Risk Factors of Unfavorable Outcomes, Major Bleeding, and All-Cause Mortality in Patients with Venous Thromboembolism

Purpose@#This study aimed to analyze the clinical outcomes of venous thromboembolism (VTE) patients and identify the risk factors for VTE-related unfavorable outcomes, major bleeding, and 30-day all-cause mortality. @*Materials and Methods@#From January 2016 to December 2020, 198 patients with confirmed VTE were enrolled. Potential risk factors for unfavorable outcomes, major bleeding, and all-cause mortality were analyzed. @*Results@#VTE-related unfavorable outcomes developed in 13.1%, while 30-day all-cause mortality was 8.6%. In the multivariate analysis, a pulse ≥110/min and respiratory rate ≥30/min were statistically significant predictors for VTE-related unfavorable outcomes. Diabetes was a significant risk factor for major bleeding. In addition, a history of malignancy, no anticoagulation treatment, and need for mechanical ventilation were significant predictors of all-cause mortality. @*Conclusion@#VTE-related mortality and morbidity rates remained high. In cases of tachycardia and tachypnea, early aggressive treatment is needed to prevent unfavorable outcomes. Patients with risk factors should be closely monitored.

Feasibility of optic nerve sheath diameter measured on initial brain computed tomography as an early neurologic outcome predictor after cardiac arrest.

OBJECTIVES: Few parameters are available to predict neurologic outcome of post-cardiac arrest patients in the early stage of treatment. Optic nerve sheath diameter (ONSD) has been used to indirectly assess intracranial pressure. This study evaluated whether ONSD, an additional parameter in initial brain computed tomography (CT) scans, can be an early predictor of neurologic outcome in post-cardiac arrest patients. METHODS: A total of 112 cardiac arrest patients between November 2012 and October 2013 were identified. Ninety-eight comatose cardiac arrest patients were evaluated with brain CT. Of these patients, after exclusion of patients whose brain CT scans were done too late or with poor baseline neurology (Cerebral Performance Category [CPC] ≥ 3), 91 patients were included for this study. The parameters of initial brain CT, i.e., gray matter-to-white matter ratio (GWR) and ONSD, were measured after clinical care as part of a retrospective reanalysis of images. ONSD on brain CT was bilaterally measured 3 mm behind the eyeball at fixed window width and level and averaged to yield the mean value. The performance of ONSD to predict poor neurologic outcome (CPC = 3 to 5) was analyzed using multiple logistic regression analysis, receiver operating characteristic (ROC) curve analysis, and cross-tabulations. RESULTS: Twenty-three patients showed good neurologic outcomes at hospital discharge. Mean (±SD) ONSD was 5.6 (±0.3) mm in the good outcome group versus 6.3 (±0.5) mm in the poor outcome group (p < 0.001). After basic clinical covariates were controlled for, i.e., age, Glasgow Coma Scale (GCS) score (3 vs. 4-15), and time from collapse to return of spontaneous circulation (ROSC), ONSD (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.1 to 3.9) and GWR (OR = 0.6; 95% CI = 0.4 to 0.9) were found to be significant factors for predicting poor neurologic outcome. ROC curve analysis showed that ONSD and GWR had areas under the ROC curve of 0.931 (95% CI = 0.87 to 0.98) and 0.922 (95% CI = 0.86 to 0.97), respectively. Combining the cutoff values of ONSD (6.21 mm, sensitivity = 56%; 95% CI = 43% to 68%) and GWR (1.23, sensitivity = 84%; 95% CI = 73% to 92%) to have 100% specificities, the sensitivity was improved to 92% (95% CI = 84% to 98%). Intrarater and interrater intraclass correlation coefficients between the investigators measuring ONSD were 0.888 and 0.833, respectively. CONCLUSIONS: Optic nerve sheath diameter on initial brain CT correlated closely with the neurologic outcome of hypoxic ischemic encephalopathy and had good reliability. Additional prospective work may be justified evaluating the standardization and diagnostic performance in real time use as a predictive tool for neurologic outcome following cardiac arrest.

Performance Assessment of the SOFA, APACHE II Scoring System, and SAPS II in Intensive Care Unit Organophosphate Poisoned Patients

This study assessed the ability of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology, Chronic Health Evaluation (APACHE) II scoring systems, as well as the Simplified Acute Physiology Score (SAPS) II method to predict group mortality in intensive care unit (ICU) patients who were poisoned with organophosphate. The medical records of 149 organophosphate poisoned patients admitted to the ICU from September 2006 to December 2012 were retrospectively examined. The SOFA, APACHE II, and SAPS II were calculated based on initial laboratory data in the Emergency Department, and during the first 24 hr of ICU admission. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and SAPS II equations. The ability to predict group mortality by the SOFA score, APACHE II score, and SAPS II method was assessed using two by two decision matrices and receiver operating characteristic (ROC) curve analysis. A total of 131 patients (mean age, 61 yr) were enrolled. The sensitivities, specificities, and accuracies were 86.2%, 82.4%, and 83.2% for the SOFA score, respectively; 65.5%, 68.6%, and 67.9% for the APACHE II scoring system, respectively; and 86.2%, 77.5%, and 79.4% for the SAPS II, respectively. The areas under the curve in the ROC curve analysis for the SOFA score, APACHE II scoring system, and SAPS II were 0.896, 0.716, and 0.852, respectively. In conclusion, the SOFA, APACHE II, and SAPS II have different capability to discriminate and estimate early in-hospital mortality of organophosphate poisoned patients. The SOFA score is more useful in predicting mortality, and easier and simpler than the APACHE II and SAPS II.

