the Severity of Acute Pancreatitis: The Search Continues

    Daniel C Sadowski


    Full Text Available This study was designed to determine the clinical utility of three rating scales (Ranson's, Acute Physiology And Chronic Health Evaluation [APACHE] II and Glasgow in predicting the severity of acute pancreatitis experienced by patients known to have human immunodeficiency virus (HIV or acquired immunodeficiency syndrome (AIDS. A retrospective analysis identified 73 patients with both acute pancreatitis and HIV who had been admitted to two Canadian hospitals between 1989 and 1999. Of those 73, 11 (15% went on to have a clinical course consistent with a diagnosis of severe pancreatitis. For the purposes of the study, severe pancreatitis was defined by the occurrence of death, intensive care unit admission, surgical intervention or significant symptomatic local complications (necrosis, abscess or pseudocyst. The authors found that the APACHE II and Ranson's scores had a sensitivity of 100% and specificities of 70% and 33% for severe pancreatitis, respectively. The Glasgow score had a statistically poorer diagnostic performance.

  13. Acute respiratory failure in scrub typhus patients

    Jyoti Narayan Sahoo


    Full Text Available Respiratory failure is a serious complication of scrub typhus. In this prospective study, all patients with a diagnosis of scrub typhus were included from a single center Intensive Care Unit (ICU. Demographic, clinical characteristics, laboratory, and imaging parameters of these patients at the time of ICU admission were compared. Of the 55 scrub typhus patients, 27 (49% had an acute respiratory failure. Seventeen patients had acute respiratory distress syndrome, and ten had cardiogenic pulmonary edema. Respiratory supported patients were older had significant chronic lungs disease and high severity illness scores (Acute Physiology and Chronic Health Evaluation-II and Sequential Organ Failure Assessment score. At ICU admission, these patients presented with more deranged laboratory markers, including high bilirubin, high creatine kinase, high lactate, metabolic acidosis, low serum albumin, and presence of ascites. The average ICU and hospital stay were 4.27 ± 2.74 and 6.53 ± 3.52 days, respectively, in the respiratory supported group. Three patients died in respiratory failure group, while only one patient died in nonrespiratory failure group.

  14. Mathematical physiology

    Sneyd, James


    There has been a long history of interaction between mathematics and physiology. This book looks in detail at a wide selection of mathematical models in physiology, showing how physiological problems can be formulated and studied mathematically, and how such models give rise to interesting and challenging mathematical questions. With its coverage of many recent models it gives an overview of the field, while many older models are also discussed, to put the modern work in context. In this second edition the coverage of basic principles has been expanded to include such topics as stochastic differential equations, Markov models and Gibbs free energy, and the selection of models has also been expanded to include some of the basic models of fluid transport, respiration/perfusion, blood diseases, molecular motors, smooth muscle, neuroendrocine cells, the baroreceptor loop, turboglomerular oscillations, blood clotting and the retina. Owing to this extensive coverage, the second edition is published in two volumes. ...

  15. Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS)

    Roemer, Frank W; Frobell, Richard; Lohmander, Stefan


    OBJECTIVE: To develop a whole joint scoring system, the Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS), for magnetic resonance imaging (MRI)-based assessment of acute anterior cruciate ligament (ACL) injury and follow-up of structural sequelae, and to assess its reliability. DESIGN...... and longitudinal changes including osteoarthritis (OA) features. Joint features assessed were acute osteochondral injury, traumatic and degenerative bone marrow lesions (BMLs), meniscus morphology and extrusion, osteophytes, collateral and cruciate ligaments including ACL graft, Hoffa-synovitis and effusion...

  16. A simple tool for mortality prediction in burns patients: APACHE III score and FTSA.

    Moore, E C; Pilcher, D V; Bailey, M J; Cleland, H; McNamee, J


    Prediction of outcome for patients with major thermal injury is important to inform clinical decision making, alleviate individual suffering and improve hospital resource allocation. Age and burn size are widely accepted as the two largest contributors of mortality amongst burns patients. The APACHE (Acute Physiology and Chronic Health Evaluation) III-j score, which incorporates patient age, is also useful for mortality prediction, of intensive care populations. Validation for the burns specific cohort is unclear. A retrospective cohort study was performed on patients admitted to the Intensive Care Unit (ICU) via the Victorian Adult Burns Service (VABS), to compare observed mortality with burns specific markers of illness severity and APACHE III-j score. Our primary aim was to develop a mortality prediction tool for the burns population. Between January 1, 2002 and December 31, 2008, 228 patients were admitted to the ICU at The Alfred with acute burns. The mean age was 45.6 years and 81% (n=184) were male. Patients had severe injuries: the average percent TBSA (total body surface area) was 28% (IQR 10-40) and percent FTSA (full thickness surface area) was 18% (IQR 10-25). 86% (n=197) had airway involvement. Overall mortality in the 7-year period was 12% (n=27). Non-survivors were older, had larger and deeper burns, a higher incidence of deliberate self-harm, higher APACHE III-j scores and spent less time in hospital (but similar time in ICU), compared with survivors. Independent risk factors for death were percent FTSA (OR 1.03, 95% CI 1.01-1.05, p=0.01) and APACHE III-j score (OR 1.04, 95% CI 1.02-1.07, pAPACHE III-j score and percent FTSA. Prospective validation of our model on different burn populations is necessary.

  17. A prospective study of the HEART scores' value in diagnosing acute coronary syndrome in the chest pain center%前瞻性研究心脏评分在胸痛中心对急性冠脉综合征的诊断价值

    王旭; 聂绍平; 曾哲淳


    Objective To study the value of HEART scores in predicting the risk of getting acute coronary syndrome in patients with chest pain and assessing the prognosis in order to elucidate the validity of the HEART scores.Methods A total of 1 200 patients with chest pain were continuously observed and followed up,and their HEART scores were calculated.The survival rates were calculated with Kaplan-Meier method and AUROC (area under ROC curve) was used to determine the accuracy of this methods.The HEART scores were compared with TIMI and GRACE scores.Results Low HEART scores (0-3) were found in 34.5% of the patients and MACE (major adverse cardiac event) occurred in 1.4% of them.The patients with intermediate HEART scores (4-6) accounted for 50.7% patients,and MACE was diagnosed in 22.2% of them.High HEART scores (7-10) were found in 14.85% patients,and MACE occurred in 60.7% of them.There was significant difference among these three groups (Log rank P < 0.01).The AUROC of HEART score was 0.83 (95% CI:0.80-0.85,P <0.01),being significantly higher than the GRACE scores (0.76) and TIMI scores (0.72).Conclusions The HEART score is applicable for predicting the risk of getting acute coronary syndrome of chest pain patients in emergency department and the prognosis.%目的 应用心脏评分(HEART)评价急诊胸痛患者中发生急性冠脉综合征的危险程度并判断其预后,以证明其应用的有效性.方法 连续观察急诊胸痛患者1 200例,分别计算各自HEART评分并进行长期随访,Kaplan-Meier法用以计算生存率,ROC曲线下面积观察该方法的准确性,并与TIMI和GRACE评分进行比较.结果 34.5%的患者为低分组(HEART评分0~3),MACE事件发生率为1.4%;50.7%为中分组(4~6),MACE事件发生率为22.2%;14.8%为高分组(7~10),MACE事件发生率为60.7%;3组比较差异具有统计学意义(Log-rank,P<0.01);心脏评分ROC曲线分析结果显示,曲线下面积(AUC) =0.83[95% CI:0.80 ~0

  18. Exercise physiology

    Kiens, Bente; Richter, Erik; Wojtaszewski, Jørgen


    The passing of Professor Bengt Saltin on September 12, 2014 truly marks the end of an era. As editor of the Journal of Applied Physiology and one of Bengt’s many collaborators and colleagues, I wanted the Journal to celebrate his many seminal contributions by means of an Editorial. Professor Bent...

  19. Reproductive physiology

    Gee, G.F.; Russman, S.E.; Ellis, David H.; Gee, George F.; Mirande, Claire M.


    Conclusions: Although the general pattern of avian physiology applies to cranes, we have identified many physiological mechanisms (e.g., effects of disturbance) that need further study. Studies with cranes are expensive compared to those done with domestic fowl because of the crane's larger size, low reproductive rate, and delayed sexual maturity. To summarize, the crane reproductive system is composed of physiological and anatomical elements whose function is controlled by an integrated neural-endocrine system. Males generally produce semen at a younger age than when females lay eggs. Eggs are laid in clutches of two (1 to 3), and females will lay additional clutches if the preceding clutches are removed. Both sexes build nests and incubate the eggs. Molt begins during incubation and body molt may be completed annually in breeding pairs. However, remiges are replaced sequentially over 2 to 3 years, or abruptly every 2 to 3 years in other species. Most immature birds replace their juvenal remiges over a 2 to 3 year period. Stress interferes with reproduction in cranes by reducing egg production or terminating the reproductive effort. In other birds, stress elevates corticosterone levels and decreases LHRH release. We know little about the physiological response of cranes to stress.




  1. Specific scoring systems to predict survival of patients with high-risk myelodysplastic syndrome (MDS) and de novo acute myeloid leukemia (AML) after intensive antileukemic treatment based on results of the EORTC-GIMEMA AML-10 and intergroup CRIANT studies

    Oosterveld, M.; Suciu, S.; Muus, P.; Germing, U.; Delforge, M.; Belhabri, A.; Aul, C.; Selleslag, D.; Ferrant, A.; Marie, J.P.; Amadori, S.; Jehn, U.; Mandelli, F.; Hess, U.; Hellstrom-Lindberg, E.; Cakmak-Wollgast, S.; Vignetti, M.; Labar, B.; Willemze, R.; Witte, T.J. de


    High-risk myelodysplastic syndrome (MDS) patients have usually a less favorable outcome after intensive treatment compared with de novo acute myeloid leukemia (AML) patients. This may reflect different disease-related and patient-related factors. The purpose of this analysis is to identify disease-s

  2. The scoring system for patients with severe sepsis after orthotopic liver transplantation

    Shun-Wei Huang; Xiang-Dong Guan; Xiao-Shun He; Juan Chen; Bin Ouyang


    BACKGROUND:Because of the complicated pathological features after liver transplantation, severe sepsis is dififcult to treat and often leads to death. This study was undertaken to analyze the role of orthotopic liver transplantation (OLT) in patients with severe sepsis and to evaluate the effect of the scoring system. METHODS:Fifty-six patients conformed to the inclusion criteria. They were divided into two groups: non-OLT group (group A) and OLT group (group B). Besides the general data of the patients, the surveillance of blood lactate, the number of failed organs, acute physiology and chronic health evaluationⅡ(APACHEⅡ) and mutiple organ dysfunction score (MODS) were evaluated at the 1st, 3rd and 7th day after OLT. RESULTS:The mortality during hospitalization was 30%in the non-OLT group and 57.6%in the other group. The level of blood lactate at the 1st day of OLT increased more signiifcantly in the OLT group than in the non-OLT group (P CONCLUSIONS: The persistently higher level of blood lactate during 7 days may be a dependent risk factor. Immunosuppression may be another risk factor for OLT patients. The mortality of OLT in patients with severe sepsis in 28 days is almost double that in non-OLT patients. The MODS score is better than the APACHEⅡscore in the assessment of organ failure in OLT patients with severe sepsis. The standard scoring system could be improved or a new scoring system that includes the blood lactate score should be established for liver transplantation.

  3. APACHE II score, rather than cardiac function, may predict poor prognosis in patients with stress-induced cardiomyopathy.

    Joe, Byung-Hyun; Jo, Uk; Kim, Hyun-Soo; Park, Chang-Bum; Hwang, Hui-Jeong; Sohn, Il-Suk; Jin, Eun-Sun; Cho, Jin-Man; Park, Jeong-Hwan; Kim, Chong-Jin


    While the disease course of stress-induced cardiomyopathy (SIC) is usually benign, it can be fatal. The prognostic factors to predict poorer outcome are not well established, however. We analyzed the Acute Physiology And Chronic Health Evaluation (APACHE) II score to assess its value for predicting poor prognosis in patients with SIC. Thirty-seven consecutive patients with SIC were followed prospectively during their hospitalization. Clinical factors, including APACHE II score, coronary angiogram, echocardiography and cardiac enzymes at presentation were analyzed. Of the 37 patients, 27 patients (73%) were women. The mean age was 66.1 ± 15.6 yr, and the most common presentation was chest pain (38%). Initial echocardiographic left ventricular ejection fraction (EF) was 42.5% ± 9.3%, and the wall motion score index (WMSI) was 1.9 ± 0.3. Six patients (16%) expired during the follow-up period of hospitalization. Based on the analysis of characteristics and clinical factors, the only predictable variable in prognosis was APACHE II score. The patients with APACHE II score greater than 20 had tendency to expire than the others (P = 0.001). Based on present study, APACHE II score more than 20, rather than cardiac function, is associated with mortality in patients with SIC.

  4. 急性生理与慢性健康状况评分系统Ⅲ及氧合指数与老年重症肺炎预后的关系分析%Relationships between acute physiology and chronic health evaluation system Ⅲ, oxygenation index and prognosis of senile severe pneumonia



    Objective To analyze the relationships between acute physiology and chronic health evaluation system Ⅲ (APACHEⅢ ), oxygenation index and prognosis of senile severe pneumonia. Methods Sixty - four senile patients with severe pneumonia in our hospital were divided into survival group and death group according to different prognosis. Patients in both groups received the same treatment, and the APACHE Ⅲ scoring, arterial blood gas analysis and oxygenation index calculation were carried during treatment. The relationships between APACHEⅢ , oxygenation index and prognosis of senile severe pneumonia were analyzed. Results Compared with the levels when diagnosed, the oxygenation indexes significantly increased from the fifth day after patients in survival group were hospitalized, and the APACHE Ⅲ scoring significantly decreased. While the oxygenation indexes significantly decreased from the fifth day after patients in death group were hospitalized, and the APACHE Ⅲ scoring significantly increased. The oxygenation index at each point in death group was significantly lower than that in survival group, while the APACHE Ⅲ scoring was significantly higher. Conclusion There is a close relationship between APACHE Ⅲ, oxygenation index and prognosis of senile severe pneumonia. It can be used as a reference to evaluate the critical degree of patients, and is important for prognosis evaluation.%目的 分析急性生理与慢性健康状况评分系统Ⅲ(APACHEⅢ)及氧合指数与老年重症肺炎预后的关系.方法 将本院收治的64例老年重症肺炎患者按照预后不同分为存活组和死亡组,2组均接受相同治疗方法,在治疗过程中进行A-PACHEⅢ评分、动脉血气分析,并计算氧合指数,分析APACHEⅢ评分及氧合指数与老年重症肺炎预后的关系.结果 存活组患者从入院第5天开始氧合指数较确诊时显著升高,APACHEⅢ评分显著降低;死亡组患者从入院第5天开始氧合指数较确诊

  5. The Bandim tuberculosis score

    Rudolf, Frauke; Joaquim, Luis Carlos; Vieira, Cesaltina


    Background: This study was carried out in Guinea-Bissau ’ s capital Bissau among inpatients and outpatients attending for tuberculosis (TB) treatment within the study area of the Bandim Health Project, a Health and Demographic Surveillance Site. Our aim was to assess the variability between 2...... physicians in performing the Bandim tuberculosis score (TBscore), a clinical severity score for pulmonary TB (PTB), and to compare it to the Karnofsky performance score (KPS). Method : From December 2008 to July 2009 we assessed the TBscore and the KPS of 100 PTB patients at inclusion in the TB cohort and...

  6. ACS 患者超敏-CRP 和 SYNTAX 积分的相关性研究%Correlation between high sensitive CRP level and SYNTAX score in patients with acute coronary syn-drome

    王黎; 任品芳; 沈剑耀


    目的:探讨超敏-CRP (hs-CRP)和SYNTAX积分所反映的ACS患者冠状动脉病变范围和严重程度的关系。方法选取 ACS 患者218例,根据 SYNTAX 积分将其分为低分组152例(1~22分)和中高分组66例(≥23分),对患者的一般临床特征、hs-CRP 等血液指标、冠状动脉造影特征等和 SYNTAX 积分的关系进行分析。结果ACS 患者中高分组的 hs-CRP 水平[(13.2±3.3)mg/L]高于低分组患者[(10.4±3.9)mg/L,P <0.05]。中高分组的年龄、血糖、血清肌酐、总胆固醇、LDL、CK-MB、心肌肌钙蛋白 T 均高于低分组(P 均<0.05),而中高分组的 LVEF 为(43.7±3.9)%,低于低分组的(53.7±6.8)%,2组比较差异有统计学意义(P <0.05)。Logistic 回归显示hs-CRP、年龄、LVEF、ST 段抬高型心肌梗死、LDL、慢性完全闭塞性病变是 SYNTAX 中高分组的独立预测因子。结论hs-CRP 是 SYNTAX 积分所反映的 ACS 患者冠状动脉病变范围和严重程度的独立预测因子。%Objective To explore the relationship between high sensitive CRP (hs-CRP)and the ex-tent and severity of coronary artery disease in patients with ACS reflected by SYNTAX score.Methods 218 cases of patients with ACS were selected.According to the SYNTAX score,the patients were divided into low SYNTAX score group (1-22 scores)including 152 cases of patients and intermediate-high SYNTAX score group (≥23 scores)including 66 cases of patients.The relationship between the clinic characteristics,blood biochemical parameters such as hs-CRP etc.coronary angiography features,etc.and SYNTAX score were ana-lyzed.Results hs-CRP levels in intermediate-high SYNTAX score group were higher than those in low SYN-TAX score group (13.2 ±3.3 mg/L vs.10.4 ±3.9 mg/L,P <0.05).At the same time,the age of pa-tients,blood glucose,serum creatinine,total cholesterol,LDL,CK-MB,cTnT in the intermediate-high SYN-TAX score group were

  7. 妊娠期呼吸生理改变与哮喘急性发作的治疗%Respiratory physiological changes during pregnancy and treatment of acute asthma

    曾笑梅; 陈惠华; 邓新宇


    . Pay close attention to the changes of respiratory physiological and lung function in the patient of pregnancy combined with asthma, and alter the treatment strategy basing on the above changes will insure the health of the pregnant women and their fetus furthest. This article outlined the respiratory physiological changes during pregnancy and the treatment of acute episoded asthma in the pregnancy.

  8. BOAS与ASTRAL评分预测急性缺血性脑卒中患者3月不良预后的价值%BOAS vs ASTRAL Score in Predicting the 3-month Unfavorable Outcome of Acute Ischemic Stroke



    Objective To study the clinical values of the Bologna Outcome Algorithm for Stroke (BOAS) and the Acute Stroke Registry and Analysis of Lausanne (ASTRAL)Score in evaluating 3-month unfavorable outcome after Acute Ischemic Stroke (AIS). Methods The clinical data and of 305 consecutive patients with AIS admit ed from January 2013 to April 2014 were col ected in this research. Al patients were evaluated according to BOAS Score and ASTRAL Score criteria. Areas under the curve were calculated to quantify the prognostic value and compared with the values between BOAS and ASTRAL Score in predicting. Unfavorable outcome was assessed as a modified Rankin Scale score >2 at 3 months. Calibration was assessed by comparing predicted and observed probability of unfavorable outcome using Pearson correlation coef icient.Results Al patients appeared functional disability (modified Rankin score> 2) or the death of a poor prognosis 115 cases (37.7%) within 3 months.The AUC of BOAS and ASTRAL Score for 3 months were 0.859( =0.000,95%CI:0.804-0.914)and 0.812( =0.000,95%CI:0.750~0.875)respectively.Conclusion BOAS and ASTRAL score assessment of acute ischemic stroke patients with poor prognosis three months have bet er predictive value, is conducive to clinical decision making.%目的比较博洛尼亚卒中结局算法(BOAS)与洛桑卒中评分(ASTRAL)评估急性缺血性脑卒中(AIS)患者3个月不良预后的预测价值。方法收集2013年1月~2014年4月我院305例急性缺血性脑卒中患者的临床资料,比较BOAS与ASTRAL评分预测缺血性脑卒中的3个月的不良预后,并绘制受试工作者特征曲线下面积(AUC),以卒中后3个月的死亡率或功能残障(改良Rankin评分>2分为不良预后),应用Pearson相关分析评估实际与预期结局事件的关联程度。结果全组患者3个月出现功能残障(改良Rankin评分>2)或死亡的不良预后有115例(37.7%);BOAS和ASTRAL评分预测3个

  9. Volleyball Scoring Systems.

    Calhoun, William; Dargahi-Noubary, G. R.; Shi, Yixun


    The widespread interest in sports in our culture provides an excellent opportunity to catch students' attention in mathematics and statistics classes. One mathematically interesting aspect of volleyball, which can be used to motivate students, is the scoring system. (MM)

  10. BISAP评分在急性胰腺炎预后的评估价值的研究%Research of score BISAP validation as a prognostic system in acute pancreatitis

    段磊; 谢静


    目的::探讨BISAP评分系统( bedside index for severity in AP)对急性胰腺炎( AP)的评估价值。方法:回顾性分析88例急性胰腺炎患者的病历进行BISAP评分。结果:BISAP评分系统,分值越高,患者的病情越严重、病死率越高。结论:对于AP预后的评估,BISAP评分系统是实用的,具有简单、快速、有效的特点。%Objective:To evaluate the value of BISAP score in predicting AP. Methods:88 cases of AP were retrospectively analyzed, and calculated with BISAP. Results:The higher the score, the patient was more serious ,the higher the fatality rate. Conclusion The BISAP score might be a practical, has simple, fast and efficient characteristics.

  11. Occupational physiology

    Toomingas, Allan; Tornqvist, Ewa Wigaeus


    In a clear and accessible presentation, Occupational Physiology focuses on important issues in the modern working world. Exploring major public health problems-such as musculoskeletal disorders and stress-this book explains connections between work, well-being, and health based on up-to-date research in the field. It provides useful methods for risk assessment and guidelines on arranging a good working life from the perspective of the working individual, the company, and society as a whole.The book focuses on common, stressful situations in different professions. Reviewing bodily demands and r

  12. 急性ST段抬高型心肌梗死患者心型脂肪酸结合蛋白水平与GRACE危险评分的相关性研究%Relationship between Heart-type Fatty Acid-binding Protein and GRACE Risk Score in Patients with Acute ST-elevation Myocardial Infarction

    魏庆民; 周彬; 王晓纲; 樊延明; 王爱平; 刘翠华


    Objective To study the relationship between heart - type fatty acid - binding protein ( H - FABP ) level and Global Registry of Acute Coronary Events ( GRACE ) risk score in patients with acute ST - elevation myocardial infarction ( STEMI ). Methods From April 2010 to December 2011 , 60 STEM patients admitted to our hospital within 2 hours of symptom onset were enrolled in this study. Twelve hours after admission, blood samples were obtained for H - FABP measurement every two hours. Then, H - FABP peak values were found. The baseline data were recorded and the GRACE risk score were calculated. The Pearson's correlation analysis were used to analyze the relationship between the H - FABP peak value and GRACE risk score. Results The peak value of H - FABP was ( 59. 4 ± 23. 1 ) μg/L, which occmed 4~8 hours after admission. It was positively correlated with GRACE risk score in these patients ( r = 0.701 , P<0. 05 ). Conclusion H -FABP peak value is directly relevant with GRACE risk score in STEMI patients. Measurement of H - FABP level can provide additional risk stratification information in these patients.%目的 探讨急性ST段抬高型心肌梗死(STEMI)患者血浆心型脂肪酸结合蛋白(H-FABP)的峰值水平与全球急性冠状动脉事件注册(GRACE)风险评分的相关性.方法 选择2010年4月-2011年12月我科收治的发病2 h内的STEMI患者60例,于患者发病后2、4、6、8、10、12 h采血,检测H-FABP水平,找出其峰值.记录患者的基线资料,计算GRACE风险评分,对GRACE评分和H-FABP的峰值水平进行Pearson直线相关分析.结果 H-FABP的达峰时间为4~8 h,平均峰值为(59.4±23.1)μg/L;STEMI患者H-FABP峰值水平与GRACE危险评分呈正相关(r=0.701,P<0.05).结论 STEMI的H-FABP峰值水平与GRACE评分相关,检测H-FABP峰值水平可以为STEMI患者的危险分层提供参考.

  13. Prognostic Value of TIMI Score versus GRACE Score in ST-segment Elevation Myocardial Infarction

    Luis C. L. Correia


    Full Text Available Background: The TIMI Score for ST-segment elevation myocardial infarction (STEMI was created and validated specifically for this clinical scenario, while the GRACE score is generic to any type of acute coronary syndrome. Objective: Between TIMI and GRACE scores, identify the one of better prognostic performance in patients with STEMI. Methods: We included 152 individuals consecutively admitted for STEMI. The TIMI and GRACE scores were tested for their discriminatory ability (C-statistics and calibration (Hosmer-Lemeshow in relation to hospital death. Results: The TIMI score showed equal distribution of patients in the ranges of low, intermediate and high risk (39 %, 27 % and 34 %, respectively, as opposed to the GRACE Score that showed predominant distribution at low risk (80 %, 13 % and 7%, respectively. Case-fatality was 11%. The C-statistics of the TIMI score was 0.87 (95%CI = 0.76 to 0.98, similar to GRACE (0.87, 95%CI = 0.75 to 0.99 - p = 0.71. The TIMI score showed satisfactory calibration represented by χ2 = 1.4 (p = 0.92, well above the calibration of the GRACE score, which showed χ2 = 14 (p = 0.08. This calibration is reflected in the expected incidence ranges for low, intermediate and high risk, according to the TIMI score (0 %, 4.9 % and 25 %, respectively, differently to GRACE (2.4%, 25% and 73%, which featured middle range incidence inappropriately. Conclusion: Although the scores show similar discriminatory capacity for hospital death, the TIMI score had better calibration than GRACE. These findings need to be validated populations of different risk profiles.

  14. Physiological Determinants of Human Acute Hypoxia Tolerance


    45.72 ± 10.40 (25.30 – 70.43) Resting VO2 (ml/kg/min) 3.93 ± 0.90 (2.76 – 6.35) DLO2 (ml/mm Hg/min) 40.65 ± 7.72 (25.83 – 59.00) Total Hgb...less SpO2 fell during the 5-min exposure. Max velocity of MCA flow gradually increased after the start of the hypoxia exposure in all subjects and...Model C B SEB B t p Intercept -18.73 20.4 -9.18 .367 VO2 MAX (ml/min/kg) .027 -.200 .127 -.216 -1.57 .128 Heart Rate Variability (LF/HF) .221 .383

  15. Physiological Mechanisms of Acute Intestinal Radiation Death


    Radiation Death 18 3 1 A eutron 19 ABSTRACT (Contfnuo on rlvorJ of re.•u•ldy ,d d..nfflfy by blo*,t ftmO,) e overall objective was to claikUTyhe role...neutron kerma rates. These changes are attributable to attenuation of neutrons and the production of gamma rays by thermal neutroncapture by hydrogen in...but also injuries from blast and thermal effects. These non-ionizing radiation traumas can result in sequestering large amounts of fluid and

  16. CT-guided percutaneous drainage of intra-abdominal abscesses: APACHE III score stratification of 1-year results

    Betsch, Angelika; Belka, Claus [Department of Radiation Oncology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076 Tuebingen (Germany); Wiskirchen, Jakub; Truebenbach, Jochen; Claussen, Claus D.; Duda, Stephan H. [Department of Diagnostic Radiology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076 Tuebingen (Germany); Manncke, Klaus H. [Department of General Surgery, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076 Tuebingen (Germany)


    Our objective was to evaluate the clinical success rates of percutaneously drained intra-abdominal abscesses using a risk stratification score for severely ill patients (APACHE III; Acute Physiology, Age, Chronic Health Evaluation). In 75 patients CT-guided percutaneous abscess drainage was performed to treat intra-abdominal abscesses. The clinical success rate based on a 1-year follow-up was correlated with abscess etiology, size, and structure, as well as with the initial APACHE III score. Clinical success, i.e., the complete removal of the abscess without surgical treatment, was observed in 62 of 75 patients (83%). Abscess size (<200 cm{sup 3}) and abscesses with a simple structure correlated with higher clinical success rates. Patients presenting with APACHE III scores below 30 were treated by percutaneous abscess drainages (PAD) alone significantly more often than patients presenting with higher APACHE scores. The percutaneous drainage of intra-abdominal abscesses shows good long-term results as long as abscesses are singular, small (<200 cm{sup 3}), and located in well accessible regions in combination with low APACHE scores (<30). (orig.)

  17. Instant MuseScore

    Shinn, Maxwell


    Get to grips with a new technology, understand what it is and what it can do for you, and then get to work with the most important features and tasks. Instant MuseScore is written in an easy-to follow format, packed with illustrations that will help you get started with this music composition software.This book is for musicians who would like to learn how to notate music digitally with MuseScore. Readers should already have some knowledge about musical terminology; however, no prior experience with music notation software is necessary.

  18. Physiological Acoustics

    Young, Eric D.

    The analysis of physiological sound in the peripheral auditory system solves three important problems. First, sound energy impinging on the head must be captured and presented to the transduction apparatus in the ear as a suitable mechanical signal; second, this mechanical signal needs to be transduced into a neural representation that can be used by the brain; third, the resulting neural representation needs to be analyzed by central neurons to extract information useful to the animal. This chapter provides an overview of some aspects of the first two of these processes. The description is entirely focused on the mammalian auditory system, primarily on human hearing and on the hearing of a few commonly used laboratory animals (mainly rodents and carnivores). Useful summaries of non-mammalian hearing are available [1]. Because of the large size of the literature, review papers are referenced wherever possible.

  19. Correlation of APACHE II and SOFA scores with length of stay in various surgical intensive care units.

    Milić, Morena; Goranović, Tatjana; Holjevac, Jadranka Katancić


    The aim of this study was to evaluate the usefulness of using Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score as the predictors of length of stay (LOS) in various surgical intensive care units (ICUs) and to test the hypothesis that the significance of scoring for predicting LOS is greater in specialized surgical ICUs. We scored patients in a non-specialized general surgical ICU (n = 328) and in a specialized cardiosurgical ICU (n = 158) consecutively on admission (APACHE II-1st day; SOFA-1st day) and on third day of stay (APACHE II-3rd day; SOFA-3rd day) in a 4-month period. LOS and APACHE II/SOFA scores were significantly correlated both on admission and on third day of stay in the general surgical ICU (APACHE II-1st day r = 0.289; SOFA-1st day r = 0.306; APACHE II-3rd day r = 0.728; SOFA-3rd day r = 0.725). LOS and APACHE II on admission were not significantly correlated in the cardiosurgical ICU (APACHE II-1st day r = 0.092), while SOFA on admission and APACHE II and SOFA on third day were significantly correlated (SOFA-1st day r = 0.258; APACHE II-3rd day r = 0.716; SOFA-3rd day r = 0.719). Usefulness of scoring for predicting LOS in ICU varied between different surgical ICUs. Contrary to our hypothesis, scoring had greater value for predicting LOS in the non-specialized general surgical ICU. APACHE II score on admission had no value for predicting LOS in the cardiosurgical ICU.

  20. Developing Scoring Algorithms

    We developed scoring procedures to convert screener responses to estimates of individual dietary intake for fruits and vegetables, dairy, added sugars, whole grains, fiber, and calcium using the What We Eat in America 24-hour dietary recall data from the 2003-2006 NHANES.

  1. Tensorial Orientation Scores

    van de Gronde, Jasper J.; Azzopardi, George; Petkov, Nicolai


    Orientation scores are representations of images built using filters that only select on orientation (and not on the magnitude of the frequency). Importantly, they allow (easy) reconstruction, making them ideal for use in a filtering pipeline. Traditionally a specific set of orientations has to be c

  2. The lod score method.

    Rice, J P; Saccone, N L; Corbett, J


    The lod score method originated in a seminal article by Newton Morton in 1955. The method is broadly concerned with issues of power and the posterior probability of linkage, ensuring that a reported linkage has a high probability of being a true linkage. In addition, the method is sequential, so that pedigrees or lod curves may be combined from published reports to pool data for analysis. This approach has been remarkably successful for 50 years in identifying disease genes for Mendelian disorders. After discussing these issues, we consider the situation for complex disorders, where the maximum lod score (MLS) statistic shares some of the advantages of the traditional lod score approach but is limited by unknown power and the lack of sharing of the primary data needed to optimally combine analytic results. We may still learn from the lod score method as we explore new methods in molecular biology and genetic analysis to utilize the complete human DNA sequence and the cataloging of all human genes.

  3. Early recognition of abdominal compartment syndrome in patients with acute pancreatitis

    Zilvinas Dambrauskas; Audrius Parseliunas; Antanas Gulbinas; Juozas Pundzius; Giedrius Barauskas


    AIM: To assess the value of widely used clinical scores in the early identification of acute pancreatitis (AP) patients who are likely to suffer from intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). METHODS: Patients ( n = 44) with AP recruited in this study were divided into two groups (ACS and non-ACS) according to intra-abdominal pressure (IAP) determined by indirect measurement using the transvesical route via Foley bladder catheter. On admission and at regular intervals, the severity of the AP and presence of organ dysfunction were assessed utilizing different multifactorial prognostic systems: Glasgow-Imrie score, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE-Ⅱ) score, and Multiorgan Dysfunction Score (MODS). The diagnostic performance of scores predicting ACS development, cut-off values and specificity and sensitivity were established using receiver operating characteristic (ROC) curve analysis. RESULTS: The incidence of ACS in our study population was 19.35%. IAP at admission in the ACS group was 22.0 (18.5-25.0) mmHg and 9.25 (3.0-12.4) mmHg in the non-ACS group ( P 7; MODS > 2 or Glasgow-Imrie score > 3).

  4. Automated Essay Scoring

    Semire DIKLI


    Full Text Available Automated Essay Scoring Semire DIKLI Florida State University Tallahassee, FL, USA ABSTRACT The impacts of computers on writing have been widely studied for three decades. Even basic computers functions, i.e. word processing, have been of great assistance to writers in modifying their essays. The research on Automated Essay Scoring (AES has revealed that computers have the capacity to function as a more effective cognitive tool (Attali, 2004. AES is defined as the computer technology that evaluates and scores the written prose (Shermis & Barrera, 2002; Shermis & Burstein, 2003; Shermis, Raymat, & Barrera, 2003. Revision and feedback are essential aspects of the writing process. Students need to receive feedback in order to increase their writing quality. However, responding to student papers can be a burden for teachers. Particularly if they have large number of students and if they assign frequent writing assignments, providing individual feedback to student essays might be quite time consuming. AES systems can be very useful because they can provide the student with a score as well as feedback within seconds (Page, 2003. Four types of AES systems, which are widely used by testing companies, universities, and public schools: Project Essay Grader (PEG, Intelligent Essay Assessor (IEA, E-rater, and IntelliMetric. AES is a developing technology. Many AES systems are used to overcome time, cost, and generalizability issues in writing assessment. The accuracy and reliability of these systems have been proven to be high. The search for excellence in machine scoring of essays is continuing and numerous studies are being conducted to improve the effectiveness of the AES systems.

