1,720,987 research outputs found
Improving resuscitation and Extracorporeal Membrane Oxygenation outcomes in critically ill pediatric cardiac patients: from big data, to bench, to bedside
Full text linkIntroduction: Despite an undeniable improvement in knowledge and care over time, resuscitation in cardiac patients remains one of the most relevant challenges for cardiologists and intensivists.
Objectives: We aimed to provide insight into resuscitation and outcomes of critically ill pediatric cardiac patients, exploring different knowledge opportunities - from big data, to bench, to bedside. We performed 6 individual projects, aiming to define, predict, and treat resuscitation events and ultimately improve the associated outcome.
Methods: We performed:
1. a systematic review and meta-analysis on the incidence, risk factors, and outcome of CA in pediatric cardiac critically ill patients;
2. a big data analysis to determine whether novel mathematically computed variables as shock index (SI), coronary perfusion pressure (CPP), and rate pressure product (RPP) may predict resuscitation events;
3. a retrospective analysis of ELSO Registry data on patients resuscitated with ECMO after failure to wean (FTW) from cardiopulmonary bypass (CPB);
4. a review of extracorporeal CPR (ECPR) events and their outcomes at our center (BCH), modeling prediction of severe functional impairment or death;
5. a propensity-weighted analysis to define the benefits of left atrial (LA) decompression in patients supported with ECMO;
6. a prospective Phase1 study for the safety evaluation of a new FDA-approved drug, the inhaled hydrogen (H2), which has shown potential in prevention/treatment of ischemia-reperfusion injury in animal models.
Results: We have shown:
1. Among 126,087 critically ill cardiac patients, 5% (CI 4-7%) experienced CA, and21% (CI 15-28%) underwent ECPR. Overall, 35% of patients (CI 27-44%) did not reach ROSC, and 54% died before discharge (CI 47-62%);
2. 7% (296/4,161) of patients who underwent cardiac surgery had CPR/ECPR, need for ECMO/VAD, unplanned surgery, heart transplant, or death within 7 postoperative days. In a multivariable regression model adjusted for age, surgical complexity, inotropic and respiratory support, and organ dysfunction, SI>1.83 was significantly associated with the adverse outcome (OR 6.6 [CI 4.4-10.0]), and CPP>35mmHg was protective against the outcome (OR 0.5 [0.4-0.7]);
3. 55% of the 2,322 patients who FTW from CPB died before discharge. Non-cardiac congenital anomalies, comorbidities, pre-operative CA, pre-operative mechanical ventilation>24h, pre-operative bicarbonate administration, longer CPB time, complex surgical procedures, longer ECMO duration, and ECMO complications were all independently associated with in-hospital mortality. Age>26 days (OR 0.56 [CI 0.42-0.75]) reduced the odds of mortality;
4. 52% of the 182 patients who underwent ECPR at BCH died before discharge. The median Functional Status Scale (FSS) among survivors was 8 (IQR 6-8), and only one survivor had severe functional impairment. Predictive models identified FSS at admission, single ventricle physiology, ECMO duration, mean PELOD-2, and worst mASPECTS as independent predictors of severe functional outcome at discharge (AUC=0.931) and at 6 months (AUC=0.924);
5. 18% of the 1,508 cardiac patients with biventricular physiology supported with ECMO underwent LA decompression (LA+). Covariates were well-balanced after propensity-weighting. In-hospital adverse outcome rate was 47% in LA+ vs 51% in LA-. Propensity-weighted multivariable logistic regression showed LA decompression to be protective for in-hospital adverse outcome (OR 0.77 [CI 0.64-0.93]);
6. H2 inhalation is safe in adult healthy volunteers, with no significant adverse events. This lays the foundation of a future trial for the use of H2 for the prevention/treatment of ischemia-reperfusion injury.
Conclusion: We have provided new insight into resuscitation and outcomes of critically ill cardiac patients, from big data, to bench, to bedside. Future steps will include a randomized trial on the use of H2 to improve neurologic outcomes in cardiac ECPR patients.Introduction: Despite an undeniable improvement in knowledge and care over time, resuscitation in cardiac patients remains one of the most relevant challenges for cardiologists and intensivists.
