Detailed Changes in Oxygenation following Awake Prone Positioning for Non-Intubated Patients with COVID-19 and Hypoxemic Respiratory Failure-A Historical Cohort Study.

Few studies have reported on the effectiveness of awake prone therapy in the clinical course of coronavirus disease (COVID-19) patients. This study aimed to investigate the effects of awake prone therapy during spontaneous breathing on the improvement of oxygenation over 3 weeks for COVID-19 acute respiratory failure. Data of consecutive COVID-19 patients with lung disorder with a fraction of inspired oxygen (FIO2) ≥ 0.4 and without tracheal intubation were analyzed. We examined changes in SpO2/FIO2, ROX index ((SpO2/FIO2)/respiratory rate) and the seven-category ordinal scale after the initiation of FIO2 ≥ 0.4 and compared these changes between patients who did and did not receive prone therapy. Of 58 patients, 27 received awake prone therapy, while 31 did not. Trend relationships between time course and change in SpO2/FIO2 and ROX index were observed in both groups, although a significant interaction in the relationship was noted between prone therapy and change in SpO2/FIO2 and ROX index. The seven-category ordinal scale also revealed a trend relationship with time course in the prone therapy group. The awake prone therapy was significantly associated with a lower rate of tracheal intubation. In patients with COVID-19 pneumonia treated with FIO2 ≥ 0.4, awake prone therapy may improve oxygenation within two weeks.

Use of electrical muscle stimulation body massager (EMS-BMs) improves deep venous blood flow.

We investigated whether using electrical muscle stimulation body massagers (EMS-BMs) for the passive contraction of the lower extremity muscles reduces venous stasis in the deep veins of the lower extremities. In this randomized crossover design study of 20 healthy volunteers between November 2018 and February 2019, we measured both the popliteal and femoral vein peak velocities (PV, cm/s) and blood flow volumes (BFV,mL/min), using pulsed-wave Doppler ultrasound at rest (baseline), and at 2 and 10 min after starting EMS-BM use. Two EMS types: types A (two small pads) and B (one large pad) devices respectively, were examined. The PVs of the femoral (A: 23±7, B: 25±8) and popliteal (A: 26±12, B: 27±12) veins and BFV of types A (107±46) and B (141±88) of the femoral vein were significantly increased compared to the baseline (PV of femoral vein: 19±9, PV of popliteal vein: 14±5, BFV of popliteal vein: 81±46) (P<0.01). No significant differences occurred between the devices in the PV or BFV at either 2 or 10 min. Regardless of the type of stimulation or the shape of the pad, contraction of the lower limb muscles by EMS-BM effectively reduces venous stasis in the lower limb.

Six-Minute Walk Test Predicts Postoperative Delirium After Transcatheter Aortic Valve Replacement.

OBJECTIVE: This study investigated the incidence and risk factors of postoperative delirium (POD) after transcatheter aortic valve replacement (TAVR) and to evaluate the association between preoperative conditions, particularly frailty, and POD. DESIGN: Observational, case-control study. SETTING: Single-center university hospital. PARTICIPANTS: The study comprised 124 patients who underwent TAVR and were divided into the following two groups: group D (patients diagnosed with POD) and group C (patients without POD). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Twenty-seven patients (21.7%) developed POD (95% confidence interval 14.9%-30.1%). POD was defined as a diagnosis of delirium using the Confusion Assessment Method for Intensive Care Unit scale during the patients' intensive care unit stay. Preoperative and postoperative data of patient characteristics were obtained from their medical records. A multivariate logistic regression analysis was performed using variables associated with POD incidence. Frailty scores were significantly higher in group D than in group C. The distance covered in the six-minute walk test (6MD) was significantly shorter in group D than in group C. The risk of developing POD was significantly higher in patients with a 6MD shorter than 220 m. Multivariate logistic regression analysis showed that a shorter 6MD was an independent risk factor for POD (odds ratio 5.66; p = 0.004). CONCLUSION: In the present study, POD was seen in 21.7% of the patients who underwent TAVR. A 6MD shorter than 220 m was an independent preoperative risk factor for POD. For patients at high risk of POD, more careful management in the perioperative period may reduce POD.

Preoperative sepsis is a predictive factor for 30-day mortality after major lower limb amputation among patients with arteriosclerosis obliterans and diabetes.

BACKGROUND: While many patients with lower limb ischemia also have severe infections, few studies have investigated whether the presence of preoperative sepsis affects patient prognosis following lower limb amputation (LLA). Therefore, we investigated the factors (including sepsis as defined in SEPSIS-3) that contribute to the acute mortality rate in patients who underwent LLA due to arteriosclerosis obliterans (ASO) or diabetes mellitus (DM). METHODS: In this retrospective, single-center, 10-year chart review study, 122 adult patients who underwent LLA due to ASO and/or DM were identified from 56,438 surgery cases. Patient characteristics, including co-morbidities, surgical conditions, the presence/absence of sepsis, and acute physiological condition after surgery, were investigated in patients who died within 30 days of LLA and those who survived. Univariate analysis between groups was performed using the chi-square test. Comparisons of age and American Society of Anesthesiologists-Physical Status classification between groups were performed using the Mann-Whitney U test. Risk factors for 30-day mortality after LLA were examined using stepwise logistic regression (backward elimination). Statistical results were considered significant at P < 0.05. RESULTS: Eight cases of mortality (6.6%) were found; we identified the causes as sepsis, myocardial infarction, fatal arrhythmia, and mesenteric artery occlusive disease in 5 (62.5%), 1 (12.5%), 1 (12.5%), and 1 (12.5%) cases, respectively. Using univariate analysis, we identified that age (≥74), delirium, sepsis, intensive care unit admission, non-DM (ASO only), hemodialysis, and acute kidney injury were significantly higher in the mortality group. In logistic regression analysis, non-DM (odds ratio [OR]: 35.2, 95% confidence interval [CI]: 2.8-432) and sepsis (OR: 80.7, 95% CI: 6.7-959) were potential risk factors for 30-day mortality. CONCLUSIONS: This study suggests that cases resulting in amputation due to ASO pathology alone might have poor prognosis and that preoperative sepsis can increase perioperative mortality; hence, the decision to amputate must be considered before the development of sepsis.

Efficient production of 2-pyrone 4,6-dicarboxylic acid as a novel polymer-based material from protocatechuate by microbial function.

Sphingomonas paucimobilis SYK-6, which can degrade various low molecular weight compounds derived from plant polyphenols such as lignin, lignan, and tannin, metabolizes these substances via 2-pyrone-4,6-dicarboxylic acid (PDC). We focused on this metabolic intermediate as a potential raw material for novel, bio-based polymers. We cloned the ligAB and ligC genes of SYK-6, which respectively encode protocatechuate 4,5-dioxygenase and 4-carboxy-2-hydroxymuconate-6-semialdehyde dehydrogenase, into a broad host range plasmid vector, pKT230MC. The resulting plasmid, pDVABC, was introduced into the PpY1100 strain of Pseudomonas putida, and we found that PDC could be stably produced from protocatechuate and accumulated. In addition, we examined the efficiency of production of PDC from protocatechuate on a 5-L scale in a Luria-Bertani medium containing 100 mM glucose and determined that PDC was stably produced from protocatechuate to yield 10 g/L or more.