  5. Relationship of GRACE risk score with Plasma Brain Natriuretic Peptide and Myeloperoxidase in Patients with Non- ST Segment el-evation Acute Coronary Syndrome%非ST段抬高急性冠状动脉综合征患者GRACE危险积分与血浆 BNP、MPO的相关性

    阚国庆; 高永; 王德启; 蔡忠贵; 王继征


    目的:探讨非 ST段抬高急性冠状动脉综合征(NSTE-ACS)患者全球急性冠状动脉事件注册(GRACE)评分与血浆脑钠肽( BNP)、髓过氧化酶(myeloperoxidase,MPO)水平的相关性。方法入选120例在我院住院的 NSTE-ACS患者,临床预测变量对其进行GRACE危险评分积分,并进行危险层次分层,入院后测定血浆 BNP、MPO水平。分析其与 GRACE危险积分不同层次之间的关系。结果①血浆 BNP、 MPO水平与GRACE危险积分呈正相关( r=0.71,P<0.05);随着 GRACE危险积分评分值增加,患者血浆 BNP、MPO水平亦逐渐升高;②随访期主要心血管事件发生率也增多(P <0.05)。结论 GRACE积分与BNP、MPO水平呈正相关,并与 NSTACS预后有关,能够对NSTEACS患者进行危险分层。%ObjectiveTo investigate the correlation of GRACE risk score and plasma brain natriuretic pep-tide ( BNP), myeloperoxidase in patients with non- ST segment elevation acute coronary syndrome.MethodsSelected 120 cases in NSTE-ACS patients in our hospital, clinical predictors its GRACE risk score points and dangerous level stratification, determination of plasma BNP, MPO levels after admission. Analyze the relationship between the different levels between the GRACE risk score.Results① The GRACE risk score is positively correlated with the plasma BNP and MPO levels ( r=0.71, P<0.05) ;② The incidence of MACE increased significantly with the rise of GRACE risk score and BNP, MPO levels.Conclusion: The higher GRACE risk score and BNP, MPO levels, the worse the prognosis, it could be use to predict the prognosis.

  6. Space Physiology within an Exercise Physiology Curriculum

    Carter, Jason R.; West, John B.


    Compare and contrast strategies remain common pedagogical practices within physiological education. With the support of an American Physiological Society Teaching Career Enhancement Award, we have developed a junior- or senior-level undergraduate curriculum for exercise physiology that compares and contrasts the physiological adaptations of…

  7. Predicting outcomes in organophosphate poisoning based on APACHE II and modified APACHE II scores.

    Eizadi-Mood, N; Saghaei, M; Jabalameli, M


    The aim of this study was to evaluate the scores of the Acute Physiology and Chronic Health Evaluation (APACHE) II and a modified APACHE II system (MAS), without parameters of biochemical tests; and to find prognostic value of individual elements of the APACHE II and MAS in predicting outcomes in organophosphate (OP) poisoning. Data were collected from 131 patients. The median (25th-75th percentiles) of APACHE II score for survivors without intubation were found to be lower than those of non survivors or survivors with intubation and ventilation, [4 (1-7); versus 17.5 (7.8-29), and 13.5 (7.8-16.3)]. Logistic regression analysis identified white blood cell (WBC), potassium, Glasgow coma scale (GCS), age and sodium in APACHE II; GCS and mean arterial pressure in MAS system as prognostically valuable. There was no statistically significance difference between APACHE II and MAS scores in terms of area under Receiver Operating Characteristic Curve [(0.902, 95% confidence interval: (0.837-0.947) for APACHE II), and (0.892, 95% confidence interval: (0.826-0.940) for MAS); P=0.74) to predict need for intubation. It is concluded usage of MAS facilitates the prognostication of the OP poisoned patients due to simplicity, less time-consuming and effectiveness in an emergency situation.

  8. Prognostic scoring systems for mortality in intensive care units--the APACHE model.

    Niewiński, Grzegorz; Starczewska, Małgorzata; Kański, Andrzej


    The APACHE (Acute Physiology and Chronic Health Evaluation) scoring system is time consuming. The mean time for introducing a patient's data to APACHE IV is 37.3 min. Nevertheless, statisticians have known for years that the higher the number of variables the mathematical model describes, the more accurate the model. Because of the necessity of gathering data over a 24-hour period and of determining one cause for ICU admission, the system is troublesome and prone to mistakes. The evolution of the APACHE scoring system is an example of unfulfilled hopes for accurately estimating the risk of death for patients admitted to the ICU; satisfactory prognostic effects resulting from the use of APACHE II and III have been recently studied in patients undergoing liver transplantations. Because no increase in the predictive properties of successive versions has been observed, the search for other solutions continues. The APACHE IV scoring system is helpful; however, its use without prepared spreadsheets is almost impractical. Therefore, although many years have passed since its original publication, APACHE II or its extension APACHE III is currently used in clinical practice.

  9. Comparison of different scoring systems evaluating short-term prognosis of patients with hepatitis B associated acute hepatic failure%不同评分系统对乙肝相关慢加急性肝衰竭患者短期预后评估的比较

    刘磊; 王凤梅; 阚志超; 李岩; 肖时湘; 刘华; 李莹


    Objective To assessment short-term prognosis in patients with acute on chronic liver failure , several scoring systems were compared. Methods Two hundred and sixteen patients with acute on chronic liver failure were divided into survival group and death group according to the results of 90 days after admission.CTP , MELD,APACHEⅡ, SOFA and SMSVH score were calculated.After ROC curves were performed ,the areas under the curves of these scoring systems were compared. Results The areas under the ROC curves of MELD, APACHEⅡ, SOFA, CTP and SMSVH were 0.88, 0.76, 0.89,0.79and 0.69,respectively. The areas under the curves of SOFA and MELD were larger than the APACHEⅡ, CTP and SMSVH (P0.05). The area under the curve of CTP was larger than the APACHEⅡ, but there was no statistically significant difference (P > 0.05). The area under the curve of SMSVH were less than 0.7. Conclusions The SOFA, MELD,CTP and APACHEⅡcan predict the short-term prognosis of acute on chronic liver failure. The SOFA and MELD are the best scoring systems.CTP,APACHEⅡ are better than SMSVH. SMSVH fail to predict the prognosis of acute on chronic liver failure.%目的:通过对几种不同评分系统比较,找出更适合乙肝相关慢加急性肝衰竭患者短期预后评估的方法。方法:将142例乙肝相关慢加急性肝衰竭患者根据其3个月后的存活及死亡情况,分为存活组(n=72)及病死组(n=70),分别计算 CTP、MELD、ANN、SOFA 、SMSVH 、LRM 等评分,行 ROC 曲线分析,计算曲线下面积,并进行比较。结果:ROC曲线下面积从大到小分别为ANN、SOFA 、LRM、MELD、CTP、SMSVH ,相应数值分别为0.92、0.89、0.89、0.87、0.78和0.69。ANN、SOFA 、LRM、MELD的AUC之间比较差异无统计学意义(P >0.05),ANN、SOFA 、LRM、MELD 的 AUC 值> CTP、SMSVH,差异有统计学意义(P 均<0.05), CTP 的 AUC 值>SMSVH,差异有统计学意义(P<0.05

  10. Potassium physiology.

    Thier, S O


    Potassium is the most abundant exchangeable cation in the body. It exists predominantly in the intracellular fluid at concentrations of 140 to 150 meq/liter and in the extracellular fluid at concentrations of 3.5 to 5 meq/liter. The maintenance of the serum potassium concentration is a complex bodily function and results from the balance between intake, excretion, and distribution between intracellular and extracellular space. Ingested potassium is virtually completely absorbed from and minimally excreted through the intestine under nonpathologic circumstances. Renal excretion of potassium, which is the major chronic protective mechanism against abnormalities in potassium balance, depends on filtration, reabsorption, and a highly regulated distal nephron secretory process. Factors regulating potassium secretion include prior potassium intake, intracellular potassium, delivery of sodium chloride and poorly reabsorbable anions to the distal nephron, the urine flow rate, hormones such as aldosterone and beta-catecholamines, and the integrity of the renal tubular cell. The maintenance of distribution between the inside and outside of cells depends on the integrity of the cell membrane and its pumps, osmolality, pH, and the hormones insulin, aldosterone, beta 2-catecholamines, alpha-catecholamines, and prostaglandins. Both distribution across cell membranes and/or renal excretion of potassium may be altered by pharmacologic agents such as diuretics, alpha- and beta-catechol antagonists and agonists, depolarizing agents, and digitalis. Problems with hypokalemia and hyperkalemia can be analyzed on the basis of potassium physiology and pharmacology; proper treatment depends on an accurate analysis.

  11. Credit scoring for individuals

    Maria DIMITRIU


    Full Text Available Lending money to different borrowers is profitable, but risky. The profits come from the interest rate and the fees earned on the loans. Banks do not want to make loans to borrowers who cannot repay them. Even if the banks do not intend to make bad loans, over time, some of them can become bad. For instance, as a result of the recent financial crisis, the capability of many borrowers to repay their loans were affected, many of them being on default. That’s why is important for the bank to monitor the loans. The purpose of this paper is to focus on credit scoring main issues. As a consequence of this, we presented in this paper the scoring model of an important Romanian Bank. Based on this credit scoring model and taking into account the last lending requirements of the National Bank of Romania, we developed an assessment tool, in Excel, for retail loans which is presented in the case study.

  12. Cys C, BUN and sCr level in patients with early renal damage of acute glomerulonephritis

    Hong Zhang; Ge Xu


    Objective:To explore the levels of Cys C, BUN and sCr in patients of early renal damage of acute glomerulonephritis.Methods: A total of 90 cases with acute glomerulonephritis treated in Nephrology Department of our hospital from May 2013 to May 2015 were randomly selected, among whom 32 cases of AKI1 stage (A group), 28 cases of AKI2 stage (B group) and 30 cases of AKI3 stage (C group), and 35 cases of healthy volunteers receiving routine physical examination in our hospital during the same period were selected as control group. Cystatin C (Cys C), blood urea nitrogen (BUN) and serum creatinine (sCr) were detected, and acute physiology and chronic health status score (APACHEⅡ scoring) was conducted in all research subjects. The correlation of APACHEⅡ scores with Cys C, BUN and sCr levels was analyzed respectively.Results: The differences in Cys C, BUN and sCr levels and APACHEⅡ scores among groups were statistically significant (P=0.000); there was significant positive correlation between APACHEⅡ scores and levels of Cys C, BUN and sCr of three groups of patients with acute glomerulonephritis (r>0.00), and the differences were statistically significant (P<0.05); in the diagnosis of early renal damage in patients with acute glomerulonephritis, the areas of Cys C, BUN and sCr under ROC curve were 0.946, 0.832 and 0.896, respectively.Conclusions: Cys C, BUN and sCr levels significantly increase with the increase of early renal damage of acute glomerulonephritis, both sensitivity and specificity of Cys C level are higher, and it has higher clinical application value.

  13. How to Evaluate the Severity of Acute Pancreatitis: Back to the Past?

    Raffaele Pezzilli


    Full Text Available Selecting patients with severe acute pancreatitis as early as possible after the onset of symptoms is crucial for appropriate treatment [1]. The guidelines indicate that the assessment of severity should be carried out as soon as possible by a scoring system, such as Acute Physiology and Chronic Health Evaluation (APACHE II which is a grade A recommendation [2, 3]. The comment added by the authors of the Italian guidelines is that an APACHE II score greater than 8 is important for determining treatment policy and identifying the need for transfer to a referral unit. In addition, the Italian guidelines also suggest that serum C-reactive protein (CRP values are useful for severity assessment, although they may not reflect severity within the first 48 h after onset; this is also a grade A recommendation [3]. An open question is: “should we use a scoring system or a single marker?”. The question is not semantic but practical because a single marker is easy to use and clearly comparable between the various hospitals whereas scoring systems may be complex and difficult to use in routine clinical practice. Another open question regarding single markers is: “should we continue to use (CRP or should we use markers, such as interleukin (IL-6 or IL-8 which are able to predict the severity of acute pancreatitis earlier than CRP?” [4].

  14. Clinical discriminators between acute brain hemorrhage and infarction: a practical score for early patient identification Características clínicas diferenciais entre hemorragia e infarto cerebral: uma escala prática para identificação precoce do paciente

    Ayrton R. Massaro


    Full Text Available New treatments for acute stroke require a rapid triage system, which minimizes treatment delays and maximizes selection of eligible patients. Our aim was to create a score for assessing the probability of brain hemorrhage among patients with acute stroke based upon clinical information. Of 1805 patients in the Stroke Data Bank, 1273 had infarction (INF and 237 had parenchymatous hemorrhage (HEM verified by CT. INF and HEM discriminators were determined by logistic regression and used to create a score. ROC curve was used to choose the cut-point for predicting HEM (score Novas perspectivas no tratamento do acidente vascular cerebral (AVC requerem um método de triagem rápido para seleção dos pacientes. Nosso objetivo foi criar uma escala com informações clínicas simples para diferenciar hematoma intra-parenquimatoso (HEM entre os pacientes com AVC. Estudamos 1.273 pacientes com AVC isquêmico (INF e 237 com HEM do Stroke Data Bank. Variáveis independentes para o diagnóstico de INF e HEM foram determinadas pela análise de regressão logística e utilizadas para criar uma escala. Através da curva ROC foi escolhido o nível de corte para discriminar HEM (<= 2 , com sensibilidade de 76%, especificidade de 83%. Foi realizada validação externa utilizando os pacientes do estudo NOMASS. Embora o uso de uma escala de fácil aplicação pelas equipes de emergência não possa substituir os métodos de imagem na diferenciação entre INF e HEM para a indicação de trombolítico, a escala proposta pode ser útil para selecionar pacientes para estudos clínicos e tratamento pré-hospitalar, alertar técnicos de tomografia e as equipes médicas sobre a chegada de pacientes, contribuindo para reduzir atrasos cruciais no tratamento.

  15. Correlação dos escores de risco com a anatomia coronária na síndrome coronária aguda sem supra-ST Correlation of risk scores with coronary anatomy in non-ST-elevation acute coronary syndrome

    Elizabete Silva dos Santos


    Full Text Available FUNDAMENTO:Há poucas publicações sobre a correlação entre escores de risco e anatomia coronária na síndrome coronária aguda (SCA. OBJETIVO: Correlacionar os escores de risco com a gravidade da lesão coronária na SCA sem supra-ST. MÉTODOS: Foram analisados 582 pacientes entre julho de 2004 e outubro de 2006. Avaliou-se a correlação entre os escores de risco TIMI, GRACE hospitalar e em seis meses com lesão coronária > 50%, por método não paramétrico de Spearman. Modelo de regressão logística múltipla foi realizado para determinar a habilidade preditiva dos escores em discriminar quem terá ou não lesão coronária > 50%. RESULTADOS: Foram 319 (54,8% homens e a média de idade era 59,9 (± 10,6 anos. Correlação positiva foi observada entre a pontuação dos escores de risco e lesão coronária > 50% (escore de risco TIMI r = 0,363 [p 50% foi: TIMI = 0,704 [IC95% 0,656-0,752; p BACKGROUND: The literature lacks studies regarding the correlation between risk scores and coronary anatomy in acute coronary syndrome (ACS OBJECTIVE: Correlate risk scores with the severity of the coronary lesion in ACS with non-ST elevation. METHODS: A total of 582 patients were analyzed between July 2004 and October 2006. The correlation between TIMI risk scores and GRACE (hospital and six months scores was performed for patients with coronary lesion > 50%, using Spearman´s non-parametric method. Multiple regression logistics was used to determine the predictive ability of the scores to discriminate to discriminate who will have a coronary lesion > 50%. RESULTS: Most subjects were male (319 or 54.8%, mean age of 59.9 (± 10.6 years. A positive correlation was observed between risk scores and >coronary lesion > 50% (TIMI r = 0.363 [p 50% was: TIMI = 0.704 [CI95% 0.656-0.752; p <0.0001]; hospital GRACE = 0.623 [CI95% 0.573-0.673; p < 0.0001]; GRACE at six months= 0.562 [CI95% 0.510-0.613; p ;= 0.0255]. Comparing the areas under the ROC curve, it was

  16. [Human physiology: kidney].

    Natochin, Iu V


    The content of human physiology as an independent part of current physiology is discussed. Substantiated is the point that subjects of human physiology are not only special sections of physiology where functions are inherent only in human (physiology of intellectual activity, speech, labor, sport), but also in peculiarities of functions, specificity of regulation of each of physiological systems. By the example of physiology of kidney and water-salt balance there are shown borders of norm, peculiarities of regulation in human, new chapters of renal physiology which have appeared in connection with achievements of molecular physiology.

  17. Performance of the PEdiatric Logistic Organ Dysfunction-2 score in critically ill children requiring plasma transfusions

    Karam, Oliver; Demaret, Pierre; Duhamel, Alain


    BACKGROUND: Organ dysfunction scores, based on physiological parameters, have been created to describe organ failure. In a general pediatric intensive care unit (PICU) population, the PEdiatric Logistic Organ Dysfunction-2 score (PELOD-2) score had both a good discrimination and calibration...

  18. Field trials of the Baby Check score card: mothers scoring their babies at home.

    Thornton, A J; Morley, C J; Green, S J; Cole, T J; Walker, K A; Bonnett, J M


    The Baby Check score card has been developed to help parents and health professionals grade the severity of acute illness in babies. This paper reports the results of two field trials in which mothers used Baby Check at home, 104 mothers scoring their babies daily for a week and 56 using it for six months. They all found Baby Check easy to use, between 68% and 81% found it useful, and 96% would recommended it to others. Over 70% of those using it daily used it very competently. Those using it infrequently did less well, suggesting that familiarity with the assessment is important. The scores obtained show that Baby Check's use would not increase the number of mothers seeking medical advice. With introduction and practice most mothers should be able to use Baby Check effectively. It should help them assess their babies' illnesses and make appropriate decisions about seeking medical advice.

  19. Comparison of Charlson's weighted index of comorbidities with the chronic health score for the prediction of mortality in septic patients

    Cui Yunliang; Wang Tao; Bao Jun; Tian Zhaotao; Lin Zhaofen; Chen Dechang


    Background Comorbidity is one of the most important determinants of short-term and long-term outcomes in septic patients.Charlson's weighted index of comorbidities (WIC) and the chronic health score (CHS),which is a component of the acute physiology and chronic health evaluation (APACHE) Ⅱ,are two frequently-used measures of comorbidity.In this study,we assess the performance of WIC and CHS in predicting the hospital mortality of intensive care unit (ICU) patients with sepsis.Methods A total of 338 adult patients with sepsis were admitted to a multisystem ICU between October 2010 and August 2012.Clinical data were collected,including age,gender,underlying diseases,key predisposing causes,severity-of-sepsis,and hospital mortality.The APACHE Ⅱ,CHS,acute physiology score (APS),sequential organ failure assessment (SOFA) and WIC scores were assessed within the first 24 hours of admission.Univariate and multiple Logistic regression analyses were used to compare the performance of WIC and CHS.The area under the receiver operating characteristic curve (AUC) was used to predict hospital mortality over classes of risk.Results Of all the enrolled patients,224 patients survived and 114 patients died.The surviving patients had significantly lower WIC,CHS,APACHE Ⅱ,and SOFA scores than the non-surviving patients (P <0.05).Combining WIC or CHS with other administrative data showed that the hospital mortality was significantly associated with age,severe sepsis,key predisposing causes such as pneumonia,a history of underlying diseases such as hypertension and congestive cardiac failure,and WIC,CHS and APS scores (P <0.05).The AUC for the hospital mortality were 0.564 (95% confidence interval (Cl) 0.496-0.631) of CHS,0.663 (95% Cl 0.599-0.727) of WIC,0.770 (95% Cl 0.718-0.822) of APACHE Ⅱ,0.856 (95% Cl 0.815-0.897) of the CHS combined with other administrative data,and 0.857 (95% Cl 0.817-0.897) of the WIC combined with other administrative data.The diagnostic

  20. [Scoring--criteria for operability].

    Oestern, H J


    For therapeutic recommendations three different kinds of scores are essential: 1. The severity scores for trauma; 2. Severity scores for mangled extremities; 3. Intensive care scores. The severity of polytrauma patients is measurable by the AIS, ISS, RTS, PTS and TRISS which is a combination of RTS, ISS, age, and mechanism of injury. For mangled extremities there are also different scores available: MESI (Mangled Extremity Syndrome Index) and MESS (Mangled Extremity Severity Score). The aim of these scores is to assist in the indication with regard to amputate or to save the extremity. These scoring indices can be used to evaluate the severity of a systemic inflammatory reaction syndrome with respect to multiple organ failure. All scores are dynamic values which are variable with improvement of therapy.

  1. Fingerprinting of music scores

    Irons, Jonathan; Schmucker, Martin


    Publishers of sheet music are generally reluctant in distributing their content via the Internet. Although online sheet music distribution's advantages are numerous the potential risk of Intellectual Property Rights (IPR) infringement, e.g. illegal online distributions, disables any innovation propensity. While active protection techniques only deter external risk factors, additional technology is necessary to adequately treat further risk factors. For several media types including music scores watermarking technology has been developed, which ebeds information in data by suitable data modifications. Furthermore, fingerprinting or perceptual hasing methods have been developed and are being applied especially for audio. These methods allow the identification of content without prior modifications. In this article we motivate the development of watermarking and fingerprinting technologies for sheet music. Outgoing from potential limitations of watermarking methods we explain why fingerprinting methods are important for sheet music and address potential applications. Finally we introduce a condept for fingerprinting of sheet music.

  2. Relationship of Apgar Scores and Bayley Mental and Motor Scores

    Serunian, Sally A.; Broman, Sarah H.


    Examined the relationship of newborns' 1-minute Apgar scores to their 8-month Bayley mental and motor scores and to 8-month classifications of their development as normal, suspect, or abnormal. Also investigated relationships between Apgar scores and race, longevity, and birth weight. (JMB)

  3. Association between value-based purchasing score and hospital characteristics

    Borah Bijan J


    Full Text Available Abstract Background Medicare hospital Value-based purchasing (VBP program that links Medicare payments to quality of care will become effective from 2013. It is unclear whether specific hospital characteristics are associated with a hospital’s VBP score, and consequently incentive payments. The objective of the study was to assess the association of hospital characteristics with (i the mean VBP score, and (ii specific percentiles of the VBP score distribution. The secondary objective was to quantify the associations of hospital characteristics with the VBP score components: clinical process of care (CPC score and patient satisfaction score. Methods Observational analysis that used data from three sources: Medicare Hospital Compare Database, American Hospital Association 2010 Annual Survey and Medicare Impact File. The final study sample included 2,491 U.S. acute care hospitals eligible for the VBP program. The association of hospital characteristics with the mean VBP score and specific VBP score percentiles were assessed by ordinary least square (OLS regression and quantile regression (QR, respectively. Results VBP score had substantial variations, with mean score of 30 and 60 in the first and fourth quartiles of the VBP score distribution. For-profit status (vs. non-profit, smaller bed size (vs. 100–199 beds, East South Central region (vs. New England region and the report of specific CPC measures (discharge instructions, timely provision of antibiotics and beta blockers, and serum glucose controls in cardiac surgery patients were positively associated with mean VBP scores (p Conclusions Although hospitals serving the poor and the elderly are more likely to score lower under the VBP program, the correlation appears small. Profit status, geographic regions, number and type of CPC measures reported explain the most variation among scores.

  4. Extracorporeal Membrane Oxygenation Support in Adult Patients with Hematologic Malignancies and Severe Acute Respiratory Failure

    Tai Sun Park


    Full Text Available Background: Administering extracorporeal membrane oxygenation (ECMO to critically ill patients with acute respiratory distress syndrome has substantially increased over the last decade, however administering ECMO to patients with hematologic malignancies may carry a particularly high risk. Here, we report the clinical outcomes of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO. Methods: We performed a retrospective review of the medical records of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO at the medical intensive care unit of a tertiary referral hospital between March 2010 and April 2015. Results: A total of 15 patients (9 men; median age 45 years with hematologic malignancies and severe acute respiratory failure received ECMO therapy during the study period. The median values of the Acute Physiology and Chronic Health Evaluation II score, Murray Lung Injury Score, and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction Score were 29, 3.3, and -2, respectively. Seven patients received venovenous ECMO, whereas 8 patients received venoarterial ECMO. The median ECMO duration was 2 days. Successful weaning of ECMO was achieved in 3 patients. Hemorrhage complications developed in 4 patients (1 pulmonary hemorrhage, 1 intracranial hemorrhage, and 2 cases of gastrointestinal bleeding. The longest period of patient survival was 59 days after ECMO initiation. No significant differences in survival were noted between venovenous and venoarterial ECMO groups (10.0 vs. 10.5 days; p = 0.56. Conclusions: Patients with hematologic malignancies and severe acute respiratory failure demonstrate poor outcomes after ECMO treatment. Careful and appropriate selection of candidates for ECMO in these patients is necessary.

  5. Acute pancreatitis

    ... its blood vessels. This problem is called acute pancreatitis. Acute pancreatitis affects men more often than women. Certain ... pancreatitis; Pancreas - inflammation Images Digestive system Endocrine glands Pancreatitis, acute - CT scan Pancreatitis - series References Forsmark CE. Pancreatitis. ...

  6. Cystitis - acute

    Uncomplicated urinary tract infection; UTI - acute cystitis; Acute bladder infection; Acute bacterial cystitis ... cause. Menopause also increases the risk for a urinary tract infection. The following also increase your chances of having ...

  7. Predicting hospital mortality using APACHE II scores in neurocritically ill patients: a prospective study.

    Su, Ying-Ying; Li, Xia; Li, Si-jie; Luo, Rong; Ding, Jian-ping; Wang, Lin; Cao, Gui-hua; Wang, Dong-yu; Gao, Jin-xia


    Four versions of Acute Physiology and Chronic Health Evaluation are limited in predicting hospital mortality for neurocritically ill patients. This prospective study aimed to develop and assess the accuracy of a modified APACHE II model in predicting mortality in neurologic intensive care unit (N-ICU). A total of 653 patients entered the study. APACHE II scores on admission, and worst 24-, 48-, and 72-h scores were obtained. Neurologic diagnoses on admission were classified into five categories: cerebral infarction, intracranial hemorrhage, neurologic infection, neuromuscular disease, and other neurologic diseases. We developed a modified APACHE II model based on the variables of the 72-h APACHE II score and disease category using a multivariate logistic regression procedure to estimate probability of death. We assessed the calibration and discrimination of the modified APACHE II model using the Hosmer-Lemeshow goodness-of-fit chi-squared statistic and area under the receiver operating characteristic curve (AU-ROC). The modified APACHE II model had good discrimination (AU-ROC = 0.88) and calibration (Hosmer-Lemeshow statistic: chi (2) = 3.707, P = 0.834). The discrimination of the 72-h APACHE II score for cerebral infarction, intracerebral hemorrhage, and neurologic infection was satisfactory, with AU-ROC of 0.858, 0.863, and 1.000, respectively, but it was poor in discriminating for the categories of other neurologic diseases and neuromuscular disease. The results showed that our modified APACHE II model can accurately predict hospital mortality for patients in N-ICU. It is more applicable to clinical practice than the previous model because of its simplicity and ease of use.

  8. Applicability of different scoring systems in outcome prediction of patients with mixed drug poisoning-induced coma

    Nastaran Eizadi Mood


    Full Text Available Background: Mixed drugs poisoning (MDP is common in the emergency departments. Because of the limited number of intensive care unit beds, recognition of risk factors to divide the patients into different survival groups is necessary. Poisoning due to ingestion of different medications may have additive or antagonistic effects on different parameters included in the scoring systems; therefore, the aim of the study was to compare applicability of the different scoring systems in outcomes prediction of patients admitted with MDP-induced coma. Methods: This prospective, observational study included 93 patients with MDP-induced coma. Clinical and laboratory data conforming to the Acute Physiology and Chronic Health Evaluation (APACHE II, Modified APACHE II Score (MAS, Mainz Emergency Evaluation Scores (MEES and Glasgow Coma Scale (GCS were recorded for all patients on admission (time 0 and 24 h later (time 24 . The outcome was recorded in two categories: Survived with or without complication and non-survived. Discrimination was evaluated using receiver operating characteristic (ROC curves and area under the ROC curve (AUC. Results: The mortality rate was 9.7%. Mean of each scoring system was statistically significant between time 0 and time 24 in the survivors. However, it was not significant in non-survivors. Discrimination was excellent for GCS 24 (0.90±0.05, APACHE II 24 (0.89±0.01, MAS 24 (0.86±0.10, and APACHE II 0 (0.83±0.11 AUC. Conclusion: The GCS 24 , APACHE II 24 , MAS 24 , and APACHE II 0 scoring systems seem to predict the outcome in comatose patients due to MDP more accurately. GCS and MAS may have superiority over the others in being easy to perform and not requiring laboratory data.

  9. The Disease Activity Score and the EULAR response criteria.

    Fransen, J.; Riel, P.L.C.M. van


    In rheumatoid arthritis (RA), inflammatory activity cannot be measured using one single variable. For this reason the Disease Activity Score (DAS). has been developed. The DAS is a clinical index of RA disease activity that combines information from swollen joints, tender joints, the acute phase res

  10. Line Lengths and Starch Scores.

    Moriarty, Sandra E.


    Investigates readability of different line lengths in advertising body copy, hypothesizing a normal curve with lower scores for shorter and longer lines, and scores above the mean for lines in the middle of the distribution. Finds support for lower scores for short lines and some evidence of two optimum line lengths rather than one. (SKC)

  11. Developmental Sentence Scoring for Japanese

    Miyata, Susanne; MacWhinney, Brian; Otomo, Kiyoshi; Sirai, Hidetosi; Oshima-Takane, Yuriko; Hirakawa, Makiko; Shirai, Yasuhiro; Sugiura, Masatoshi; Itoh, Keiko


    This article reports on the development and use of the Developmental Sentence Scoring for Japanese (DSSJ), a new morpho-syntactical measure for Japanese constructed after the model of Lee's English Developmental Sentence Scoring model. Using this measure, the authors calculated DSSJ scores for 84 children divided into six age groups between 2;8…

  12. Credit Scoring Modeling

    Siana Halim


    Full Text Available It is generally easier to predict defaults accurately if a large data set (including defaults is available for estimating the prediction model. This puts not only small banks, which tend to have smaller data sets, at disadvantage. It can also pose a problem for large banks that began to collect their own historical data only recently, or banks that recently introduced a new rating system. We used a Bayesian methodology that enables banks with small data sets to improve their default probability. Another advantage of the Bayesian method is that it provides a natural way for dealing with structural differences between a bank’s internal data and additional, external data. In practice, the true scoring function may differ across the data sets, the small internal data set may contain information that is missing in the larger external data set, or the variables in the two data sets are not exactly the same but related. Bayesian method can handle such kind of problem.

  13. Sequential Oxygenation Index and Organ Dysfunction Assessment within the First 3 Days of Mechanical Ventilation Predict the Outcome of Adult Patients with Severe Acute Respiratory Failure

    Hsu-Ching Kao


    Full Text Available Objective. To determine early predictors of outcomes of adult patients with severe acute respiratory failure. Method. 100 consecutive adult patients with severe acute respiratory failure were evaluated in this retrospective study. Data including comorbidities, Sequential Organ Failure Assessment (SOFA score, Acute Physiological Assessment and Chronic Health Evaluation II (APACHE II score, PaO2, FiO2, PaO2/FiO2, PEEP, mean airway pressure (mPaw, and oxygenation index (OI on the 1st and the 3rd day of mechanical ventilation, and change in OI within 3 days were recorded. Primary outcome was hospital mortality; secondary outcome measure was ventilator weaning failure. Results. 38 out of 100 (38% patients died within the study period. 48 patients (48% failed to wean from ventilator. Multivariate analysis showed day 3 OI ( and SOFA ( score were independent predictors of hospital mortality. Preexisting cerebrovascular accident (CVA ( was the predictor of weaning failure. Results from Kaplan-Meier method demonstrated that higher day 3 OI was associated with shorter survival time (log-Rank test, . Conclusion. Early OI (within 3 days and SOFA score were predictors of mortality in severe acute respiratory failure. In the future, prospective studies measuring serial OIs in a larger scale of study cohort is required to further consolidate our findings.

  14. Comparison of integrated Chinese and Western medicine with and without somatostatin supplement in the treatment of severe acute pancreatitis

    Qing Xia; Lin Yuan; Xiao-Nan Yang; Wen-Fu Tang; Jun-Ming Jiang


    AIM: To evaluate the therapeutic effect of the combined use of early short-term somatostatin and conventional integrated Chinese and Western medicine in treating severe acute pancreatitis.METHODS: Sixty patients with severe acute pancreatitis were divided at random into a somatostatin group and a basic treatment group. Both groups received integrated traditional Chinese and Western medicine without surgery.For patients in the somatostatin group, somatostatin was infused intravenously 250 μg/h for 72 h; other medications were the same as in the basic treatment group. In both groups, comparisons of therapeutic effectiveness were made in terms of morbidity of organic dysfunction and mortality rate, and severity of the disease according to serum levels of C-reaction protein, scores of acute physiology and chronic health evaluation (APACHE Ⅱ), and scores of Balthazar-CT.RESULTS: The indexes for C-reaction protein levels on the fourth and seventh days, and APACHE Ⅱ scores on the seventh day after treatment, were significantly improved in the somatostatin group than in the basic treatment group. The morbidity of organic dysfunction was lower in the somatostatin group than in the basic treatment group, although the difference was not statistically significant. There was no significant difference in mortality between the two groups.CONCLUSION: We conclude that combined traditional Chinese and Western medicines with an early short-term use of somatostatin can improve the condition of patients with severe acute pancreatitis.

  15. Performance of the PEdiatric Logistic Organ Dysfunction-2 score in critically ill children requiring plasma transfusions

    Karam, Oliver; Duhamel, Alain; Stanworth, Simon J; Leteurtre,Stéphane; ,; Butt, Warwick; Delzoppo, Carmel; Bain, Kym; Erickson, Simon; Smalley, Nathan; Dorofaeff, Tavey; Long, Debbie; Wiseman, Greg; Clénent de Cléty, Stéphan; Berghe, Caroline


    Background Organ dysfunction scores, based on physiological parameters, have been created to describe organ failure. In a general pediatric intensive care unit (PICU) population, the PEdiatric Logistic Organ Dysfunction-2 score (PELOD-2) score had both a good discrimination and calibration, allowing to describe the clinical outcome of critically ill children throughout their stay. This score is increasingly used in clinical trials in specific subpopulation. Our objective was to assess the per...

