Purpose
The aim of this study was to evaluate a sample of patients who sustained hip fractures during the years 1997–2011 and identify risk factors for a subsequent contralateral hip fracture; ...one-year mortality rates were compared in both groups.
Methods
A total of 5,102 patients with hip fractures were prospectively studied to identify patients who had also suffered a subsequent, contralateral, hip fracture (SCHF). Those patients who had sustained a second fracture within 18 months of the initial fracture were then studied. All data were statistically processed.
Results
Within 18 months of the first fracture, a SCHF occurred in 105 patients (2.1 %). These patients were an average of three years older than those in the single fracture group. Risk factors for the development of a SCHF included: female gender, residing in a residential care facility, and limited mobility prior to injury. Trochanteric fractures did not represent a statistically significant risk factor for SCHF. More than three-quarters of patients with subsequent injuries suffered the same type of fractures on the opposite side. Patients with subsequent fractures had lower one-year mortality rates than patients with only one fracture.
Conclusion
Patients at greatest risk for a SCHF were women with limited mobility who resided in nursing homes for the elderly. The lower mortality rate associated with second fractures shows that the prognosis for such patients is good. Since the at-risk group is so well defined, prophylactic measures for these patients should be utilized in order to minimize the risk of additional fractures.
Abstract Background Xe-Derma® is a new dry sterile biological cover derived from acellular pig dermis. Hydrated Xe-Derma® displays bio-mechanical features similar to the normal skin. The aim of the ...present study was to compare the efficacy of Xe-Derma® with hydrocolloid dressing Askina THINSite® for treatment of superficial burns in children in a prospective study. Materials and methods In a prospective study, 86 patients (5 months to 7 years of age) with superficial scald burns on a surface area of 1–35% BSA were enrolled. In the course of the study, 43 patients were treated with Xe-Derma® and 43 patients with Askina THINSite® . We collected data including the percentage of BSA covered with biological or synthetic material, epithelization time, the number of complete conversions (deepening of 100% of covered area into deep dermal wound) under each cover, the number and extent of partial conversions (deepening of less then 100% of covered area into deep dermal wound), infectious complications, the number of reapplications of the temporary cover and the extent in square centimetres of dressing material needed for successful healing of 1% BSA. Results No significant difference in the epithelization time, percentage of conversion from superficial to deep dermal burns and percentage of infectious complication was detected between the two groups. However, patients in the Xe-Derma® group were burned on a more extensive burn surface area ( p ≤ 0.028). Xe-Derma® showed adherence to the wound and therefore there has been no need to be changed The number of reapplications and therefore also the number of square centimetres needed for successful healing of 1% BSA were statistically higher in the Askina THINSite® group ( p < 0.01) due to increased secretion and accumulation of fluid underneath this hydrocoloid cover. The minimal frequency of changes of this biological cover material brings a significant benefit to pediatric patients. Conclusion Acellular pig dermis Xe-Derma® represents a reliable biological cover material. It is an advantageous alternative to synthetic temporary skin covers in the treatment of superficial scald burns in children.
Intraoperative use of the intraluminal shunt may reduce the risk of a stroke by reducing cerebral blood flow compromise, but it may also increase the risk of atherosclerotic arterial wall damage with ...subsequent stroke during carotid endarterectomy (CEA). There is still no evidence to support routine or selective shunting.
A total of 754 CEAs were performed in a prospective study from 2005 to 2011 at our department. All procedures were done under regional anesthesia with selective carotid artery shunting according to neurologic status after internal carotid artery clamping. Magnetic resonance (MR) evaluation of brain parenchyma using diffusion-weighed imaging (DWI) sequence was performed upon hospital admission and 24 hours after the surgical procedure. Acute new MR DWI lesions were evaluated according to the classification published by Szabo et al. A routine neurologic evaluation was recorded as well.
The intraluminal shunt was used in 46 of 754 patients (6.1%). A new ischemic lesion was detected in 45 patients (6%). Most of these lesions were neurologically asymptomatic (80%). A new lesion on MR DWI in the subgroup of shunted patients was detected in 15 cases (32.6%) and in the subgroup of nonshunted patients in 30 cases (4.2%). Most of these lesions were due to embolization or hypoperfusion during shunt insertion.
