Therapeutic hypothermia is recommended for comatose adults after witnessed out-of-hospital cardiac arrest, but data about this intervention in children are limited.
We conducted this trial of two ...targeted temperature interventions at 38 children's hospitals involving children who remained unconscious after out-of-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose patients who were older than 2 days and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a Vineland Adaptive Behavior Scales, second edition (VABS-II), score of 70 or higher (on a scale from 20 to 160, with higher scores indicating better function), was evaluated among patients with a VABS-II score of at least 70 before cardiac arrest.
A total of 295 patients underwent randomization. Among the 260 patients with data that could be evaluated and who had a VABS-II score of at least 70 before cardiac arrest, there was no significant difference in the primary outcome between the hypothermia group and the normothermia group (20% vs. 12%; relative likelihood, 1.54; 95% confidence interval CI, 0.86 to 2.76; P=0.14). Among all the patients with data that could be evaluated, the change in the VABS-II score from baseline to 12 months was not significantly different (P=0.13) and 1-year survival was similar (38% in the hypothermia group vs. 29% in the normothermia group; relative likelihood, 1.29; 95% CI, 0.93 to 1.79; P=0.13). The groups had similar incidences of infection and serious arrhythmias, as well as similar use of blood products and 28-day mortality.
In comatose children who survived out-of-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a good functional outcome at 1 year. (Funded by the National Heart, Lung, and Blood Institute and others; THAPCA-OH ClinicalTrials.gov number, NCT00878644.).
Approximately 40% of children who have an in-hospital cardiac arrest (IHCA) in the US survive to discharge. We aimed to evaluate the impact of post-cardiac arrest hypotension during targeted ...temperature management following IHCA on survival to discharge.
This is a secondary analysis of the therapeutic hypothermia after pediatric cardiac arrest in-hospital (THAPCA-IH) trial. “Early hypotension” was defined as a systolic blood pressure less than the fifth percentile for age and sex for patients not treated with extracorporeal membrane oxygenation (ECMO) or a mean arterial pressure less than fifth percentile for age and sex for patients treated with ECMO during the first 6 h of temperature intervention. The primary outcome was survival to hospital discharge.
Of 299 children, 142 (47%) patients did not receive ECMO and 157 (53%) received ECMO. Forty-two of 142 (29.6%) non-ECMO patients had systolic hypotension. Twenty-three of 157 (14.7%) ECMO patients had mean arterial hypotension. After controlling for confounders of interest, non-ECMO patients who had early systolic hypotension were less likely to survive to hospital discharge (40.5% vs. 72%; adjusted OR aOR 0.34; 95%CI, 0.12–0.93). There was no difference in survival to discharge by blood pressure groups for children treated with ECMO (30.4% vs. 49.3%; aOR = 0.60; 95%CI, 0.22–1.63).
In this secondary analysis of the THAPCA-IH trial, in patients not treated with ECMO, systolic hypotension within 6 h of temperature intervention was associated with lower odds of discharge survival. Blood pressure groups in patients treated with ECMO were not associated with survival to discharge.
Computational Pathology (CPath) is an interdisciplinary science that augments developments of computational approaches to analyze and model medical histopathology images. The main objective for CPath ...is to develop infrastructure and workflows of digital diagnostics as an assistive CAD system for clinical pathology, facilitating transformational changes in the diagnosis and treatment of cancer that are mainly address by CPath tools. With evergrowing developments in deep learning and computer vision algorithms, and the ease of the data flow from digital pathology, currently CPath is witnessing a paradigm shift. Despite the sheer volume of engineering and scientific works being introduced for cancer image analysis, there is still a considerable gap of adopting and integrating these algorithms in clinical practice. This raises a significant question regarding the direction and trends that are undertaken in CPath. In this article we provide a comprehensive review of more than 800 papers to address the challenges faced in problem design all-the-way to the application and implementation viewpoints. We have catalogued each paper into a model-card by examining the key works and challenges faced to layout the current landscape in CPath. We hope this helps the community to locate relevant works and facilitate understanding of the field’s future directions. In a nutshell, we oversee the CPath developments in cycle of stages which are required to be cohesively linked together to address the challenges associated with such multidisciplinary science. We overview this cycle from different perspectives of data-centric, model-centric, and application-centric problems. We finally sketch remaining challenges and provide directions for future technical developments and clinical integration of CPath. For updated information on this survey review paper and accessing to the original model cards repository, please refer to GitHub. Updated version of this draft can also be found from arXiv.
Isolated chylopericardium is an exceedingly rare complication in any age group. Review of the limited published case series shows the most common cause of isolated chylopericardium to be cardiac ...surgery. We present a case of isolated chylopericardium after a bidirectional Glenn procedure in an infant with hypoplastic left heart syndrome. (Level of Difficulty: Intermediate.)