  16. Physiological effects in aromatherapy


    The effects of aromas on humans are divided into physiological and psychological effects. The physiological effect acts directly on the physical organism, the psychological effect acts via the sense of smell or olfactory system, which in turn may cause a physiological effect. This paper reviews on the physiological effects which are used for the evaluation of the effects of aromas. Physiological parameters, i.e. heart rate blood pressure, electrodermal activity, electroencephalogram, slow pot...

  17. Acute Bronchitis

    ... Smoking also slows down the healing process. Acute bronchitis treatment Most cases of acute bronchitis can be treated at home.Drink fluids, but ... bronchial tree. Your doctor will decide if this treatment is right for you. Living with acute bronchitis Most cases of acute bronchitis go away on ...

  18. Challenges in uncomplicated acute appendicitis

    Fernando Resende; Ana Beatriz Almeida; Jose Costa Maia; Renato Bessa Melo


    Acute appendicitis is one of the most common abdominal emergencies requiring surgery. It still represents, however, a challenging diagnosis. In order to facilitate this process, several scoring systems were developed, namely, the Alvarado score, acute inflammatory response and Raja Isteri Pengiran Anak Saleha Appendicitis scores, which are the most used in clinical practice. This clinical condition encompasses a wide spectrum of clinical presentations, from the uncomplicated form to the one with diffuse peritonitis. Treatment of uncomplicated acute appendicitis remains a matter of discussion. Although appen-dectomy has been regarded as the gold-standard, conservative management with antibi-otics is gaining more and more acceptance. The approach to appendectomy constitutes another controversial issue, namely, its performance through an open or a laparoscopic approach, which seems to be establishing itself, in some centers, as the standard of care. With this paper, we intend to give some insight on the aforementioned topics, through a review of the available literature on uncomplicated appendicitis.

  19. Conceptual Learning: Enhancing Student Understanding of Physiology

    Waltz, Micah J.

    Students are leaving undergraduate science programs without the knowledge and skills they are expected to have. This is apparent in professional programs, such as medical and veterinary school, where students do not possess the critical thinking skills necessary to be successful. Physiology is a required discipline for these professional programs and often before, as a pre-requisite. Physiology classrooms are an excellent place to teach critical thinking skills because the content consists of integrated processes. Therefore, in one study, it was investigated whether focusing on physiological concepts improved student understanding of physiology in both a non-physiological science course, Invertebrate Zoology, and in an undergraduate physiology course. An educational intervention was used in Invertebrate Zoology, where students were exposed to human physiology concepts that were similar to comparative physiology concepts they had learned during the semester. A pre-/post-test was used to assess learning gains. In a second study, the use of multimedia file usage was correlated to student exam scores in a physiology course. This was done to see if providing additional study materials that focused on specific concepts improved student understanding, as assessed using exam scores. Overall these studies indicate that encouraging assimilation of new concepts that expand upon material from lecture may help students gain a more complete understanding of a concept. The integration of these concepts into pre-existing conceptual frameworks may serve to teach students valuable critical thinking skills such as evaluation of new ideas within their current understanding and synthesizing the new content with the existing information. Focusing on this type of conceptual learning may enable students to apply content knowledge and think through problems. Additionally, focusing on concepts may enable students to improve their understanding of material without being overwhelmed by

  20. Prediction of acute stroke progression by the National Institutes of Health Stroke Scale

    Vinh Phuong; Tran Van Huy


    Objective To determine the occurrence of neurological changes during the first 48 hours after acute stroke as it relates to the initial stroke severity assessment. Methods The assessment with the National Institutes of Health Stroke Scale (NIHSS) was performed serially for the first 48 hours on 68 consecutive ischemic stroke patients admitted to the Department of Geriatric Cardiology at the Khanh Hoa Hospital, Nha Trang, Vietnam. Incidence of stroke progression (a ≥ 3-point increase on the NIHSS) was recorded and analysis performed to determine its association with initial stroke severity and other demographic and physiological variables. Deficit resolution by 48 hours, defined as an NIHSS score of 0 or 1, measured the frequency of functional recovery predicted by the initial deficit.Results Overall progression was noted in 28% of events (19/68). Applying Bayes' solution to the observed frequency of worsening, the greatest likelihood of predicting future patient progression occurred with NIHSS score of =7 and >7. Patients with an initial NIHSS score of =7 experienced a 13% (6/47) worsening rate versus those of an initial score of>7 with a 62% (13/21) worsening rate (P<0.01). 42.5%(20/47) of those with an initial score of =7 were functionally normal at 48 hours, whereas only 4.7% (1/21) of those with scores of >7 retnrned to a normal examination within this period (x2, P<0.05). Conclusions This study suggests that the early clinical course of neurological deficit after acute stroke be dependent on the initial stroke severity and that a dichotomy in early outcome exist surrounding an initial NIHSS score of 7. These findings may have significant implications for the design and patient stratification in treatment protocols with respect to primary clinical outcome.

  1. Confidence scores for prediction models

    Gerds, Thomas Alexander; van de Wiel, MA


    modelling strategy is applied to different training sets. For each modelling strategy we estimate a confidence score based on the same repeated bootstraps. A new decomposition of the expected Brier score is obtained, as well as the estimates of population average confidence scores. The latter can be used...... to distinguish rival prediction models with similar prediction performances. Furthermore, on the subject level a confidence score may provide useful supplementary information for new patients who want to base a medical decision on predicted risk. The ideas are illustrated and discussed using data from cancer...

  2. Physiological and behavioural responses of young horses to hot iron branding and microchip implantation.

    Erber, R; Wulf, M; Becker-Birck, M; Kaps, S; Aurich, J E; Möstl, E; Aurich, C


    Branding is the traditional and well-established method used to mark horses, but recently microchip transponders for implantation have become available. In this study, behaviour, physiological stress variables and skin temperature in foals were determined in response to hot-iron branding (n=7) and microchip implantation (n=7). Salivary cortisol concentrations increased in response to branding (1.8 ± 0.2 ng/mL) and microchip implantation (1.4 ± 0.1ng/mL), but cortisol release over time did not differ. In response to both manipulations there was a transient increase in heart rate (PBranding and microchip implantation induced a comparable aversive behaviour (branding, score 3.86 ± 0.85; microchip, score 4.00 ± 0.82). Both techniques thus caused similar physiological and behavioural changes indicative of stress. Acutely, implantation of a microchip was as stressful as branding in foals. Branding caused a necrotising skin burn lasting at least 7 days. Moreover branding, but not microchip implantation (P<0.001), was accompanied by a generalized increase in skin temperature which was comparable to low degree post-burn hypermetabolism in humans.

  3. Prophylactic Administration of Silybin Ameliorates L-Arginine-Induced Acute Pancreatitis

    Uçmak, Feyzullah; Ekin, Nazım; İbiloğlu, İbrahim; Arslan, Serkan; Kaplan, İbrahim; Şenateş, Ebubekir


    Background Oxidative stress have been shown to play a role in the pathogenesis of acute pancreatitis. The aim of this study was to investigate the potential effect of silybin, a potent antioxidant, on L-arginine-induced acute pancreatitis in an experimental rat model. Material/Methods Forty female Wistar Albino rats were divided into 5 groups as follows: Group 1 (C): control group (n=8), Group 2 (SL): silybin group (n=8), Group 3 (LA): acute pancreatitis group (n=8), Group 4 (SLLA): prophylaxis group (n=8), and Group 5 (LASL): treatment group (n=8). Group C (control) received 2 intraperitoneal (i.p.) injections of physiological saline at an interval of 1 h. Group SL received only a single i.p. injection of silybin. The SLLA group received a single i.p. injection of silybin before the induction of acute pancreatitis with L-arginine, whereas the LASL group received the same injection after the induction of acute pancreatitis with L-arginine. Pancreatic tissues were histopathologically examined. Levels of amylase and oxidative stress markers (total oxidant status and total anti-oxidant status) were determined in the blood samples. Oxidative stress index was calculated. Results In comparison to the LA, the prophylaxis and treatment groups showed significant improvements in serum oxidative stress parameters (p=0.001 and p=0.005, respectively). Histopathological analysis showed that the treatment group had significant improvements in edema scores only (p=0.006), whereas the prophylaxis group had the same improvements in inflammation and necrosis scores as well as in total scores (p=0.004, 0.006, and 0.004, respectively). Conclusions When used for prophylactic rather than therapeutic purposes, silybin ameliorates serum oxidative stress parameters and improves histopathological results via its antioxidant and anti-inflammatory properties. PMID:27725627

  4. Preterm labor and preterm premature rupture of membranes have a different pattern in the involved compartments of acute histologoic chorioamnionitis and/or funisitis: Patho-physiologic implication related to different clinical manifestations.

    Park, Chan-Wook; Park, Joong Shin; Moon, Kyung Chul; Jun, Jong Kwan; Yoon, Bo Hyun


    It is unknown whether histo-topographic findings about the involved compartments (i.e., choriodecidua, amnion, chorionic-plate) of acute-histologic chorioamnionitis (acute-HCA) and/or funisitis according to the presence or absence of intra-amniotic inflammation (IAI) and/or fetal inflammatory response syndrome (FIRS) are different between preterm labor and intact membranes (PTL) and preterm premature rupture of membranes (preterm-PROM). The involved compartments of acute-HCA and/or funisitis were examined in 161 singleton preterm-births (preterm-PROM (n = 73). The study-population was divided into IAI(-)/FIRS(-), IAI(+)/FIRS(-), and IAI(+)/FIRS(+) groups according to the presence or absence of IAI (amniotic-fluid MMP-8 ≥ 23 ng/ml) and/or FIRS (umbilical-cord plasma CRP ≥ 200 ng/ml). Histological inflammation was not detected in any-compartment except choriodecidua in IAI(-)/FIRS(-) group with PTL while inflammation appeared in all-compartment0s (choriodeciduitis-46.2 %; amnionitis-23.1 %; funisitis-30.8 %; chorionic-plate inflammation-7.7 %) in IAI(-)/FIRS(-) group with preterm-PROM. IAI(+)/FIRS(-) group had a significantly higher frequency of inflammation in each-compartment than IAI(-)/FIRS(-) group in PTL (each-for P preterm-PROM (each-for P > 0.1). However, IAI(+)/FIRS(+) group had a significantly higher rate of inflammation in each compartment than IAI(+)/FIRS(-) group in both PTL and preterm-PROM (each-for P preterm-PROM had a different pattern in the involved compartments of acute-HCA and/or funisitis in the IAI(-)/FIRS(--) group and in the change of involved compartments from IAI(-)/FIRS(-) to IAI(+)/FIRS(-).

  5. Applicationof CRUSADE scoring system and the proton pump inhibitors in patients with acute coronary syndrome%CRUSADE 评分及质子泵抑制剂在急性冠脉综合征患者中的应用

    赵新闻; 綦素霞; 王松梅; 孔光明; 司君利


    Objective To evaluate the application of CRUSADE scoring system in prediction of hemorrhage in pa-tientswith acute coronary syndromes(ACS)and the clinical value of PPIs in patients with high bleeding risk. Methods To se-lect572 cases of ACS of ACS from Cardiology and emergency ward in hospital since 2010 June to 2013 June,andto valuatethe risk stratification of these patients according to CRUSADE score system. Then the high risk of bleeding were randomly divided into PPIs group and control group. All the patients were taking dual antiplatelet drugs(aspirin and clopidogrel)for 1 year,then to Follow up the incidence of gastrointestinal bleeding,minor and major adverse cardiovascular events. Results Compared with the low risk group of CRUSADE score,the incidence of gastrointestinal bleeding of high-risk group were markedly increased. And the incidence of digestive hemorrhage were decreasedin the high risk group with PPIs,and the difference was statistically significant. Although the incidence of major and minor cardiovascular events was increased,but the difference was not statisti-cally significant. Conclusion The CRUSADE scoring system is good for the risk assessment of bleedingin ACS patients with dual antiplatelet therapy. Combined with a proton pump inhibitor can effectively reduce the rate of digestive tract hemorrhage in patients of high-risk. And the incidence of cardiovascular adverse events is not significant increased.%目的:评价 CRUSADE 评分系统对急性冠脉综合征(ACS)患者抗血小板治疗的出血风险进行评估的准确性及高出血风险患者应用 PPIs 的临床价值。方法选取自2010年6月-2013年6月于医院心内科并急诊病房住院的 ACS 病例572例,按照 CRUSADE 评分对这些患者进行危险分层,并将其中的高危出血组随机分为 PPIs 治疗组及对照组。所有患者均服用双重抗血小板药物(阿司匹林与氯吡格雷联用)1年,随访观察期间的消化道出血发

  6. Physiological Information Database (PID)

    EPA has developed a physiological information database (created using Microsoft ACCESS) intended to be used in PBPK modeling. The database contains physiological parameter values for humans from early childhood through senescence as well as similar data for laboratory animal spec...

  7. GRACE评分对NSTEACS合并CKD患者住院期间全因病死率的预测价值%Predictive Value of the Global Registry of Acute Coronary Event Score for In-hospital Mortality of Patients with Non-segment Elevated Acute Coronary Syndrome and Chronic Kidney Diseases

    李红; 金泽宁; 孟帅; 唐熠达


    目的 探讨全球急性冠状动脉事件注册(global registry of acute coronary events,GRACE)评分对非ST段抬高型急性冠状动脉综合征(non-segment elevated acute coronary syndromes,NSTEACS)合并慢性肾脏疾病(chronic kidney disease,CKD)患者住院期间全因病死率的预测价值.方法 选取2012年1月-2014年12月在我院住院期间发生全因死亡的NSTEACS合并CKD 60例作为病死组,随机抽取同期未发生死亡的NSTEACS合并CKD 60例作为生存组,两组均进行GRACE评分.比较两组一般资料、GRACE评分危险分层构成比及中位数(四分位数).采用受试者工作特征(ROC)曲线分析GRACE评分对NSTEACS合并CKD患者住院期间全因病死率的预测价值.结果 两组一般资料中Killip分级、心电图ST段改变、低密度脂蛋白胆固醇及空腹血糖比较差异有统计学意义(P<0.05);两组GRACE评分危险分层构成比比较差异有统计学意义(P<0.05),病死组GRACE评分中位数(四分位数)明显高于生存组,差异亦具有统计学意义(P<0.05).ROC曲线显示GRACE评分对NSTEACS合并CKD患者住院期间全因病死率预测价值良好[AUC 0.864,95%可信区间(0.763,0.911)].结论 GRACE评分对NSTEACS合并CKD患者住院期间全因病死率具有良好的预测价值.

  8. High inter-tester reliability of the new mobility score in patients with hip fracture

    Kristensen, M.T.; Bandholm, T.; Foss, N.B.;


    OBJECTIVE: To assess the inter-tester reliability of the New Mobility Score in patients with acute hip fracture. DESIGN: An inter-tester reliability study. SUBJECTS: Forty-eight consecutive patients with acute hip fracture at a median age of 84 (interquartile range, 76-89) years; 40 admitted from...

  9. Modelling sequentially scored item responses

    Akkermans, W.


    The sequential model can be used to describe the variable resulting from a sequential scoring process. In this paper two more item response models are investigated with respect to their suitability for sequential scoring: the partial credit model and the graded response model. The investigation is c

  10. Skyrocketing Scores: An Urban Legend

    Krashen, Stephen


    A new urban legend claims, "As a result of the state dropping bilingual education, test scores in California skyrocketed." Krashen disputes this theory, pointing out that other factors offer more logical explanations of California's recent improvements in SAT-9 scores. He discusses research on the effects of California's Proposition 227,…

  11. The Machine Scoring of Writing

    McCurry, Doug


    This article provides an introduction to the kind of computer software that is used to score student writing in some high stakes testing programs, and that is being promoted as a teaching and learning tool to schools. It sketches the state of play with machines for the scoring of writing, and describes how these machines work and what they do.…

  12. Trends in Classroom Observation Scores

    Casabianca, Jodi M.; Lockwood, J. R.; McCaffrey, Daniel F.


    Observations and ratings of classroom teaching and interactions collected over time are susceptible to trends in both the quality of instruction and rater behavior. These trends have potential implications for inferences about teaching and for study design. We use scores on the Classroom Assessment Scoring System-Secondary (CLASS-S) protocol from…

  13. Classification of current scoring functions.

    Liu, Jie; Wang, Renxiao


    Scoring functions are a class of computational methods widely applied in structure-based drug design for evaluating protein-ligand interactions. Dozens of scoring functions have been published since the early 1990s. In literature, scoring functions are typically classified as force-field-based, empirical, and knowledge-based. This classification scheme has been quoted for more than a decade and is still repeatedly quoted by some recent publications. Unfortunately, it does not reflect the recent progress in this field. Besides, the naming convention used for describing different types of scoring functions has been somewhat jumbled in literature, which could be confusing for newcomers to this field. Here, we express our viewpoint on an up-to-date classification scheme and appropriate naming convention for current scoring functions. We propose that they can be classified into physics-based methods, empirical scoring functions, knowledge-based potentials, and descriptor-based scoring functions. We also outline the major difference and connections between different categories of scoring functions.

  14. D-score: a search engine independent MD-score.

    Vaudel, Marc; Breiter, Daniela; Beck, Florian; Rahnenführer, Jörg; Martens, Lennart; Zahedi, René P


    While peptides carrying PTMs are routinely identified in gel-free MS, the localization of the PTMs onto the peptide sequences remains challenging. Search engine scores of secondary peptide matches have been used in different approaches in order to infer the quality of site inference, by penalizing the localization whenever the search engine similarly scored two candidate peptides with different site assignments. In the present work, we show how the estimation of posterior error probabilities for peptide candidates allows the estimation of a PTM score called the D-score, for multiple search engine studies. We demonstrate the applicability of this score to three popular search engines: Mascot, OMSSA, and X!Tandem, and evaluate its performance using an already published high resolution data set of synthetic phosphopeptides. For those peptides with phosphorylation site inference uncertainty, the number of spectrum matches with correctly localized phosphorylation increased by up to 25.7% when compared to using Mascot alone, although the actual increase depended on the fragmentation method used. Since this method relies only on search engine scores, it can be readily applied to the scoring of the localization of virtually any modification at no additional experimental or in silico cost.

  15. 非ST段抬高型急性冠状动脉综合征患者血清胱抑素C与SYNTAX评分的相关性研究%Relationship between serum cystatin C level and SYNTAX score in patients with non-ST segment elevation acute coronary syndrome

    王林; 袁国裕; 陈国雄; 陈士良


    Objective To evaluate the relationship between serum cystatin C level and the severity of coronary lesion in patients with non- ST segment elevation acute coronary syndrome (NSTE- ACS). Methods 202 patients with NSTE- ACS underwent coronary angiography (CAG) and were divided into unstable angina pectoris (UAP) group(n=124) and non- ST segment elevation myocardial infarction (NSTEMI) group (n=78). 54 persons with negative result of CAG served as control group. According to SYNTAX score, NSTE- ACS patients were divided into low- risk group(1~22scores, n=69), intermediate- risk group (23~32scores, n=92) and high- risk group (>32scores, n=41). Serum cystatin C was measured before CAG and compared between groups. The relation between serum cystatin C and SYNTAX score was determined. Results The serum cystatin C level was significantly higher in UAP group and NSTEMI group than in control group, and significantly higher in the intermediate- and high- risk groups than in the low- risk group. The Pearson correlation analysis showed that SYNTAX score was positively correlated to serum cystatin C level (r=0.78, P32 (P<0.01, P<0.05). Conclusion The level of serum cystatin C may be used to predict SYNTAX score in patients with NSTE- ACS.%目的:探讨非ST段抬高型急性冠状动脉综合征(NSTE- ACS)患者血清胱抑素C(CysC)水平与冠状动脉病变严重程度的关系。方法选择行冠状动脉造影的NSTE- ACS患者202例,分为不稳定性心绞痛(UAP组)124例,非ST段抬高型心肌梗死(NSTEMI组)78例,54例冠状动脉造影阴性的患者为对照组。将NSTE- ACS患者根据冠状动脉造影结果分为(SYNTAX)评分低分组(1~22分)69例、中分组(23~32分)92例、高分组(>32分)41例。所有患者冠状动脉造影前均检测血清CysC,比较各组的CysC水平并分析CysC与SYNTAX评分的相关性。结果 UAP组、NSTEMI组患者CysC[(1.26±0.38)、(1.38±0.55)mg/L]高于对照组[(0

  16. Validação de um escore para predição de eventos hemorrágicos em síndromes coronarianas agudas Validación de un escore para predicción de eventos hemorrágicos en síndromes coronarios agudos Validation of a score for predicting bleeding events during acute coronary syndromes

    Luis C. L. Correia


    validar un escore de riesgo de sangrado para pacientes con SCA. MÉTODOS: Fueron utilizados predictores independientes de sangrado relatados por el Registro GRACE. Variables con odds ratio (OR > 2,5 en ese Registro sumaron 3 puntos (histórico anterior de sangrado, OR=1,5-2,4 sumaron 2 puntos (clearance de creatinina 30, infra o supra-desnivel del segmento ST, enfermedad arterial periférica y tabaco. El escore fue validado en una cohorte de 383 individuos con SCA. Sangrado intrahospitalario fue definido como caída de hematocrito > 10%, transfusión de sangre > 2 unidades, sangrado intracerebral o sangrado fatal. RESULTADOS: La incidencia de eventos hemorrágicos fue de 3,1% y la estadística-C del escore fue 0,66 (IC95% = 0,52-0,80, indicando capacidad predictiva para esos eventos. Aquellos con escore > 7 presentaron 6% de incidencia de sangrado, comparados con 1,9% si el escore era 7 y un mayor riesgo impuesto por el tratamiento con Clopidogrel (P=0,02, bloqueadores IIb/IIIa (P=0,06 y revascularización quirúrgica (PBACKGROUND: Bleeding is a major complication in patients treated for acute coronary syndromes (ACS with antithrombotic and invasive therapies. Consequently, the benefit of such therapies should be balanced against the potential risk of hemorrhagic complications. Therefore, a score to estimate individual risk of bleeding might represent an important tool in clinical decision-making. OBJECTIVE: This study aims to create and validate a bleeding risk score for patients with ACS. METHODS: Independent predictors of bleeding reported by the GRACE Registry were utilized. Variables with odds ratio (OR > 2.5 in that Registry added 3 points (previous history of bleeding, OR = 1.5-2.4 added 2 points (creatinine clearance 30, ST-deviation, peripheral artery disease and smoking. The score was validated in a cohort of 383 individuals with ACS. In-hospital bleeding was defined as hematocrit fall > 10%, blood transfusion > 2 units, intracerebral bleeding or fatal bleeding

  17. Cardiovascular physiology and sleep.

    Murali, Narayana S; Svatikova, Anna; Somers, Virend K


    effects of sleep could be objectively differentiated from the effects of rest and recumbency. Furthermore, the specific effects of sleep onset and termination, and the effects of different sleep stages, could be assessed. Technological advances, with consequently enhanced and relatively non-invasive approaches to cardiovascular regulation, have greatly broadened our understanding of the effects of sleep stage on cardiovascular function. Continuous monitoring of simultaneous measures of polysomnographic and cardiovascular variables enables characterization of the effects of dynamic changes and rapid transitions in sleep stage, such as arousals. The capacity for measuring acute and immediate changes in autonomic, EEG and hemodynamic responses to sleep and arousal on a continuous basis has played an important role in enabling us to understand the interplay between changes in EEG and changes in the more peripheral measurements of neural and circulatory variables, such as sympathetic nerve traffic, heart rate (HR) and blood pressure (BP). Measurements of heart rate variability (HRV) (8-10), baroreflex sensitivity (BRS) (11-16), and intraneural measurement of sympathetic nerve traffic to muscle (MSNA) (17-22) and skin (SSNA) (23-24) have further advanced our understanding of mechanisms linking sleep and cardiovascular physiology.

  18. Chewing Over Physiology Integration

    Abdulkader, Fernando; Azevedo-Martins, Anna Karenina; de Arcisio Miranda, Manoel; Brunaldi, Kellen


    An important challenge for both students and teachers of physiology is to integrate the differentareas in which physiological knowledge is didactically divided. In developing countries, such an issue is even more demanding, because budget restrictions often affect the physiology program with laboratory classes being the first on the list when it…

  19. APACHEⅡ APACHEⅢ评分及PSI评分评估老年重症肺炎预后的对比研究%Comparative study to the practice of APACHEⅡ score, APACHEⅢ score and pneumonia severity index in the elderly patients with severe pneumonia

    李晓如; 李志军; 王东强; 沈青


    Objective The aim of this study was to compare the effects of Acute Physiology and Chronic Health EvaluationⅡ score ( APACHEⅡ score ) , Acute Physiology and Chronic Health EvaluationⅢscore (APACHEⅢscore) and pneumonia severity index (PSI score) for the prediction of 28-day mortality in the elderly patients with severe pneumonia .Methods A total of 102 critical patients during May 2014 and September 2015 , undertook APACHEⅡ, score APACHEⅢscore and PSI score.Correlations between the scores from the three methods and prognoses were compared according to the survival and death conditions during a 28-day observation period; the accuracy of evaluating the prognoses with three scoring systems was compared by areas under the ROC curve . Results APACHEⅡ/Ⅲscore had good discrimination for predicting 28-day mortality in elderly patients with severe pneumonia, and with AUC 0.930 (P=0.000, 95%CI 0.861~1.000), 0.795 (P=0.001, 95%CI 0.661 ~0.929).However, the PSI score did not have discrimination power for predicting mortality, with AUC 0.677(P=0.047, 95%CI 0.515~0.839).Conclusion These data suggest that APACHEⅡ, as well as APACHEⅢ score, is effective for predicting 28 -day mortality in elderly patients with severe pneumonia , but that the PSI score does not have good discrimination and calibration for predicting mortality .APACHEⅡscore is excellent in the prediction of 28-day mortality .%目的 对比分析APACHEⅡ、APACHEⅢ评分及PSI评分评估老年重症肺炎患者预后的临床价值. 方法 研究纳入2014-05~2015-09 入住天津市第一中心医院的老年重症肺炎患者102例,根据28 d生存情况分为生存组与死亡组,分析比较两组患者APACHEⅡ、APACHEⅢ评分及PSI评分差异,通过ROC曲线下的面积评估各评分系统的预测能力. 结果 APACHEⅢ、PSI评分与 APACHEⅡ评分呈显著正相关(r 值分别为0.579、0.218,P <0.01);APACHEⅡ、APACHEⅢ评分及PSI评分ROC曲线下面积分别为0.930(P=0

  20. Retrospective analysis on acute respiratory distress syndrome in ICU

    LI Jin-bao; ZHANG Liang; ZHU Ke-ming; DENG Xiao-ming


    Objective:To assess the incidence, etiology, physiological and clinical features, mortality, and predictors of acute respiratory distress syndrome (ARDS) in intensive care unit (ICU).Methods: A retrospective analysis of 5 314 patients admitted to the ICU of our hospital from April 1994 to December 2003 was performed in this study. The ARDS patients were identified with the criteria of the American-European Consensus Conference ( AECC ). Acute physiology and chronic health evaluation Ⅲ ( APACHE in), multiple organ dysfunction syndrome score (MODS score), and lung injury score (LIS) were determined on the onset day of ARDS for all the patients. Other recorded variables included age, sex, biochemical indicators, blood gas analysis, length of stay in ICU, length of ventilation, presence or absence of tracheostomy, ventilation variables, elective operation or emergency operation.Results:Totally, 131 patients (2.5%) developed ARDS, among whom, 12 patients were excluded from this study because they died within 24 hours and other 4 patients were also excluded for their incomplete information. Therefore, there were only 115 cases (62 males and 53 females, aged 22-75 years, 58 years on average) left,accounting for 2. 2% of the total admitted patients. Their average ICU stay was (11. 27±7. 24) days and APACHE in score was 17.23±7.21. Pneumonia and sepsis were the main cause of ARDS. The non-survivors were obviously older and showed significant difference in the ICU length of stay and length of ventilation as compared with the survivors. On admission, the non-survivors had significantly higher MODS and lower BE ( base excess). The hospital mortality was 55. 7%. The main cause of death was multiple organ failure. Predictors of death at the onset of ARDS were advanced age, MODS≥8, and LIS≥2.76.Conclusions: ARDS is a frequent syndrome in this cohort. Sepsis and pneumonia are the most common risk factors. The main cause of death is multiple organ failure. The mortality is

  1. The ability of two scoring systems to predict in-hospital mortality of patients with moderate and severe traumatic brain injuries in a Moroccan intensive care unit

    Hicham Nejmi


    Full Text Available Aim of Study: We aim to assess and to compare the predicting power for in-hospital mortality (IHM of the Acute Physiology and Chronic Health Evaluation-II (APACHE-II and the Simplified Acute Physiology Score-II (SAPS-II for traumatic brain injury (TBI. Patients and Methods: This retrospective cohort study was conducted during a period of 2 years and 9 months in a Moroccan intensive care unit. Data were collected during the first 24 h of each admission. The clinical and laboratory parameters were analyzed and used as per each scoring system to calculate the scores. Univariate and multivariate analyses through regression logistic models were performed, to predict IHM after moderate and severe TBIs. Areas under the receiver operating characteristic curves (AUROC, specificities and sensitivities were determined and also compared. Results: A total of 225 patients were enrolled. The observed IHM was 51.5%. The univariate analysis showed that the initial Glasgow coma scale (GCS was lower in nonsurviving patients (mean GCS = 6 than the survivors (mean GCS = 9 with a statistically significant difference (P = 0.0024. The APACHE-II and the SAPS-II of the nonsurviving patients were higher than those of the survivors (respectively 20.4 ± 6.8 and 31.2 ± 13.6 for nonsurvivors vs. 15.7 ± 5.4 and 22.7 ± 10.3 for survivors with a statistically significant difference (P = 0.0032 for APACHE-II and P = 0.0045 for SAPS-II. Multivariate analysis: APACHE-II was superior for predicting IHM (AUROC = 0.92. Conclusion: The APACHE-II is an interesting tool to predict IHM of head injury patients. This is particularly relevant in Morocco, where TBI is a greater public health problem than in many other countries.

  2. 中药外洗联合光疗对急性手部湿疹患者EASI评分及复发率的影响%Influence of External Washing with Chinese Medicine Combined with Phototherapy on the Score of EASI and the Recurrence Rate of Patients with Acute Hand Eczema

    钟萍; 徐丽红; 王鹏; 柴宝


    目的:观察中药外洗联合光疗对急性手部湿疹患者EASI评分及复发率的影响.方法:将2013年2月-2015年2月本院收治的90例急性手部湿疹患者随机分为光疗组、中药洗剂组、中药洗剂联合光疗组各30例.光疗组单纯采用光疗进行,选择304 nm中波高能紫外线进行照射治疗;中药洗剂组单纯采用中药外洗治疗;中药洗剂联合光疗组给予中药外洗联合光疗进行治疗.治疗2周后观察两组患者临床瘙瘁症状的改善情况,用EASI评估湿疹面积以及皮损严重程度,比较3组的有效率、不良反应发生率及复发情况.结果:光疗组的有效率60%低于中药洗剂组的有效率70%,两组差异性不显著(P>0.05);光疗组和中药洗剂组的有效率均明显低于中药洗剂联合光疗组的有效率93.3%,差异有统计学意义(P<0.05);治疗前3组患者的EASI各指标评分对比,差异性不显著(P>0.05);治疗后EASI评分相比治疗前下降,中药洗剂联合光疗组EASI评分变化更突出,其次为中药洗剂组,光疗组EASI评分改善明显不足其余两组,差异有统计学意义(P<0.05).光疗组不良反应发生率、复发率明显高于其余两组,而中药洗剂联合光疗组患者并无明显不良反应,随访期间亦无复发.结论:中药外洗联合光疗更利于改善急性手部湿疹患者的瘙痒症状,减少皮损面积,减轻皮损状况,疗效确切.%Objective:To observe the influence of external washing with Chinese medicine combined with phototherapy on the score of EASI and the recurrence rate of patients with acute hand eczema.Methods:Totally 90 patients with acute hand eczema hospitalized between February,2013 and February,2015 were randomized into phototherapy group,Chinese medicine washing group,Chinese medicine washing + phototherapy group,with 30 cases in each group.Phototherapy group were simply given phototherapy with 304 nm medium-high energy ultraviolet radiation.Chinese medicine

  3. Physiological effects in aromatherapy

    Tapanee Hongratanaworakit


    Full Text Available The effects of aromas on humans are divided into physiological and psychological effects. The physiological effect acts directly on the physical organism, the psychological effect acts via the sense of smell or olfactory system, which in turn may cause a physiological effect. This paper reviews on the physiological effects which are used for the evaluation of the effects of aromas. Physiological parameters, i.e. heart rate blood pressure, electrodermal activity, electroencephalogram, slow potential brain waves (contingent negativevariation, and eye blink rate or pupil functions, are used as indices for the measurement of the aroma effects

  4. Doppler radar physiological sensing

    Lubecke, Victor M; Droitcour, Amy D; Park, Byung-Kwon; Singh, Aditya


    Presents a comprehensive description of the theory and practical implementation of Doppler radar-based physiological monitoring. This book includes an overview of current physiological monitoring techniques and explains the fundamental technology used in remote non-contact monitoring methods. Basic radio wave propagation and radar principles are introduced along with the fundamentals of physiological motion and measurement. Specific design and implementation considerations for physiological monitoring radar systems are then discussed in detail. The authors address current research and commercial development of Doppler radar based physiological monitoring for healthcare and other applications.

  5. Acute Cholecystitis in Patients with Scrub Typhus

    Lee, Hyun; Ji, Misuk; Hwang, Jeong-Hwan; Lee, Ja-Yeon; Lee, Ju-Hyung; Chung, Kyung Min; Lee, Chang-Seop


    Acute cholecystitis is a rare complication of scrub typhus. Although a few such cases have been reported in patients with scrub typhus, the clinical course is not well described. Of 12 patients, acute cholecystitis developed in 66.7% (8/12) of patients older than 60 yr. The scrub typhus group with acute cholecystitis had marginal significant longer hospital stay and higher cost than the group without cholecystitis according to propensity score matching. Scrub typhus should be kept in mind as ...

  6. Sonographic Scoring for Operating Room Triage in Trauma

    Raghavendran, Krishnan MD


    Full Text Available Objective: The focused assessment with sonography for trauma (FAST exam is a routine diagnostic adjunct in the initial assessment of blunt trauma victims but lacks the ability to reliably predict which patients require laparotomy. Physiologic data play a major role in decision making regarding the need for emergent laparotomy versus further diagnostic testing or observation. The need for laparotomy often influences the decision to transfer the patient to a trauma center. We set out to derive a simple scoring system using both ultrasound findings and immediately available physiologic data that would predict which patients require laparotomy.Methods: We conducted a prospective observational study of victims of blunt trauma who presented to a Level 1 Trauma Center. We collected FAST findings, physiologic data, and lab values. A previously-developed ultrasound scoring system was applied to the FAST findings. Patients were followed to determine if they underwent laparotomy. We used logistic regression analysis to determine which variables correlated with laparotomy and developed a new scoring system.Results: We enrolled a convenience sample of 1,393 patients. A simple scoring system (range 0-6 was developed that included both FAST findings and vital signs (heart rate and blood pressure. Patients with a score of 0 or 1 had a less than 1% chance of requiring laparotomy.Conclusion: The combination of FAST findings with vital signs in our scoring system predicted which victims of blunt trauma did not undergo laparotomy. Applying this to trauma patients who present to non-trauma centers could help prevent unnecessary patient transfers. This derivation set must be validated prior to use in patient care. [West J Emerg Med. 2010; 11(2:138-143.

