Correlation and validity of imputed PaO2/FiO2 and SpO2/FiO2 in patients with invasive mechanical ventilation at 2600m above sea level.

OBJECTIVE: To establish the correlation and validity between PaO2/FiO2 obtained on arterial gases versus noninvasive methods (linear, nonlinear, logarithmic imputation of PaO2/FiO2 and SpO2/FiO2) in patients under mechanical ventilation living at high altitude. DESIGN: Ambispective descriptive multicenter cohort study. SETTING: Two intensive care units (ICU) from Colombia at 2600m a.s.l. PATIENTS OR PARTICIPANTS: Consecutive critically ill patients older than 18 years with at least 24h of mechanical ventilation were included from June 2016 to June 2019. INTERVENTIONS: None. VARIABLES: Variables analyzed were demographic, physiological messures, laboratory findings, oxygenation index and clinical condition. Nonlinear, linear and logarithmic imputation formulas were used to calculate PaO2 from SpO2, and at the same time the SpO2/FiO2 by severe hypoxemia diagnosis. The intraclass correlation coefficient, area under the ROC curve, sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were calculated. RESULTS: The correlation between PaO2/FiO2 obtained from arterial gases, PaO2/FiO2 derived from one of the proposed methods (linear, non-linear, and logarithmic formula), and SpO2/FiO2 measured by the intraclass correlation coefficient was high (greater than 0.77, p<0.001). The different imputation methods and SpO2/FiO2 have a similar diagnostic performance in patients with severe hypoxemia (PaO2/FiO2 <150). PaO2/FiO2 linear imputation AUC ROC 0,84 (IC 0.81-0.87, p<0.001), PaO2/FiO2 logarithmic imputation AUC ROC 0.84 (IC 0.80-0.87, p<0.001), PaO2/FiO2 non-linear imputation AUC ROC 0.82 (IC 0.79-0.85, p<0.001), SpO2/FiO2 oximetry AUC ROC 0.84 (IC 0.81-0.87, p<0.001). CONCLUSIONS: At high altitude, the SaO2/FiO2 ratio and the imputed PaO2/FiO2 ratio have similar diagnostic performance in patients with severe hypoxemia ventilated by various pathological conditions.

Thumb carpometacarpal arthroplasty and trapeziectomy using a tenodesis screw compared to ligament reconstruction.

This study aimed to compare the results of patients treated with a thumb carpometacarpal (CMC) suspension arthroplasty using an interference screw technique with patients that were treated by trapeziectomy and ligament reconstruction. A retrospective chart review was conducted of patients over 18 years old who required surgical treatment for thumb CMC joint arthritis treated by a single surgeon. Patients included in the study followed the same preoperative and postoperative protocol. Information related to functional outcomes was collected (pinch and grip strength, pain, Kapandji score, proximal migration of first metacarpal bone). One hundred and five patients were included, 77% were female, age at the time of the study was 62.7 years old; 74 (70%) patients were treated with the tenodesis screw (TS) technique and 31 (30%) with trapeziectomy and ligament reconstruction (TZLR). Patients were followed for a mean of 8.4 months. Postoperative pain was 1.2 in the TS group and 0.6 in the TZLR group; Kapandji score was 8.3 in the TS group and 9 in the TZLR group; in the TS group, the grip strength was 26.2kg and key pinch strength was 6.15kg; in the TZLR group, grip strength was 12.8kg and key pinch strength was 4.7kg. Proximal migration was 0.4cm in the TZLR group and 0.6cm in the TS group. The use of tenodesis screw and half of the flexor carpi radialis had minor advantages, such as increasing the grip and key pinch strength without differences relative the non-operated thumb, minimal migration of the first metacarpal bone compared with the other technique.

Correlation and validity of imputed PaO2/FiO2 and SpO2/FiO2 in patients with invasive mechanical ventilation at 2600m above sea level.