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For ideal hydrodynamic modeling of earthquake-generated tsunamis, the principal features of tsunamis occuring in nature are abstracted to provide a fundamental case of a one-dimensional solitary wave ...of height
a
, propagating in a layer of water of uniform rest depth
h
for modeling the tsunami progressing in the open ocean over long range, with height down to
a
/
h
≃ 10
−4
as commonly known. The Euler model is adopted for evaluating the irrotational flow in an incompressible and inviscid fluid to attain exact solutions so that the effects of nonlinearity and wave dispersion can both be fully accounted for with maximum relative error of
O
(10
−6
) or less. Such high accuracy is needed to predict the wave-energy distribution as the wave magnifies to deliver any devastating attack on coastal destinations. The present UIFE method, successful in giving the maximum wave of height (
a
/
h
= 0.8331990) down to low ones (e.g.
a
/
h
= 0.01), becomes, however, impractical for similar evaluations of the dwarf waves (
a
/
h
< 0.01) due to the algebraic branch singularities rising too high to be accurately resolved. Here, these singularities are all removed by introducing regularized coordinates under conformal mapping to establish the regularized solitary-wave theory. This theory is ideal to differentiate between the nonlinear and dispersive effects in various premises for producing an optimal tsunami model, with new computations all regular uniformly down to such low tsunamis as that of height
a
/
h
= 10
−4
.
Targeted temperature management is recommended for comatose adults and children after out-of-hospital cardiac arrest; however, data on temperature management after in-hospital cardiac arrest are ...limited.
In a trial conducted at 37 children's hospitals, we compared two temperature interventions in children who had had in-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose children older than 48 hours and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a score of 70 or higher on the Vineland Adaptive Behavior Scales, second edition (VABS-II, on which scores range from 20 to 160, with higher scores indicating better function), was evaluated among patients who had had a VABS-II score of at least 70 before the cardiac arrest.
The trial was terminated because of futility after 329 patients had undergone randomization. Among the 257 patients who had a VABS-II score of at least 70 before cardiac arrest and who could be evaluated, the rate of the primary efficacy outcome did not differ significantly between the hypothermia group and the normothermia group (36% 48 of 133 patients and 39% 48 of 124 patients, respectively; relative risk, 0.92; 95% confidence interval CI, 0.67 to 1.27; P=0.63). Among 317 patients who could be evaluated for change in neurobehavioral function, the change in VABS-II score from baseline to 12 months did not differ significantly between the groups (P=0.70). Among 327 patients who could be evaluated for 1-year survival, the rate of 1-year survival did not differ significantly between the hypothermia group and the normothermia group (49% 81 of 166 patients and 46% 74 of 161 patients, respectively; relative risk, 1.07; 95% CI, 0.85 to 1.34; P=0.56). The incidences of blood-product use, infection, and serious adverse events, as well as 28-day mortality, did not differ significantly between groups.
Among comatose children who survived in-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a favorable functional outcome at 1 year. (Funded by the National Heart, Lung, and Blood Institute; THAPCA-IH ClinicalTrials.gov number, NCT00880087 .).
This volume presents more than 40 original papers on recent advances in several topics in engineering mechanics presented at The Theodore Y-T Wu Symposium on Engineering Mechanics: A celebration of ...Professor Wu's scientific contributions for his 80th birthday. The distinguished contributors include several members of the National Academy of Engineers and the topics cover nonlinear water waves, swimming and flying in nature, biomechanics, data analysis methodology, and propulsion hydrodynamics. The papers honor the significant accomplishments of Professor Wu in Engineering Science at Caltech, particularly in the areas of nonlinear waves, hydrodynamics, biomechanics and wave-structure interaction. They review the present state of the art of engineering mechanics, and chart the future of the field from the viewpoint of civil engineering, biomechanics, geophysics, mechanical engineering, naval architecture, ocean, and offshore engineering. The primary purpose of this book is to provide guidance and inspiration for those interested in continuing to advance engineering mechanics into the 21st century. To quote Professor Wu: ”The value of a book publication lies in disseminating new knowledge attained with effort and dedication from all those who participate, and in having the useful results within ready reach of students and researchers actively working in the field.”
The subject of fish locomotion is addressed. A further extension of the large-amplitude theory of fish locomotion is presented to evaluate swimming motions along arbitrary trajectory in ...(2+1)-dimensions, with arbitrary amplitude. The kinematic and dynamic conditions are expressed in terms of the surface variables on the body surface S sub(b)(t) and the wake surface S sub(w )(t). The theory is applicable not only to fish locomotion, but also to aerial locomotion of bird and insect.
A non-linear unsteady flexible wing theory Wu, Theodore Y.
Structural control & health monitoring/Structural control and health monitoring,
01/2006, Letnik:
13, Številka:
1
Journal Article
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