Objectives: We aimed to provide insight into resuscitation and outcomes of critically ill pediatric cardiac patients, exploring different knowledge opportunities - from big data, to bench, to bedside. We performed 6 individual projects, aiming to define, predict, and treat resuscitation events and ultimately improve the associated outcome.
Methods: We performed:
1. a systematic review and meta-analysis on the incidence, risk factors, and outcome of CA in pediatric cardiac critically ill patients;
2. a big data analysis to determine whether novel mathematically computed variables as shock index (SI), coronary perfusion pressure (CPP), and rate pressure product (RPP) may predict resuscitation events;
3. a retrospective analysis of ELSO Registry data on patients resuscitated with ECMO after failure to wean (FTW) from cardiopulmonary bypass (CPB);
4. a review of extracorporeal CPR (ECPR) events and their outcomes at our center (BCH), modeling prediction of severe functional impairment or death;
5. a propensity-weighted analysis to define the benefits of left atrial (LA) decompression in patients supported with ECMO;
6. a prospective Phase1 study for the safety evaluation of a new FDA-approved drug, the inhaled hydrogen (H2), which has shown potential in prevention/treatment of ischemia-reperfusion injury in animal models.
Results: We have shown:
1. Among 126,087 critically ill cardiac patients, 5% (CI 4-7%) experienced CA, and21% (CI 15-28%) underwent ECPR. Overall, 35% of patients (CI 27-44%) did not reach ROSC, and 54% died before discharge (CI 47-62%);
2. 7% (296/4,161) of patients who underwent cardiac surgery had CPR/ECPR, need for ECMO/VAD, unplanned surgery, heart transplant, or death within 7 postoperative days. In a multivariable regression model adjusted for age, surgical complexity, inotropic and respiratory support, and organ dysfunction, SI>1.83 was significantly associated with the adverse outcome (OR 6.6 [CI 4.4-10.0]), and CPP>35mmHg was protective against the outcome (OR 0.5 [0.4-0.7]);
3. 55% of the 2,322 patients who FTW from CPB died before discharge. Non-cardiac congenital anomalies, comorbidities, pre-operative CA, pre-operative mechanical ventilation>24h, pre-operative bicarbonate administration, longer CPB time, complex surgical procedures, longer ECMO duration, and ECMO complications were all independently associated with in-hospital mortality. Age>26 days (OR 0.56 [CI 0.42-0.75]) reduced the odds of mortality;
4. 52% of the 182 patients who underwent ECPR at BCH died before discharge. The median Functional Status Scale (FSS) among survivors was 8 (IQR 6-8), and only one survivor had severe functional impairment. Predictive models identified FSS at admission, single ventricle physiology, ECMO duration, mean PELOD-2, and worst mASPECTS as independent predictors of severe functional outcome at discharge (AUC=0.931) and at 6 months (AUC=0.924);
5. 18% of the 1,508 cardiac patients with biventricular physiology supported with ECMO underwent LA decompression (LA+). Covariates were well-balanced after propensity-weighting. In-hospital adverse outcome rate was 47% in LA+ vs 51% in LA-. Propensity-weighted multivariable logistic regression showed LA decompression to be protective for in-hospital adverse outcome (OR 0.77 [CI 0.64-0.93]);
6. H2 inhalation is safe in adult healthy volunteers, with no significant adverse events. This lays the foundation of a future trial for the use of H2 for the prevention/treatment of ischemia-reperfusion injury.
Conclusion: We have provided new insight into resuscitation and outcomes of critically ill cardiac patients, from big data, to bench, to bedside. Future steps will include a randomized trial on the use of H2 to improve neurologic outcomes in cardiac ECPR patients
Scleroderma in children: An update
No full textPURPOSE OF REVIEW: Scleroderma, in its localized and systemic presentation,
represents the third most frequent rheumatic condition in childhood after
juvenile idiopathic arthritis and systemic lupus erythematosus. Early diagnosis,
appropriate assessment and effective treatment are crucial to improve the
long-term outcome.