  7. 急诊科醉酒患者血清hs-CRP水平、NLR及EPIC评分对急性胰腺炎的诊断价值%The Value of Serum Hs-CRP Level NLR and EPIC Score for the Diagnosis of Acute Pancreatitis in Alcoholism Patients in Emergency Department

    王书强; 张晓兰


    Objective To study the value of serum hs-CRP level NLR and EPIC score for the diagnosis of acute pancreatitis in alcoholism patients with emergency department. Method 100 cases of alcoholism patients in our hospital from January 2013-December 2014 were selected, including 38 patients with AAP as observation group, 62 cases of patients without the AAP as control group, all patients received blood tests and abdominal CT examination within 24h admitted to hospital, compared the serum hs-CRP levels, NLR and EPIC scale of the two groups of patients, analysis the relationship between three indicators and AAP illness severity. Results The proportion of male patients, proportion of SAP patients, the serum hs-CRP levels, NLR and EPIC score of the observing group were higher than the control group, the age of the observation group was younger than those in control group, the difference has statistical signiifcance (all P<0.05). Conclusion AAP occurs in young and middle-aged men, its has high incidence of SAP, its serum hs-CRP levels, NLR and EPIC score was higher than the non-AAP patients;the serum hs-CRP levels, NLR and EPIC scale can be used as the effective index response the severity of the alcoholism patients.%目的:探讨急诊科醉酒患者血清hs-CRP水平、NLR(中性粒细胞与淋巴细胞比值)及EPIC(胰腺外炎症CT评分)对急性胰腺炎(AAP)的诊断价值及与病情严重程度的关系。方法选取2013年1月至2014年12月我院收治的醉酒患者100例,其中AAP患者38例作为观察组,非AAP患者62例作为对照组,所有患者入院24 h内进行血液检验及腹部CT检查,对比两组患者的血清hs-CRP水平、NLR及EPIC评分,分析三项指标与AAP病情严重性的关系。结果观察组男性患者比例、血清hs-CRP水平、NLR及EPIC评分较对照组高,观察组患者年龄较对照组轻,差异具有统计学意义(均P<0.05)。结论醉酒患者中,AAP好发于中青年男性,其重

  8. Streptococcal acute pharyngitis

    Lais Martins Moreira Anjos


    Full Text Available Acute pharyngitis/tonsillitis, which is characterized by inflammation of the posterior pharynx and tonsils, is a common disease. Several viruses and bacteria can cause acute pharyngitis; however, Streptococcus pyogenes (also known as Lancefield group A β-hemolytic streptococci is the only agent that requires an etiologic diagnosis and specific treatment. S. pyogenes is of major clinical importance because it can trigger post-infection systemic complications, acute rheumatic fever, and post-streptococcal glomerulonephritis. Symptom onset in streptococcal infection is usually abrupt and includes intense sore throat, fever, chills, malaise, headache, tender enlarged anterior cervical lymph nodes, and pharyngeal or tonsillar exudate. Cough, coryza, conjunctivitis, and diarrhea are uncommon, and their presence suggests a viral cause. A diagnosis of pharyngitis is supported by the patient's history and by the physical examination. Throat culture is the gold standard for diagnosing streptococcus pharyngitis. However, it has been underused in public health services because of its low availability and because of the 1- to 2-day delay in obtaining results. Rapid antigen detection tests have been used to detect S. pyogenes directly from throat swabs within minutes. Clinical scoring systems have been developed to predict the risk of S. pyogenes infection. The most commonly used scoring system is the modified Centor score. Acute S. pyogenes pharyngitis is often a self-limiting disease. Penicillins are the first-choice treatment. For patients with penicillin allergy, cephalosporins can be an acceptable alternative, although primary hypersensitivity to cephalosporins can occur. Another drug option is the macrolides. Future perspectives to prevent streptococcal pharyngitis and post-infection systemic complications include the development of an anti-Streptococcus pyogenes vaccine.

  9. Predictors of mortality of patients with acute respiratory failure secondary to chronic obstructive pulmonary disease admitted to an intensive care unit: A one year study

    Banga Amit


    Full Text Available Abstract Background Patients with acute exacerbation of chronic obstructive pulmonary disease (COPD commonly require hospitalization and admission to intensive care unit (ICU. It is useful to identify patients at the time of admission who are likely to have poor outcome. This study was carried out to define the predictors of mortality in patients with acute exacerbation of COPD and to device a scoring system using the baseline physiological variables for prognosticating these patients. Methods Eighty-two patients with acute respiratory failure secondary to COPD admitted to medical ICU over a one-year period were included. Clinical and demographic profile at the time of admission to ICU including APACHE II score and Glasgow coma scale were recorded at the time of admission to ICU. In addition, acid base disorders, renal functions, liver functions and serum albumin, were recorded at the time of presentation. Primary outcome measure was hospital mortality. Results Invasive ventilation was required in 69 patients (84.1%. Fifty-two patients survived to hospital discharge (63.4%. APACHE II score at the time of admission to ICU {odds ratio (95 % CI: 1.32 (1.138–1.532; p Conclusion APACHE II score at admission and SA levels with in 24 hrs after admission are independent predictors of mortality for patients with COPD admitted to ICU. The equation derived from these two parameters is useful for predicting outcome of these patients.

  10. What Is the Apgar Score?

    ... Development Infections Diseases & Conditions Pregnancy & Baby Nutrition & Fitness Emotions & Behavior School & Family Life First Aid & Safety Doctors & ... 2 being the best score: A ppearance (skin color) P ulse (heart rate) G rimace response (reflexes) ...

  11. From Rasch scores to regression

    Christensen, Karl Bang


    Rasch models provide a framework for measurement and modelling latent variables. Having measured a latent variable in a population a comparison of groups will often be of interest. For this purpose the use of observed raw scores will often be inadequate because these lack interval scale propertie....... This paper compares two approaches to group comparison: linear regression models using estimated person locations as outcome variables and latent regression models based on the distribution of the score....

  12. Acute pancreatitis

    Bo-Guang Fan


    Full Text Available Background : Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims : The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods : We reviewed the English-language literature (Medline addressing pancreatitis. Results : Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion. There are a number of important issues regarding clinical highlights in the classification, treatment and prognosis of acute pancreatitis, and treatment options for complications of acute pancreatitis including pancreatic pseudocysts. Conclusions : Multidisciplinary approach should be used for the management of the patient with acute pancreatitis.

  13. Acute pancreatitis

    Bo-Guang Fan


    Full Text Available Background: Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims: The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods: We reviewed the English-language literature (Medline addressing pancreatitis. Results: Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion. There are a number of important issues regarding clinical highlights in the classification, treatment and prognosis of acute pancreatitis, and treatment options for complications of acute pancreatitis including pancreatic pseudocysts. Conclusions: Multidisciplinary approach should be used for the management of the patient with acute pancreatitis.

  14. Comparação entre diferentes escores de risco de mortalidade em unidade de tratamento intensivo neonatal Comparison between different mortality risk scores in a neonatal intensive care unit

    Mariani Schlabendorff Zardo


    Full Text Available OBJETIVO: Avaliar peso de nascimento e os escores como preditores de mortalidade neonatal em unidade de terapia intensiva neonatal, comparando os seus resultados. MÉTODOS: Foram avaliados 494 recém-nascidos admitidos em uma unidade de terapia intensiva neonatal (UTIN de um hospital geral de Porto Alegre, RS, logo após o nascimento, entre março de 1997 e junho de 1998. Foram avaliados o peso de nascimento e os escores considerando a variável óbito durante a internação na UTI. Os critérios de exclusão foram: alta ou óbito da UTIN com menos de 24 horas de internação, recém-nascidos cuja internação não ocorreu logo após o nascimento, protocolo de estudo incompleto e malformações congênitas incompatíveis com a vida. Para avaliação do CRIB (Clinical Risk Index for Babies foram considerados somente os pacientes com peso de nascimento inferior a 1.500 g. Foram calculadas as curvas ROC (Receiver Operating Characteristics Curve para SNAP (Score for Neonatal Acute, SNAP-PE (Score for Neonatal Acute Physiology Perinatal Extension, SNAP II, SNAP-PE II, CRIB e peso de nascimento. RESULTADOS: Dos 494 pacientes, 44 faleceram (8,9% de mortalidade. Dos 102 recém-nascidos com peso de até 1.500 g, 32 (31,3% faleceram. As áreas abaixo da curva ROC variaram de 0,81 a 0,94. Todos os escores avaliados mostraram áreas abaixo da curva ROC sem diferenças estatisticamente significativas. Os escores de risco de mortalidade estudados apresentaram um melhor desempenho que o peso de nascimento, especialmente em recém-nascidos com peso de nascimento igual ou menor que 1.500 g. CONCLUSÕES: Todos os escores de mortalidade neonatal apresentaram melhor desempenho e foram superiores ao peso de nascimento como medidores de risco de óbito hospitalar para recém-nascidos internados em UTIN.OBJECTIVES: To evaluate and compare birthweight and scores as predictors of neonatal mortality in a Neonatal Intensive Care Unit (NICU. METHODS: The survey included

  15. Morbimortality Indicators in Severe Acute Pancreatitis

    Tercio De Campos


    Full Text Available Objective The aim of this study was to determine the factors related to the development of systemic complications, mortality and pancreatic necrosis in patients with severe acute pancreatitis. Patients Thirty-nine patients (22.3% out of 175 patients with acute pancreatitis who were admitted to our center, had an APACHE II score greater than 8; they were classified as having severe acute pancreatitis and were evaluated in the study. Main outcome measures Sepsis-related Organ Failure Assessment (SOFA and Marshall scores were obtained. The variables analyzed were age, sex, etiology, hematocrit, leukocyte count, CRP level, CT findings and length of hospital stay. These variables were related to the development of systemic complications, mortality and necrotizing pancreatitis. Results The mean APACHE II value of the patients included was 11.6±3.1, the mean SOFA score was 3.2±2.0 and the Marshall score was 1.5±1.9. Eleven patients developed necrotizing pancreatitis. The mortality rate among severe acute pancreatitis patients was 3 out of 39 (7.7%. Variables found to be related to systemic complications were the APACHE II score as well as SOFA and Marshall scores greater than 3. The variables related to mortality were SOFA score greater than 3 and leukocytosis greater than 19,000 mm-3. CRP greater than 19.5 mg/dL and length of hospital stay were related to necrotizing pancreatitis. Conclusions The scoring systems, especially the SOFA score, were related to the development of systemic complications and mortality. CRP showed a relationship to necrotizing pancreatitis. There was no relationship between the evaluated scoring systems and necrotizing pancreatitis in patients with severe acute pancreatitis.


    Ilkka Väänänen


    sympathoadrenal stress. The acute increasing effect of a single walking session on cortisol was seen only after the first day when there was a 60% increase. Responses after skiing were greater (2.2- and 2.6-fold. The acute reductions in testosterone concentrations were seen after the first two marching sessions, when they were decreased by 18-22%. LH concentration was decreased by 31-44% after the second and third day. For FSH concentrations suppression was consistently seen after the second march, but not after skiing. The total mood disturbance score remained unchanged during the events. The Fatigue-Inertia affective state was higher after exercise than before the events. This study demonstrates that the pituitary-gonadal axis, excluding the secretion of FSH and the adrenal cortex, adapted to four days of repeated moderate 8 h walking, but not to two days of repeated strenuous 3 h skiing. However, when using the sensitive IFMA, which can detect low concentrations of gonadotropins, secretion of FSH was seen to remain reduced and no adaptation was seen in walking. This study indicated that daily repeated long lasting acute but non-competitive walk and skiing of intensity at approximately 60-90% of the maximum heart rate is well within the physiological capabilities of individuals with good aerobic capacity.

  17. Predictors of the outcomes of acute-on-chronic hepatitis B liver failure

    Hsiu-Lung Fan; Po-Sheng Yang; Hui-Wei Chen; Teng-Wei Chen; De-Chuan Chan; Chi-Hong Chu; Jyh-Cherng Yu


    AIM:TO identify the risk factors in predicting the outcome of acute-on-chronic hepatitis B liver failure patients.METHODS:We retrospectively divided 113 patients with acute-on-chronic liver failure-hepatitis B virus (ACLF-HBV) and without concurrent hepatitis C or D virus infection and hepatocellular carcinoma into two groups according to their outcomes after anti-HBV therapy.Their demographic,clinical,and biochemical data on the day of diagnosis and after the first week of treatment were analyzed using the Mann-Whitney U test,Fisher's exact test,and a multiple logistic regression analysis.RESULTS:The study included 113 patients (87 men and 26 women) with a mean age of 49.84 years.Fiftytwo patients survived,and 61 patients died.Liver failure (85.2%),sepsis (34.4%),and multiple organ failure (39.3%) were the main causes of death.Multivariate analyses showed that Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores ≥ 12[odds ratio (OR) =7.160,95% CI:2.834-18.092,P <0.001] and positive blood culture (OR =13.520,95%CI:2.740-66.721,P =0.001) on the day of diagnosis and model for end-stage liver disease (MELD) scores ≥ 28 (OR =8.182,95% CI:1.884-35.527,P =0.005)after the first week of treatment were independent predictors of mortality.CONCLUSION:APACHE Ⅱ scores on the day of diagnosis and MELD scores after the first week of anti-HBV therapy are feasible predictors of outcome in ACLF-HBV patients.

  18. Acute cholecystitis

    Halpin, Valerie


    Acute cholecystitis causes unremitting right upper quadrant pain, anorexia, nausea, vomiting, and fever, and if untreated can lead to perforations, abscess formation, or fistulae. About 95% of people with acute cholecystitis have gallstones.It is thought that blockage of the cystic duct by a gallstone or local inflammation can lead to acute cholecystitis, but we don't know whether bacterial infection is also necessary.

  19. Correlation between admission plasma glucose level and cardiac insufficiency or GRACE scores in patients with acute ST-segment elevation myocardial infarction%急性ST段抬高型心肌梗死患者入院血糖水平与心功能不全和GRACE评分的相关性分析

    白玉蓉; 靳志涛; 鞠鹏; 卢鑫


    目的:探讨急性ST段抬高型心肌梗死(STEMI)患者入院血糖水平与心功能不全和GRACE评分的相关性。方法连续入选2007年1月至2009年12月因STEMI住院的患者244例,收集其人口学信息和临床资料并进行GRACE危险评分。根据入院随机血糖水平分为3组:Ⅰ组(血糖<7 mmol/L,n=102);Ⅱ组(7 mmol/L≤血糖<11 mmol/L,n=102),Ⅲ组(血糖≥11 mmol/L,n=40)。分析其入院随机血糖水平和心功能不全、GRACE危险评分的关系。结果Ⅰ组、Ⅱ组、Ⅲ组患者随着血糖水平升高,女性患者(5.9%vs.17.6%vs.25.0%,P<0.05)及糖尿病患者(8.9%vs.33.3%vs.95.0%,P<0.05)比例增加。Ⅰ组患者心功能不全比例少于Ⅱ组及Ⅲ组(15.7%vs.23.5%vs.25.0%,P<0.05);GRACE评分值低于Ⅱ组及Ⅲ组及Ⅱ组[(148.7±33.1)vs.(160.0±37.6)vs.(171.5±41.2),P<0.05],而Ⅱ组及Ⅲ组心功能不全患者比例及GRACE评分无统计学差异(P>0.05)。相关分析表明入院即刻血糖水平与GRACE危险性评分(r=0.77,P=0.009)和心功能不全(tau_b=0.248,P<0.0001)有显著相关性。结论 STEMI患者入院应激性血糖水平升高与住院心力衰竭和GRACE评分密切相关。无论是糖尿病还是非糖尿病患者,入院即刻血糖水平大于7 mmol/L时心力衰竭发生率明显增加。%Objective To investigate the correlation between admission plasma glucose level and cardiac insufficiency or GRACE scores in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods STEMI patients (n=244) were chosen from Jan. 2007 to Dec. 2009, and their demographic information and clinical data were collected and given GRACE risk scoring. All patients were divided, according their admission glucose level, into 3 groups: group I (glucose0.05). Correlation analysis showed that admission plasma glucose level was significantly correlated to GRACE scores (r=0.77,P=0

  20. Appilcation of CRUSADE scoring system in assessment of hemorrhage in patients with acute ST-segment elevation myocardial infarction treated with tirofiban%Crusade 评分系统评估急性 ST 段抬高性心肌梗死患者应用替罗非班的出血风险

    吴钟伟; 王圣; 李斌; 王裕岱; 董小莉


    目的:运用危险分层级别( Crusade)评分系统对急性ST段抬高性心肌梗死( ST-segment elevation myocardial infarction, STEMI)患者应用替罗非班的出血风险进行评估。方法选择2010-01~2014-06在我院心内科住院的STEMI患者共364例,对每例患者进行Crusade评分并进行危险分层,其中单纯应用双重抗血小板(阿司匹林+氯吡格雷)共160例(对照组),双重抗血小板基础上加用替罗非班204例,观察住院7 d内主要出血事件发生率。结果364例患者中共有30例发生主要出血事件,出血发生率为8.2%。其中消化道出血发生率最高,占43%,其次为泌尿系统出血,呼吸系统、腹膜后及颅内出血发生率相对较低。在160例单纯使用双重抗血小板患者中,住院期间有9例发生出血,总出血发生率为5.6%,由极低危组至极高危组出血发生率依次为0、0、0.6%、1.9%和3.1%。在204例患者中使用双重抗血小板基础上加用替罗非班患者中,住院期间有21例发生出血,总的出血发生率为10.3%;由极低危组至极高危组出血发生率依次为0、0、0.9%、3.4%和5.9%;高危组及极高危组出血发生率显著高于各组(P<0.05)。与对照组比较,应用替罗非班患者高危组及极高危组出血发生率显著增加(P<0.05)。极低危组、低危组及中危组出血发生率比较差异无统计学意义( P>0.05)。结论随着Crusade评分增加,各组出血发生率呈增加趋势。与对照组比较,替罗非班组在评分高危组及极高危组出血发生率显著增加。 Crusade评分系统对STEMI患者住院期间应用替罗非班的出血风险有良好的评估价值。%Objective To evaluate the risk of bleeding in patients with acute ST -segment elevation myocardial infarction ( STEMI ) treated with tirofiban using CRUSADE scoring system. Methods CRUSADE

  1. Clinical study on nutrition support in patients with severe acute pancreatitis

    Gang Zhao; Chun-You Wang; Fang Wang; Jiong-Xin Xiong


    AIM: To investigate the effect of nutritional support therapy on severe acute pancreatitis (SAP).METHODS: A total of 96 patients with severe acute pancreatitis were divided randomly into control and treatment groups.The former group received total parenteral nutrition (TPN)via central venous infusion, while parenteral nutrition (PN)and enteral nutrition (EN) therapies were applied in different phases for the latter group. The nutrition status, acute phase responses, pancreas lesions, enteric mucosa penetrability and immune functions were monitored.RESULTS: Body weight and prealbumin concentration were increased in treatment group, compared to those in the control group, but albumin concentration did not change significantly.Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ)scores decreased after 7 d of treatment, whereas the scores of the control group decreased on the 11th day. Concentrations of tumor necrosis factor-α (TNF-α), interleukine-6 (IL-6) and serum C reactive protein (CRP) dropped earlier in the treatment group (on the 4th day) than that in the control group (on the 7th day). No difference was observed in pancreatic lesions between the control and treatment groups.Concentration of endotoxin and lactulose/manicol (L:M) ratio of urine did not change in treatment group, but those in the control group were elevated markedly. Compared with the treatment group, CD4:CD8 T cells ratio and immunoglobulin G (IgG) concentration in the control group decreased significantly.CONCLUSION: Compared to TPN, the combined therapy of EN and PN could improve the nutrition status and moderate the acute phase response obviously. Moreover, the integrity of enteric mucosa and immune function were protected more effectively in treatment group than in the control one. On the other hand, EN did not simulate the excretion of pancreas and avoid exaggerating the inflammation of pancreas. Thus,appropriate application of PN and EN appears to be more effective for patients

  2. Clinical Application of AIMS65 Scores to Predict Outcomes in Patients with Upper Gastrointestinal Hemorrhage

    Sharma, Manik; John, Anil K; Al-Ejji, Khalid Mohsin; Wani, Hamidulla; Sultan, Khaleel; Al-Mohannadi, Muneera; Yakoob, Rafie; Derbala, Moutaz; Al-Dweik, Nazeeh; Butt, Muhammed Tariq; Al-Kaabi, Saad Rashid


    Background/Aims To evaluate the ability of the recently proposed albumin, international normalized ratio (INR), mental status, systolic blood pressure, age >65 years (AIMS65) score to predict mortality in patients with acute upper gastrointestinal bleeding (UGIB). Methods AIMS65 scores were calculated in 251 consecutive patients presenting with acute UGIB by allotting 1 point each for albumin level 1.5, alteration in mental status, systolic blood pressure ≤90 mm Hg, and age ≥65 years. Risk stratification was done during the initial 12 hours of hospital admission. Results Intensive care unit (ICU) admission, endoscopic therapy, or surgery were required in 51 patients (20.3%), 64 (25.5%), and 12 (4.8%), respectively. The predictive accuracy of AIMS65 scores ≥2 was high for blood transfusion (area under the receiver operator characteristic curve [AUROC], 0.59), ICU admission (AUROC, 0.61), and mortality (AUROC, 0.74). The overall mortality was 10.3% (n=26), and was 3%, 7.8%, 20%, 36%, and 40% for AIMS65 scores of 0, 1, 2, 3, and 4, respectively; these values were significantly higher in those with scores ≥2 (30.9%) than in those with scores <2 (4.5%, p<0.001). Conclusions AIMS65 is a simple, accurate, non-endoscopic risk score that can be applied early (within 12 hours of hospital admission) in patients with acute UGIB. AIMS65 scores ≥2 predict high in-hospital mortality. PMID:26473120

  3. Physiological changes in pregnancy

    SOMA-PILLAY, Priya; Catherine, Nelson-Piercy; Tolppanen, Heli; Mebazaa, Alexandre


    Abstract Physiological changes occur in pregnancy to nurture the developing foetus and prepare the mother for labour and delivery. Some of these changes influence normal biochemical values while others may mimic symptoms of medical disease. It is important to differentiate between normal physiological changes and disease pathology. This review highlights the important changes that take place during normal pregnancy.

  4. Physiology of sport.

    Maughan, Ron


    The elite athlete represents the extreme of the human gene pool, where genetic endowment is developed by an intensive training programme. Sport encompasses many different activities, calling for different physical and mental attributes. Understanding the physiology of exercise provides insights into normal physiological function.

  5. Advances in physiological computing

    Fairclough, Stephen H


    This edited collection will provide an overview of the field of physiological computing, i.e. the use of physiological signals as input for computer control. It will cover a breadth of current research, from brain-computer interfaces to telemedicine.

  6. Phun Week: Understanding Physiology

    Limson, Mel; Matyas, Marsha Lakes


    Topics such as sports, exercise, health, and nutrition can make the science of physiology relevant and engaging for students. In addition, many lessons on these topics, such as those on the cardiovascular, respiratory, and digestive systems, align with national and state life science education standards. Physiology Understanding Week (PhUn…

  7. Skin scoring in systemic sclerosis

    Zachariae, Hugh; Bjerring, Peter; Halkier-Sørensen, Lars


    Forty-one patients with systemic sclerosis were investigated with a new and simple skin score method measuring the degree of thickening and pliability in seven regions together with area involvement in each region. The highest values were, as expected, found in diffuse cutaneous systemic sclerosis...... (type III SS) and the lowest in limited cutaneous systemic sclerosis (type I SS) with no lesions extending above wrists and ancles. A positive correlation was found to the aminoterminal propeptide of type III procollagen, a serological marker for synthesis of type III collagen. The skin score...

  8. Estimating Decision Indices Based on Composite Scores

    Knupp, Tawnya Lee


    The purpose of this study was to develop an IRT model that would enable the estimation of decision indices based on composite scores. The composite scores, defined as a combination of unidimensional test scores, were either a total raw score or an average scale score. Additionally, estimation methods for the normal and compound multinomial models…

  9. Developing Scoring Algorithms (Earlier Methods)

    We developed scoring procedures to convert screener responses to estimates of individual dietary intake for fruits and vegetables, dairy, added sugars, whole grains, fiber, and calcium using the What We Eat in America 24-hour dietary recall data from the 2003-2006 NHANES.

  10. Fetal cardiovascular physiology.

    Rychik, J


    The cardiovascular system of the fetus is physiologically different than the adult, mature system. Unique characteristics of the myocardium and specific channels of blood flow differentitate the physiology of the fetus from the newborn. Conditions of increased preload and afterload in the fetus, such as sacrococcygeal teratoma and twin-twin transfusion syndrome, result in unique and complex pathophysiological states. Echocardiography has improved our understanding of human fetal cadiovasvular physiology in the normal and diseased states, and has expanded our capability to more effectively treat these disease processes.

  11. Genetic effect on apgar score

    Carla Franchi-Pinto


    Full Text Available Intraclass correlation coefficients for one- and five-min Apgar scores of 604 twin pairs born at a southeastern Brazilian hospital were calculated, after adjusting these scores for gestational age and sex. The data support a genetic hypothesis only for 1-min Apgar score, probably because it is less affected by the environment than 4 min later, after the newborns have been under the care of a neonatology team. First-born twins exhibited, on average, better clinical conditions than second-born twins. The former showed a significantly lower proportion of Apgar scores under seven than second-born twins, both at 1 min (17.5% vs. 29.8% and at 5 min (7.2% vs. 11.9%. The proportion of children born with "good" Apgar scores was significantly smaller among twins than among 1,522 singletons born at the same hospital. Among the latter, 1- and 5-min Apgar scores under seven were exhibited by 9.2% and 3.4% newborns, respectively.Os coeficientes de correlação intraclasse foram calculados para os índices de Apgar 1 e 5 minutos após o nascimento de 604 pares de gêmeos em uma maternidade do sudeste brasileiro, depois que esses índices foram ajustados para idade gestacional e sexo. Os dados obtidos apoiaram a hipótese genética apenas em relação ao primeiro índice de Apgar, provavelmente porque ele é menos influenciado pelo ambiente do que 4 minutos depois, quando os recém-nascidos já estiveram sob os cuidados de uma equipe de neonatologistas. Os gêmeos nascidos em primeiro lugar apresentaram, em média, melhor estado clínico que os nascidos em segundo lugar, visto que os primeiros mostraram uma proporção de índices de Apgar inferiores a 7 significativamente menor do que os nascidos em segundo lugar, tanto um minuto (17,5% contra 29,8% quanto cinco minutos após o nascimento (7,2% contra 11,9%. A proporção de recém-nascidos com índices de Apgar que indicam bom prognóstico foi significativamente menor nos gêmeos do que em 1.522 conceptos

  12. Discrepancy Between Clinician and Research Assistant in TIMI Score Calculation (TRIAGED CPU

    Taylor, Brian T.


    Full Text Available Introduction: Several studies have attempted to demonstrate that the Thrombolysis in Myocardial Infarction (TIMI risk score has the ability to risk stratify emergency department (ED patients with potential acute coronary syndromes (ACS. Most of the studies we reviewed relied on trained research investigators to determine TIMI risk scores rather than ED providers functioning in their normal work capacity. We assessed whether TIMI risk scores obtained by ED providers in the setting of a busy ED differed from those obtained by trained research investigators. Methods: This was an ED-based prospective observational cohort study comparing TIMI scores obtained by 49 ED providers admitting patients to an ED chest pain unit (CPU to scores generated by a team of trained research investigators. We examined provider type, patient gender, and TIMI elements for their effects on TIMI risk score discrepancy. Results: Of the 501 adult patients enrolled in the study, 29.3% of TIMI risk scores determined by ED providers and trained research investigators were generated using identical TIMI risk score variables. In our low-risk population the majority of TIMI risk score differences were small; however, 12% of TIMI risk scores differed by two or more points. Conclusion: TIMI risk scores determined by ED providers in the setting of a busy ED frequently differ from scores generated by trained research investigators who complete them while not under the same pressure of an ED provider. [West J Emerg Med. 2015;16(1:24–33.

  13. Cardiovascular anatomy and physiology in the female.

    Wingate, S


    Important differences in male and female cardiovascular anatomy and physiology may account for many of the gender differences seen in various cardiac disease states. Predominant influences on female disease manifestations include (1) women's smaller body size, hence smaller hearts and smaller coronary vessels and (2) women's fluctuating levels of estrogen throughout their lifespan. Understanding these critical anatomic and physiologic differences allows the clinician to better predict and plan care for women. For example, knowing that women generally have a smaller body surface area than men allows one to better understand why men have higher creatine kinase (CK) values than do women--an important distinction when interpreting these values in the acute care setting. The fact that women's hearts and coronary vessels are generally smaller than men's also helps one understand why women have a higher in-hospital mortality than men post-coronary artery bypass graft surgery (see article by Allen in this issue for more detailed information on revascularization). These are only a few examples of the many opportunities that acute care nurses have to integrate their knowledge of anatomy and physiology into proactive planning for their female cardiac patients.

  14. Reproduction, physiology and biochemistry

    This chapter summarizes fundamental knowledge and recent discoveries about the reproduction, physiology and biochemistry of plant-parasitic nematodes. Various types of reproduction are reviewed, including sexual reproduction and mitotic and meiotic parthenogenesis. Although much is known about the p...

  15. Acute Kidney Failure

    ... out of balance. Acute kidney failure — also called acute renal failure or acute kidney injury — develops rapidly over ... 2015. Palevsky PM. Definition of acute kidney injury (acute renal failure). Accessed April ...

  16. Acute Pancreatitis and Pregnancy

    ... Pancreatitis Acute Pancreatitis and Pregnancy Acute Pancreatitis and Pregnancy Timothy Gardner, MD Acute pancreatitis is defined as ... pancreatitis in pregnancy. Reasons for Acute Pancreatitis and Pregnancy While acute pancreatitis is responsible for almost 1 ...

  17. Analysis of clinical risk factors associated with mortality of severely injured multiple trauma patients with acute lung injury

    MA Yue-feng; SHENG Lei; GU Jun; ZHANG Mao; JIANG Guan-yu


    Background It is important to study the factors affecting the clinical mortality of the severe multiple trauma population. The present study was aimed to identify the potential risk factors that could affect mortality rate of acute lung injury (ALI) in severely injured multiple trauma population and to investigate the effects of certain risk factors on the prognosis of different patient subpopulations.Methods This is a follow-up study treating trauma as a single cause for emergency department (ED) and emergency intensive care unit (EICU) admissions. Patients identified with severe multiple trauma with early onset of ALI were enrolled from five trauma centers. Nineteen potential risk factors affecting the prognosis of ALI were examined by univariate and multivariate Logistic regression analyses to identify the ones that affected the mortality of these severe multiple trauma patients.Results There were 687 multiple trauma patients with post-traumatic ALl admitted to ED and EICU during the study period. The six risk factors that affected the mortality with unadjusted odd ratios (ORs) and 95% confidence intervals (Cls)were Acute Physiology Score and Chronic Health Evaluation Score (APACHE) II score, Injury Severity Score (ISS), duration of trauma, age, aspiration of gastric contents, and disseminated intravascular coagulation (DIC). Specific risk factors also affected different patient subpopulations at different degrees (surviving beyond 24 hours, 72 hours, 28 days and with multiple blood transfusions and higher injury scores).Conclusions Factors of APACHE Ⅱ score, ISS and aspiration of gastric contents that could predict the mortality of ALI may exist in the early stage of trauma. Duration of trauma and DIC that greatly affected and predicted the short- and long-term development and mortality of ALI deserve special attention. Elderly patients (aged beyond 65 years) were the independent risk factor for the secondary sepsis and deterioration of pulmonary function

  18. Mangled extremity severity score in children.

    Fagelman, Mitchell F; Epps, Howard R; Rang, Mercer


    Treatment of the severely traumatized or mangled lower extremity poses significant challenges. The Mangled Extremity Severity Score (MESS) is a scale that uses objective criteria to assist with acute management decisions. Most research on the MESS has been in adults or combined series with few children. The study was performed to investigate the MESS in children exclusively. The MESS was applied retrospectively to 36 patients with grades IIIB and IIIC open lower extremity fractures collected from two level 1 pediatric trauma centers. Patients were divided into limb salvage and primary amputation groups based on the decision of the treating surgeon. In the salvage group there were 18 grade IIIB fractures and 10 grade IIIC fractures. The MESS prediction was accurate in 93% of the injured limbs. In the amputation group eight limbs met the inclusion criteria; the MESS agreed with the treating surgeon in 63% of cases. These findings suggest the MESS should be considered when managing a child with severe lower extremity trauma.

  19. Initial dosing regimen of vancomycin to achieve early therapeutic plasma concentration in critically ill patients with MRSA infection based on APACHE II score.

    Imaura, Masaharu; Yokoyama, Haruko; Kohata, Yuji; Kanai, Riichiro; Kohyama, Tomoki; Idemitsu, Wataru; Maki, Yuichi; Igarashi, Takashi; Takahashi, Hiroyuki; Kanno, Hiroshi; Yamada, Yasuhiko


    It is essential to assure the efficacy of antimicrobials at the initial phase of therapy. However, increasing the volume of distribution (Vd) of hydrophilic antimicrobials in critically ill patients leads to reduced antimicrobial concentration in plasma and tissue, which may adversely affect the efficacy of that therapy. The aim of the present study was to establish a theoretical methodology for setting an appropriate level for initial vancomycin therapy in individual patients based on Acute Physiology and Chronic Health Evaluation (APACHE) II score. We obtained data from patients who received intravenous vancomycin for a suspected or definitively diagnosed Gram-positive bacterial infection within 72 h after admission to the intensive care unit. The Vd and elimination half-life (t 1/2) of vancomycin values were calculated using the Bayesian method, and we investigated the relationship between them and APACHE II score. There were significant correlations between APACHE II scores and Vd/actual body weight (ABW), as well as t 1/2 (r = 0.58, p < 0.05 and r = 0.74, p < 0.01, respectively). Our results suggested that the Vd and t 1/2 of vancomycin could be estimated using the following regression equations using APACHE II score.[Formula: see text] [Formula: see text]We found that APACHE II score was a useful index for predicting the Vd and t 1/2 of vancomycin, and used that to establish an initial vancomycin dosing regimen comprised of initial dose and administration interval for individual patients.

