Use of noninvasive volume assessment methods to predict acute blood loss in spontaneously breathing volunteers

Objective@#The use of noninvasive volume assessment methods to predict acute blood loss in spontaneously breathing patients remains unclear. We aimed to investigate changes in the pleth variability index (PVI), vena cava collapsibility index (VCCI), end-tidal carbon dioxide (EtCO2), pulse pressure (PP), and mean arterial pressure (MAP) in spontaneously breathing volunteers after acute loss of 450 mL blood and passive leg raise (PLR). @*Methods@#This prospective observational study enrolled healthy volunteers in the blood donation center of an academic hospital. We measured the PVI, EtCO2, VCCI, MAP, and PP before blood donation; at the 0th and 10th minute of blood donation; and after PLR. The primary outcome was the changes in PVI, EtCO2, VCCI, MAP, and PP. @*Results@#We enrolled thirty volunteers. There were significant differences among the four obtained measurements of the PVI, EtCO2, and MAP (P<0.001, P<0.001, P<0.001, respectively). Compared to the predonation values, post-hoc analysis revealed an increase in the PVI at the 0th min postdonation (mean difference [MD], 5.4±5.9; 95% confidence interval [CI], -7.6 to -3.1; P<0.001); a decrease in the EtCO2 and MAP at the 0th and 10th minute postdonation, respectively (MD, 2.4±4.6; 95% CI, 0.019 to 4.84; P=0.008 and MD, 6.4±6.4; 95% CI, 3 to 9.7; P<0.001, respectively). Compared with EtCO2 at the 10th minute, the value increased after PLR (MD, 1.8±3.2; 95% CI, 0.074 to 4.44; P=0.006). @*Conclusion@#The PVI and EtCO2 could detect early hemodynamic changes after acute blood loss. However, it remains unclear whether they can determine volume status in spontaneously breathing patients.

Use of noninvasive volume assessment methods to predict acute blood loss in spontaneously breathing volunteers

Objective@#The use of noninvasive volume assessment methods to predict acute blood loss in spontaneously breathing patients remains unclear. We aimed to investigate changes in the pleth variability index (PVI), vena cava collapsibility index (VCCI), end-tidal carbon dioxide (EtCO2), pulse pressure (PP), and mean arterial pressure (MAP) in spontaneously breathing volunteers after acute loss of 450 mL blood and passive leg raise (PLR). @*Methods@#This prospective observational study enrolled healthy volunteers in the blood donation center of an academic hospital. We measured the PVI, EtCO2, VCCI, MAP, and PP before blood donation; at the 0th and 10th minute of blood donation; and after PLR. The primary outcome was the changes in PVI, EtCO2, VCCI, MAP, and PP. @*Results@#We enrolled thirty volunteers. There were significant differences among the four obtained measurements of the PVI, EtCO2, and MAP (P<0.001, P<0.001, P<0.001, respectively). Compared to the predonation values, post-hoc analysis revealed an increase in the PVI at the 0th min postdonation (mean difference [MD], 5.4±5.9; 95% confidence interval [CI], -7.6 to -3.1; P<0.001); a decrease in the EtCO2 and MAP at the 0th and 10th minute postdonation, respectively (MD, 2.4±4.6; 95% CI, 0.019 to 4.84; P=0.008 and MD, 6.4±6.4; 95% CI, 3 to 9.7; P<0.001, respectively). Compared with EtCO2 at the 10th minute, the value increased after PLR (MD, 1.8±3.2; 95% CI, 0.074 to 4.44; P=0.006). @*Conclusion@#The PVI and EtCO2 could detect early hemodynamic changes after acute blood loss. However, it remains unclear whether they can determine volume status in spontaneously breathing patients.

Reliability of chest pain risk scores in cancer patients with suspected acute coronary syndrome

Objective@#The history, electrocardiogram, age, risk factors, troponin (HEART), the thrombolysis in myocardial infarction (TIMI), and Global Registry of Acute Coronary Events (GRACE) scores are useful risk stratification tools in the emergency department (ED). However, the accuracy of these scores in the cancer population is not well known. This study aimed to compare the performance of cardiac risk stratification scores in cancer patients with suspected acute coronary syndrome (ACS) in the ED. @*Methods@#This prospective cohort study recruited patients with cancer who visited the ED because of suspected ACS. The development of any major adverse cardiac events (MACE) within 6 weeks was recorded, with the study outcome being a MACE within 6 weeks of ED admission. @*Results@#A total of 178 patients participated in this study, of whom 5.6% developed a MACE. Statistically significant differences were found between the mean HEART and TIMI scores in predicting MACE. The HEART score had the highest area under the curve (0.64; 95% confidence interval, 0.48–0.81), highest sensitivity (80%), and highest negative predictive value (97.5) in patients with cancer. @*Conclusion@#We found a similar rate of MACE in cancer patients with low-risk chest pain compared to that in the general population. However, the HEART, TIMI, and GRACE scores had a lower performance in cancer patients with MACE compared to that in the general population.

