Comparing the Usefulness of the Initial Predisposition Infection Response Organ Failure Score and the Mortality in Emergency Department Sepsis Score for Predicting the Prognosis of Septic Patients Admitted to the Intensive Care Unit

PURPOSE: The predisposition infection response organ failure (PIRO) score has been developed to be used in the emergency department (ED) to risk stratify sepsis case but has not been well studied domestically. The aim of this study was to compare the usefulness between the PIRO score and the mortality in emergency department sepsis (MEDS) score in predicting the mortality of septic patients admitted to the intensive care unit (ICU). METHODS: We conducted a retrospective study of patients who were suspected to have sepsis and were admitted to the ICU via the ED during a period between January 2013 and June 2015. PIRO and MEDS scores were calculated from the ED data. A comparative analysis was performed the evaluate the areas under the receiver operator characteristic (ROC) curves for 28-day mortality. RESULTS: During the 30-month period, a total of 199 patients diagnosed with sepsis were enrolled. Fifty-seven patients (28.6%) died within 28 days of presentation. The PIRO score showed increasing mortality with higher scores. The area under the ROC curve (AUC) for mortality was 0.890 (95% confidence interval [CI]=0.830 to 0.950) for PIRO and 0.705 (95% CI=0.609 to 0.801) for MEDS score. CONCLUSION: The MEDS score in the ED did not predict mortality better than PIRO score. The PIRO score was a good predictor of the outcome for patients with suspected sepsis. We believe that the PIRO score may be the most useful and appropriate clinical prediction tool for patients with suspected sepsis in the ED.

The Effect of the Suspension, Electrical Stimulation and Treadmill Training in the Hindlimb Muscle of the Rats

OBJECTIVE: The purposes of this study were to investigate the effect of suspension, the electrical stimulation and full weight bearing treadmill training on the muscle atrophy and transformation of muscle fibers. METHOD: Forty Spraque-Dawley rats were divided into control and 3 intervention groups: suspension control (n= 10), suspension with weight bearing treadmill (n=10), and suspension with electrical stimulation (n=10). After 4 weeks intervention, both gastrocnemius and soleus were dissected and the muscle weight and transformation of muscle fibers were analyzed. RESULTS: In suspension control and suspension electrical stimulation groups, muscle to body weight ratio of gastro-cnemius was decreased compared to control group (p<0.05). In all intervention groups, muscle to body weight ratio of soleus was decreased compared to control group (p<0.05). In suspension electrical stimulation group, type I muscle fiber ratio of gastrocnemius was increased compared to control and suspension control groups (p<0.05). In suspension electrical stimulation group, type IIa muscle fiber ratio of gastrocnemius was increased compared to suspension control group (p<0.05). CONCLUSION: It is suggested that muscle atrophy induced by disuse and transformation of muscle fiber can be prevented by electrical stimulation intervention.

Effect of EMG-triggered Electrical Stimulation to Improve Arm Function in Patients with Chronic Hemiplegia

OBJECTIVE: The purpose of this study was to identify the effect of EMG-triggered electrical neuromuscular stimulation for recovery of hemiplegic arm function. METHOD: EMG-triggered electrical stimulation was applied to the extensor digitorum communis (EDC) of 8 chronic hemiplegics who showed no functional changes for more than 3 months. Stimulation was started when the amplitude of processed EMG signal from the same muscle exceeded the preset threshold. The therapeutic effect was evaluated by kinesiologic and clinical methods before and after 4 weeks. Quantitative EMG from EDC, excursion of second metacarpophalangeal joint, and functional measurements were used. We also evaluated cognitive and perceptual effect on recovery of arm function. RESULTS: Subjects treated with EMG-triggered electrical stimulation showed significant gain in amplitude of quantitative EMG and excursion sum during maximal exertion comparing to those of pre-treatment (p0.05). CONCLUSION: These results suggest that EMG-triggered electrical stimulation might be an effective therapeutic modality to improve motor function of the hemiplegic arm of chronic brain injured patients.

Inhibition of Hyper-reflexic Detrusor Contraction by Sacral Afferent Nerve Stimulation in Spinal Cord Injury

OBJECTIVE: To evaluate the inhibition effects of hyper-reflexic detrusor activity by sacral afferent nerve stimulation in spinal cord injury (SCI) patients. METHOD: The subjects were thirteen patients with SCI who had symptoms of urinary incontinence, because of hyper-reflexic bladder contractions. According to the level and severity of injury, the patients were divided into groups of tetraplegia/paraplegia and complete/incomplete. We applied dorsal penile nerve (DPN) stimulation using portable stimulator during the continuous bladder filling. Stimulation parameters were biphasic rectangular pulses of 25 Hz frequency, 250 microseconds pulse width. Stimulation intensity was twice the threshold of pudendo-anal reflex. The one minute stimulation was repeated to every reflex contraction during the cystometry. Immediate suppressive effect of DPN was analyzed. RESULTS: Of 13 patients who had a reflex bladder, hyper-reflexic detrusor contractions were suppressed effectively in 12 by DPN stimulation. The suppressive effect in groups of level and severity was not statistically significant. CONCLUSION: DPN stimulation for inhibition of hyper-reflexic bladder contraction is an adjunctive method of incontinence management in SCI patients of different level and severity.