  20. Interpreting force concept inventory scores: Normalized gain and SAT scores

    Jeffrey J. Steinert


    Full Text Available Preinstruction SAT scores and normalized gains (G on the force concept inventory (FCI were examined for individual students in interactive engagement (IE courses in introductory mechanics at one high school (N=335 and one university (N=292 , and strong, positive correlations were found for both populations ( r=0.57 and r=0.46 , respectively. These correlations are likely due to the importance of cognitive skills and abstract reasoning in learning physics. The larger correlation coefficient for the high school population may be a result of the much shorter time interval between taking the SAT and studying mechanics, because the SAT may provide a more current measure of abilities when high school students begin the study of mechanics than it does for college students, who begin mechanics years after the test is taken. In prior research a strong correlation between FCI G and scores on Lawson’s Classroom Test of Scientific Reasoning for students from the same two schools was observed. Our results suggest that, when interpreting class average normalized FCI gains and comparing different classes, it is important to take into account the variation of students’ cognitive skills, as measured either by the SAT or by Lawson’s test. While Lawson’s test is not commonly given to students in most introductory mechanics courses, SAT scores provide a readily available alternative means of taking account of students’ reasoning abilities. Knowing the students’ cognitive level before instruction also allows one to alter instruction or to use an intervention designed to improve students’ cognitive level.

  1. Assessing the need for hospital admission by the Cape Triage discriminator presentations and the simple clinical score.

    Emmanuel, Andrew


    There is uncertainty about how to assess unselected acutely ill medical patients at the time of their admission to hospital. This study examined the use of the Simple Clinical Score (SCS) and the medically relevant Cape Triage discriminator clinical presentations to determine the need for admission to an acute medical unit.

  2. Use of a respiratory clinical score among different providers.

    Liu, Lenna L; Gallaher, Margaret M; Davis, Robert L; Rutter, Carolyn M; Lewis, Toby C; Marcuse, Edgar K


    Respiratory assessment of children with asthma or bronchiolitis is problematic because both the components of the assessment and their relative importance vary among care providers. Use of a systematic standard assessment process and clinical score may reduce interobserver variation. Our objective was to determine observer agreement among physicians (MD), nurses (RN), and respiratory therapists (RT), using a standard respiratory clinical score. A clinical score was developed incorporating four physiologic parameters: respiratory rate, retractions, dyspnea, and auscultation. One hundred and sixty-five provider pairs (e.g., MD-MD, RN-RT) independently assessed a total of 55 patients admitted for asthma, bronchiolitis, or wheezing at an urban tertiary-care hospital. A weighted kappa statistic measured agreement beyond chance. Rater pairs had high observed agreement on total score of 82-88% and weighted kappas ranging from 0.52 (MD-RN; 95% CI, 0.19, 0.79) to 0.65 (RN-RN; 95% CI, 0.46, 0.87). Observed agreement on individual components of the score ranged from 58% (auscultation) to 74% (dyspnea), with unweighted kappas of 0.36 (respiratory rate; 95% CI, 0.26, 0.46) to 0.53 (dyspnea; 95% CI, 0.41, 0.65). In conclusion, this respiratory clinical score demonstrates good interobserver agreement between MDs, RNs, and RTs. Future research is needed to examine validity and responsiveness in clinical settings. By standardizing respiratory assessments, use of a clinical score may facilitate care coordination by physicians, nurses, and respiratory therapists and thereby improve care of children hospitalized with asthma and bronchiolitis.

  3. Glutamine Attenuates Acute Lung Injury Caused by Acid Aspiration

    Chih-Cheng Lai


    Full Text Available Inadequate ventilator settings may cause overwhelming inflammatory responses associated with ventilator-induced lung injury (VILI in patients with acute respiratory distress syndrome (ARDS. Here, we examined potential benefits of glutamine (GLN on a two-hit model for VILI after acid aspiration-induced lung injury in rats. Rats were intratracheally challenged with hydrochloric acid as a first hit to induce lung inflammation, then randomly received intravenous GLN or lactated Ringer’s solution (vehicle control thirty min before different ventilator strategies. Rats were then randomized to receive mechanical ventilation as a second hit with a high tidal volume (TV of 15 mL/kg and zero positive end-expiratory pressure (PEEP or a low TV of 6 mL/kg with PEEP of 5 cm H2O. We evaluated lung oxygenation, inflammation, mechanics, and histology. After ventilator use for 4 h, high TV resulted in greater lung injury physiologic and biologic indices. Compared with vehicle treated rats, GLN administration attenuated lung injury, with improved oxygenation and static compliance, and decreased respiratory elastance, lung edema, extended lung destruction (lung injury scores and lung histology, neutrophil recruitment in the lung, and cytokine production. Thus, GLN administration improved the physiologic and biologic profiles of this experimental model of VILI based on the two-hit theory.

  4. Validating the effectiveness of Clinically Oriented Physiology Teaching (COPT in undergraduate physiology curriculum

    Ramnarayan Komattil


    Full Text Available Abstract Background It has been proved that basic science knowledge learned in the context of a clinical case is actually better comprehended and more easily applied by medical students than basic science knowledge learned in isolation. The present study intended to validate the effectiveness of Clinically Oriented Physiology Teaching (COPT in undergraduate medical curriculum at Melaka Manipal Medical College (Manipal Campus, Manipal, India. Methods COPT was a teaching strategy wherein, students were taught physiology using cases and critical thinking questions. Three batches of undergraduate medical students (n = 434 served as the experimental groups to whom COPT was incorporated in the third block (teaching unit of Physiology curriculum and one batch (n = 149 served as the control group to whom COPT was not incorporated. The experimental group of students were trained to answer clinically oriented questions whereas the control group of students were not trained. Both the group of students undertook a block exam which consisted of clinically oriented questions and recall questions, at the end of each block. Results Comparison of pre-COPT and post-COPT essay exam scores of experimental group of students revealed that the post-COPT scores were significantly higher compared to the pre-COPT scores. Comparison of post-COPT essay exam scores of the experimental group and control group of students revealed that the experimental group of students performed better compared to the control group. Feedback from the students indicated that they preferred COPT to didactic lectures. Conclusion The study supports the fact that assessment and teaching patterns should fall in line with each other as proved by the better performance of the experimental group of students compared to the control group. COPT was also found to be a useful adjunct to didactic lectures in teaching physiology.

  5. Neuropeptide physiology in helminths.

    Mousley, Angela; Novozhilova, Ekaterina; Kimber, Michael J; Day, Tim A


    Parasitic worms come from two distinct, distant phyla, Nematoda (roundworms) and Platyhelminthes (flatworms). The nervous systems of worms from both phyla are replete with neuropeptides and there is ample physiological evidence that these neuropeptides control vital aspects of worm biology. In each phyla, the physiological evidence for critical roles for helminth neuropeptides is derived from both parasitic and free-living members. In the nematodes, the intestinal parasite Ascaris suum and the free-living Caenorhabditis elegans have yielded most of the data; in the platyhelminths, the most physiological data has come from the blood fluke Schistosoma mansoni. FMRFamide-like peptides (FLPs) have many varied effects (excitation, relaxation, or a combination) on somatic musculature, reproductive musculature, the pharynx and motor neurons in nematodes. Insulin-like peptides (INSs) play an essential role in nematode dauer formation and other developmental processes. There is also some evidence for a role in somatic muscle control for the somewhat heterogeneous grouping ofpeptides known as neuropeptide-like proteins (NLPs). In platyhelminths, as in nematodes, FLPs have a central role in somatic muscle function. Reports of FLP physiological action in platyhelminths are limited to a potent excitation of the somatic musculature. Platyhelminths are also abundantly endowed with neuropeptide Fs (NPFs), which appear absent from nematodes. There is not yet any data linking platyhelminth NPF to any particular physiological outcome, but this neuropeptide does potently and specifically inhibit cAMP accumulation in schistosomes. In nematodes and platyhelminths, there is an abundance of physiological evidence demonstrating that neuropeptides play critical roles in the biology of both free-living and parasitic helminths. While it is certainly true that there remains a great deal to learn about the biology of neuropeptides in both phyla, physiological evidence presently available points

  6. The HEART score for chest pain patients

    Backus, B.E.


    The HEART score was developed to improve risk stratification in chest pain patients in the emergency department (ED). This thesis describes series of validation studies of the HEART score and sub studies for individual elements of the score. The predictive value of the HEART score for the occurrence

  7. Scoring and Standard Setting with Standardized Patients.

    Norcini, John J.; And Others


    The continuous method of scoring a performance test composed of standardized patients was compared with a derivative method that assigned each of the 131 examinees (medical residents) a dichotomous score, and use of Angoff's method with these scoring methods was studied. Both methods produce reasonable means and distributions of scores. (SLD)

  8. Prediction of left ventricular remodeling in patients with acute myocardial infarction by speckle tracking imaging with wall motion score index:a clinical follow-up study%斑点追踪成像联合室壁运动评分预测急性心肌梗死患者左心室重构的随访研究

    胡波; 周青; 陈金玲; 姚雪; 宋宏宁; 谭团团; 郭瑞强


    Objective To explore the prognostic value of speckle tracking imaging (STI) for left ventricular remodeling(LVR) in acute myocardial infarction (AMI) patients with the analysis of the relation between regional wall motion abnormality after AMI and LVR by STI in association with wall motion score index (WMSI).Methods Eighty-three patients with first onset AMI were enrolled from January 2012 to May 2015 and underwent echocardiography within 24 h of the onset and at 6-month follow-up.LVR was defined as more than 20% of the percentage change of left ventricular end-diastolic volume (△LVEDV%) from baseline to 6-month follow-up (divided as LVR and non-LVR group).Standard long-axis and shortaxis views were stored and analyzed for longitudinal (LS),radial (RS) and circumferential (CS) strain of STI metrics as well as scores of WMSI.Segments of WMSI≥2 were selected and calculated for the mean values of LS (LS_WMSI),RS (RS_WMSI) and CS (CS_WMSI).Results LVR occurred in twenty-seven AMI patients at 6-month follow-up.No difference has shown for demographics,electrocardiogram,lab tests,coronary angiography as well as the measurements of two-dimensional echocardiography between the two groups from baseline,while all STI metrics had statistical difference when the comparisons (P <0.05,all),especially the WMSI selected STI metrics (P <0.001,all).Linear regression analysis demonstrated that CS_WMSI (r =0.716,P <0.001) was best correlated to △LVEDV% among all STI metrics and also the best predictor of LVR by receive operator curve analysis (sensitivity of 92.6%,specificity of 87.5 % and area under the curve of 0.9563).Conclusions Baseline STI metrics can precisely predict LVR at 6-month follow-up.Among the STI metrics,CS_WMSI has shown preferable predictive and diagnostic value,which indicates that the impairment of segmental circumferential wall motion is closely correlated to LVR after myocardial infarction.%目的 应用斑点追踪成像(STI)技术联合

  9. Leptin Is Associated With Persistence of Hyperglycemia in Acute Pancreatitis: A Prospective Clinical Study.

    Kennedy, James I C; Askelund, Kathryn J; Premkumar, Rakesh; Phillips, Anthony R J; Murphy, Rinki; Windsor, John A; Petrov, Maxim S


    Adipokines have many homeostatic roles, including modulation of glucose metabolism, but their role in the pathophysiology of hyperglycemia associated with acute and critical illnesses in general, and acute pancreatitis (AP) in particular, is largely unknown. This study aimed to investigate the relationship between a panel of adipokines and hyperglycemia in the early course of AP, as well as the role of adipokines as predictors of AP severity.Adiponectin, leptin, omentin, resistin, and visfatin were measured on a daily basis in the first 72 hours after hospital admission. A first set of analyses was undertaken with admission glycemia stratified by severity, and a second set of analyses was undertaken based on persistence of early hyperglycemia. All of the analyses were adjusted for confounders.A total of 32 patients with AP were included in this study. None of the studied adipokines was significantly associated with glucose level on admission. Leptin was significantly (P = 0.003) increased in patients with persistent hyperglycemia. Adiponectin was significantly associated with the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in patients with persistent hyperglycemia (P = 0.015), visfatin with APACHE II score in patients with persistent hyperglycemia (P = 0.014), and omentin with APACHE II score in all of the patients regardless of the presence or absence of hyperglycemia (P = 0.021).Leptin is significantly associated with persistent hyperglycemia in the early course of AP. Omentin has a potential to become an accurate predictor of AP severity.

  10. Bias Adjusted Precipitation Threat Scores

    F. Mesinger


    Full Text Available Among the wide variety of performance measures available for the assessment of skill of deterministic precipitation forecasts, the equitable threat score (ETS might well be the one used most frequently. It is typically used in conjunction with the bias score. However, apart from its mathematical definition the meaning of the ETS is not clear. It has been pointed out (Mason, 1989; Hamill, 1999 that forecasts with a larger bias tend to have a higher ETS. Even so, the present author has not seen this having been accounted for in any of numerous papers that in recent years have used the ETS along with bias "as a measure of forecast accuracy".

    A method to adjust the threat score (TS or the ETS so as to arrive at their values that correspond to unit bias in order to show the model's or forecaster's accuracy in extit{placing} precipitation has been proposed earlier by the present author (Mesinger and Brill, the so-called dH/dF method. A serious deficiency however has since been noted with the dH/dF method in that the hypothetical function that it arrives at to interpolate or extrapolate the observed value of hits to unit bias can have values of hits greater than forecast when the forecast area tends to zero. Another method is proposed here based on the assumption that the increase in hits per unit increase in false alarms is proportional to the yet unhit area. This new method removes the deficiency of the dH/dF method. Examples of its performance for 12 months of forecasts by three NCEP operational models are given.

  11. Efficacy of the APACHE II score at ICU discharge in predicting post-ICU mortality and ICU readmission in critically ill surgical patients.

    Lee, H; Lim, C W; Hong, H P; Ju, J W; Jeon, Y T; Hwang, J W; Park, H P


    In this study, we evaluated the efficacy of the discharge Acute Physiology and Chronic Health Evaluation (APACHE) II score in predicting post-intensive care unit (ICU) mortality and ICU readmission during the same hospitalisation in a surgical ICU. Of 1190 patients who were admitted to the ICU and stayed >48 hours between October 2007 and March 2010, 23 (1.9%) died and 86 (7.2%) were readmitted after initial ICU discharge, with 26 (3.0%) admitted within 48 hours. The area under the receiver operating characteristics curve of the discharge and admission APACHE II scores in predicting in-hospital mortality was 0.631 (95% confidence interval [CI] 0.603 to 0.658) and 0.669 (95% CI 0.642 to 0.696), respectively (P=0.510). The area under the receiver operating characteristics curve of discharge and admission APACHE II scores for predicting all forms of readmission was 0.606 (95% CI 0.578 to 0.634) and 0.574 (95% CI 0.545 to 0.602), respectively (P=0.316). The area under the receiver operating characteristics curve of discharge APACHE II score in predicting early ICU readmissions was, however, higher than that of admission APACHE II score (0.688 [95% CI 0.660 to 0.714] versus 0.505 [95% CI 0.476 to 0.534], P=0.001). The discharge APACHE II score (odds ratio [OR] 1.1, 95% CI 1.01 to 1.22, P=0.024), unplanned ICU readmission (OR 20.0, 95% CI 7.6 to 53.1, P=0.001), eosinopenia at ICU discharge (OR 6.0, 95% CI 1.34 to 26.9, P=0.019), and hospital length-of-stay before ICU admission (OR 1.02, 95% CI 1.01 to 1.03, P=0.021) were significant independent factors in predicting post-ICU mortality. This study suggests that the discharge APACHE II score may be useful in predicting post-ICU mortality and is superior to the admission APACHE II score in predicting early ICU readmission in surgical ICU patients.

  12. Circadian physiology of metabolism.

    Panda, Satchidananda


    A majority of mammalian genes exhibit daily fluctuations in expression levels, making circadian expression rhythms the largest known regulatory network in normal physiology. Cell-autonomous circadian clocks interact with daily light-dark and feeding-fasting cycles to generate approximately 24-hour oscillations in the function of thousands of genes. Circadian expression of secreted molecules and signaling components transmits timing information between cells and tissues. Such intra- and intercellular daily rhythms optimize physiology both by managing energy use and by temporally segregating incompatible processes. Experimental animal models and epidemiological data indicate that chronic circadian rhythm disruption increases the risk of metabolic diseases. Conversely, time-restricted feeding, which imposes daily cycles of feeding and fasting without caloric reduction, sustains robust diurnal rhythms and can alleviate metabolic diseases. These findings highlight an integrative role of circadian rhythms in physiology and offer a new perspective for treating chronic diseases in which metabolic disruption is a hallmark.

  13. Human physiology in space

    Vernikos, J.


    The universality of gravity (1 g) in our daily lives makes it difficult to appreciate its importance in morphology and physiology. Bone and muscle support systems were created, cellular pumps developed, neurons organised and receptors and transducers of gravitational force to biologically relevant signals evolved under 1g gravity. Spaceflight provides the only microgravity environment where systematic experimentation can expand our basic understanding of gravitational physiology and perhaps provide new insights into normal physiology and disease processes. These include the surprising extent of our body's dependence on perceptual information, and understanding the effect and importance of forces generated within the body's weightbearing structures such as muscle and bones. Beyond this exciting prospect is the importance of this work towards opening the solar system for human exploration. Although both appear promising, we are only just beginning to taste what lies ahead.

  14. Plant Physiology and Development

    Taiz, Lincoln; Zeiger, Eduardo; Møller, Ian Max

    Physiology and Development. As before, Unit III begins with updated chapters on Cell Walls and Signals and Signal Transduction. The latter chapter has been expanded to include a discussion of major signaling molecules, such as calcium ions and plant hormones. A new, unified chapter entitled Signals from......Throughout its twenty-two year history, the authors of Plant Physiology have continually updated the book to incorporate the latest advances in plant biology and implement pedagogical improvements requested by adopters. This has made Plant Physiology the most authoritative, comprehensive......, and widely used upper-division plant biology textbook. In the Sixth Edition, the Growth and Development section (Unit III) has been reorganized and expanded to present the complete life cycle of seed plants from germination to senescence. In recognition of this enhancement, the text has been renamed Plant...

  15. Re-Scoring the Game’s Score

    Gasselseder, Hans-Peter


    that a compatible integration of global and local goals in the ludonarrative contributes to a motivational-emotional reinforcement that can be gained through musical feedback. Shedding light on the implications of music dramaturgy within a semantic ecology paradigm, the perception of varying relational attributes......This study explores immersive presence as well as emotional valence and arousal in the context of dynamic and non-dynamic music scores in the 3rd person action-adventure video game genre while also considering relevant personality traits of the player. 60 subjects answered self......-report questionnaires of experiential states each time after playing the game 'Batman: Arkham City' in one of three randomized conditions accounting for [1] dynamic music, [2] non-dynamic music/low arousal potential and [3] non-dynamic music/high arousal potential, aiming to manipulate emotional arousal and structural...

  16. Disclosure Risk from Factor Scores

    Drechsler Jörg


    Full Text Available Remote access can be a powerful tool for providing data access for external researchers. Since the microdata never leave the secure environment of the data-providing agency, alterations of the microdata can be kept to a minimum. Nevertheless, remote access is not free from risk. Many statistical analyses that do not seem to provide disclosive information at first sight can be used by sophisticated intruders to reveal sensitive information. For this reason the list of allowed queries is usually restricted in a remote setting. However, it is not always easy to identify problematic queries. We therefore strongly support the argument that has been made by other authors: that all queries should be monitored carefully and that any microlevel information should always be withheld. As an illustrative example, we use factor score analysis, for which the output of interest - the factor loading of the variables - seems to be unproblematic. However, as we show in the article, the individual factor scores that are usually returned as part of the output can be used to reveal sensitive information. Our empirical evaluations based on a German establishment survey emphasize that this risk is far from a purely theoretical problem.

  17. Score lists in multipartite hypertournaments

    Pirzada, Shariefuddin; Iványi, Antal


    Given non-negative integers $n_{i}$ and $\\alpha_{i}$ with $0 \\leq \\alpha_{i} \\leq n_i$ $(i=1,2,...,k)$, an $[\\alpha_{1},\\alpha_{2},...,\\alpha_{k}]$-$k$-partite hypertournament on $\\sum_{1}^{k}n_{i}$ vertices is a $(k+1)$-tuple $(U_{1},U_{2},...,U_{k},E)$, where $U_{i}$ are $k$ vertex sets with $|U_{i}|=n_{i}$, and $E$ is a set of $\\sum_{1}^{k}\\alpha_{i}$-tuples of vertices, called arcs, with exactly $\\alpha_{i}$ vertices from $U_{i}$, such that any $\\sum_{1}^{k}\\alpha_{i}$ subset $\\cup_{1}^{k}U_{i}^{\\prime}$ of $\\cup_{1}^{k}U_{i}$, $E$ contains exactly one of the $(\\sum_{1}^{k} \\alpha_{i})!$ $\\sum_{1}^{k}\\alpha_{i}$-tuples whose entries belong to $\\cup_{1}^{k}U_{i}^{\\prime}$. We obtain necessary and sufficient conditions for $k$ lists of non-negative integers in non-decreasing order to be the losing score lists and to be the score lists of some $k$-partite hypertournament.

  18. Physiologic amputation: a case study.

    Long, Jeri; Hall, Virginia


    Acute limb ischemia is a complication of severe peripheral arterial disease that can be a threatening limb as well as life. Multiple procedures exist today to help revascularize extremities; however, even with the latest technologies, surgical amputation of the limb may still be necessary. Cryoamputation, or physiologic amputation, is a method used to treat patients who are hemodynamically unstable for the operating room and who are in need of urgent amputation owing to arterial ischemia. This procedure is used in the rare instance where not only a persons' limb is threatened, but also their life. This is a case study regarding one patient who presented to the hospital with limb-threatening ischemia who became hemodynamically unstable owing to the rhabdomyolysis associated with the ischemia of his lower extremity. Cryoamputation was used to stabilize the patient and prevent further deterioration, so that he could safely undergo surgical amputation of the limb without an increase in mortality risk. Cryoamputation must be followed by formal surgical amputation when the patient is hemodynamically stabilized. It is not a limb salvaging, procedure but it is a life-saving procedure. This case study demonstrates the usefulness of the procedure and discusses the technique used for cryoamputation.

  19. A clinical study of multiple trauma combined with acute lung injury

    Tao Liang; Yong-Fu Ma; Jian Zhu; Dao-Xi Wang; Yang Liu


    Objective: To study the changes of the contents of inflammatory mediators in serum of polytrauma patients with acute lung injury (ALI) and their correlation with the disease. Methods: Patients suffering from multiple trauma combined with ALI were selected as ALI group (n=54). Patients suffering from multiple trauma without ALI were considered as the control group (n=117). The severity of the disease of patients in the two groups was assessed. Arterial blood was extracted for blood gas analysis. Venous blood was extracted to detect the contents of inflammatory mediators tumor necrosis factor-a, interleukin-1b (IL-1b), IL-10, granulocyte-macrophage colony stimulating factor, NO, endothelin-1. Results: The scores of injury severity score [(25.42 ± 3.58) vs. (17.03 ± 2.25)], systemic inflammatory response syndrome [(3.85 ± 0.52) vs. (2.20 ± 0.36)] and acute physiology and chronic health evaluation II [(92.63 ± 11.04) vs. (60.46 ± 8.87)] in patients in ALI group were all significantly higher than those in the control group and its correcting shock time [(8.39 ± 1.05) vs. (5.15 ± 0.72) h] was longer than that of the control group. The amount of blood transfusion [(674.69 ± 93.52) vs. (402.55 ± 57.65) mL] was greater than that in the control group. The contents of the arterial partial pressure of oxygen [(76.65 ± 9.68) vs. (86.51 ± 10.56) mmHg], arterial blood pressure of carbon dioxide [(27.76 ± 4.82) vs. (36.78 ± 5.82) mmHg] and arterial partial pressure of oxygen/fraction of inspired oxygen [(236.94 ± 36.49) vs. (353.95 ± 47.76)] were all significantly lower than those in the control group. The contents of serum tumor necrosis factor-a, IL-1b, IL-10, granulocyte-macrophage colony stimulating factor, NO and endothelin-1 were obviously higher than those of control group and also positively correlated with the scores of injury severity score, systemic inflammatory response syndrome and acute physiology and chronic health evaluation II.

  20. A clinical study of multiple trauma combined with acute lung injury

    Tao Liang


    Full Text Available Objective: To study the changes of the contents of inflammatory mediators in serum of polytrauma patients with acute lung injury (ALI and their correlation with the disease. Methods: Patients suffering from multiple trauma combined with ALI were selected as ALI group (n = 54. Patients suffering from multiple trauma without ALI were considered as the control group (n = 117. The severity of the disease of patients in the two groups was assessed. Arterial blood was extracted for blood gas analysis. Venous blood was extracted to detect the contents of inflammatory mediators tumor necrosis factor-a, interleukin-1b (IL-1b, IL-10, granulocyte-macrophage colony stimulating factor, NO, endothelin-1. Results: The scores of injury severity score [(25.42 ± 3.58 vs. (17.03 ± 2.25], systemic inflammatory response syndrome [(3.85 ± 0.52 vs. (2.20 ± 0.36] and acute physiology and chronic health evaluation II [(92.63 ± 11.04 vs. (60.46 ± 8.87] in patients in ALI group were all significantly higher than those in the control group and its correcting shock time [(8.39 ± 1.05 vs. (5.15 ± 0.72 h] was longer than that of the control group. The amount of blood transfusion [(674.69 ± 93.52 vs. (402.55 ± 57.65 mL] was greater than that in the control group. The contents of the arterial partial pressure of oxygen [(76.65 ± 9.68 vs. (86.51 ± 10.56 mmHg], arterial blood pressure of carbon dioxide [(27.76 ± 4.82 vs. (36.78 ± 5.82 mmHg] and arterial partial pressure of oxygen/fraction of inspired oxygen [(236.94 ± 36.49 vs. (353.95 ± 47.76] were all significantly lower than those in the control group. The contents of serum tumor necrosis factor-a, IL-1b, IL- 10, granulocyte-macrophage colony stimulating factor, NO and endothelin-1 were obviously higher than those of control group and also positively correlated with the scores of injury severity score, systemic inflammatory response syndrome and acute physiology and chronic health evaluation II. Conclusions

  1. [Induced labor for gravidae with low Bishop's scores (with report of 242 cases)].

    Shan, J


    In planned/selective delivery, gravidae with Bishop's score 5 or below 5 are deal with lower position water sac, the aim of which is to induce regular uterine contraction and complete physiological latent period of cervical dilation. From Oct 1986 to Dec 1988, 242 cases of primiparae by this method and the latent period in physiological limit. This is a great breakthrough in induced labour for gravidae with low Bishop's scores. We found that this method is simple, effective, safe, and economic. It not only alleviates pain of the gravidae, but also helps to prevent the rise of caesarean section rate.

  2. Evaluation of the Prognosis for Elderly Critical Patients in Emergency Department Using MEWS Score and APACHE Ⅱ Score%MEWS评分和APACHE Ⅱ评分对急诊老年危重症患者预后的评估

    刘静波; 黄萍


    Objective To study the assessment value of Modified Early Warning Score( MEWS ) and Acute Physiology and Chronic Health Evaluation( APACHE Ⅱ ) score for the prognosis of critical elderly patients in emergency department. Methods 158 elderly patients from emergency ICL of Xuanwu Hospital of Capital Lniversity of Medical Sciences were collected. MEW S score and APACHE Ⅱ score were calculated for them and the differences were compared between death group and survival group. The difference of the area under receiver operating characteristic curve( ALROCC ) were compared between MEWS score and APACHE Ⅱ score. The death rate were analyzed in the different groups with MEW S score ≤3 ,4-6 ,7-9 ,and ≥ 10 respectively. The correlation analysis of MEW S score and APACHE Ⅱ score was done. Results MEWS score and APACHE Ⅱ score in death group were 8.06 ±2.71 and 24.60 ±4.20 respectively,those in survival group were 4. 80 ±2. 47 and 19. 06 ± 3. 93 respectively P 0. 05 ). With MEWS increasing, the fatality rose( P < 0. 01 ). MEWS score and APACHE Ⅱ score were correlated ( r-0. 647 ,P-0.001 ). Conclusion MEWS score,as well as APACHE Ⅱ score,is a convenient and fast scoring system,with which the disease condition and prognosis of critical elderly patients can be assessed.%目的 研究改良早期预警评分(MEWS)和急性生理与慢性健康状况评估(APACHE Ⅱ)评分对急诊老年危重症患者预后的评估价值.方法 收集首都医科大学宣武医院急诊监护室老年患者158例,入院后分别给予MEWS评分与APACHE Ⅱ评分,比较死亡组与存活组MEWS评分、APACHE Ⅱ评分的差别,分别比较MEWS评分与APACHE Ⅱ评分受试者工作特征曲线(ROC)下面积的区别及MEWS评分≤3分、4 ~6分,7 ~9分、≥10分患者病死率的区别,研究MEWS评分与APACHE Ⅱ评分的相关性.结果 死亡组MEWS评分和APACHE Ⅱ评分分别为(8.06±2.71)分和(24.60±4.20)分,存活组分别为(4.80±2.47)分和(19.06±3

  3. Teaching baroreflex physiology to medical students

    Berg, Ronan M G; Plovsing, Ronni R.; Damgaard, Morten


    Quiz-based and collaborative teaching strategies have previously been found to be efficient for the improving meaningful learning of physiology during lectures. These approaches have, however, not been investigated during laboratory exercises. In the present study, we compared the impact of solving...... quizzes individually and in groups with conventional teaching on the immediate learning during a laboratory exercise. We implemented two quizzes in a mandatory 4-h laboratory exercise on baroreflex physiology. A total of 155 second-year medical students were randomized to solve quizzes individually...... questions, and two integrated questions. The integrated questions were of moderate and advanced difficulty, respectively. Finally, students completed an evaluation form. Intervention group I reached the highest total test scores and proved best at answering the integrated question of advanced difficulty...

  4. Human Physiology: Improving Students' Achievements through Intelligent Studyware.

    Dori, Yehudit J.; Yochim, Jerome M.


    A studyware comprising a set of interconnected modules on human physiology has been developed and used to improve undergraduate students' achievements. Study results show the scores of students who used the optional computer laboratory sessions were enhanced over those who did not use the studyware. Presents examples from the modules. (LZ)

  5. Physiology of Sleep.

    Carley, David W; Farabi, Sarah S


    IN BRIEF Far from a simple absence of wakefulness, sleep is an active, regulated, and metabolically distinct state, essential for health and well-being. In this article, the authors review the fundamental anatomy and physiology of sleep and its regulation, with an eye toward interactions between sleep and metabolism.

  6. The Face of Physiology

    Paul White


    Full Text Available This article explores the relationship between the physiology of the emotions and the display of character in Victorian Britain. Charles Bell and others had begun to link certain physiological functions, such as respiration, with the expression of feelings such as fear, regarding the heart and other internal organs as instruments by which the emotions were made visible. But a purely functional account of the emotions, which emerged through the development of reflex physiology during the second half of the century, would dramatically alter the nature of feelings and the means of observing them. At the same time, instinctual or acquired sympathy, which had long underpinned the accurate reading of expressions, became a problem to be surmounted by new 'objectively'. Graphic recording instruments measuring a variety of physiological functions and used with increasing frequency in clinical diagnostics became of fundamental importance for tracing the movement of feelings during the period prior to the development of cinematography. They remained, in the form of devices such as the polygraph, a crucial and controversial means of measuring affective states, beneath the potentially deceptive surface of the body.

  7. Integrative Physiology of Fasting.

    Secor, Stephen M; Carey, Hannah V


    Extended bouts of fasting are ingrained in the ecology of many organisms, characterizing aspects of reproduction, development, hibernation, estivation, migration, and infrequent feeding habits. The challenge of long fasting episodes is the need to maintain physiological homeostasis while relying solely on endogenous resources. To meet that challenge, animals utilize an integrated repertoire of behavioral, physiological, and biochemical responses that reduce metabolic rates, maintain tissue structure and function, and thus enhance survival. We have synthesized in this review the integrative physiological, morphological, and biochemical responses, and their stages, that characterize natural fasting bouts. Underlying the capacity to survive extended fasts are behaviors and mechanisms that reduce metabolic expenditure and shift the dependency to lipid utilization. Hormonal regulation and immune capacity are altered by fasting; hormones that trigger digestion, elevate metabolism, and support immune performance become depressed, whereas hormones that enhance the utilization of endogenous substrates are elevated. The negative energy budget that accompanies fasting leads to the loss of body mass as fat stores are depleted and tissues undergo atrophy (i.e., loss of mass). Absolute rates of body mass loss scale allometrically among vertebrates. Tissues and organs vary in the degree of atrophy and downregulation of function, depending on the degree to which they are used during the fast. Fasting affects the population dynamics and activities of the gut microbiota, an interplay that impacts the host's fasting biology. Fasting-induced gene expression programs underlie the broad spectrum of integrated physiological mechanisms responsible for an animal's ability to survive long episodes of natural fasting.

  8. Avian reproductive physiology

    Gee, G.F.; Gibbons, Edward F.; Durrant, Barbara S.; Demarest, Jack


    Knowledge of the many physiological factors associated with egg production , fertility, incubation, and brooding in nondomestic birds is limited. Science knows even less about reproduction in most of the 238 endangered or threatened birds. This discussion uses studies of nondomestic and, when necessary, domestic birds to describe physiological control of reproduction. Studies of the few nondomestic avian species show large variation in physiological control of reproduction. Aviculturists, in order to successfully propagate an endangered bird, must understand the bird's reproductive peculiarities. First, investigators can do studies with carefully chosen surrogate species, but eventually they need to confirm the results in the target endangered bird. Studies of reproduction in nondomestic birds increased in the last decade. Still, scientists need to do more comparative studies to understand the mechanisms that control reproduction in birds. New technologies are making it possible to study reproductive physiology of nondomestic species in less limiting ways. These technologies include telemetry to collect information without inducing stress on captives (Howey et al., 1987; Klugman, 1987), new tests for most of the humoral factors associated with reproduction, and the skill to collect small samples and manipulate birds without disrupting the physiological mechanisms (Bercovitz et al., 1985). Managers are using knowledge from these studies to improve propagation in zoological parks, private and public propagation facilities, and research institutions. Researchers need to study the control of ovulation, egg formation, and oviposition in the species of nondomestic birds that lay very few eggs in a season, hold eggs in the oviduct for longer intervals, or differ in other ways from the more thoroughly studied domestic birds. Other techniques that would enhance propagation for nondomestlc birds include tissue culture of cloned embryonic cells, cryopreservation of embryos

  9. Physiological attributes of triathletes.

    Suriano, R; Bishop, D


    Triathlons of all distances can be considered endurance events and consist of the individual disciplines of swimming, cycling and running which are generally completed in this sequential order. While it is expected that elite triathletes would possess high values for submaximal and maximal measures of aerobic fitness, little is known about how these values compare with those of single-sport endurance athletes. Earlier reviews, conducted in the 1980s, concluded that triathletes possessed lower V(O2(max)) values than other endurance athletes. An update of comparisons is of interest to determine if the physiological capacities of elite triathletes now reflect those of single-sport athletes or whether these physiological capacities are compromised by the requirement to cross-train for three different disciplines. It was found that although differences in the physiological attributes during swimming, cycling and running are evident among triathletes, those who compete at an international level possess V(O2(max)) values that are indicative of success in endurance-based individual sports. Furthermore, various physiological parameters at submaximal workloads have been used to describe the capacities of these athletes. Only a few studies have reported the lactate threshold among triathletes with the majority of studies reporting the ventilatory threshold. Although observed differences among triathletes for both these submaximal measures are complicated by the various methods used to determine them, the reported values for triathletes are similar to those for trained cyclists and runners. Thus, from the limited data available, it appears that triathletes are able to obtain similar physiological values as single-sport athletes despite dividing their training time among three disciplines.

