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Background: Ventilatory ratio (VR) has been proposed as an alternative approach to estimate physiological dead space. However, the absolute value of VR, at constant dead space, might be affected by venous admixture and CO volume expired per minute (VCO).
Methods: This was a retrospective, observational study of mechanically ventilated patients with acute respiratory distress syndrome (ARDS) in the UK and Italy. Venous admixture was either directly measured or estimated using the surrogate measure Pa/FiO ratio. VCO was estimated through the resting energy expenditure derived from the Harris-Benedict formula.
Results: A total of 641 mechanically ventilated patients with mild (n=65), moderate (n=363), or severe (n=213) ARDS were studied. Venous admixture was measured (n=153 patients) or estimated using the Pa/FiO ratio (n=448). The VR increased exponentially as a function of the dead space, and the absolute values of this relationship were a function of VCO. At a physiological dead space of 0.6, VR was 1.1, 1.4, and 1.7 in patients with VCO equal to 200, 250, and 300, respectively. VR was independently associated with mortality (odds ratio [OR]=2.5; 95% confidence interval [CI], 1.8-3.5), but was not associated when adjusted for V/V, VCO, Pa/FiO (OR=1.2; 95% CI, 0.7-2.1). These three variables remained independent predictors of ICU mortality (V/V [OR=17.9; 95% CI, 1.8-185; P<0.05]; VCO [OR=0.99; 95% CI, 0.99-1.00; P<0.001]; and Pa/FiO (OR=0.99; 95% CI, 0.99-1.00; P<0.001]).
Conclusions: VR is a useful aggregate variable associated with outcome, but variables not associated with ventilation (VCO and venous admixture) strongly contribute to the high values of VR seen in patients with severe illness.
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http://dx.doi.org/10.1016/j.bja.2022.10.035 | DOI Listing |
BMC Infect Dis
December 2024
Department of Urology, 900th Hospital of Joint Logistics Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025, China.
Background: Retroperitoneal abscesses caused by donor-derived Carbapenem-Resistant Klebsiella Pneumoniae (CRKP) infections are rare and often challenging to diagnose early due to a lack of specific symptoms.
Case Presentation: In case one, a 64-year-old male presented with unexplained fever and emaciation three months after undergoing a kidney transplant for end-stage renal disease. Metagenomic Next-Generation Sequencing identified CRKP in peripheral blood samples, and CT scans confirmed a retroperitoneal abscess.
J Craniofac Surg
December 2024
Department of Plastic Surgery, the Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University.
Background: Nasal packing (NP), trans-septal suturing (TSS), and submucosal trans-septal suturing (STSS) are common techniques to avoid dead space after the deviated septum is corrected. However, there is rare data about surgical complications and discomfort of these techniques after septal extension grafts (SEG) with autogenous costicartilage.
Objective: To compare the complications and discomfort of NP, TSS, and STSS techniques after SEG with autogenous costicartilage.
Cogn Neurodyn
December 2024
School of Mathematics and Statistics, Shaanxi Normal University, Xi'an, 710119 People's Republic of China.
The accumulation of amyloid peptide is assumed to be one of the main causes of Alzheimer's disease . There is increasing evidence that astrocytes are the primary targets of A. A can cause abnormal synaptic glutamate, aberrant extrasynaptic glutamate, and astrocytic calcium dysregulation through astrocyte glutamate transporters facing the synaptic cleft (GLT-syn), astrocyte glutamate transporters facing the extrasynaptic space (GLT-ess), metabotropic glutamate receptors in astrocytes (mGluR), N-methyl-D-aspartate receptors in astrocytes (NMDAR), and glutamatergic gliotransmitter release (Glio-Rel).
View Article and Find Full Text PDFAm J Biol Anthropol
January 2025
Departamento de Antropología e Historia, Museo Nacional de Costa Rica, San José, Costa Rica.
Objectives: Burial space reuse and prolonged interaction with the dead were common practices in the Isthmo-Colombian Area, dating back to at least the Early Ceramic Period in the Greater Coclé region. However, biological and social relationships of individuals interred in collective burial contexts remain unclear. Here, we explore intra-cemetery biological variation through a biological distance analysis of individuals interred in large mortuary features from the first mortuary horizon at the site of Cerro Juan Díaz in Panamá.
View Article and Find Full Text PDFRadiography (Lond)
December 2024
Research Unit of Radiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Radiology, Odense University Hospital, Odense, Denmark.
Introduction: In cases of suspected physical abuse (SPA) in children, a full skeletal survey is performed. Radiographers performing the survey may experience emotional challenges during the examination. The purpose of the study was to explore the emotional aspects of SPA imaging among radiographers and how they respond to potential challenges.
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