RECENT FINDINGS: Recent studies, concerning histopathology and clinical
associations with other conditions, open new horizons on the etiopathogenesis of
scleroderma. New developments have been also reached in the field of outcome
measures. In juvenile localized scleroderma (JLS), new techniques such as Doppler
and laser Doppler imaging have shown their usefulness for the daily monitoring of
the patients. In juvenile systemic sclerosis (JSSc), a new severity score has
been developed and needs to be validated in future trials. Finally, a randomized,
double-blind controlled trial, a multicenter consensus statement and long-term
follow-up studies have confirmed the important role of methotrexate (MTX) for the
treatment of JLS.
SUMMARY: Studies over recent years highlighted the role of imaging as outcome
measures for JLS and introduced a severity score for JSSc. New studies on MTX
confirmed its important role for the treatment of JLS
Prevalence of antinuclear antibodies in schoolchildren during puberty and possible relationship with musculoskeletal pain: A longitudinal study
No full text
Musculoskeletal pain in schoolchildren across puberty: A 3-year follow-up study
Full text linkBACKGROUND: Chronic Musculoskeletal Pain (MSP) in children can be due to
non-inflammatory conditions, such as the benign joint hypermobility syndrome
(BJHS) or idiopathic MSP (IMSP). Aim of the study was to evaluate type and
persistence of MSP in a cohort of schoolchildren with MSP followed for 3 years,
in order to identify the main risk factors.
METHODS: Healthy schoolchildren, aged 8-13 years, underwent a general and
rheumatologic examination, focusing on presence of chronic MSP, defined as
continuous or recurrent pain lasting more than 3 months and heavily interfering
with daily life activities, presence of generalized joint hypermobility, the body
mass index and the pubertal stage. All symptomatic subjects were re-evaluated 3
years later with the same methods.
RESULTS: Seventy of the 88 symptomatic subjects of the initial cohort of 289 were
re-evaluated 3 years later. Of these, 38 (54.3 %) still presented MSP, including
19 with BJHS and 19 with IMSP. Main symptoms were lower limbs arthralgia and
myalgia. MSP persisted more in females than in males (p = 0.038) and in pubertal
rather than pre-pubertal subjects (p = 0.022); these subjects recovered
significantly more both from BJHS (p = 0.004) and IMSP (p = 0.016). Gender did
not influence the distribution of MSP according to pubertal stage.
CONCLUSIONS: Female gender, BJHS and pubertal stage are important risk factors
for persistence of MSP. Further studies are needed to evaluate the natural
history of MSP towards adulthood and the role of the pubertal age
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Joint hypermobility, growing pain and obesity are mutually exclusive as causes of musculoskeletal pain in schoolchildren
No full textObjective: Chronic musculoskeletal pain (MSP) is common in children and can be due to several non-inflammatory conditions such as the benign joint hypermobility syndrome (BJHS), and growing pains (GP). We evaluated frequency, risk factors and causes of MSP in a large cohort of healthy schoolchildren. Methods: We conducted a cross sectional study in a cohort of healthy schoolchildren, aged 8-13 years, by collecting information and performing a physical examination. The anamnesis was focused on family history for MSP, presence and sites of MSP interfering with the regular daily activities during the previous 6 months and presence of GP. Physical examination included body mass index, pubertal stage and musculoskeletal examination focused on the presence of hypermobility according to the Beighton criteria. Results: Two hundred and eighty-nine schoolchildren, 143 females and 146 males, participated in the study. Chronic MSP occurred in 30.4% of subjects, BJHS occurred in 13.2%. GJH was more frequent in symptomatic subjects than in asymptomatic ones (p=0.054). Symptomatic subjects were more frequently pre-pubertal than pubertal (p=0.006). In general, GP, BJHS and obesity (OB) were mutually exclusive as causes of MSP as, among 88 symptomatic subjects, 52.3% had GP, 40.9% presented BJHS, 4.5% were OB and only two (2.3%) presented both BJHS and OB. After puberty, GP persisted in 66.7%, BJHS in 26.7% and in association with OB in 6.7%. Conclusion: Approximately one third of schoolchildren suffer from MSP. BJHS, GP and OB are mutually exclusive as causes of MSP in schoolchildren. Pubertal stage plays an important role in the physiopathology of this condition
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