Use of the intraluminal shunt was the most important risk factor for the new MR DWI lesion in the entire group of CEAs. Results support the strategy of a selective use of intraluminal shunts.
OBJECTIVES:To estimate the efficacy and metabolic effects of growth hormone substitution as intravenous pulses together with alanyl-glutamine supplementation and tight blood glucose control in ...prolonged critical illness.
DESIGN:Prospective double-blind, randomized trial with open-label control arm.
SETTING:Intensive care unit of tertiary level hospital.
PATIENTS:Thirty multiple trauma patients (median Injury Severity Score 34).
INTERVENTIONS:Patients were randomized, at day 4 after trauma, to receive intravenous alanyl-glutamine supplementation (0.3 g/kg·day from day 4 until day 17) and intravenous growth hormone (administered days 7–17, full dose 50 μg/kg·day from day 10 onward) (group 1, n = 10) or alanyl-glutamine and placebo (group 2, n = 10). Group 3 (n = 10) received isocaloric isonitrogenous nutrition (proteins 1.5 g/kg·day) without alanyl-glutamine.
MEASUREMENTS AND MAIN RESULTS:Cumulative nitrogen balance for the whole study period was −97 ± 38 g of nitrogen for group 1, −193 ± 50 g of nitrogen for group 2, and −198 ± 77 g of nitrogen for group 3 (p < .001). This represents a daily saving of 300 g of lean body mass in group 1. Insulin-mediated glucose disposal, during euglycemic clamp, as a measure of insulin sensitivity, significantly worsened between days 4 and 17 in group 1 but improved in groups 2 and 3. Group 1 required significantly more insulin to control blood glucose, resulting in higher insulinemia (∼70 mIU in group 1 vs. ∼25 mIU in groups 2 and 3). Despite this, growth hormone treatment caused an increase in plasma nonesterified fatty acid (∼0.5–0.6 mM in group 1 in comparison with ∼0.2–0.3 mM in groups 2 and 3) but did not influence lipid oxidation. There were no differences in morbidity, mortality, or 6-month outcome among the groups.
CONCLUSIONS:Treatment with frequent intravenous pulses of low-dose growth hormone together with alanyl-glutamine supplementation improves nitrogen economy in patients with prolonged critical illness after multiple trauma but worsens insulin sensitivity. Tight blood glucose control is possible but requires higher doses of insulin.
Introduction
The oral part of European Diploma in Intensive Care diploma examinations changed in 2013 into an objective structured clinical examination-type exam. This step was undertaken to provide ...a fair and reproducible clinical exam. All candidates face identical questions with predefined correct answers simultaneously in seven high throughput exam centres on the same day. We describe the factors that are associated with success in part 2 European Diploma in Intensive Care exam.
Methods
We prospectively collected self-reported data from all candidates sitting European Diploma in Intensive Care part 2 in 2015, namely demographics, professional background and attendance to a European Diploma in Intensive Care part 2 or generic objective structured clinical examination preparatory courses. After testing association with success (with cutoff at p < 0.10) and co-linearity of these factors as independent variables, we performed a multivariate logistical analysis, with binary exam outcome (pass/fail) as the dependent variable. Structural equation modelling was used to gain further insight into relations among determinants of success in the oral part of the European Diploma in Intensive Care.
Results
Out of 427 candidates sitting the exam, completed data from 341 (80%) were available for analysis. The following candidates' factors were associated with increased chance of success: English as native language (odds ratio 4.3 (95% CI 1.7–10.7)), use of Patient-centred Acute Care Training e-learning programme module (odds ratios 2.0 (1.2–3.3)), working in an EU country (odds ratios 2.5 (1.5–4.3)), and better results in the written part of the European Diploma in Intensive Care (for each additional SD of 6.1 points odds ratios 1.9 (1.4–2.4)). Chance of success in the European Diploma in Intensive Care 2 decreased with increased candidates ‘age (for each additional SD of 5.5 years odds ratios 0.67 (0.51–0.87)). Exam centres (7 in total) could be clustered into 3 groups with similar success rates. There were significant differences in exam outcomes among these 3 groups of exam centres even after adjustment to known candidates' factors (G1 vs G2 odds ratios 2.4 (1.4–4.1); G1 vs G3 odds ratios 9.7 (4.0–23.1) and G2 vs G3 odds ratios 3.9 (1.7–9.2)). A short data collection period (only one year) and 20% of missing candidates' data are the main limitations of this study.