Preimplantation genetic diagnosis of chromosome translocations by analysis of polymorphic short tandem repeats

<p><b>INTRODUCTION</b>We aimed to develop and implement a short tandem repeat (STR) polymerase chain reaction alternative to fluorescence in situ hybridisation (FISH) for the preimplantation genetic diagnosis (PGD) of chromosomal translocations.</p><p><b>METHODS</b>Selected informative STRs located on translocated arms of relevant chromosomes were used to discriminate between normal and unbalanced chromosome states in each embryo.</p><p><b>RESULTS</b>PGD cycles were performed on five couples where one spouse carried a balanced translocation. 27 embryos were analysed, of which 12 were normal/balanced, 12 were abnormal/unbalanced and three were indeterminate. Four PGD cycles proceeded to embryo transfer, of which two led to pregnancy. The first pregnancy showed a normal male karyotype, and a healthy baby was delivered at term. A second pregnancy unexpectedly miscarried in the second trimester from unknown causes.</p><p><b>CONCLUSION</b>STR analysis is a simple and suitable alternative to FISH for detecting unbalanced chromosomal states in preimplantation embryos.</p>

The Prognostic Value of the C-reactive Protein Levels in Acute Organophosphate Poisoning

PURPOSE: Organophosphate poisoning is a worldwide concern and there have been many reports describing the factors affecting the severity and prognosis resulting from its toxicity. This study aims to investigate if C-reactive protein is a useful independent predictor of mortality in organophosphate poisoning patients. METHODS: This retrospective study targeted organophosphate intoxication patients who were admitted to the emergency department of Samsung Changwon Hospital from January 1st, 2006 to December 31st, 2010. The data was retrospectively collected from clinical records and laboratory files, and using multivariate logistic analysis, the total population data was retrospectively analyzed for its association with mortality. RESULTS: A total of 70 patients were enrolled in this study. Of the 70, 53 survived and 17 died. Significant clinical factors such as age, mean arterial pressure, Glasgow coma scale score, respiratory rate, PaO2/FiO2, hematocrit, albumin, glucose and C-reactive protein (measured 24 hours after admission) were associated with mortality. The fatality rate resulting from organophosphate poisoning was 24.3%, and there was an increase observed in the mortality rate of patients with higher C-reactive protein at 24 hours after admission. CONCLUSION: The initial serum C-reactive protein and acetylcholinesterase results had no significant association with the severity of acute organophosphate poisoning. However, C-reactive protein results after 24 hours were significant independent predictors of mortality in the total population of patients afflicted with acute organophosphate poisoning.

The Prognostic Value of the C-reactive Protein Levels in Acute Organophosphate Poisoning

PURPOSE: Organophosphate poisoning is a worldwide concern and there have been many reports describing the factors affecting the severity and prognosis resulting from its toxicity. This study aims to investigate if C-reactive protein is a useful independent predictor of mortality in organophosphate poisoning patients. METHODS: This retrospective study targeted organophosphate intoxication patients who were admitted to the emergency department of Samsung Changwon Hospital from January 1st, 2006 to December 31st, 2010. The data was retrospectively collected from clinical records and laboratory files, and using multivariate logistic analysis, the total population data was retrospectively analyzed for its association with mortality. RESULTS: A total of 70 patients were enrolled in this study. Of the 70, 53 survived and 17 died. Significant clinical factors such as age, mean arterial pressure, Glasgow coma scale score, respiratory rate, PaO2/FiO2, hematocrit, albumin, glucose and C-reactive protein (measured 24 hours after admission) were associated with mortality. The fatality rate resulting from organophosphate poisoning was 24.3%, and there was an increase observed in the mortality rate of patients with higher C-reactive protein at 24 hours after admission. CONCLUSION: The initial serum C-reactive protein and acetylcholinesterase results had no significant association with the severity of acute organophosphate poisoning. However, C-reactive protein results after 24 hours were significant independent predictors of mortality in the total population of patients afflicted with acute organophosphate poisoning.

Polyethylene Failure Following TKRA

PURPOSE: We purpose to analyze the factors related to the polyethylene failure through the 7 exchanged polyethylene. MATERIALS AND METHODS: We experienced 7 cases of polyethylene failure from Apr. 1988 to Jan. 2000. The average duration of reoperation is 5 year 2 months(1 year 8 months-8 year 11 months), age at primary operation is 62 years old(55-64 years old), weight is 65kg(56-78kg) and height is 155cm(150-162cm). The used prostheses were AGC(Biomet, Warsaw, U.S.A) in 2 patients, AMK(Depuy, Warsaw, U.S.A) in 1 patient, ,MG II(Zimmer, Warsaw, U.S.A) in 1 patient, PFC(Johnson and Johnson, Warsaw U.S.A) in 2 patients and Series 7000(Osteonics, New Jersey, U.S.A.) in 1 patient. RESULTS: The thickness of polyethylene is Smm in 6 patients and 9mm in 1 patient. All of prostheses are cruciate retaining type with relatively flat surface geometry and low-height intercondylar eminence, and the minimal thickness of each system. CONCLUSION: We consider that the thicker polyethylene should be used when feasible in order to avoid reoperation which is caused by accelerated wear of polyethylene, and early detection of polyethylene wear is important. This can be got through knee standing AP, fluroscopic evaluation with varus and valgus stress.