Herein we present a chimeric recombinant spider silk protein (spidroin) whose aqueous solubility equals that of native spider silk dope and a spinning device that is based solely on aqueous buffers, ...shear forces and lowered pH. The process recapitulates the complex molecular mechanisms that dictate native spider silk spinning and is highly efficient; spidroin from one liter of bacterial shake-flask culture is enough to spin a kilometer of the hitherto toughest as-spun artificial spider silk fiber.
We aimed to analyze risk factors related to the development of delirium, aiming for early intervention in patients with greater risk.
Observational study, including prospectively collected patients ...treated in a single general ICU. These were classified into two groups, according to whether they developed delirium or not (screening performed using CAM-ICU tool). Demographics and clinical data were analyzed. Multivariate logistic regression analyses were performed to quantify existing associations.
1462 patients were included. 93 developed delirium (incidence: 6.3%). These were older, scored higher on the Clinical Frailty Scale, on the risk scores on admission (SAPS-3 and SOFA), and had a greater number of organ failures (OF). We observed more incidence of delirium in patients who (a) presented more than two OF (20.4%; OR 4.9; CI95%: 2.9-8.2), and (b) were more than 74 years old albeit having <2 OF (8.6%; OR 2.1; CI95%: 1.3-3.5). Patients who developed delirium had longer ICU and hospital length-of-stays and a higher rate of readmission.
The highest risk observed for developing delirium clustered in patients who presented more than 2 OF and patients over 74 years old. The detection of patients at high risk for developing delirium could imply a change in management and improved quality of care.
Recently, in a study of by group we found similar results; factors independently associated with hospital mortality were the Simplified Acute Physiology Score (SAPS)3 (odds ratio (OR) 1.10; 95% ...confidence interval (CI) 1.08-1.12) and belonging to the “off-hours” group (weekend and holidays; OR 2.00; 95% CI 1.20-3.33) 2. Not withdrawing scheduled surgery patients or not differentiating them from unplanned/urgent admissions could imply a selection bias, despite a baseline mortality risk adjustment using the SAPS3. ...the difference in reasons for ICU admission between weekdays and weekends is noteworthy, as Zajic et al. discuss. ...we would like to point out that the early detection of patients at risk of organ failure is a task that must be adapted to the circumstances of each center.
Survivors of critical illness are frequently left with a long-lasting disability. We hypothesised that patients who developed delirium during ICU stay, compared with patients who did not, would have ...worse health-related quality of life following a critical illness.
Prospective longitudinal observational and analytical study assessing functional independence, frailty and perceived quality of life measured with the Barthel Index, the Clinical Frailty Scale, and the SF-36, comparing patients who developed delirium during ICU stay and patients who did not. The questionnaires were used at different times during the follow-up (upon ICU admission, at ICU discharge, at hospital discharge and 2 years after hospital discharge).
In a cohort of 1462 patients, we matched 93 patients who developed delirium (delirium group) with 93 patients who did not develop delirium (no-delirium group). Of 156 completed questionnaires (84.7%), we observed that (a) in each of the two groups of patients, the scores related to functional independence (Barthel Index) and frailty (Clinical Frailty Scale) tended to improve over time (p < 0.001), being consistently less favourable in the delirium group compared to the no-delirium group (p < 0.001); (b) the patients who developed delirium also presented lower scores on the SF-36 scale, these differences being statistically significant, and therefore evidencing a worse quality of life, with impact on both the psychological and social spheres (p < 0.001).
Patients who developed delirium had significantly lower scores 2 years after hospital discharge on the three used questionnaires, displaying a clear negative impact on the physical, psychological, and social dimensions. The study's results reinforce the need to support and strengthen the care of ICU survivors.
Hemos leído con gran interés el articulo de Varón-Vega FA et al “Traqueobronquitis y neumonía asociada a ventilación mecánica en unidades de cuidado intensivo de Latinoamérica: epidemiología, curso ...clínico y desenlaces (estudio LATINAVE)”1 . Es conocido que la neumonía asociada a ventilación mecánica (NAVM) se relaciona con un incremento de la estancia en las Unidades de Cuidados Intensivos (UCI) y en el hospital, mayor consumo de antibióticos, un alargamiento de la duración de la ventilación mecánica y un aumento de la mortalidad bruta y atribuid
Background
Up to 25% of patients with acute pancreatitis develop severe complications and are classified as severe pancreatitis with a high death rate. To improve outcomes, patients may require ...interventional measures including surgical procedures. Multidisciplinary approach and best practice guidelines are important to decrease mortality.