OBJECTIVE: To establish the correlation and validity between PaO2/FiO2 obtained on arterial gases versus noninvasive methods (linear, nonlinear, logarithmic imputation of PaO2/FiO2 and SpO2/FiO2) in patients under mechanical ventilation living at high altitude. DESIGN: Ambispective descriptive multicenter cohort study. SETTING: Two intensive care units (ICU) from Colombia at 2600m a.s.l. PATIENTS OR PARTICIPANTS: Consecutive critically ill patients older than 18 years with at least 24h of mechanical ventilation were included from June 2016 to June 2019. INTERVENTIONS: None. VARIABLES: Variables analyzed were demographic, physiological messures, laboratory findings, oxygenation index and clinical condition. Nonlinear, linear and logarithmic imputation formulas were used to calculate PaO2 from SpO2, and at the same time the SpO2/FiO2 by severe hypoxemia diagnosis. The intraclass correlation coefficient, area under the ROC curve, sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were calculated. RESULTS: The correlation between PaO2/FiO2 obtained from arterial gases, PaO2/FiO2 derived from one of the proposed methods (linear, non-linear, and logarithmic formula), and SpO2/FiO2 measured by the intraclass correlation coefficient was high (greater than 0.77, p<0.001). The different imputation methods and SpO2/FiO2 have a similar diagnostic performance in patients with severe hypoxemia (PaO2/FiO2 <150). PaO2/FiO2 linear imputation AUC ROC 0,84 (IC 0.81-0.87, p<0.001), PaO2/FiO2 logarithmic imputation AUC ROC 0.84 (IC 0.80-0.87, p<0.001), PaO2/FiO2 non-linear imputation AUC ROC 0.82 (IC 0.79-0.85, p<0.001), SpO2/FiO2 oximetry AUC ROC 0.84 (IC 0.81-0.87, p<0.001). CONCLUSIONS: At high altitude, the SaO2/FiO2 ratio and the imputed PaO2/FiO2 ratio have similar diagnostic performance in patients with severe hypoxemia ventilated by various pathological conditions.

Correlation and validity of imputed PaO2/FiO2 and SpO2/FiO2 in patients with invasive mechanical ventilation at 2600m above sea level / Correlación y validez de la PaO2/FiO2 y SpO2/FiO2 imputadas en pacientes con ventilación mecánica invasiva a 2.600 metros sobre el nivel del mar

Objective To establish the correlation and validity between PaO2/FiO2 obtained on arterial gases versus noninvasive methods (linear, nonlinear, logarithmic imputation of PaO2/FiO2 and SpO2/FiO2) in patients under mechanical ventilation living at high altitude. Design Ambispective descriptive multicenter cohort study. Setting Two intensive care units (ICU) from Colombia at 2600m a.s.l. Patients or participants Consecutive critically ill patients older than 18 years with at least 24h of mechanical ventilation were included from June 2016 to June 2019. Interventions None. Variables Variables analyzed were demographic, physiological messures, laboratory findings, oxygenation index and clinical condition. Nonlinear, linear and logarithmic imputation formulas were used to calculate PaO2 from SpO2, and at the same time the SpO2/FiO2 by severe hypoxemia diagnosis. The intraclass correlation coefficient, area under the ROC curve, sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were calculated. Results The correlation between PaO2/FiO2 obtained from arterial gases, PaO2/FiO2 derived from one of the proposed methods (linear, non-linear, and logarithmic formula), and SpO2/FiO2 measured by the intraclass correlation coefficient was high (greater than 0.77, p<0.001). The different imputation methods and SpO2/FiO2 have a similar diagnostic performance in patients with severe hypoxemia (PaO2/FiO2 <150). PaO2/FiO2 linear imputation AUC ROC 0,84 (IC 0.81–0.87, p<0.001), PaO2/FiO2 logarithmic imputation AUC ROC 0.84 (IC 0.80–0.87, p<0.001), PaO2/FiO2 non-linear imputation AUC ROC 0.82 (IC 0.79–0.85, p<0.001), SpO2/FiO2 oximetry AUC ROC 0.84 (IC 0.81–0.87, p<0.001). Conclusions At high altitude, the SaO2/FiO2 ratio and the imputed PaO2/FiO2 ratio have similar diagnostic performance in patients with severe hypoxemia ventilated by various pathological conditions (AU)

Objetivo Establecer la correlación y validez entre PaO2/FiO2 obtenida en gases arteriales versus métodos no invasivos (imputación lineal, no lineal, logarítmica de PaO2/FiO2 y SpO2/FiO2) en pacientes bajo ventilación mecánica que viven en altitudes elevadas. Diseño Estudio de cohorte multicéntrico descriptivo ambispectivo Ámbito Dos unidades de cuidados intensivos de Colombia a 2.600 m s.n.m. Pacientes o participantes Se incluyeron pacientes consecutivos en estado crítico mayores de 18 años con al menos 24h de ventilación mecánica desde junio de 2016 a junio de 2019. Intervenciones Ninguna. Variables Las variables analizadas fueron demográficas, fisiológicas, hallazgos de laboratorio, índice de oxigenación y estado clínico. Se utilizaron fórmulas de imputación no lineales, lineales y logarítmicas para calcular la PaO2 a partir de la SpO2, y al mismo tiempo la SpO2/FiO2 mediante el diagnóstico de hipoxemia severa. Se calculó el coeficiente de correlación intraclase, el área bajo la curva ROC, la sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo, la razón de verosimilitud positiva y negativa. Resultados La correlación entre PaO2/FiO2 obtenida a partir de gases arteriales, PaO2/FiO2 derivada de uno de los métodos propuestos (fórmula lineal, no lineal y logarítmica) y SpO2/FiO2 medida por el coeficiente de correlación intraclase fue alta (mayor a 0,77, p<0,001). Los diferentes métodos de imputación y SpO2/FiO2 tienen un rendimiento diagnóstico similar en pacientes con hipoxemia severa (PaO2/FiO2<150). PaO2/FiO2 imputación lineal AUC ROC 0,84 (IC 0,81-0,87; p<0,001), PaO2/FiO2 imputación logarítmica AUC ROC 0,84 (IC 0,80-0,87; p<0,001), PaO2/Imputación no lineal de FiO2 AUC ROC 0,82 (IC 0,79-0,85; p<0,001), oximetría de SpO2/FiO2 AUC ROC 0,84 (IC 0,81-0,87; p<0,001). Conclusiones A gran altitud, el cociente SaO2/FiO2 y el cociente PaO2/FiO2 (AU)