  10. Stroke Survivors Scoring Zero on the NIH Stroke Scale Score Still Exhibit Significant Motor Impairment and Functional Limitation

    Brittany Hand


    Full Text Available Objective. To determine the National Institutes of Health Stroke Scale’s (NIHSS’s association with upper extremity (UE impairment and functional outcomes. Design. Secondary, retrospective analysis of randomized controlled trial data. Setting. Not applicable. Participants. 146 subjects with stable, chronic stroke-induced hemiparesis. Intervention. The NIHSS, the UE Fugl-Meyer (FM, and the Arm Motor Ability Test (AMAT were administered prior to their participation in a multicenter randomized controlled trial. Main Outcome Measures. The NIHSS, FM, and AMAT. Results. The association between the NIHSS and UE impairment was statistically significant (P=-0.204;p=0.014 but explained less than 4% of the variance among UE FM scores. The association between NIHSS total score and function as measured by the AMAT was not statistically significant (P=-0.141;p=0.089. Subjects scoring a “zero” on the NIHSS exhibited discernible UE motor deficits and varied scores on the UE FM and AMAT. Conclusion. While being used in stroke trials, the NIHSS may have limited ability to discriminate between treatment responses, even when only a relatively narrow array of impairment levels exists among patients. Given these findings, NIHSS use should be restricted to acute stroke studies and clinical settings with the goal of reporting stroke severity.

  11. Neuropsychological intervention in the acute phase

    Norup, Anne; Siert, Lars; Mortensen, Erik Lykke


    This pilot study investigated the effects of acute neuropsychological intervention for relatives of patients with severe brain injury. Participants were enrolled in an intervention group comprising 39 relatives, and a control group comprising 47 relatives. The intervention consisted of supportive.......0100.30), but also significantly lower Role Emotional scores (= 2.12 = 0.043, = 0.40). In the sub-acute setting, an analysis of covariance model showed a borderline significant difference between the intervention and the control group on the anxiety scale (= 0.066 = 0.59). Any effects of the acute neuropsychological...

  12. Application of leukostasis grading score system to evaluate the efficacy of leukocyte reduction in hyperleukocytic acute myeloid leukemia%白细胞淤滞分级评分在高白细胞急性髓系白血病降白细胞治疗效果评估中的应用

    孟广强; 陈以娟; 张晶晶; 郭慧霞; 武悦; 王立茹


    Objective To evaluate the treatment efficacy of leukocyte reduction in hyperleukocytic acute myeloid leukemia (HAML) patients with leukostasis grading score (LGS).Methods The data of 54 HAML patients were analyzed retrospectively.The relationship between LGS and leukocyte stasis symptoms or early mortality was observed, and the impact of leukapheresis on LGS was analyzed.Results Among 54 patients with HAML, there were 1 case of M1, 16 cases of M2, 10 cases of M4, 20 cases of M5 and 7 cases of unclassified AML.Based on clinical symptoms and LGS system, 3 cases were LGS 0, 15 cases LGS 1, 17 cases LGS 2, and 19 cases LGS 3.In patients with LGS ≤ 2, the rates of type Ⅰ respiratory failure, central nevers system (CNS) symptoms and early mortality caused by leukostasis were significantly lower than those in patients with LGS 3 (P < 0.05).The LGS of HAML patients was reduced by leukocyte reduction therapy (P < 0.000 1).The LGS of HAML patients treated by leukapheresis and low dose chemotherapy was improved significantly than that of patients treated without leukapheresis (P =0.008).Among 37 cases receiving induction chemotherapy, 20 cases reached complete remission (CR) after the first cycle of induction chemotherapy.CR rate of patients with LGS ≤ 2 was no significantly different compared with that of patients with LGS 3 (P =0.703).Conclusions LGS can be used to evaluate the degree and the improvement status of leukostasis after treatment in HAML patients.The early death often occurres in patients with high LGS.Leukapheresis combined with low-dose chemotherapy can effectively improve the LGS of HAML patients.%目的 应用白细胞淤滞分级评分(LGS)评价高白细胞急性髓系白血病(HAML)降白细胞的疗效.方法 回顾性分析54例HAML患者临床资料,根据患者临床症状和LGS系统进行评分,分析LGS与患者白细胞淤滞症状和早期病死率的关系,并分析降白细胞治疗后LGS变化.结果 54例HAML患者中M11例,M216

  13. Surgical management of fulminant acute pancreatitis%暴发性急性胰腺炎的诊断与治疗



    @@ 经过国内、外学者近40年的不懈努力,重症急性胰腺炎(severe acute pancreatitis,SAP)患者的生存率大幅度提高,达86%.但SAP中的暴发性急性胰腺炎(fulminant acute pancreatitis,FAP),因其病情发展迅速,即使在起病72 h内经充分的液体复苏,仍可能出现器官功能衰竭[1].%With the unremitting efforts of researchers for the past 40 years, the survival of patients with severe acute pancreatitis (SAP) has been improved to 86%. Patients with SAP, although had been given fluid resuscitation and formal non-operative therapy in 72 hours after the onset, still progress to organ dysfunction can be diagnosed with fulminant acute pancreatitis (FAP). The treatment methods for FAP include sufficient fluid resuscitation, formal non-operative therapy and removing etiological factors. If patients have the tendency toward deterioration of organ function or incidence of abdominal compartment syndrome (ACS), creating conditions for early surgical drainage is essential, and the surgical procedure should be as simple as possible. The survival rate of patients with FAP is still unsatisfactory, and the advanced age, high scores of acute physiology and chronic health enquiry ( APACHE Ⅱ ), sequential organ failure assessment (SOFA) and Balthazar, and the incidence of ACS are the indicators for a poor prognosis of patients with FAP.

  14. 急诊脓毒症病死率评分在急诊脓毒症患者中的应用%Application of the mortality in emergency department sepsis score for emergency department patients with sepsisi

    赵永祯; 李春盛


    目的 验证急诊脓毒症病死率评分(mortality in emergency department sepsis score,MEDS)对于急诊脓毒症患者病情评估的应用价值,并将其对患者28 d病死率的预测效果进行比较。方法 对2009年9月至2010年9月首都医科大学附属北京朝阳医院急诊抢救室救治的613例脓毒症患者进行前瞻性研究。记录患者的证急诊脓毒症病死率评分(MEDS)、急性生理学与慢性健康情况评价系统Ⅱ(acute physiology and chronic health evaluation,APACHEⅡ)、简化急性生理学评分Ⅱ(simplified acute physiology score,SAPSⅡ)和改良早期预警评分(modified early warning score,MEWS)。随访28 d转归。根据患者MEDS评分分值将死亡风险分级:极低危险组(0 ~4分)、低度危险组(5~7分)、中度危险组(8~12分)、高度危险组(13 ~ 15分)、极高危险组(大于15分),各组间实际病死率采用X2检验比较。再对生存组和死亡组进行比较,通过logistic 回归分析确定预测死亡的独立因素,应用受试者工作特征曲线(ROC曲线)比较MEDS与APACHEⅡ,SAPSⅡ和MEWS评分对预后的预测能力。结果 失访10例,完整记录603例。MEDS评分患者各组实际病死率分别为0%,7.7%,18.5%,46.7%,63%,各组间实际病死率有显著区别。生存组(440例)与死亡组(163例)之间年龄和四种评分差异均具有统计学意义(P<0.01)。MEDS,APACHEⅡ,SAPSⅡ、MEWS评分均是预测死亡的独立因素,ROC曲线下的面积(AUC)分别为0.767,0.743,0.741和0.636。结论 MEDS评分可以对脓毒症患者死亡风险进行分级,在患者28 d病死率方面有较好的预测能力,适用于急诊脓毒症患者。%Objective To assess the sepsis score used for detecting the mortality of patients with sepsis in emergency department, and to compare with APACHE Ⅱ score, simplified acute physiologyscore ( SAPS Ⅱ ) and modified early warning

  15. The treatment of acute vertigo.

    Cesarani, A; Alpini, D; Monti, B; Raponi, G


    Vertigo and dizziness are very common symptoms in the general population. The aim of this paper is to describe the physical and pharmacological treatment of symptoms characterized by sudden onset of rotatory vertigo. Acute vertigo can be subdivided into two main groups: (1) spontaneous vertigo and (2) provoked vertigo, usually by postural changes, generally called paroxysmal positional vertigo (PPV). Sudden onset of acute vertigo is usually due to acute spontaneous unilateral vestibular failure. It can be also fluctuant as, e.g., in recurrent attacks of Ménière's disease. Pharmacotherapy of acute spontaneous vertigo includes Levo-sulpiride i.v., 50 mg in 250 physiologic solution, once or twice a day, methoclopramide i.m., 10 mg once or twice a day, or triethilperazine rectally, once or twice a day, to reduce neurovegetative symptoms; diazepam i.m., 10 mg once or twice a day, to decrease internuclear inhibition, sulfate magnesium i.v., two ampoules in 500 cc physiological solution, twice a day, or piracetam i.v., one ampoule in 500 cc physiological solution, twice a day, to decrease vestibular damage. At the onset of the acute symptoms, patients must lie on their healthy side with the head and trunk raised 20 degrees. The room must be quiet but not darkened. If the patient is able to swallow without vomiting, it is important to reduce nystagmus and stabilize the visual field with gabapentine, per os, 300 mg twice or three times a day. The first step of the physical therapy of acute vertigo is vestibular electrical stimulation, that is to say, a superficial paravertebral electrical stimulation of neck muscles, aimed to reduce antigravitary failure and to increase proprioceptive cervical sensory substitution. PPV is a common complaint and represents one of the most common entities in peripheral vestibular pathology. While the clinical picture is well known and widely described, the etiopathogenesis of PPV is still a matter of debate. Despite the different

  16. Contemporary Management of Acute Biliary Pancreatitis

    Orhan Ozkan


    Full Text Available Acute biliary pancreatitis is one of the major causes of acute pancreatitis.Gallstones, biliary sludge and microlithiasis, especially in pancreatitis without detectable reason, can be the cause of acute pancreatitis. Acute biliary pancreatitis has many controversions in the literature, and its classification and guidelines are being updated very frequently. Atlanta classifications which determine the definitions and guidelines about acute pancreatitis were renewed and published in 2013. It has various clinical aspects, ranging from a mild form which is easily treated, to a severe form that causes complications leading to mortality. The pathogenesis of this disease has not been fully elucidated and several theories have been suggested. New scoring systems and laboratory methods such as proteomics have been suggested for both diagnosis and to predict disease severity, and research on these topics is still in progress. Novel therapeutic approaches with technological developments such as ERCP, ES, MRCP, and EUS are also suggested.

  17. Acute metabolic and physiologic response of goats to narcosis

    Schatte, C. L.; Bennett, P. B.


    Assessment of the metabolic consequences of exposure to elevated partial pressures of nitrogen and helium under normobaric and hyperbaric conditions in goats. The results include the finding that hyperbaric nitrogen causes and increase in metabolic rate and a general decrease in blood constituent levels which is interpreted as reflecting a shift toward fatty acid metabolism at the expense of carbohydrates. A similar but more pronounced pattern was observed with hyperbaric helium.

  18. An ultrasound score for knee osteoarthritis

    Riecke, B F; Christensen, R.; Torp-Pedersen, S


    OBJECTIVE: To develop standardized musculoskeletal ultrasound (MUS) procedures and scoring for detecting knee osteoarthritis (OA) and test the MUS score's ability to discern various degrees of knee OA, in comparison with plain radiography and the 'Knee injury and Osteoarthritis Outcome Score' (KOOS...

  19. Developing Score Reports for Cognitive Diagnostic Assessments

    Roberts, Mary Roduta; Gierl, Mark J.


    This paper presents a framework to provide a structured approach for developing score reports for cognitive diagnostic assessments ("CDAs"). Guidelines for reporting and presenting diagnostic scores are based on a review of current educational test score reporting practices and literature from the area of information design. A sample diagnostic…

  20. An objective fluctuation score for Parkinson's disease.

    Malcolm K Horne

    Full Text Available Establishing the presence and severity of fluctuations is important in managing Parkinson's Disease yet there is no reliable, objective means of doing this. In this study we have evaluated a Fluctuation Score derived from variations in dyskinesia and bradykinesia scores produced by an accelerometry based system.The Fluctuation Score was produced by summing the interquartile range of bradykinesia scores and dyskinesia scores produced every 2 minutes between 0900-1800 for at least 6 days by the accelerometry based system and expressing it as an algorithm.This Score could distinguish between fluctuating and non-fluctuating patients with high sensitivity and selectivity and was significant lower following activation of deep brain stimulators. The scores following deep brain stimulation lay in a band just above the score separating fluctuators from non-fluctuators, suggesting a range representing adequate motor control. When compared with control subjects the score of newly diagnosed patients show a loss of fluctuation with onset of PD. The score was calculated in subjects whose duration of disease was known and this showed that newly diagnosed patients soon develop higher scores which either fall under or within the range representing adequate motor control or instead go on to develop more severe fluctuations.The Fluctuation Score described here promises to be a useful tool for identifying patients whose fluctuations are progressing and may require therapeutic changes. It also shows promise as a useful research tool. Further studies are required to more accurately identify therapeutic targets and ranges.

  1. Semiparametric score sevel susion: Gaussian sopula approach

    Susyanyo, N.; Klaassen, C.A.J.; Veldhuis, R.N.J.; Spreeuwers, L.J.


    Score level fusion is an appealing method for combining multi-algorithms, multi- representations, and multi-modality biometrics due to its simplicity. Often, scores are assumed to be independent, but even for dependent scores, accord- ing to the Neyman-Pearson lemma, the likelihood ratio is the opti

  2. Credit Scores, Race, and Residential Sorting

    Nelson, Ashlyn Aiko


    Credit scores have a profound impact on home purchasing power and mortgage pricing, yet little is known about how credit scores influence households' residential location decisions. This study estimates the effects of credit scores on residential sorting behavior using a novel mortgage industry data set combining household demographic, credit, and…

  3. Breaking of scored tablets : a review

    van Santen, E; Barends, D M; Frijlink, H W


    The literature was reviewed regarding advantages, problems and performance indicators of score lines. Scored tablets provide dose flexibility, ease of swallowing and may reduce the costs of medication. However, many patients are confronted with scored tablets that are broken unequally and with diffi

  4. Assessment of acute foot and ankle sprains.

    Lynam, Louise


    Acute ankle and foot trauma is a regular emergency presentation and prompt strategic assessment skills are required to enable nurses to categorise and prioritise these injuries appropriately. This article provides background information on the anatomy and physiology of the lower limb to help nurses to identify various grades of ankle sprain as well as injuries that are limb threatening

  5. Tuna comparative physiology.

    Graham, Jeffrey B; Dickson, Kathryn A


    Thunniform swimming, the capacity to conserve metabolic heat in red muscle and other body regions (regional endothermy), an elevated metabolic rate and other physiological rate functions, and a frequency-modulated cardiac output distinguish tunas from most other fishes. These specializations support continuous, relatively fast swimming by tunas and minimize thermal barriers to habitat exploitation, permitting niche expansion into high latitudes and to ocean depths heretofore regarded as beyond their range.

  6. Neonatal cardiovascular physiology.

    Hines, Michael H


    The pediatric surgeon deals with a large number and variety of congenital defects in neonates that frequently involve early surgical intervention and care. Because the neonatal cardiac physiology is unique, starting with the transition from fetal circulation and including differences in calcium metabolism and myocardial microscopic structure and function, it serves the pediatric surgeon well to have a sound understanding of these principles and how they directly and indirectly affect their plans and treatments. In addition, many patients will have associated congenital heart disease that can also dramatically influence not only the surgical and anesthetic care but also the timing and planning of procedures. Finally, the pediatric surgeon is often called upon to treat conditions and complications associated with complex congenital heart disease such as feeding difficulties, bowel perforations, and malrotation in heterotaxy syndromes. In this article, we will review several unique aspects of neonatal cardiac physiology along with the basic physiology of the major groups of congenital heart disease to better prepare the training and practicing pediatric surgeon for care of these complex and often fragile patients.

  7. A new scoring system to stratify risk in unstable angina

    Salzberg Simón


    Full Text Available Abstract Background We performed this study to develop a new scoring system to stratify different levels of risk in patients admitted to hospital with a diagnosis of unstable angina (UA, which is a complex syndrome that encompasses different outcomes. Many prognostic variables have been described but few efforts have been made to group them in order to enhance their individual predictive power. Methods In a first phase, 473 patients were prospectively analyzed to determine which factors were significantly associated with the in-hospital occurrence of refractory ischemia, acute myocardial infarction (AMI or death. A risk score ranging from 0 to 10 points was developed using a multivariate analysis. In a second phase, such score was validated in a new sample of 242 patients and it was finally applied to the entire population (n = 715. Results ST-segment deviation on the electrocardiogram, age ≥ 70 years, previous bypass surgery and troponin T ≥ 0.1 ng/mL were found as independent prognostic variables. A clear distinction was shown among categories of low, intermediate and high risk, defined according to the risk score. The incidence of the triple end-point was 6 %, 19.2 % and 44.7 % respectively, and the figures for AMI or death were 2 %, 11.4 % and 27.6 % respectively (p Conclusions This new scoring system is simple and easy to achieve. It allows a very good stratification of risk in patients having a clinical diagnosis of UA. They may be divided in three categories, which could be of help in the decision-making process.

  8. Exogenous Carbon Monoxide Decreases Sepsis-Induced Acute Kidney Injury and Inhibits NLRP3 Inflammasome Activation in Rats.

    Wang, Peng; Huang, Jian; Li, Yi; Chang, Ruiming; Wu, Haidong; Lin, Jiali; Huang, Zitong


    Carbon monoxide (CO) has shown various physiological effects including anti-inflammatory activity in several diseases, whereas the therapeutic efficacy of CO on sepsis-induced acute kidney injury (AKI) has not been reported as of yet. The purpose of the present study was to explore the effects of exogenous CO on sepsis-induced AKI and nucleotide-binding domain-like receptor protein 3 (NLRP3) inflammasome activation in rats. Male rats were subjected to cecal ligation and puncture (CLP) to induce sepsis and AKI. Exogenous CO delivered from CO-releasing molecule 2 (CORM-2) was used intraperitoneally as intervention after CLP surgery. Therapeutic effects of CORM-2 on sepsis-induced AKI were assessed by measuring serum creatinine (Scr) and blood urea nitrogen (BUN), kidney histology scores, apoptotic cell scores, oxidative stress, levels of cytokines TNF-α and IL-1β, and NLRP3 inflammasome expression. CORM-2 treatment protected against the sepsis-induced AKI as evidenced by reducing serum Scr/BUN levels, apoptotic cells scores, increasing survival rates, and decreasing renal histology scores. Furthermore, treatment with CORM-2 significantly reduced TNF-α and IL-1β levels and oxidative stress. Moreover, CORM-2 treatment significantly decreased NLRP3 inflammasome protein expressions. Our study provided evidence that CORM-2 treatment protected against sepsis-induced AKI and inhibited NLRP3 inflammasome activation, and suggested that CORM-2 could be a potential therapeutic candidate for treating sepsis-induced AKI.

  9. Exogenous Carbon Monoxide Decreases Sepsis-Induced Acute Kidney Injury and Inhibits NLRP3 Inflammasome Activation in Rats

    Peng Wang


    Full Text Available Carbon monoxide (CO has shown various physiological effects including anti-inflammatory activity in several diseases, whereas the therapeutic efficacy of CO on sepsis-induced acute kidney injury (AKI has not been reported as of yet. The purpose of the present study was to explore the effects of exogenous CO on sepsis-induced AKI and nucleotide-binding domain-like receptor protein 3 (NLRP3 inflammasome activation in rats. Male rats were subjected to cecal ligation and puncture (CLP to induce sepsis and AKI. Exogenous CO delivered from CO-releasing molecule 2 (CORM-2 was used intraperitoneally as intervention after CLP surgery. Therapeutic effects of CORM-2 on sepsis-induced AKI were assessed by measuring serum creatinine (Scr and blood urea nitrogen (BUN, kidney histology scores, apoptotic cell scores, oxidative stress, levels of cytokines TNF-α and IL-1β, and NLRP3 inflammasome expression. CORM-2 treatment protected against the sepsis-induced AKI as evidenced by reducing serum Scr/BUN levels, apoptotic cells scores, increasing survival rates, and decreasing renal histology scores. Furthermore, treatment with CORM-2 significantly reduced TNF-α and IL-1β levels and oxidative stress. Moreover, CORM-2 treatment significantly decreased NLRP3 inflammasome protein expressions. Our study provided evidence that CORM-2 treatment protected against sepsis-induced AKI and inhibited NLRP3 inflammasome activation, and suggested that CORM-2 could be a potential therapeutic candidate for treating sepsis-induced AKI.

  10. Committee Opinion No. 644: The Apgar Score.


    The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed. The Apgar score alone cannot be considered to be evidence of or a consequence of asphyxia, does not predict individual neonatal mortality or neurologic outcome, and should not be used for that purpose. An Apgar score assigned during a resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists encourage use of an expanded Apgar score reporting form that accounts for concurrent resuscitative interventions.

  11. Tracking Undergraduate Student Achievement in a First-Year Physiology Course Using a Cluster Analysis Approach

    Brown, S. J.; White, S.; Power, N.


    A cluster analysis data classification technique was used on assessment scores from 157 undergraduate nursing students who passed 2 successive compulsory courses in human anatomy and physiology. Student scores in five summative assessment tasks, taken in each of the courses, were used as inputs for a cluster analysis procedure. We aimed to group…

  12. Predicting outcome after traumatic brain injury: development of prognostic scores based on the IMPACT and the APACHE II.

    Raj, Rahul; Siironen, Jari; Kivisaari, Riku; Hernesniemi, Juha; Skrifvars, Markus B


    Prediction models are important tools for heterogeneity adjustment in clinical trials and for the evaluation of quality of delivered care to patients with traumatic brain injury (TBI). We sought to improve the predictive performance of the IMPACT (International Mission for Prognosis and Analysis of Clinical Trials) prognostic model by combining it with the APACHE II (Acute Physiology and Chronic Health Evaluation II) for 6-month outcome prediction in patients with TBI treated in the intensive care unit. A total of 890 patients with TBI admitted to a large urban level 1 trauma center in 2009-2012 comprised the study population. The IMPACT and the APACHE II scores were combined using binary logistic regression. A randomized, split-sample technique with secondary bootstrapping was used for model development and internal validation. Model performance was assessed by discrimination (by area under the curve [AUC]), calibration, precision, and net reclassification improvement (NRI). Overall 6-month mortality was 22% and unfavorable neurological outcome 47%. The predictive power of the new combined IMPACT-APACHE II models was significantly superior, compared to the original IMPACT models (AUC, 0.81-0.82 vs. 0.84-0.85; p0.05). However, NRI showed a significant improvement in risk stratification of patients with unfavorable outcome by the IMPACT-APACHE II models, compared to the original models (NRI, 5.4-23.2%; pAPACHE II with the IMPACT, improved 6-month outcome predictive performance is achieved. This may be applicable for heterogeneity adjustment in forthcoming TBI studies.

  13. Scoring System Approach for Assessment of Critical Illness using Mobile Phones

    Karupothula Madhavi Latha


    Full Text Available This paper demonstrates the use of mobile phones in assessing the illness of patients by developing a Scoring Systemwhere medical practitioners (often nurses collect various physiological signals like ECG, EEG, SpO2, temperature, continuous blood pressure and subjective parameters like level of pain, level of alertness, awareness, behavioral responses etc. After taking the data, a scoring system is utilized for early detection of critical illnesses. The mechanism of scoring is performed either manually, where the medical practitioner ticks on to a scoring board or is automated by relocating the information from scoring board to a PC, where the software performs the scoring calculation. In the proposed system, the medical practitioner inputs the parameters directly on to their mobile phone by collecting the parameters fromthe patient. The score is automatically calculated by miniature java based software running inside themobile phone. Based on the score, level of urgency is determined by the intelligent program. At the end, specialists are contacted automatically by messaging services. Moreover, the results of the scoring are transmitted to the hospital server. Therefore, assistance from civilians with mobile phone based medical intelligence can save precious life.

  14. The Effect of a Physiological Evaluation Program on Coronary Heart Disease Risk Scores for Sedentary Individuals.

    Finkenberg, Mel; And Others

    The purpose of this study was to compare the coronary heart disease (CHD) probability estimates of a group of sedentary males involved in an exercise stress test program from 1968 through 1974 with those of a comparison group of sedentary males not involved in the program. The program was designed to evaluate cardiopulmonary function and improve…

  15. Acute abdomen

    Wig J


    Full Text Available 550 cases of acute abdomen have been analysed in detail includ-ing their clinical presentation and operative findings. Males are more frequently affected than females in a ratio of 3: 1. More than 45% of patients presented after 48 hours of onset of symptoms. Intestinal obstruction was the commonest cause of acute abdomen (47.6%. External hernia was responsible for 26% of cases of intestinal obstruction. Perforated peptic ulcer was the commonest cause of peritonitis in the present series (31.7% while incidence of biliary peritonitis was only 2.4%.. The clinical accuracy rate was 87%. The mortality in operated cases was high (10% while the over-all mortality rate was 7.5%.

  16. The Mystery of the Z-Score.

    Curtis, Alexander E; Smith, Tanya A; Ziganshin, Bulat A; Elefteriades, John A


    Reliable methods for measuring the thoracic aorta are critical for determining treatment strategies in aneurysmal disease. Z-scores are a pragmatic alternative to raw diameter sizes commonly used in adult medicine. They are particularly valuable in the pediatric population, who undergo rapid changes in physical development. The advantage of the Z-score is its inclusion of body surface area (BSA) in determining whether an aorta is within normal size limits. Therefore, Z-scores allow us to determine whether true pathology exists, which can be challenging in growing children. In addition, Z-scores allow for thoughtful interpretation of aortic size in different genders, ethnicities, and geographical regions. Despite the advantages of using Z-scores, there are limitations. These include intra- and inter-observer bias, measurement error, and variations between alternative Z-score nomograms and BSA equations. Furthermore, it is unclear how Z-scores change in the normal population over time, which is essential when interpreting serial values. Guidelines for measuring aortic parameters have been developed by the American Society of Echocardiography Pediatric and Congenital Heart Disease Council, which may reduce measurement bias when calculating Z-scores for the aortic root. In addition, web-based Z-score calculators have been developed to aid in efficient Z-score calculations. Despite these advances, clinicians must be mindful of the limitations of Z-scores, especially when used to demonstrate beneficial treatment effect. This review looks to unravel the mystery of the Z-score, with a focus on the thoracic aorta. Here, we will discuss how Z-scores are calculated and the limitations of their use.

  17. Acute Pancreatitis Concomitant Acute Coronary Syndrome

    Okay Abacı


    Full Text Available Acute pancreatitis is an inflammatory syndrome with unpredictable progression to systemic inflammation and multi-organ dysfunction. As in our case rarely, acute pancreatitis can be presented with the coexistance of acute coronary syndrome. To prevent a misdiagnosis of acute situation presented with chest or abdominal pain, physicians must be aware for coexisting pathophysiologies and take into account the differential diagnosis of all life-threatening causes such as cardiac ischemia or acute abdominal situations.

  18. The relationship between second-year medical students' OSCE scores and USMLE Step 1 scores.

    Simon, Steven R; Volkan, Kevin; Hamann, Claus; Duffey, Carol; Fletcher, Suzanne W


    The relationship between objective structured clinical examinations (OSCEs) and standardized tests is not well known. We linked second-year medical students' physical diagnosis OSCE scores from 1998, 1999 and 2000 (n = 355) with demographic information, Medical College Admission Test (MCAT) scores, and United States Medical Licensing Examination (USMLE) Step 1 scores. The correlation coefficient for the total OSCE score with USMLE Step 1 score was 0.41 (p USMLE Step 1 score. OSCE station scores accounted for approximately 22% of the variability in USMLE Step 1 scores. A second-year OSCE in physical diagnosis is correlated with scores on the USMLE Step 1 exam, with skills that foreshadow the clinical clerkships most predictive of USMLE scores. This correlation suggests predictive validity of this OSCE and supports the use of OSCEs early in medical school.

  19. The value of procalcitonin and the SAPS II and APACHE III scores in the differentiation of infectious and non-infectious fever in the ICU: a prospective, cohort study.

    Jeon, Eun Ju; Jung, Jae Woo; Choi, Jae Chol; Shin, Jong Wook; Park, In Won; Choi, Byoung Whui; Park, Ae Ja; Kim, Jae Yeol


    Early and accurate differentiation between infectious and non-infectious fever is vitally important in the intensive care unit (ICU). In the present study, patients admitted to the medical ICU were screened daily from August 2008 to February 2009. Within 24 hr after the development of fever (>38.3℃), serum was collected for the measurement of the procalcitonin (PCT) and high mobility group B 1 levels. Simplified Acute Physiology Score (SAPS) II and Acute Physiology And Chronic Health Evaluation (APACHE) III scores were also analyzed. Sixty-three patients developed fever among 448 consecutive patients (14.1%). Fever was caused by either infectious (84.1%) or non-infectious processes (15.9%). Patients with fever due to infectious causes showed higher values of serum PCT (7.8±10.2 vs 0.5±0.2 ng/mL, P=0.026), SAPS II (12.0±3.8 vs 7.6±2.7, P=0.006), and APACHE III (48±20 vs 28.7±13.3, P=0.039) than those with non-infectious fever. In receiver operating characteristic curve analysis, the area under the curve was 0.726 (95% CI; 0.587-0.865) for PCT, 0.759 (95% CI; 0.597-0.922) for SAPS II, and 0.715 (95% CI; 0.550-0.880) for APACHE III. Serum PCT, SAPS II, and APACHE III are useful in the differentiation between infectious and non-infectious fever in the ICU.

  20. Physiology of bile secretion

    Alejandro Esteller


    The formation of bile depends on the structural and functional integrity of the bile-secretory apparatus and its impairment,in different situations,results in the syndrome of cholestasis.The structural bases that permit bile secretion as well as various aspects related with its composition and flow rate in physiological conditions will first be reviewed.Canalicular bile is produced by polarized hepatocytes that hold transporters in their basolateral (sinusoidal) and apical (canalicular) plasma membrane.This review summarizes recent data on the molecular determinants of this primary bile formation.The major function of the biliary tree is modification of canalicular bile by secretory and reabsorptive processes in bileduct epithelial cells (cholangiocytes) as bile passes through bile ducts.The mechanisms of fluid and solute transport in cholangiocytes will also be discussed.In contrast to hepatocytes where secretion is constant and poorly controlled,cholangiocyte secretion is regulated by hormones and nerves.A short section dedicated to these regulatory mechanisms of bile secretion has been included.The aim of this revision was to set the bases for other reviews in this series that will be devoted to specific issues related with biliary physiology and pathology.

  1. Vasogenic shock physiology

    Sotiria Gkisioti


    Full Text Available Sotiria Gkisioti, Spyros D MentzelopoulosDepartment of Intensive Care Medicine, University of Athens Medical School, Evaggelismos General Hospital, Athens, GreeceAbstract: Shock means inadequate tissue perfusion by oxygen-carrying blood. In vasogenic shock, this circulatory failure results from vasodilation and/or vasoplegia. There is vascular hyporeactivity with reduced vascular smooth muscle contraction in response to α1 adrenergic agonists. Considering vasogenic shock, one can understand its utmost importance, not only because of its association with sepsis but also because it can be the common final pathway for long-lasting, severe shock of any cause, even postresuscitation states. The effective management of any patient in shock requires the understanding of its underlying physiology and pathophysiology. Recent studies have provided new insights into vascular physiology by revealing the interaction of rather complicated and multifactorial mechanisms, which have not been fully elucidated yet. Some of these mechanisms, such as the induction of nitric oxide synthases, the activation of adenosine triphosphate-sensitive potassium channels, and vasopressin deficiency, have gained general acceptance and are considered to play an important role in the pathogenesis of vasodilatory shock. The purpose of this review is to provide an update on the pathogenesis of vasogenic shock.Keywords: nitric oxide synthases, KATP channels, vasopressin, H2S, vasoplegic syndrome

  2. Random Walk Picture of Basketball Scoring

    Gabel, Alan


    We present evidence, based on play-by-play data from all 6087 games from the 2006/07--2009/10 seasons of the National Basketball Association (NBA), that basketball scoring is well described by a weakly-biased continuous-time random walk. The time between successive scoring events follows an exponential distribution, with little memory between different scoring intervals. Using this random-walk picture that is augmented by features idiosyncratic to basketball, we account for a wide variety of statistical properties of scoring, such as the distribution of the score difference between opponents and the fraction of game time that one team is in the lead. By further including the heterogeneity of team strengths, we build a computational model that accounts for essentially all statistical features of game scoring data and season win/loss records of each team.

  3. Network Physiology: Mapping Interactions Between Networks of Physiologic Networks

    Ivanov, Plamen Ch.; Bartsch, Ronny P.

    The human organism is an integrated network of interconnected and interacting organ systems, each representing a separate regulatory network. The behavior of one physiological system (network) may affect the dynamics of all other systems in the network of physiologic networks. Due to these interactions, failure of one system can trigger a cascade of failures throughout the entire network. We introduce a systematic method to identify a network of interactions between diverse physiologic organ systems, to quantify the hierarchical structure and dynamics of this network, and to track its evolution under different physiologic states. We find a robust relation between network structure and physiologic states: every state is characterized by specific network topology, node connectivity and links strength. Further, we find that transitions from one physiologic state to another trigger a markedly fast reorganization in the network of physiologic interactions on time scales of just a few minutes, indicating high network flexibility in response to perturbations. This reorganization in network topology occurs simultaneously and globally in the entire network as well as at the level of individual physiological systems, while preserving a hierarchical order in the strength of network links. Our findings highlight the need of an integrated network approach to understand physiologic function, since the framework we develop provides new information which can not be obtained by studying individual systems. The proposed system-wide integrative approach may facilitate the development of a new field, Network Physiology.