Methods
We have conducted a retrospective analysis from a prospectively maintained database in a low-volume hospital. A total of 1075 patients were attended for acute pancreatitis over a ten-year period. We have analysed 44 patients meeting the criteria for severe acute pancreatitis and for intensive care unit (ICU) admittance. Demographics and clinical data were analysed. Patients were treated according to international guidelines and a multidisciplinary flowchart for acute pancreatitis and a step-up approach for pancreatic necrosis.
Results
Forty-four patients were admitted to the ICU due to severe acute pancreatitis. Twenty-five patients needed percutaneous drainage of peri-pancreatic or abdominal fluid collections or cholecystitis. Eight patients underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis and biliary sepsis or pancreatic leakage, and one patient received endoscopic trans-gastric endoscopic prosthesis for pancreatic necrosis. Sixteen patients underwent surgery: six patients for septic abdomen, four patients for pancreatic necrosis and two patients due to abdominal compartment syndrome. Four patients had a combination of surgical procedures for pancreatic necrosis and for abdominal compartment syndrome. Overall mortality was 9.1%.
Conclusion
Severe acute pancreatitis represents a complex pathology that requires a multidisciplinary approach. Establishing best practice treatments and evidence-based guidelines for severe acute pancreatitis may improve outcomes in low-volume hospitals.
Una vez en un millón. Sousa Escandón, Alejandro; Pérez Arias, Mª Concepción; Carballo Fernández, Noelia ...
Archivos españoles de urología
70, Številka:
7
Journal Article
Electrical impedance tomography Lobo, Beatriz; Hermosa, Cecilia; Abella, Ana ...
Annals of translational medicine
6, Številka:
2
Journal Article
Odprti dostop
Continuous assessment of respiratory status is one of the cornerstones of modern intensive care unit (ICU) monitoring systems. Electrical impedance tomography (EIT), although with some constraints, ...may play the lead as a new diagnostic and guiding tool for an adequate optimization of mechanical ventilation in critically ill patients. EIT may assist in defining mechanical ventilation settings, assess distribution of tidal volume and of end-expiratory lung volume (EELV) and contribute to titrate positive end-expiratory pressure (PEEP)/tidal volume combinations. It may also quantify gains (recruitment) and losses (overdistention or derecruitment), granting a more realistic evaluation of different ventilator modes or recruitment maneuvers, and helping in the identification of responders and non-responders to such maneuvers. Moreover, EIT also contributes to the management of life-threatening lung diseases such as pneumothorax, and aids in guiding fluid management in the critical care setting. Lastly, assessment of cardiac function and lung perfusion through electrical impedance is on the way.
Poly(vinylidene fluoride) (PVDF) based composites incorporating conductive fillers enable quick achievement of ultrahigh dielectric constant based on percolation theory; however, the accompanying ...drawbacks high dielectric loss and poor insulation have impeded their practical applications. A novel ternary Bi2S3-BaTiO3/PVDF nanocomposite architecture has been constructed via hot stretching process, where oriented Bi2S3 nanorods arranged as numerous microcapacitors with homogeneously distributed high-k BaTiO3 nanoparticles embedded in PVDF as dielectric media. The series connected numerous microcapacitors provide high dielectric constant which is testified by microcapacitor model simulation while the alignment of one-dimensional microcapacitors along stretching direction greatly reduces the dielectric loss caused by semiconductor Bi2S3. Numerical simulations reveal the positive effect brought by one-dimensional nanofiller orientation in breakdown strength enhancement. This study provide an alternate strategy to reach a balance between high dielectric permittivity, low dielectric loss and high breakdown strength in dielectric composites with conductive filler, which are promising for extensive applications in flexible electronic devices and electrostatic energy storage devices.
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•Novel ternary nanocomposites with oriented one-dimensional Bi2S3 arrangement have been constructed via stretching process.•Microcapacitor model fits well with dielectric constant of oriented composite in the perpendicular direction.•Oriented ternary composites show greatly suppressed dielectric loss and enhanced breakdown strength.•Numerical simulations reveal the reason for breakdown strength enhancement in oriented composites.
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