Significance of serum for the preservation of insulin secretion during culture.

The effects of serum and serum fractions on the maintenance of glucose-stimulated insulin secretion during culture of pancreatic islets were studied. The basal insulin release was independent of previous culture with serum but glucose-stimulated secretion increased with serum concentrations up to 0.3% which was sufficient for maximal effect. Although a high molecular size fraction (greater than 30,000 daltons) possessed the full activity of serum it is possible that the active principles are lighter compounds bound to serum proteins. Whereas the islet content of insulin was unaffected by culture with 3% serum, the presence of serum tended to increase the levels of pyridine nucleotides and the uptake of intracellular 45Ca in response to glucose. The sites of action for the serum factors are, therefore, the stimulus-secretion coupling and hormone discharge mechanisms rather than insulin biosynthesis.

Glucose inhibition of 45Ca efflux from pancreatic islets.

Pancreatic islets were microdissected from ob/ob mice, loaded for 2 h with 45Ca and perfused with calcium-deficient medium. Irrespective of the glucose and calcium concentrations in the loading medium, increased glucose in the perfusion medium resulted in reduced amounts of radioactivity in the perfusate. A glucose inhibition of 45Ca washout was also evident when the specific radioactivity of the islets approached that of the labeling medium, indicating that the effect was not simply due to isotopic dilution. The depression of 45Ca washout diminished after culture of the islets in a serum-free medium and it was absent in islets taken from mice homozygous for the gene diabetes. The glucose effect became less pronounced when 50 micron D-600, an inhibitor of the calcium inward transport, was added to the calcium-deficient perfusion medium and abolished in the presence of 20 mM Ca-EGTA. The inhibition of the 45Ca washout observed is not necessarily due to a direct glucose interaction with the outward calcium transport but may also result from stimulation of the uptake and intracellular trapping of the cation.

Function of microdissected pancreatic islets cultured in a chemically defined medium. I. Insulin content and release.

Microdissected pancreatic islets from non-inbred ob/ob-mice were cultured for 6 or 7 days in serum-free tissue culture medium 199. The insulin content of the islets decreased 60% during culture in 17 mM or 28 mM glucose and about 70% in the presence of 3.3 mM or 5.6 mM glucose. At the end of a culture period in high glucose, the sum of the insulin in the islet plus that in the culture medium was almost twice as high as the insulin content of fresh islets, indicating an active insulin biosynthesis. The maximal insulin response to glucose after culture in 17 mM or 28 mM glucose was about 40% of that in fresh islets; after culture in 3.3 mM glucose it was 10%. Half-maximal stimulation was observed at a glucose concentration of 5 mM for islets cultured with high glucose as compared to 9 mM for fresh islets. Like glucose, glibenclamide was a more effective insulin stimulator after culture with a high glucose concentration than with a low one. However, leucine-induced insulin release was not affected by the glucose concentration in the preceding culture medium. Whereas potentiation of glucose-stimulated release by arginine or dibutyryl-cAMP was independent of glucose concentration during the culture, theophylline released three times more insulin when the islets had been cultured with high glucose.

[Syndrome of hypomelia, hypotrichosis and facial hemangioma (pseudothalidomide syndrome)]. / Síndrome de hipomelia, hipotricosis y hemangioma facial (Síndrome pseudotalidomídico).

A case of hypomelia, hypotrichosis and facial hemangioma (pseudothalidomide S.) is presented, which according to bibliography consulted, is the first case in Spain and the tenth mentioned in world literature. A differential diagnosis with dysostosis is proposed. Authors described characteristic traits of the patient and indicate differences with those presented in previous publications emphasizing association with cleft lip, absence of eyes anomalies, and normal neurological development. The importance of the administration of tetracyclines and spiramycins to the mother during first month of gestation is also noted.