  4. Evaluation of EMLA cream for preventing pain during tattooing of rabbits: changes in physiological, behavioural and facial expression responses.

    Stephanie C J Keating

    Full Text Available BACKGROUND: Ear tattooing is a routine procedure performed on laboratory, commercial and companion rabbits for the purpose of identification. Although this procedure is potentially painful, it is usually performed without the provision of analgesia, so compromising animal welfare. Furthermore, current means to assess pain in rabbits are poor and more reliable methods are required. The objectives of this study were to assess the physiological and behavioural effects of ear tattooing on rabbits, evaluate the analgesic efficacy of topical local anaesthetic cream application prior to this procedure, and to develop a scale to assess pain in rabbits based on changes in facial expression. METHODOLOGY/PRINCIPAL FINDINGS: In a crossover study, eight New Zealand White rabbits each underwent four different treatments of actual or sham ear tattooing, with and without prior application of a topical local anaesthetic (lidocaine/prilocaine. Changes in immediate behaviour, heart rate, arterial blood pressure, serum corticosterone concentrations, facial expression and home pen behaviours were assessed. Changes in facial expression were examined to develop the Rabbit Grimace Scale in order to assess acute pain. Tattooing without EMLA cream resulted in significantly greater struggling behaviour and vocalisation, greater facial expression scores of pain, higher peak heart rate, as well as higher systolic and mean arterial blood pressure compared to all other treatments. Physiological and behavioural changes following tattooing with EMLA cream were similar to those in animals receiving sham tattoos with or without EMLA cream. Behavioural changes 1 hour post-treatment were minimal with no pain behaviours identifiable in any group. Serum corticosterone responses did not differ between sham and tattoo treatments. CONCLUSIONS: Ear tattooing causes transient and potentially severe pain in rabbits, which is almost completely prevented by prior application of local

  5. APACHE score, Severity Index of Paraquat Poisoning, and serum lactic acid concentration in the prognosis of paraquat poisoning of Chinese Patients.

    Xu, Shuyun; Hu, Hai; Jiang, Zhen; Tang, Shiyuan; Zhou, Yuangao; Sheng, Jie; Chen, Jinggang; Cao, Yu


    Many prognostic indictors have been studied to evaluate the prognosis of paraquat poisoning. However, the optimal indicator remains unclear. To determine the value of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, the Severity Index of Paraquat Poisoning (SIPP), and serum lactate levels in the prognosis of paraquat poisoning, we performed a prospective study that enrolled 143 paraquat patients. Data were collected from patients (161) at West China Hospital in Chengdu, China, including details about the patients' general conditions, laboratory examinations, and treatment. Receiver operating characteristic curves for predicting inpatient mortality based on APACHE II score, SIPP, and lactate levels were generated. To analyze the best cutoff values for lactate levels, APACHE II scores, and SIPP in predicting the prognosis of paraquat poisoning, the initial parameters on admission and 7-day survival curves of patients with lactate levels greater than or equal to 2.95 mmol/L, APACHE II score greater than or equal to 15.22, and SIPP greater than or equal to 5.50 h · mg/L at the time of arrival at West China Hospital were compared using the 1-way analysis of variance and the log-rank test. The APACHE II score (5.45 [3.67] vs 11.29 [4.31]), SIPP (2.78 [1.89] vs 7.63 [2.46] h · mg/L), and lactate level (2.78 [1.89] vs 7.63 [2.46] mmol/L) were significantly lower in survivors (77) after oral ingestion of paraquat, compared with nonsurvivors (66). The APACHE II score, SIPP, and lactate level had different areas under the curve (0.847, 0.789, and 0.916, respectively) and accuracy (0.64, 0.84, and 0.89, respectively). Respiratory rate, serum creatinine level, Paco2, and mortality rate at 7 days after admission in patients with lactate levels greater than or equal to 2.95 mmol/L were markedly different compared with those of other patients (P paraquat poisoning.

  6. [The cardiovascular surgeon and the Syntax score].

    Gómez-Sánchez, Mario; Soulé-Egea, Mauricio; Herrera-Alarcón, Valentín; Barragán-García, Rodolfo


    The Syntax score has been established as a tool to determine the complexity of coronary artery disease and as a guide for decision-making among coronary artery bypass surgery and percutaneous coronary intervention. The purpose of this review is to systematically examine what the Syntax score is, and how the surgeon should integrate the information in the selection and treatment of patients. We reviewed the results of the SYNTAX Trial, the clinical practice guidelines, as well as the benefits and limitations of the score. Finally we discuss the future directions of the Syntax score.

  7. Security Risk Scoring Incorporating Computers' Environment

    Eli Weintraub


    Full Text Available A framework of a Continuous Monitoring System (CMS is presented, having new improved capabilities. The system uses the actual real-time configuration of the system and environment characterized by a Configuration Management Data Base (CMDB which includes detailed information of organizational database contents, security and privacy specifications. The Common Vulnerability Scoring Systems' (CVSS algorithm produces risk scores incorporating information from the CMDB. By using the real updated environmental characteristics the system enables achieving accurate scores compared to existing practices. Framework presentation includes systems' design and an illustration of scoring computations.

  8. Pneumonia severity scores in resource poor settings

    Jamie Rylance


    Full Text Available Clinical prognostic scores are increasingly used to streamline care in well-resourced settings. The potential benefits of identifying patients at risk of clinical deterioration and poor outcome, delivering appropriate higher level clinical care, and increasing efficiency are clear. In this focused review, we examine the use and applicability of severity scores applied to patients with community acquired pneumonia in resource poor settings. We challenge clinical researchers working in such systems to consider the generalisability of existing severity scores in their populations, and where performance of scores is suboptimal, to promote efforts to develop and validate new tools for the benefit of patients and healthcare systems.

  9. Modified Da-Cheng-Qi Decoction reduces intra-abdominal hypertension in severe acute pancreatitis: a pilot study

    WAN Mei-hua; LI Juan; HUANG Wei; Rajarshi Mukherjee; GONG Han-lin; XIA Qing; ZHU Lin; CHENG Gui-lan; TANG Wen-fu


    Background Intra-abdominal hypertension (IAH) is a recognized prognostic marker for severity of severe acute pancreatitis (SAP) and has a strong impact on the clinical course of SAP.Previous studies indicate that a Da-Cheng-Qi Decoction (DCQD) is beneficial in the treatment of SAP.The purpose of this study was to evaluate the effect of modified DCQD on IAH in patients with SAP.Methods Between January 2008 and December 2008,42 patients from the West China Hospital were randomized into either the DCQD or control group (n=21 in each group).Mortality,intra-abdominal pressure (lAP),Acute Physiology and Chronic Health Evaluation II (APACHE II) score,C-reactive protein (CRP),oxygenation index,Balthazar CT score,rate of renal failure,decompression rate,intensive care unit (ICU) transfer rate,and length of hospital stay (LOS) were compared between the two groups.Results Compared to the control group,the modified DCQD treatment significantly decreased lAP (P <0.05) and APACHE Ⅱ (P <0.05) scores on days 4-8,CRP on day 8 (P <0.01 ),renal failure rate (P <0.05),and LOS (P <0.05).The oxygenation index was significantly improved in the DCQD group compared with the control group (P <0.05).No significant differences in the Balthazar CT score,shock rate,ICU transfer rate,or mortality occurred between the two groups.Conclusions The modified DCQD can effectively relieve IAH and decrease LOS for patients with SAP.Larger clinical trials are needed to confirm these findings.

  10. Effects of weightlessness on human fluid and electrolyte physiology

    Leach, Carolyn S.; Johnson, Philip C., Jr.


    Skylab and Spacelab data on changes occurring in human fluid and electrolyte physiology during the acute and adaptive phases of adaptation to spaceflight are summarized. The combined results for all three Spacelab studies show that hyponatremia developed within 20 h after the onset of weightlessness and continued throughout the flights, and hypokalemia developed by 40 h. Antidiuretic hormone was increased in plasma throughout the flights. Aldosterone decreased by 40 h, but after 7 days it had reached preflight levels.

  11. Biomechanics and histology of bovine claw suspensory tissue in early acute laminitis.

    Danscher, A M; Toelboell, T H; Wattle, O


    Weakening of the suspensory tissue supporting the pedal bone is the central issue in the theory of acute bovine laminitis, but this aspect has never been tested. The objective of this study was to investigate the effect of laminitis on the suspensory tissue. The hypothesis was that clinical and histological signs of acute laminitis are associated with decreased strength of the suspensory tissue of the bovine claw. Nonpregnant dairy heifers (n=10) received oral oligofructose overload (17 g/kg of body weight) and were killed 24 (n=4) and 72h (n=6) after overload. Control heifers (n=6) received tap water and were killed at 72 or 96h. Clinical, orthopedic, and histological examinations were carried out to confirm the occurrence of laminitis. After euthanasia, 2 adjacent tissue samples including the horn wall, lamellar layer, dermis, and pedal bone were cut from the dorso-abaxial aspect of each claw. Tissue samples were kept on ice until mounted on a mechanical testing frame, fixed by horn and bone, and loaded to failure. A stress displacement curve was generated and measurements of physiological support (force needed to displace 1mm beyond first resistance) and maximal support (force needed to break the tissue) were recorded. Heifers treated with oligofructose developed clinical signs consistent with ruminal and systemic acidosis after treatment as well as acute laminitis, characterized by weight shifting (35% of observations vs. 6% in controls), moderate lameness (100 vs. 17%, score of 3 out of 5 at 72h), and reaction to hoof testing (30 and 50% at 48 and 72h, respectively, vs. 0% in controls). Histological examination of claws from heifers killed 72h after overload showed changes consistent with acute laminitis, including stretched lamellae, wider basal cells with low chromatin density, and a thick, wavy, and blurry appearance of the basement membrane. Biomechanical results showed no effect of oligofructose overload on physiological support of the suspensory tissue

  12. Therapeutic effectiveness of sustained low-efficiency hemodialysis plus hemoperfusion and continuous hemofiltration plus hemoperfusion for acute severe organophosphate poisoning.

    Hu, Shou-liang; Wang, Dan; Jiang, Hong; Lei, Qing-feng; Zhu, Xiao-hua; Cheng, Jun-zhang


    There is no report on the effects of sustained low-efficiency dialysis (SLED) plus hemoperfusion (HP) (SLED + HP) in patients with acute severe organophosphate (OP) poisoning (ASOPP). This study was designed to compare the therapeutic effectiveness between SLED + HP and continuous hemofiltration (CHF) plus HP (CHF + HP) in patients with ASOPP. In order to assess the two treatment methods, 56 patients with ASOPP were divided into CHF + HP group and SLED + HP group. The biochemical indicators, in-hospital duration, hemodynamic parameters, Acute Physiology, and Chronic Health Evaluation (APACHE II) score, and survival and mortality rates were compared. In both groups after treatment, the levels of serum creatine kinase isozyme MB, creatine kinase, creatinine, glutamic-oxalacetic transaminease, and glutamate-pyruvate transaminase, and the APACHE II scores on the first, second, and seventh day decreased (P  0.05). In conclusion, SLED has similar hemodynamic stability to CHF and the two treatment methods have similar effects on ASOPP patients. More importantly, SLED plus HP is relatively economical and convenient for patients with ASOPP in clinical practice.

  13. Exploratory study of factors related to educational scores of first preclinical year medical students.

    Sitticharoon, Chantacha; Srisuma, Sorachai; Kanavitoon, Sawita; Summachiwakij, Sarayut


    The relationships among the scores of major subjects taught in the first preclinical year of a Thai medical school, previous academic achievements, and daily life activities are rarely explored. We therefore performed an exploratory study identifying various factors possibly related to the educational scores of these medical students. Questionnaires were sent out to all first preclinical year medical students, with 79.8% being returned (245/307 questionnaires). Positive correlations were revealed between the premedical year grade point average (pre-MD GPA) and anatomy, physiology, and biochemistry scores (R = 0.664, 0.521, and 0.653, respectively, P < 0.001 for all) by Pearson's method. Using multiple linear regression analysis, anatomy scores could be predicted by pre-MD GPA, student satisfaction with anatomy, the percentage of expected reading, monthly earnings, reading after class and near exam time, and duration of sleeping periods near exam time (R = 0.773, R(2) = 0.598, P < 0.001). Physiology scores could be estimated by pre-MD GPA, the percentage of expected reading, monthly earnings, and percentage of those who fell asleep during class and near exam time (R = 0.722, R(2) = 0.521, P < 0.001). Biochemistry scores could be calculated by pre-MD GPA, the percentage of expected reading, motivation to study medicine, student satisfaction with biochemistry, and exam performance expectations (R = 0.794, R(2) = 0.630, P < 0.001). In conclusion, pre-MD GPA and the percentage of expected reading are factors involved in producing good academic results in the first preclinical year. Anatomy and biochemistry, but not physiology, scores are influenced by satisfaction.

  14. Assessment and comparison of student engagement in a variety of physiology courses.

    Hopper, Mari K


    Calls for reform in science education have promoted active learning as a means to improve student engagement (SENG). SENG is generally acknowledged to have a positive effect on student learning, satisfaction, and retention. A validated 14-question survey was used to assess SENG in a variety of upper- and lower-level physiology courses, including 100-level Anatomy and Physiology 1, 300-level Animal Physiology, 400-level Advanced Physiology, and 500-level Medical Physiology courses. The results indicated that SENG did not vary consistently by course level, format, or curriculum. The highest levels of SENG were found in the Advanced Physiology course, which included SENG as a primary objective of the course. Physiology student SENG scores were compared with National Survey of Student Engagement (NSSE) scores. The results demonstrated that physiology students enrolled in the Anatomy and Physiology 1 course reported lower levels of SENG than first-year students that completed the NSSE. Students enrolled in the Advanced Physiology course reported higher levels of SENG than fourth-year students that completed the NSSE. Assessment of SENG offers insights as to how engaged students are, identifies where efforts may best be applied to enhance SENG, and provides a baseline measure for future comparisons after targeted course modifications.

  15. Physiology for engineers applying engineering methods to physiological systems

    Chappell, Michael


    This book provides an introduction to qualitative and quantitative aspects of human physiology. It looks at biological and physiological processes and phenomena, including a selection of mathematical models, showing how physiological problems can be mathematically formulated and studied. It also illustrates how a wide range of engineering and physics topics, including electronics, fluid dynamics, solid mechanics and control theory can be used to describe and understand physiological processes and systems. Throughout the text there are introductions to measuring and quantifying physiological processes using both signal and imaging technologies. Physiology for Engineers describes the basic structure and models of cellular systems, the structure and function of the cardiovascular system, the electrical and mechanical activity of the heart and provides an overview of the structure and function of the respiratory and nervous systems. It also includes an introduction to the basic concepts and applications of reacti...

  16. Network Physiology reveals relations between network topology and physiological function

    Bashan, Amir; Kantelhardt, Jan W; Havlin, Shlomo; Ivanov, Plamen Ch; 10.1038/ncomms1705


    The human organism is an integrated network where complex physiologic systems, each with its own regulatory mechanisms, continuously interact, and where failure of one system can trigger a breakdown of the entire network. Identifying and quantifying dynamical networks of diverse systems with different types of interactions is a challenge. Here, we develop a framework to probe interactions among diverse systems, and we identify a physiologic network. We find that each physiologic state is characterized by a specific network structure, demonstrating a robust interplay between network topology and function. Across physiologic states the network undergoes topological transitions associated with fast reorganization of physiologic interactions on time scales of a few minutes, indicating high network flexibility in response to perturbations. The proposed system-wide integrative approach may facilitate the development of a new field, Network Physiology.

  17. Single Cell Physiology

    Neveu, Pierre; Sinha, Deepak Kumar; Kettunen, Petronella; Vriz, Sophie; Jullien, Ludovic; Bensimon, David

    The possibility to control at specific times and specific places the activity of biomolecules (enzymes, transcription factors, RNA, hormones, etc.) is opening up new opportunities in the study of physiological processes at the single cell level in a live organism. Most existing gene expression systems allow for tissue specific induction upon feeding the organism with exogenous inducers (e.g., tetracycline). Local genetic control has earlier been achieved by micro-injection of the relevant inducer/repressor molecule, but this is an invasive and possibly traumatic technique. In this chapter, we present the requirements for a noninvasive optical control of the activity of biomolecules and review the recent advances in this new field of research.

  18. [Physiology of the neuropeptides].

    García-López, M J; Martínez-Martos, J M; Mayas, M D; Carrera, M P; Ramírez- Expósito, M J

    In the present review, the characteristics of mammalian neuropeptides have been studied. Neuropeptides are widely distributed not only in the nervous system but also in the periphery. They are synthesised by neurons as large precursor molecules (pre propeptides) which have to be cleaved and modified in order to form the mature neuropeptides. Neuropeptides may exert actions as neurotransmitters, neuromodulators and/or neurohormones. In the neurons, they coexist with classic transmitters and often with other peptides. After their releasing, they bind to especific receptors to exert their action in the target cell. Most of these receptors belongs to a family of G protein coupled receptors. Finally, peptidases are the enzymes involved in the degradation of neuropeptides. Conclusions. In the last years, the number of known neuropeptides and the understanding of their functions have been increased. With these data, present investigations are looking for the treatment of different pathologies associated with alterations in the physiology of neuropeptides.

  19. Widening clinical applications of the SYNTAX Score.

    Farooq, Vasim; Head, Stuart J; Kappetein, Arie Pieter; Serruys, Patrick W


    The SYNTAX Score ( has established itself as an anatomical based tool for objectively determining the complexity of coronary artery disease and guiding decision-making between coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI). Since the landmark SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) Trial comparing CABG with PCI in patients with complex coronary artery disease (unprotected left main or de novo three vessel disease), numerous validation studies have confirmed the clinical validity of the SYNTAX Score for identifying higher-risk subjects and aiding decision-making between CABG and PCI in a broad range of patient types. The SYNTAX Score is now advocated in both the European and US revascularisation guidelines for decision-making between CABG and PCI as part of a SYNTAX-pioneered heart team approach. Since establishment of the SYNTAX Score, widening clinical applications of this clinical tool have emerged. The purpose of this review is to systematically examine the widening applications of tools based on the SYNTAX Score: (1) by improving the diagnostic accuracy of the SYNTAX Score by adding a functional assessment of lesions; (2) through amalgamation of the anatomical SYNTAX Score with clinical variables to enhance decision-making between CABG and PCI, culminating in the development and validation of the SYNTAX Score II, in which objective and tailored decisions can be made for the individual patient; (3) through assessment of completeness of revascularisation using the residual and post-CABG SYNTAX Scores for PCI and CABG patients, respectively. Finally, the future direction of the SYNTAX Score is covered through discussion of the ongoing development of a non-invasive, functional SYNTAX Score and review of current and planned clinical trials.

  20. Network physiology reveals relations between network topology and physiological function

    Bashan, Amir; Bartsch, Ronny P.; Kantelhardt, Jan W.; Havlin, Shlomo; Ivanov, Plamen Ch.


    The human organism is an integrated network where complex physiological systems, each with its own regulatory mechanisms, continuously interact, and where failure of one system can trigger a breakdown of the entire network. Identifying and quantifying dynamical networks of diverse systems with different types of interactions is a challenge. Here we develop a framework to probe interactions among diverse systems, and we identify a physiological network. We find that each physiological state is...


    Suhaib Rehaman


    Full Text Available INTRODUCTION : Early diagnosis and severity evaluation on patients with acute pancreatitis are very important due to its potential morbidity and mortality. Given the wide spectrum of disease seen, the care of patients with pancreatitis must be highly individualized. Sev eral clinical, laboratory and radiologic factors and many scoring systems have been proposed for outcome prediction. AIMS AND OBJECTIVES: To study the symptomatology, clinical presentation and management in pancreatitis . To study the severity of acute panc reatitis according to Glasgow Scale . METHODS: Present study includes consecutive 38 patients hospitalized in CSI Holdsworth Memorial Hospital over the period of 2 years. All patients were thoroughly investigated and were stratified according to the Glasgow criteria. Data was collected on complications, investigations and interventions undertaken, outcome, duration of stay in hospital and ICU. STATISTICAL ANALYSIS USED: Descriptive, Chi square tests, Crosstabs (Contingency coefficient analysis . RESULTS : Mean age of presentation in our study was 43.1 years. There was a male predominance accounting for 68.4% compared to 31.6% females. Alcohol was the main etiological factor in about 50% of the patients. Sensitivity to S. amylase was about 100%. Accuracy of USG abdomen in diagnosing pancreatitis was about 88.5%. Ascitis was the commonest complication seen in 13.2%. Mean duration of hospital stay was 6.2 days. The patient were stratified according to Glasgow scoring system into mild (0 - 3 and severe (>3 panc reatitis. In our study 32 people were graded with mild pancreatitis, all improved and in 6 people who were graded with severe pancreatitis, 83.3 % improved and 2.6% expired because of complications. Test statistics showed Contingency coefficient 0.355 and P 0.019 (NS. CONCLUSION : Glasgow scoring system remains a valid predicting system for the outcome in patients with acute pancreatitis. It is simple easy to apply with

  2. Bayesian Model Averaging for Propensity Score Analysis

    Kaplan, David; Chen, Jianshen


    The purpose of this study is to explore Bayesian model averaging in the propensity score context. Previous research on Bayesian propensity score analysis does not take into account model uncertainty. In this regard, an internally consistent Bayesian framework for model building and estimation must also account for model uncertainty. The…

  3. Starreveld scoring method in diagnosing childhood constipation

    Kokke, F.T.; Sittig, J.S.; de Bruijn, A.; Wiersma, T.; van Rijn, R.R.; Limpen, J.L.; Houwen, R.H.; Fischer, K.; Benninga, M.A.


    Four scoring methods exist to assess severity of fecal loading on plain abdominal radiographs in constipated patients (Barr-, Starreveld-, Blethyn- and Leech). So far, the Starreveld score was used only in adult patients. To determine accuracy and intra- and inter-observer agreement of the Starrevel

  4. Causal Moderation Analysis Using Propensity Score Methods

    Dong, Nianbo


    This paper is based on previous studies in applying propensity score methods to study multiple treatment variables to examine the causal moderator effect. The propensity score methods will be demonstrated in a case study to examine the causal moderator effect, where the moderators are categorical and continuous variables. Moderation analysis is an…



    This paper presents a study of the effect of cultur-al background on TOEFL scores.It proceeds from therelation between culture and language,then illus-trates with actual questions from various sections ofTOEFL tests how American cultural background exertsa remarkable influence on TOEFL scores,and con-cludes with revelations with regard to English teachingin this country.

  6. Clinical scoring scales in thyroidology: A compendium

    Sanjay Kalra


    Full Text Available This compendium brings together traditional as well as contemporary scoring and grading systems used for the screening and diagnosis of various thyroid diseases, dysfunctions, and complications. The article discusses scores used to help diagnose hypo-and hyperthyroidism, to grade and manage goiter and ophthalmopathy, and to assess the risk of thyroid malignancy.

  7. On k-hypertournament losing scores

    Pirzada, Shariefuddin


    We give a new and short proof of a theorem on k-hypertournament losing scores due to Zhou et al. [G. Zhou, T. Yao, K. Zhang, On score sequences of k-tournaments, European J. Comb., 21, 8 (2000) 993-1000.

  8. Acute arterial occlusion - kidney

    Acute renal arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... kidney can often result in permanent kidney failure. Acute arterial occlusion of the renal artery can occur after injury or trauma to ...

  9. Acute cerebellar ataxia

    Cerebellar ataxia; Ataxia - acute cerebellar; Cerebellitis; Post-varicella acute cerebellar ataxia; PVACA ... Acute cerebellar ataxia in children, especially younger than age 3, may occur several weeks after an illness caused by a virus. ...

  10. A Bayesian Approach to Learning Scoring Systems.

    Ertekin, Şeyda; Rudin, Cynthia


    We present a Bayesian method for building scoring systems, which are linear models with coefficients that have very few significant digits. Usually the construction of scoring systems involve manual effort-humans invent the full scoring system without using data, or they choose how logistic regression coefficients should be scaled and rounded to produce a scoring system. These kinds of heuristics lead to suboptimal solutions. Our approach is different in that humans need only specify the prior over what the coefficients should look like, and the scoring system is learned from data. For this approach, we provide a Metropolis-Hastings sampler that tends to pull the coefficient values toward their "natural scale." Empirically, the proposed method achieves a high degree of interpretability of the models while maintaining competitive generalization performances.

  11. Propensity score weighting with multilevel data.

    Li, Fan; Zaslavsky, Alan M; Landrum, Mary Beth


    Propensity score methods are being increasingly used as a less parametric alternative to traditional regression to balance observed differences across groups in both descriptive and causal comparisons. Data collected in many disciplines often have analytically relevant multilevel or clustered structure. The propensity score, however, was developed and has been used primarily with unstructured data. We present and compare several propensity-score-weighted estimators for clustered data, including marginal, cluster-weighted, and doubly robust estimators. Using both analytical derivations and Monte Carlo simulations, we illustrate bias arising when the usual assumptions of propensity score analysis do not hold for multilevel data. We show that exploiting the multilevel structure, either parametrically or nonparametrically, in at least one stage of the propensity score analysis can greatly reduce these biases. We applied these methods to a study of racial disparities in breast cancer screening among beneficiaries of Medicare health plans.

  12. Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage

    Hong Chen; Fei Li; Jia-Bang Sun; Jian-Guo Jia


    AIM: To study retrospectively the influence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in patients with early acute pancreatitis (AP) (during the first week after admission) on physiological functions, and the association of the presence of LAH/ACS and outcome.METHODS: Patients (n=74) with AP recruited in this study were divided into two groups according to intra-abdominal pressure (IAP) determined by indirect measurement using the transvesical route via Foley bladder catheter during the first week after admission. Patients (n=44) with IAP≥12 mmHg were assigned in IAH group, and the remaining patients (n=30) with IAP<12mmHg in normal IAP group. For analysis of the influence of IAH/ACS on organ function and outcome, the physiological parameters and the occurrence of organ dysfunction during intensive care unit (ICU) stay were recorded, as were the incidences of pancreatic infection and in-hospital mortality.RESULTS: LAH within the first week after admission was found in 44 patients (59.46%). Although the APACHE Ⅱ scores on admission and the Ranson scores within 48h after hospitalization were elevated in IAH patients in early stage, they did not show the statistically significant differences from patients with normal IAP within a week after admission (16.18±3.90 vs 15.70±4.25, P=0.616; 3.70±0.93 vs 3.47±0.94, P=0.285, respectively). ACS in early AP was recorded in 20 patients (27.03%). During any 24-h period of the first week after admission, the recorded mean IAP correlated significantly with the Marshall score calculated at the same time interval in IAH group (r=0.635, P<0.001). Although ACS patients had obvious amelioration in physiological variables within 24h after decompression, the incidences of pancreatitic infection, septic shock, multiple organ dysfunction syndrome (MODS) and death in the patients with ACS were significantly higher than that in other patients without ACS (pancreatitic infection: 60.0% vs 7.4%, P<0

  13. Barometer. Acute trusts February 2005.


    Almost two thirds of acute trusts rate the quality of commissioning from their PCTs at three out of 10 or less, according to the latest HSJ Barometer survey. This is the lowest score since we began the survey a year ago. Confidence in their performance against the 98 per cent four-hour A&E target fell sharply from a December high to an average of 6.87. The survey also found that fewer than one in seven trusts were confident of winning foundation status by the end of 2006-07.


    田照辉; 徐绍刚; 王巍; 胡红霞; 马国庆


    The effect of acute thermal stress on HSP1Q mRNA expression, physiology and nonspecific immunity were investigated in Siberian sturgeon. In the experiment, ten fish were transferred froml7.5℃ to 27.5℃ water, then data were measured at lh and 3h. Fish in 17.5℃ water were taken as Oh group. Respiratory rate increased from 80-90 breaths/min to 210 breaths/min, then decreased to 180 breaths/min after 0.5h. Among the three tissues including gill, spleen and brain, the HSP70 mRNA expression in gill rose most quickly after lh stress, and was about 1.63 fold compared with the Oh group (P<0.05), then remained this level to 3h; The HSP10 mRNA expression in spleen and brain had nearly no change in lh thermal stress, then rose quickly from lh to 3h in the two tissues, especially in brain at 3h rose most quickly to about 1.77 fold compared with the lh group (P<0.05). Compared with the Oh group, serum cortisol increased quickly and was 5.14 fold (PO.05) at lh, then decreased quickly to 2.1 fold at 3h. Spleen macrophage respiratory burst achieved the maximum (P<0.05) at lh, then reduced to the Oh group level. Serum complement C3 increased at lh and decreased significantly at 3h (P<0.05). Serum lysozyme activity firstly elevated then decreased but had no significant differences. Serum SOD activity decreased when thermal stress time prolonged, and achieved the minimum at 3h (P<0.05). Serum MDA content decreased when thermal stress time prolonged and had no significant difference. The results showed that lh acute thermal stress promoted the nonspecific immunity and tolerance, but 3h acute thermal stress decreased it.%为研究西伯利亚鲟(Acipenser baerii)对急性热应激的抗逆机理,将体质量为(155.47±19.50) g的鱼从17.5 ℃迅速转至27.5 ℃水中,在1h和3h取样测定HSP70 mRNA表达变化、血清皮质醇和非特异性免疫指标.结果显示:急性热应激时鳃、脾和脑的HSP70 mRNA表达量升高,具有组织特异性,热应激1h时

  15. Effect of Chaiqinchengqi decoction on serum amyloid A in severe acute pancreatitis patients

    Wei Wu; Jia Guo; Xiao-Nan Yang; Zi-Qi Lin; zhen-Zhen Huang; Qing Xia; Ping Xue


    Objective:To investigate the effect of Chaiqinchengqi decoction (CQCQD) on serum amyloid A (SAA) in severe acute pancreatitis (SAP) patients. Methods: Thirty-five participants enrolled and were randomly assigned into either a treatment condition (n=17, treated with CQCQD) or a control condition (n=18, treated with placebo) 24 hours following the onset of the disease. No statistical difference was observed in either group at baseline. Upon admission, the Acute Physiology and Chronic Health Evaluation scoreⅡ (APACHEⅡ), SAA, serum C-reactive protein (CRP) and interleukin-6 (IL-6) were measured, as well as on the first, 3rd and 7th day and were compared between the two groups. Organ complications, infection, operation rate, mortality and hospital stay were also compared. Results:The duration of acute respiratory distress syndrome, acute hepatitis, acute renal failure, gastrointestinal failure and blood coagulation dysfunction were shorter in the treatment group than in those in the control group (P<0.05). The secondary infection rates and the hospital fees in the treatment group were lower than those in the control group (P< 0.05) as well as length of hospital stay (P< 0.01). After 3 days of hospitalization, the APACHEⅡ, score SAA levels, serum CRP and IL-6 in the treatment group was lower than those in the control group (P< 0.05). SAA was positively correlated with serum CRP (R= 0.346, P=0.042), Ranson score (R= 0.442, P= 0.008) and serum IL-6 (R=0.359, P=0.034). The area under the receiver operating characteristic curve of admission SAA predict pancreatic necrosis (PN) was 0.815 (95%CI:0.625-0.954;P=0.006). The best cut-off value of admission SAA was 7.85 mg/L with the sensitivity 84.6%and specificity 68.2%. Conclusions: The CQCQD can reduce the duration of organ damage through lowering the SAA in SAP patients and the SAA can early predict the PN and severity of SAP patients.

  16. Procedures of Exercise Physiology Laboratories

    Bishop, Phillip A.; Fortney, Suzanne; Greenisen, Michael; Siconolfi, Steven F.; Bamman, Marcas M.; Moore, Alan D., Jr.; Squires, William


    This manual describes the laboratory methods used to collect flight crew physiological performance data at the Johnson Space Center. The Exercise Countermeasures Project Laboratory is a standard physiology laboratory; only the application to the study of human physiological adaptations to spaceflight is unique. In the absence of any other recently published laboratory manual, this manual should be a useful document staffs and students of other laboratories.

  17. Evaluation of Right Iliac Fossa Pain with Reference to Alvarado Score – Can We Prevent Unnecessary Appendicectomies?

    P. D. Gurav


    Full Text Available Background: Appendicectomy for acute appen-dicitis is the most common surgical cause ofemergency laparotomy throughout the world.Acute appendicitis is a clinical diagnosis; theaccuracy of clinical examination has been re-ported from 71 to 97% and varies greatly de-pending upon the experience of the examiner.The treatment being surgical, negative appen-dicectomy rates are high. Aim and Objective:Present study was conducted to evaluateAlvarado Scoring system for diagnosis of acuteappendicitis and its co-relation by histopathol-ogy. Material and Methods: Prospective studyof consecutive patients admitted with suspectedacute appendicitis during the period of July2011 to December 2012 was undertaken.Alvarado Score of each patient was calculated.Out of 130, 95 patients had histologicallyproven acute appendicitis. Reliability of scor-ing system was assessed by calculating posi-tive predictive value and negative appendicec-tomy rate. Results and Conclusion: The posi-tive predictive value was 88.37% and negativeappendicectomy rate was 11.63% (with respectto Alvarado score > 7. Alvarado Scoring sys-tem is easy, simple, cheap, useful tool in pre-operative diagnosis of acute appendicitis.

  18. A new electromechanical trainer for sensorimotor rehabilitation of paralysed fingers: A case series in chronic and acute stroke patients

    Tomelleri C


    Full Text Available Abstract Background The functional outcome after stroke is improved by more intensive or sustained therapy. When the affected hand has no functional movement, therapy is mainly passive movements. A novel device for repeating controlled passive movements of paralysed fingers has been developed, which will allow therapists to concentrate on more complicated tasks. A powered cam shaft moves the four fingers in a physiological range of movement. Methods After refining the training protocol in 2 chronic patients, 8 sub-acute stroke patients were randomised to receive additional therapy with the Finger Trainer for 20 min every work day for four weeks, or the same duration of bimanual group therapy, in addition to their usual rehabilitation. Results In the chronic patients, there was a sustained reduction in finger and wrist spasticity, but there was no improvement in active movements. In the subacute patients, mean distal Fugl-Meyer score (0–30 increased in the control group from 1.25 to 2.75 (ns and 0.75 to 6.75 in the treatment group (p Conclusion Treatment with the Finger Trainer was well tolerated in sub-acute & chronic stroke patients, whose abnormal muscle tone improved. In sub-acute stroke patients, the Finger Trainer group showed small improvements in active movement and avoided the increase in tone seen in the control group. This series was too small to demonstrate any effect on functional outcome however.