Conclusions
Younger age, English as native language, better results in written part of the exam, working at a European country and the use of PACT for preparation, were factors associated with success in the oral part of the European Diploma in Intensive Care exam. Despite the limitations of this study, the differences in outcome among the exam centres will need further investigation.
We studied the influence of acute renal failure (ARF) on the relationship between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and hemodynamic parameters.
The echocardiographic parameters ...and NT-proBNP levels were compared between 26 mechanically ventilated patients with ARF requiring continuous hemodiafiltration and 44 control patients.
The relationships between NT-proBNP and left ventricular ejection fraction (p = 0.001), left ventricular end-diastolic volume (p = 0.03), tricuspid annular plane systolic excursion (p = 0.008), and pulmonary artery pressure (p = 0.01) were found only in the control group. The median and interquartile range of NT-proBNP (1,717.5, 389.5-4,138 ng/l) were significantly higher (p < 0.001) in the low diuresis subgroup than the levels (748.8, 384.2-2,217 ng/l) in the subgroup where daily diuresis increased and both had significantly higher levels than controls (350.7, 130.2-661.2 ng/l, p < 0.001).
The high levels of NT-proBNP >1,000 ng/l seem to be typical, particularly for oliguric ARF. It seems that ARF precludes its utilization for any hemodynamic diagnosis.
This study examines the epidemiological data of patients with hip fractures from 1997–2007. Adult patients treated for hip fracture between the years 1997–2007 were included in the study. ...Retrospective statistical assessment of continually gathered data focussed on epidemiology and demographics. The study involved 3,683 patients (2,678 women and 1,005 men). Patients older than 70 years accounted for 82% of all cases. There were 2.7 times more women; in patients younger than 60 years men significantly outnumbered women (
p
< 0.001). The mean patient age was 77.9 years (SD ± 12.6; women, 80.3 years; men, 71.5 years). There was a slight increase in the average age in both sexes. Trochanteric fractures accounted for 54.7% and femoral neck fractures accounted for 45.3% of fractures. The ratio of men to women was the same in femoral neck (AO-31B) and trochanteric (AO-31A) fractures. The average year-to-year increase in the number of fractures was 5.9%. For femoral neck fractures (AO-31B), there was a statistically insignificant increase in the number of fractures (
p
= 0.63); for intertrochanteric factures (AO-31A3) there was a statistically insignificant decrease (
p
= 0.65). There was an increase in the number of hip fractures resulting in a significant increase in pertrochanteric fractures (AO-31A1+2) (
p
< 0.001). The ratio of trochanteric to neck fractures increased from 0.99 to 1.53. Continual monitoring of patients with hip fracture offers data which allows comparisons between regions and countries. There has been a continual increase in the number of patients with hip fractures.
Diversity of blood pressure response and great variability within studies emphasise the need to identify predictors of renal denervation efficacy. Previous studies identified various predictors ...within periods of 3–6 months. The goal of the current study is to examine the possible predictors of sustained decline of blood pressure (BP) after renal denervation in a long-term period of 2 years.
Evaluated patients were either randomised in the original Prague-15 study or were pilot patients, meeting the same inclusion criteria of true-resistant hypertension. Patients were considered as responsive when the decline of 24h systolic BP≥10mmHg was present 6, 12 and 24 months after the procedure. In addition, analysis for separate visits was performed. Denervation was performed using the unipolar Symplicity® Renal Denervation System. Extensive assessment of computed tomography angiography by numerous measurements including morphology of the renal arteries was performed.
A total of 48 patients were analysed, with 27 patients suitable for long-term prediction. Five of the 27 patients were identified as long-term responders with average 24h BP decline of 20/9mmHg. Strongest predictors of BP decline were higher baseline 24h systolic blood pressure (p=0.01) and higher diameter of the left renal artery (p=0.04).
Only a minority of denervated patients exhibited sustained BP decline. Higher baseline BP and higher renal artery diameter might be the strongest predictors. Our findings might theoretically support the actual hypothesis of the necessity to ablate the distal parts of the renal artery (these conditions might allow such ablation to be performed).
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