Reliability of chest pain risk scores in cancer patients with suspected acute coronary syndrome

Objective@#The history, electrocardiogram, age, risk factors, troponin (HEART), the thrombolysis in myocardial infarction (TIMI), and Global Registry of Acute Coronary Events (GRACE) scores are useful risk stratification tools in the emergency department (ED). However, the accuracy of these scores in the cancer population is not well known. This study aimed to compare the performance of cardiac risk stratification scores in cancer patients with suspected acute coronary syndrome (ACS) in the ED. @*Methods@#This prospective cohort study recruited patients with cancer who visited the ED because of suspected ACS. The development of any major adverse cardiac events (MACE) within 6 weeks was recorded, with the study outcome being a MACE within 6 weeks of ED admission. @*Results@#A total of 178 patients participated in this study, of whom 5.6% developed a MACE. Statistically significant differences were found between the mean HEART and TIMI scores in predicting MACE. The HEART score had the highest area under the curve (0.64; 95% confidence interval, 0.48–0.81), highest sensitivity (80%), and highest negative predictive value (97.5) in patients with cancer. @*Conclusion@#We found a similar rate of MACE in cancer patients with low-risk chest pain compared to that in the general population. However, the HEART, TIMI, and GRACE scores had a lower performance in cancer patients with MACE compared to that in the general population.

Can we use serum gamma-glutamyl transferase levels to predict early mortality in stroke?

Serum gamma-glutamyl transferase [GGT] is a marker for alcohol consumption and hepatobiliary diseases. There are reports on the prognostic role of GGT in coronary artery diseases and stroke. The aim of our study was to identify the potential differences in GGT levels in different types of stroke, and to evaluate the correlation between GGT and 30-day mortality. Patients diagnosed with stroke in emergency department between 01.01.2010 and 30.12.2012 was included in the study. Imaging techniques were used to distinguish between hemorrhagic and ischemic stroke. Ischemic strokes were further classified as either atherosclerotic/lacunar or embolic. Parameters including age, gender, vital signs [systolic and diastolic blood pressure], comorbid diseases [HT, DM, CAD, smoking and alcohol consumption], used medications, previous history of stroke, NIHSS score at the time of admission to emergency department, laboratory parameters [glucose, white blood cell count, hemoglobin, platelet, total cholesterol, creatinine] and duration of hospitalization were recorded. Death records were obtained from patients' medical records. One thousand eighty six patients were included in the study. GGT levels were not significantly different between ischemic and hemorrhagic strokes [p=0.435]. On the other hand, GGT levels in embolic strokes were significantly higher compared to atherosclerotic/lacunar, strokes [p=0.001]. GGT levels [median 24.50 [16.00-43.00]] in Intensive Care Unit patients were significantly higher compared to GGT level [22.00 [15.00-34.25]] in admitted to service beds patients [p=0.015]. Median GGT level of deceased patients was 24.00 [16.00-41.25] and median GGT level of alive patients was 22.00 [15.00-35.00]. GGT level of deceased patients was significantly higher compared to GGT levels of alive patients [p=0.048]. There was no difference in GGT levels between ischemic and hemorrhagic strokes; however, GGT levels in embolic strokes were significantly higher compared to atherosclerotic/lacunar strokes. High GGT levels are correlated with early mortality in stroke. We believe that GGT may be used as a predictor of mortality in future studies

Pre-treatment and post-treatment changes in platelet indices in patients with immune thrombocytopenia

To investigate if there is a correlation between pre- and post-treatment mean platelet volume [MPV], platelet size deviation width [PDW], and platecrit [PCT] values and to investigate whether we can use them as laboratory parameters to estimate the relapses of immune thrombocytopenia [ITP] patients. Patients with ITP diagnosed at the Hematology Clinic, School of Medicine, Cumhuriyet University, Sivas, Turkey between January 2005 and December 2011 were evaluated by a retrospective review of our patients' records. Eighty-one patients with ITP were collected. The first relapse was termed as the hospitalization day before second-line therapy, and the second relapse was termed as the hospitalization day before alternate second-line therapy. We provided the following data of ITP patients at diagnosis, before and after first relapses, and before and after second relapses: presenting symptoms, platelet count, MPV, PDW, and PCT values. We obtained significant statistical differences between MPV values after initial treatment and before second-line therapy [first relapse] [p=0.005], between MPV values after splenectomy and before immunosuppressive or immune modulator therapy [second relapse] [p=0.028], and also, between PCT values after splenectomy and before second relapse [p=0.043]. Mean platelet volume is gradually increasing before first and second relapses, and again normal values are being obtained after appropriate therapies. We conclude that MPV is a useful parameter as a predictor of relapses

Trace metal levels in lichen samples from roadsides in East Black Sea region, Turkey / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To determine the metal contents of lichen species from East Black Sea region of Turkey for investigation of trace metal pollution sourced traffic.</p><p><b>METHODS</b>The levels of copper, cadmium, lead, zinc, manganese, iron, chromium, nickel, cobalt, palladium in lichen samples collected from East Black Sea region of Turkey were determined by flame and graphite furnace atomic absorption spectrometry after microwave digestion method. The accuracy of the method was corrected by standard reference material (NIST SRM IAEA-336 Lichen).</p><p><b>RESULTS</b>The contents of investigated trace metals in lichen samples were 7.19-22.4 microg/g for copper, 0.10-0.64 microg/g for cadmium, 4.03-44.6 microg/g for lead, 14.5-41.8 microg/g for zinc, 25.8-208 microg/g for manganese, 331-436 microg/g for iron, 1.20-3.01 microg/g for chromium, 1.48-3.90 microg/g for nickel, 0.20-3.55 microg/g for cobalt, 0.11-0.64 microg/g for palladium. The results were compared with the literature values.</p><p><b>CONCLUSION</b>Some lichen species such as Xanthoparmelia conspersa, Xanthoria calcicola, Peltigera membranacea, and Physcia adscendens are accumulated trace metals at a high ratio.</p>