  19. Physiological adaptability of members of Chinese National Earthquake Disaster Emergency Rescue Team (CNEDERT) in altitude of Yushu area of Qinghai province and prevention of acute mountain sickness%急进高原救援队员血氧饱和度、心率、血红蛋白动态监测与防范高原反应风险的研究

    焦小杰; 方涛; 樊毫军; 侯世科


    Objective As members of CNEDERT, we were trusted to take the mission of medical rescue in April of this year in Yushu area of Qinghai province. As soon as we heard of the news of earthquake with shock of 7.1 on Richter scale happened on 14th April 2010, our team of 32 members from the General Hospital of Armed Police Force rapidly rushed to get there at 19 o'clock on 14th April. It is a cold plateau with 4000 meters in average above sea level. Of course, they would face many difficult problems and some of them could not be figured out in advance. It was really a new and big challenge. First of all, we had to bear the very low barometric pressure,threatening lives of team members. In order to fulfill the mission of medical rescue, and to prevent the acute mountain sickness (AMS) ,we monitored the physiological changes of every member. Method A total of 32 members aged from 27 - 42 years old with average age of (33.26 + 12.54) years, 6 male and 6 female, gathered at Peking, 50 meters above sea level, 6 hours ahead of getting to Yushu and received physical examination with measurements of SaO2, HR, Hb and breath holding test. The team worked in Yushu area for 13 days and returned back to Peking on 27th April at 13 o'clock. The measurements of SaO2, HR and He were kept on from 14th April to 4th May, 21 days in total. The occurrence of AMS was surveyed by questionnaire from 18 to 48 hours after arrival,and the AMSA was diagnosed and scored according to the Lake Louise consensus on the definition and quantification of altitude illness. When the score was equal or above 3, it was considered to be AMS. Our work activities included searching the victims under the collapsed building, carrying out treatment and operation as soon as possible in the mobile hospital, doing medical round visiting, public health and disease prevention, work of joint rescue of multiple professions and psychological counseling. Results Of them 26 (81.25%) members suffered from AMS of various

  20. Conservation physiology of marine fishes

    Jørgensen, Christian; Peck, Myron A.; Antognarelli, Fabio


    At the end of May, 17 scientists involved in an EU COST Action on Conservation Physiology of Marine Fishes met in Oristano, Sardinia, to discuss how physiology can be better used in modelling tools to aid in management of marine ecosystems. Current modelling approaches incorporate physiology...... to different extents, ranging from no explicit consideration to detailed physiological mechanisms, and across scales from a single fish to global fishery resources. Biologists from different sub-disciplines are collaborating to rise to the challenge of projecting future changes in distribution and productivity...

  1. Acute pancreatitis in children and adolescents

    Mitsuyoshi; Suzuki; Jin; Kan; Sai; Toshiaki; Shimizu


    In this Topic Highlight, the causes, diagnosis, and treat-ment of acute pancreatitis in children are discussed. Acute pancreatitis should be considered during the dif-ferential diagnosis of abdominal pain in children and requires prompt treatment because it may become life-threatening. The etiology, clinical manifestations, and course of acute pancreatitis in children are often differ-ent than in adults. Therefore, the specific features of acute pancreatitis in children must be considered. The etiology of acute pancreatitis in children is often drugs, infections, trauma, or anatomic abnormalities. Diagnosis is based on clinical symptoms(such as abdominal pain and vomiting), serum pancreatic enzyme levels, and im-aging studies. Several scoring systems have been pro-posed for the assessment of severity, which is useful for selecting treatments and predicting prognosis. The basic pathogenesis of acute pancreatitis does not greatly dif-fer between adults and children, and the treatments for adults and children are similar. In large part, our under-standing of the pathology, optimal treatment, assess-ment of severity, and outcome of acute pancreatitis in children is taken from the adult literature. However, we often find that the common management of adult pan-creatitis is difficult to apply to children. With advances in diagnostic techniques and treatment methods, severeacute pancreatitis in children is becoming better under-stood and more controllable.




    Full Text Available BACKGROUND: There are many multifactorial scoring systems, radiological scores, and biochemical markers are available for early prediction of severity, and mortality in patients with acute pancreatitis (AP. The bedside index for severity in acute pancreatitis (BISAP has been considered as an accurate method for risk stratification in patients with acute pancreatitis. OBJECTIVE: This study aimed to evaluate the usefulness of the BISAP as a predictor for severe pancreatitis. METHODS AND MATERIAL: We analyzed 100 patients diagnosed with acute pancreatitis at our hospital between October 2012 and April 2013. We used BISAP score in all such patients within 24 hours of admission. Patient were assessed for organ failure and followed throughout the period of hospitalization for complications. Statistical analysis was made using the student t test and chi-square test and statistical significance was analyzed. RESULTS: Out of 100 patients, 20% had severe pancreatitis. Acute Pancreatitis was seen male (87%, in 4th decade (70%, alcohol was the most common etiology (60%, biliary pancreatitis (25%, remaining idiopathic (15%. Patients with BISAP >= 3 was associated with transient or persistent organ failure and pancreatic necrosis. CONCLUSION: BISAP scoring is a simple clinical method to identify patients at risk of increased mortality within 24 hours of presentation in patients with acute pancreatitis.

  3. Do MCAT scores predict USMLE scores? An analysis on 5 years of medical student data

    Gauer, Jacqueline L.; Wolff, Josephine M.; Jackson, J. Brooks


    Introduction: The purpose of this study was to determine the associations and predictive values of Medical College Admission Test (MCAT) component and composite scores prior to 2015 with U.S. Medical Licensure Exam (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) scores, with a focus on whether students scoring low on the MCAT were particularly likely to continue to score low on the USMLE exams.Method: Multiple linear regression, correlation, and chi-square analyses were performed to determi...

  4. Do MCAT scores predict USMLE scores? An analysis on 5 years of medical student data

    Jacqueline L. Gauer


    Full Text Available Introduction: The purpose of this study was to determine the associations and predictive values of Medical College Admission Test (MCAT component and composite scores prior to 2015 with U.S. Medical Licensure Exam (USMLE Step 1 and Step 2 Clinical Knowledge (CK scores, with a focus on whether students scoring low on the MCAT were particularly likely to continue to score low on the USMLE exams. Method: Multiple linear regression, correlation, and chi-square analyses were performed to determine the relationship between MCAT component and composite scores and USMLE Step 1 and Step 2 CK scores from five graduating classes (2011–2015 at the University of Minnesota Medical School (N=1,065. Results: The multiple linear regression analyses were both significant (p<0.001. The three MCAT component scores together explained 17.7% of the variance in Step 1 scores (p<0.001 and 12.0% of the variance in Step 2 CK scores (p<0.001. In the chi-square analyses, significant, albeit weak associations were observed between almost all MCAT component scores and USMLE scores (Cramer's V ranged from 0.05 to 0.24. Discussion: Each of the MCAT component scores was significantly associated with USMLE Step 1 and Step 2 CK scores, although the effect size was small. Being in the top or bottom scoring range of the MCAT exam was predictive of being in the top or bottom scoring range of the USMLE exams, although the strengths of the associations were weak to moderate. These results indicate that MCAT scores are predictive of student performance on the USMLE exams, but, given the small effect sizes, should be considered as part of the holistic view of the student.

  5. Physiological regulation of NEFA availability: lipolysis pathway.

    Stich, V; Berlan, M


    Plasma NEFA are an important energy substrate and, furthermore, play a key role in the induction of insulin resistance in the body. The availability of NEFA is determined predominantly by their mobilization from adipose tissue triacylglycerol stores by the process of lipolysis. Adipose tissue lipolysis in man is regulated by a number of hormonal and paracrine and/or autocrine signals. The main hormonal signals may be represented by catecholamines, insulin, growth hormone, natriuretic peptides and some adipocytokines. The absolute levels and relative importance and contribution of these signals vary in different physiological situations, with diet and physical exercise being the main physiological variables that affect the hormonal signalling. Thus, modulations in hormonal signals induce an increase in NEFA mobilization in the post-absorptive state and during an acute bout of exercise, and suppress NEFA mobilization in the postprandial state. In addition, hormonal regulation is modified by long-term interventions in energy balance, such as dietary restriction and/or physical training, and is disturbed in some pathological states, such as obesity or diabetes. The question that remains is whether disturbances in lipolysis regulation in obese and diabetic subjects may be 'corrected' by the long-term interventions in diet and physical activity.

  6. Acute Appendicitis

    Tind, Sofie; Qvist, Niels


    BACKGROUND: The classification of acute appendicitis (AA) into various grades is not consistent, partly because it is not clear whether the perioperative or the histological findings should be the foundation of the classification. When comparing results from the literature on the frequency...... patients were included. In 116 (89 %) of these cases, appendicitis was confirmed histological. There was low concordance between the perioperative and histological diagnoses, varying from 16 to 76 % depending on grade of AA. Only 44 % of the patients receiving antibiotics postoperatively had a positive...... peritoneal fluid cultivation. CONCLUSION: There was a low concordance in clinical and histopathological diagnoses of the different grades of appendicitis. Perioperative cultivation of the peritoneal fluid as a standard should be further examined. The potential could be a reduced postoperative antibiotic use...

  7. Polyamines in plant physiology

    Galston, A. W.; Sawhney, R. K.


    The diamine putrescine, the triamine spermidine, and the tetramine spermine are ubiquitous in plant cells, while other polyamines are of more limited occurrence. Their chemistry and pathways of biosynthesis and metabolism are well characterized. They occur in the free form as cations, but are often conjugated to small molecules like phenolic acids and also to various macromolecules. Their titer varies from approximately micromolar to more than millimolar, and depends greatly on environmental conditions, especially stress. In cereals, the activity of one of the major polyamine biosynthetic enzymes, arginine decarboxylase, is rapidly and dramatically increased by almost every studied external stress, leading to 50-fold or greater increases in putrescine titer within a few hours. The physiological significance of this increase is not yet clear, although most recent work suggests an adaptive, protective role. Polyamines produced through the action of ornithine decarboxylase, by contrast, seem essential for DNA replication and cell division. The application of exogenous polyamines produces effects on patterns of senescence and morphogenesis, suggesting but not proving a regulatory role for polyamines in these processes. The evidence for such a regulatory role is growing.


    Shivprasad Chiplunkar


    Full Text Available The balance of dosha  represents the healthy state and imbalance will cause various diseases. In normalcy doshas will be performing their own functions and individual doshas will be having their own specific sites. By telling the various sthana of each dosha, different function that is taken up by individual dosha in different sites has been highlighted.By mentioning ‘sparshanendriyam’ as one of the sthana of vata dosha the sensory functions of skin to vata dosha has been emphasised. By mentioning ‘sparshanam’ as one of the sthana of pittadosha, the function of colouring/pigmentation of skin, which is majorly carried out  by melanocytes by secreting melanin pigment has been highlighted. Meda is one among the sthanas of kapha dosha; this can be considered as the adipose tissue of skin/below skin. Since sweda is mala of meda it can be also considered as the secretions from the eccrine glands.With respect to skin, sensory functions, both tactile and thermal is carried out by vata dosha more specifically vyana vata, pigmentation to the skin carried out by meloncytes by secreting melanin, it is nothing but function of pitta dosha more specifically brajaka pitta with the help of udana vata and finally production of sweat in sweat glands is the function of kapha. So there is the need for further study and research regarding the sthanas of all three doshas in different structures/organs in the body and its physiology.

  9. Smolt physiology and endocrinology

    McCormick, Stephen D.; McCormick, Stephen D.; Farrell, Anthony Peter; Brauner, Colin J.


    Hormones play a critical role in maintaining body fluid balance in euryhaline fishes during changes in environmental salinity. The neuroendocrine axis senses osmotic and ionic changes, then signals and coordinates tissue-specific responses to regulate water and ion fluxes. Rapid-acting hormones, e.g. angiotensins, cope with immediate challenges by controlling drinking rate and the activity of ion transporters in the gill, gut, and kidney. Slow-acting hormones, e.g. prolactin and growth hormone/insulin-like growth factor-1, reorganize the body for long-term acclimation by altering the abundance of ion transporters and through cell proliferation and differentiation of ionocytes and other osmoregulatory cells. Euryhaline species exist in all groups of fish, including cyclostomes, and cartilaginous and teleost fishes. The diverse strategies for responding to changes in salinity have led to differential regulation and tissue-specific effects of hormones. Combining traditional physiological approaches with genomic, transcriptomic, and proteomic analyses will elucidate the patterns and diversity of the endocrine control of euryhalinity.

  10. Starting physiology: bioelectrogenesis.

    Baptista, Vander


    From a Cartesian perspective of rational analysis, the electric potential difference across the cell membrane is one of the fundamental concepts for the study of physiology. Unfortunately, undergraduate students often struggle to understand the genesis of this energy gradient, which makes the teaching activity a hard task for the instructor. The topic of bioelectrogenesis encompasses multidisciplinary concepts, involves several mechanisms, and is a dynamic process, i.e., it never turns off during the lifetime of the cell. Therefore, to improve the transmission and acquisition of knowledge in this field, I present an alternative didactic model. The design of the model assumes that it is possible to build, in a series of sequential steps, an assembly of proteins within the membrane of an isolated cell in a simulated electrophysiology experiment. Initially, no proteins are inserted in the membrane and the cell is at a baseline energy state; the extracellular and intracellular fluids are at thermodynamic equilibrium. Students are guided through a sequence of four steps that add key membrane transport proteins to the model cell. The model is simple at the start and becomes progressively more complex, finally producing transmembrane chemical and electrical gradients. I believe that this didactic approach helps instructors with a more efficient tool for the teaching of the mechanisms of resting membrane potential while helping students avoid common difficulties that may be encountered when learning this topic.


    Geoff Pollard


    Full Text Available In this paper a family of scoring systems for tennis doubles for testing the hypothesis that pair A is better than pair B versus the alternative hypothesis that pair B is better than A, is established. This family or benchmark of scoring systems can be used as a benchmark against which the efficiency of any doubles scoring system can be assessed. Thus, the formula for the efficiency of any doubles scoring system is derived. As in tennis singles, one scoring system based on the play-the-loser structure is shown to be more efficient than the benchmark systems. An expression for the relative efficiency of two doubles scoring systems is derived. Thus, the relative efficiency of the various scoring systems presently used in doubles can be assessed. The methods of this paper can be extended to a match between two teams of 2, 4, 8, …doubles pairs, so that it is possible to establish a measure for the relative efficiency of the various systems used for tennis contests between teams of players.

  12. Social-physiological compliance as a determinant of team performance.

    Henning, R A; Boucsein, W; Gil, M C


    A cybernetic model of behavior predicts that team performance may depend on physiological compliance among participants. This laboratory study tested if compliance in electrodermal activity (EDA), heart rate or breathing in two-person teams (N=16) was predictive of team performance or coordination in a continuous tracking task simulating teleoperation. Visual contact among participants was manipulated. Physiological compliance was scored with weighted coherence and cross correlation. Separate multiple regression analyses revealed that the task completion time was predicted by coherence measures for EDA and heart, but only at a trend level for breathing. Task completion time was also predicted by heart cross correlation. Team tracking error was predicted by coherence measures for EDA, heart and breathing, and also heart cross correlation. While social-visual contact did not have an impact, physiological compliance was predictive of improved performance, with coherence robust over all three physiological measures. Heart cross correlation showed the strongest predictive relationships. These results provide evidence that physiological compliance among team members may benefit team performance. While further study is needed, physiological compliance may someday provide a needed tool for the study of team work, and an objective means to guide the ergonomic design of complex sociotechnical systems requiring a high degree of team proficiency.

  13. Functional neural correlates of reduced physiological falls risk

    Hsu Chun


    Full Text Available Abstract Background It is currently unclear whether the function of brain regions associated with executive cognitive processing are independently associated with reduced physiological falls risk. If these are related, it would suggest that the development of interventions targeted at improving executive neurocognitive function would be an effective new approach for reducing physiological falls risk in seniors. Methods We performed a secondary analysis of 73 community-dwelling senior women aged 65 to 75 years old who participated in a 12-month randomized controlled trial of resistance training. Functional MRI data were acquired while participants performed a modified Eriksen Flanker Task - a task of selective attention and conflict resolution. Brain volumes were obtained using MRI. Falls risk was assessed using the Physiological Profile Assessment (PPA. Results After accounting for baseline age, experimental group, baseline PPA score, and total baseline white matter brain volume, baseline activation in the left frontal orbital cortex extending towards the insula was negatively associated with reduced physiological falls risk over the 12-month period. In contrast, baseline activation in the paracingulate gyrus extending towards the anterior cingulate gyrus was positively associated with reduced physiological falls risk. Conclusions Baseline activation levels of brain regions underlying response inhibition and selective attention were independently associated with reduced physiological falls risk. This suggests that falls prevention strategies may be facilitated by incorporating intervention components - such as aerobic exercise - that are specifically designed to induce neurocognitive plasticity. Trial Registration Identifier: NCT00426881

  14. Using situational physiology in a didactic lecture setting.

    Richardson, D


    This project used the approach of "human situations" to teach about the cardiovascular system within an undergraduate physiology course (PGY 412). About two-thirds of the students had previously taken a college-level physiology course (sophisticated), whereas one-third had not (naive). Nine didactic lectures were organized around the common human situations of orthostasis, blood donation, and exercise. For acceptance evaluation, the students were given a questionnaire consisting of six expectation statements (e.g., compared with other life science courses, I expect that I will better understand the material) and asked to rate the degree to which they agreed with each statement on a scale of 1 to 5. On completion of the lectures, the students were given a questionnaire asking them to compare experiences with expectations. Experiences were significantly less than expectations for naive (P didactic lectures. There were no significant differences between present and previous scores (77 vs. 79%; P > 0.16). Furthermore, there were no significant differences between naive and sophisticated students in cardiovascular examination scores (P > 0.608) or in total course scores (P > 0.523). These results indicate that didactic lectures based on situational physiology will yield a performance outcome equivalent to traditional lectures. However, naive students may have difficulty with the procedure and require extra attention.

  15. Kernel score statistic for dependent data.

    Malzahn, Dörthe; Friedrichs, Stefanie; Rosenberger, Albert; Bickeböller, Heike


    The kernel score statistic is a global covariance component test over a set of genetic markers. It provides a flexible modeling framework and does not collapse marker information. We generalize the kernel score statistic to allow for familial dependencies and to adjust for random confounder effects. With this extension, we adjust our analysis of real and simulated baseline systolic blood pressure for polygenic familial background. We find that the kernel score test gains appreciably in power through the use of sequencing compared to tag-single-nucleotide polymorphisms for very rare single nucleotide polymorphisms with <1% minor allele frequency.

  16. Comparison of contemporary risk scores for predicting outcomes after surgery for active infective endocarditis.

    Wang, Tom Kai Ming; Oh, Timothy; Voss, Jamie; Gamble, Greg; Kang, Nicholas; Pemberton, James


    Decision making regarding surgery for acute bacterial endocarditis is complex given its heterogeneity and often fatal course. Few studies have investigated the utility of operative risk scores in this setting. Endocarditis-specific scores have recently been developed. We assessed the prognostic utility of contemporary risk scores for mortality and morbidity after endocarditis surgery. Additive and logistic EuroSCORE I, EuroSCORE II, additive Society of Thoracic Surgeon's (STS) Endocarditis Score and additive De Feo-Cotrufo Score were retrospectively calculated for patients undergoing surgery for endocarditis during 2005-2011. Pre-specified primary outcomes were operative mortality, composite morbidity and mortality during follow-up. A total of 146 patients were included with an operative mortality of 6.8 % followed for 4.1 ± 2.4 years. Mean scores were additive EuroSCORE I: 8.0 ± 2.5, logistic EuroSCORE I: 13.2 ± 10.1 %, EuroSCORE II: 9.1 % ± 9.4 %, STS Score: 32.2 ± 13.5 and De Feo-Cotrufo Score: 14.6 ± 9.2. Corresponding areas under curve (AUC) for operative mortality 0.653, 0.645, 0.656, 0.699 and 0.744; for composite morbidity were 0.623, 0.625, 0.720, 0.714 and 0.774; and long-term mortality 0.588, 0.579, 0.686, 0.735 and 0.751. The best tool for post-operative stroke was EuroSCORE II: AUC 0.837; for ventilation >24 h and return to theatre the De Feo-Cotrufo Scores were: AUC 0.821 and 0.712. Pre-operative inotrope or intra-aortic balloon pump treatment, previous coronary bypass grafting and dialysis were independent predictors of operative and long-term mortality. In conclusion, risk models developed specifically from endocarditis surgeries and incorporating endocarditis variables have improved prognostic ability of outcomes, and can play an important role in the decision making towards surgery for endocarditis.

  17. Predictive values of D-dimer assay, GRACE scores and TIMI scores for adverse outcome in patients with non-ST-segment elevation myocardial infarction

    Satilmisoglu, Muhammet Hulusi; Ozyilmaz, Sinem Ozbay; Gul, Mehmet; Ak Yildirim, Hayriye; Kayapinar, Osman; Gokturk, Kadir; Aksu, Huseyin; Erkanli, Korhan; Eksik, Abdurrahman


    Purpose To determine the predictive values of D-dimer assay, Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) risk scores for adverse outcome in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Patients and methods A total of 234 patients (mean age: 57.2±11.7 years, 75.2% were males) hospitalized with NSTEMI were included. Data on D-dimer assay, GRACE and TIMI risk scores were recorded. Logistic regression analysis was conducted to determine the risk factors predicting increased mortality. Results Median D-dimer levels were 349.5 (48.0–7,210.0) ng/mL, the average TIMI score was 3.2±1.2 and the GRACE score was 90.4±27.6 with high GRACE scores (>118) in 17.5% of patients. The GRACE score was correlated positively with both the D-dimer assay (r=0.215, P=0.01) and TIMI scores (r=0.504, P=0.000). Multivariate logistic regression analysis revealed that higher creatinine levels (odds ratio =18.465, 95% confidence interval: 1.059–322.084, P=0.046) constituted the only significant predictor of increased mortality risk with no predictive values for age, D-dimer assay, ejection fraction, glucose, hemoglobin A1c, sodium, albumin or total cholesterol levels for mortality. Conclusion Serum creatinine levels constituted the sole independent determinant of mortality risk, with no significant values for D-dimer assay, GRACE or TIMI scores for predicting the risk of mortality in NSTEMI patients.

  18. Acute MRI Changes in Progressive Ischemic Stroke

    Kalowska, Elizabeth; Rostrup, Egill; Rosenbaum, S


    aimed to assess if acute MRI findings could be used for the prediction of stroke in progression (SIP). Methods: Prospectively 41 patients, 13 with lacunar infarcts and 28 with territorial infarcts, were admitted to an acute stroke unit within 24 h of stroke onset (median 11 h, range 3- 22). Diffusion...... the modified Rankin Scale, Barthel Index and SSS score. Patients with and without SIP were compared using both clinical and MRI data obtained on admission, on day 7 and after 3 months. Results: Fifteen patients (37%) developed SIP. Increased DWI lesion volume on day 7 in all strokes was associated with SIP...

  19. Acute MRI changes in progressive ischemic stroke

    Kalowska, E.; Rostrup, E.; Rosenbaum, S.


    aimed to assess if acute MRI findings could be used for the prediction of stroke in progression (SIP). METHODS: Prospectively 41 patients, 13 with lacunar infarcts and 28 with territorial infarcts, were admitted to an acute stroke unit within 24 h of stroke onset (median 11 h, range 3- 22). Diffusion...... the modified Rankin Scale, Barthel Index and SSS score. Patients with and without SIP were compared using both clinical and MRI data obtained on admission, on day 7 and after 3 months. RESULTS: Fifteen patients (37%) developed SIP. Increased DWI lesion volume on day 7 in all strokes was associated with SIP...

  20. Causality in physiological signals.

    Müller, Andreas; Kraemer, Jan F; Penzel, Thomas; Bonnemeier, Hendrik; Kurths, Jürgen; Wessel, Niels


    Health is one of the most important non-material assets and thus also has an enormous influence on material values, since treating and preventing diseases is expensive. The number one cause of death worldwide today originates in cardiovascular diseases. For these reasons the aim of understanding the functions and the interactions of the cardiovascular system is and has been a major research topic throughout various disciplines for more than a hundred years. The purpose of most of today's research is to get as much information as possible with the lowest possible effort and the least discomfort for the subject or patient, e.g. via non-invasive measurements. A family of tools whose importance has been growing during the last years is known under the headline of coupling measures. The rationale for this kind of analysis is to identify the structure of interactions in a system of multiple components. Important information lies for example in the coupling direction, the coupling strength, and occurring time lags. In this work, we will, after a brief general introduction covering the development of cardiovascular time series analysis, introduce, explain and review some of the most important coupling measures and classify them according to their origin and capabilities in the light of physiological analyses. We will begin with classical correlation measures, go via Granger-causality-based tools, entropy-based techniques (e.g. momentary information transfer), nonlinear prediction measures (e.g. mutual prediction) to symbolic dynamics (e.g. symbolic coupling traces). All these methods have contributed important insights into physiological interactions like cardiorespiratory coupling, neuro-cardio-coupling and many more. Furthermore, we will cover tools to detect and analyze synchronization and coordination (e.g. synchrogram and coordigram). As a last point we will address time dependent couplings as identified using a recent approach employing ensembles of time series. The

  1. Acute Myopericarditis Mimicking Acute Myocardial Infarction

    Seval İzdeş


    Full Text Available Acute coronary syndromes among young adults are relatively low when compared with older population in the intensive care unit. Electrocardiographic abnormalities mimicking acute coronary syndromes may be caused by non-coronary syndromes and the differential diagnosis requires a detailed evaluation. We are reporting a case of myopericarditis presenting with acute ST elevation and elevated cardiac enzymes simulating acute coronary syndrome. In this case report, the literature is reviewed to discuss the approach to distinguish an acute coronary syndrome from myopericarditis. (Journal of the Turkish Society Intensive Care 2011; 9:68-70

  2. Assessing prebaccalaureate human physiology courses.

    McCleary, V L


    Two surveys were conducted between 1994 and 1996. The purpose of the initial survey was to obtain demographic information about prebaccaulareate human physiology courses. Of the 117 responding physiology departments, 50% offered human physiology at the prebaccalaureate level to 14,185 students during the 1994-1995 academic year. The mean was 245 students per year (+/- 30 SE). Class size was limited by 44% of the respondents. Prebaccaluareate human physiology was offered as a separate course from anatomy by 93% of the departments. Sixty-one percent scheduled the course once a year. The purpose of the second survey was to determine how physiology departments evaluated prebaccalaureate physiology courses and faculty. All responding departments utilized student feedback; 38% of the departments included physiology chair review, 38% peer review, and 9% allied health faculty review. Twenty-eight percent of allied health programs evaluated the course. Results indicated that, whereas a significant number of undergraduate students are enrolled in prebaccaluareate physiology courses annually, those courses appear to lack formal, consistent formative evaluation.

  3. Risk assessment and risk scores in the management of aortic aneurysms.

    Von Meijenfeldt, Gerdine C I; Van Der Laan, Maarten J; Zeebregts, Clark J; Balm, Ron; Verhagen, Hence J M


    The decision whether to operate a patient or not can be challenging for a clinician for both ruptured abdominal aortic aneurysms (AAAs) as well as elective AAAs. Prior to surgical intervention it would be preferable that the clinician exactly knows which clinical variables lower or increase the chances of morbidity and mortality postintervention. To help in the preoperative counselling and shared decision making several clinical variables can be identified as risk factors and with these, risk models can be developed. An ideal risk score for aneurysm repair includes routinely obtained physiological and anatomical variables, has excellent discrimination and calibration, and is validated in different geographical areas. For elective AAA repair, several risk scores are available, for ruptured AAA treatment, these scores are far less well developed. In this manuscript, we describe the designs and results of published risk scores for elective and open repair. Also, suggestions for uniformly reporting of risk factors and their statistical analyses are described. Furthermore, the preliminary results of a new risk model for ruptured aortic aneurysm will be discussed. This score identifies age, hemoglobin, cardiopulmonary resuscitation and preoperative systolic blood pressure as risk factors after multivariate regression analysis. This new risk score can help to identify patients that would not benefit from repair, but it can also potentially identify patients who would benefit and therefore lower turndown rates. The challenge for further research is to expand on validation of already existing promising risk scores in order to come to a risk model with optimal discrimination and calibration.

  4. Applied physiology of cycling.

    Faria, I E


    Historically, the bicycle has evolved through the stages of a machine for efficient human transportation, a toy for children, a finely-tuned racing machine, and a tool for physical fitness development, maintenance and testing. Recently, major strides have been made in the aerodynamic design of the bicycle. These innovations have resulted in new land speed records for human powered machines. Performance in cycling is affected by a variety of factors, including aerobic and anaerobic capacity, muscular strength and endurance, and body composition. Bicycle races range from a 200m sprint to approximately 5000km. This vast range of competitive racing requires special attention to the principle of specificity of training. The physiological demands of cycling have been examined through the use of bicycle ergometers, rollers, cycling trainers, treadmill cycling, high speed photography, computer graphics, strain gauges, electromyography, wind tunnels, muscle biopsy, and body composition analysis. These techniques have been useful in providing definitive data for the development of a work/performance profile of the cyclist. Research evidence strongly suggests that when measuring the cyclist's aerobic or anaerobic capacity, a cycling protocol employing a high pedalling rpm should be used. The research bicycle should be modified to resemble a racing bicycle and the cyclist should wear cycling shoes. Prolonged cycling requires special nutritional considerations. Ingestion of carbohydrates, in solid form and carefully timed, influences performance. Caffeine appears to enhance lipid metabolism. Injuries, particularly knee problems which are prevalent among cyclists, may be avoided through the use of proper gearing and orthotics. Air pollution has been shown to impair physical performance. When pollution levels are high, training should be altered or curtailed. Effective training programmes simulate competitive conditions. Short and long interval training, blended with long

  5. GMAT Scores of Undergraduate Economics Majors

    Nelson, Paul A.; Monson, Terry D.


    The average score of economics majors on the Graduate Management Admission Test (GMAT) exceeds those of nearly all humanities and arts, social sciences, and business undergraduate majors but not those of most science, engineering, and mathematics majors. (Contains 1 table.)

  6. Film scoring today - Theory, practice and analysis

    Flach, Paula Sophie


    This thesis considers film scoring by taking a closer look at the theoretical discourse throughout the last decades, examining current production practice of film music and showcasing a musical analysis of the film Inception (2010).

  7. Multifactor Screener in OPEN: Scoring Procedures & Results

    Scoring procedures were developed to convert a respondent's screener responses to estimates of individual dietary intake for percentage energy from fat, grams of fiber, and servings of fruits and vegetables.

  8. Metabolic Acidosis and Strong Ion Gap in Critically Ill Patients with Acute Kidney Injury

    Cai-Mei Zheng


    Full Text Available Purpose. To determine the influence of physicochemical parameters on survival in metabolic acidosis (MA and acute kidney injury (AKI patients. Materials and Methods. Seventy-eight MA patients were collected and assigned to AKI or non-AKI group. We analyzed the physiochemical parameters on survival at 24 h, 72 h, 1 week, 1 month, and 3 months after AKI. Results. Mortality rate was higher in the AKI group. AKI group had higher anion gap (AG, strong ion gap (SIG, and apparent strong ion difference (SIDa values than non-AKI group. SIG value was higher in the AKI survivors than nonsurvivors and this value was correlated serum creatinine, phosphate, albumin, and chloride levels. SIG and serum albumin are negatively correlated with Acute Physiology and Chronic Health Evaluation IV scores. AG was associated with mortality at 1 and 3 months post-AKI, whereas SIG value was associated with mortality at 24 h, 72 h, 1 week, 1 month, and 3 months post-AKI. Conclusions. Whether high or low SIG values correlate with mortality in MA patients with AKI depends on its correlation with serum creatinine, chloride, albumin, and phosphate (P levels. AG predicts short-term mortality and SIG value predicts both short- and long-term mortality among MA patients with AKI.

  9. Use score card to boost quality.


    Keeping a score card can identify problem areas and track improvements. When specific goals are reached, staff are given rewards such as thank-you letters, tokens, or pizza parties. Staff are kept informed about the results of the score card through bulletin board postings, staff meetings, and the hospital Intranet. Data are collected with manual entry by nursing staff, chart review by performance improvement, and a computerized program.

  10. Cardiovascular risk score in Rheumatoid Arthritis

    Wagan, Abrar Ahmed; Mahmud, Tafazzul E Haque; Rasheed, Aflak; Zafar, Zafar Ali; Rehman, Ata ur; Ali, Amjad


    Objective: To determine the 10-year Cardiovascular risk score with QRISK-2 and Framingham risk calculators in Rheumatoid Arthritis and Non Rheumatoid Arthritis subjects and asses the usefulness of QRISK-2 and Framingham calculators in both groups. Methods: During the study 106 RA and 106 Non RA patients age and sex matched participants were enrolled from outpatient department. Demographic data and questions regarding other study parameters were noted. After 14 hours of fasting 5 ml of venous blood was drawn for Cholesterol and HDL levels, laboratory tests were performed on COBAS c III (ROCHE). QRISK-2 and Framingham risk calculators were used to get individual 10-year CVD risk score. Results: In this study the mean age of RA group was (45.1±9.5) for Non RA group (43.7±8.2), with female gender as common. The mean predicted 10-year score with QRISK-2 calculator in RA group (14.2±17.1%) and Non RA group was (13.2±19.0%) with (p-value 0.122). The 10-year score with Framingham risk score in RA group was (12.9±10.4%) and Non RA group was (8.9±8.7%) with (p-value 0.001). In RA group QRISK-2 (24.5%) and FRS (31.1%) cases with predicted score were in higher risk category. The maximum agreement scores between both calculators was observed in both groups (Kappa = 0.618 RA Group; Kappa = 0.671 Non RA Group). Conclusion: QRISK-2 calculator is more appropriate as it takes RA, ethnicity, CKD, and Atrial fibrillation as factors in risk assessment score. PMID:27375684

  11. Central respiratory failure during acute organophosphate poisoning.

    Carey, Jennifer L; Dunn, Courtney; Gaspari, Romolo J


    Organophosphate (OP) pesticide poisoning is a global health problem with over 250,000 deaths per year. OPs affect neuronal signaling through acetylcholine (Ach) neurotransmission via inhibition of acetylcholinesterase (AChE), leading to accumulation of Ach at the synaptic cleft and excessive stimulation at post-synaptic receptors. Mortality due to OP agents is attributed to respiratory dysfunction, including central apnea. Cholinergic circuits are integral to many aspects of the central control of respiration, however it is unclear which mechanisms predominate during acute OP intoxication. A more complete understanding of the cholinergic aspects of both respiratory control as well as neural modification of pulmonary function is needed to better understand OP-induced respiratory dysfunction. In this article, we review the physiologic mechanisms of acute OP exposure in the context of the known cholinergic contributions to the central control of respiration. We also discuss the potential central cholinergic contributions to the known peripheral physiologic effects of OP intoxication.

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