Performance Evaluation of AFIAS ST2 and Ichroma ST2 Assays in Comparison with Presage ST2 Assay.

Background: Elevated soluble suppression of tumorigenicity 2 (sST2) levels may predict mortality in heart failure (HF) patients. The AFIAS ST2 assay (AFIAS ST2, Boditech Med Inc., Chuncheon, Korea) and ichroma ST2 assay (ichroma ST2, Boditech Med Inc.) are newly developed point-of-care (POC) assays for measuring sST2 level. We evaluated the performance of these assays, in terms of cut-off validation and prognosis, and compared them with that of the Presage ST2 assay (Presage ST2, Critical Diagnostics, San Diego, CA, USA). Methods: We validated the US FDA-claimed sST2 clinical cut-off of 35 ng/mL using 420 serum samples (298 samples from the universal sample bank of the American Association for Clinical Chemistry and 122 samples from reference individuals from Konkuk University Medical Center). We compared AFIAS ST2 and ichroma ST2 with Presage ST2, using 206 samples from patients with HF. We assessed prognosis using the three assays in 252 samples from the Barcelona ambulatory HF cohort subsets. Results: The upper reference limits of AFIAS ST2 and ichroma ST2 were within the clinical cut-off of Presage ST2. The results of AFIAS ST2 and ichroma ST2 were highly correlated with those of Presage ST2 (r = 0.82 and 0.81, respectively). Based on this cut-off, all three assays predicted cardiovascular death. Conclusions: The new POC assays, AFIAS ST2 and ichroma ST2, would be useful in clinical practice for managing HF patients, with performances equivalent to that of Presage ST2.

Prognostic Value of Plasma Presepsin and Pneumonia Severity Index in Patients with Community-Acquired Pneumonia in the Emergency Department.

Background and Objectives: Presepsin (PSS) is an independent predictor for estimating disease severity and prognosis in septic patients. Few studies have reported the associations between plasma PSS and the severity and prognosis in patients with community-acquired pneumonia (CAP). We investigated whether a high plasma PSS level was associated with 30-day mortality in CAP patients. Materials and Methods: This retrospective single-center study was conducted in an emergency department. The PSS level was measured in 211 adult CAP patients admitted to the hospital and followed for up to 30 days. We recorded the pneumonia severity index (PSI) and the CURB-65 score. The primary outcome was death from any cause within 30 days. Results: The plasma PSS levels were significantly elevated in the high-risk group (PSI > 130) compared with the low- (PSI < 91) or moderate-risk groups (PSI 91−130). Forty-four patients (20.9%) died within 30 days of admission. Non-survivors had significantly higher plasma PSS levels than survivors among CAP patients: 1083 (697−1736) pg/mL vs. 385 (245−554) pg/mL (p < 0.001). The area under the curve (AUC) to predict 30-day mortality was highest for PSS (0.867), followed by procalcitonin (0.728) and lactate (0.616). The cutoff level of plasma PSS for 30-day mortality was >754 pg/mL. The combination of PSI and plasma PSS level improved the predictive ability for 30-day mortality (AUC = 0.892). Cox regression analysis showed that higher PSS levels (>754 pg/mL) and higher PSI (>126) were associated with 30-day mortality in CAP patients (hazard ratios of 19.472 and 6.375, respectively). Conclusion: Elevated plasma PSS is associated with severity and 30-day mortality in hospitalized CAP patients. Combining plasma PSS level and PSI could significantly improve the predictive ability of PSS for 30-day mortality.

Predictive Values of Procalcitonin and Presepsin for Acute Kidney Injury and 30-Day Hospital Mortality in Patients with COVID-19.

Background and Objectives: Acute kidney injury (AKI) is a common complication in patients with coronavirus disease 2019 (COVID-19). We investigated the values of procalcitonin (PCT) and presepsin (PSS) for predicting AKI and 30-day hospital mortality in patients with COVID-19. Materials and Methods: We retrospectively evaluated 151 patients with COVID-19 who were admitted to the hospital via the emergency department. The diagnosis of AKI was based on the Kidney Disease: Improving Global Outcomes clinical practice guidelines. Results: The median patient age was 77 years, and 86 patients (57%) were male. Fifty-six patients (37.1%) developed AKI, and 19 patients (12.6%) died within 30 days of hospital admission. PCT and PSS levels were significantly higher in patients with AKI and non-survivors. The cutoff values of PCT levels for predicting AKI and mortality were 2.26 ng/mL (sensitivity, 64.3%; specificity, 89.5%) and 2.67 ng/mL (sensitivity, 68.4%; specificity, 77.3%), respectively. The cutoff values of PSS levels for predicting AKI and mortality were 572 pg/mL (sensitivity, 66.0%; specificity, 69.1%) and 865 pg/mL (sensitivity, 84.6%; specificity, 76.0%), respectively. Conclusion: PCT and PSS are valuable biomarkers for predicting AKI and 30-day hospital mortality in patients with COVID-19.

Perceptions of resilience in patients undergoing peritoneal dialysis: A Q-methodology study.

Resilience is a potential human psycho-social ability that can reduce negative emotion and promote adaptation to adversity. Most previous studies on resilience have highlighted positive factors for patients with chronic illnesses; however, very few focus on the resilience of patients undergoing peritoneal dialysis (PD) using a qualitative approach. Using Q-methodology, we identified the perceptions of resilience of patients undergoing PD. We recruited 33 Korean participants undergoing PD in a university hospital, and classified 37 Q-samples into a 9-point normal distribution grid. Collected data were analyzed using the PC-QUANL program. The perceived subjectivity of the resilience of Korean patients undergoing PD was categorized as three factors: "support-based acceptance," "gloomy isolation," and "active life-oriented." The three factors explained 47.4% of the total variance. The eigenvalues were 9.99, 3.40, and 2.26, respectively. These findings suggest that a differentiated approach is needed for interventions to enhance the resilience of patients undergoing PD. This study highlights that clinical nurses and health professionals should understand the perceptions of resilience of patients undergoing PD, and consider their viewpoints in the caring and treatment process.

Effects of an examiner's positive and negative feedback on self-assessment of skill performance, emotional response, and self-efficacy in Korea: a quasi-experimental study.

BACKGROUND: Feedback is an essential element in performance training. However, little effort has been made to measure the effects of positive and negative feedback on the ability of self-rated assessment, affective responses, and motivation to learn in healthcare education. METHODS: This study was a quasi-experimental posttest design to examine the effects of an examiner's positive and negative verbal feedback on the accuracy of self-assessment, emotional responses, and self-efficacy. Second-year nursing students were recruited in a university in South Korea. A total of 110 participants were assigned randomly to a positive feedback (PF) group (n = 58) and a negative feedback (NF) group (n = 52). All participants completed the performance measure and then received a positive or negative feedback from an evaluator. After delivery of feedback, they assessed their own performance using the same sheet as the evaluator's and completed the survey for emotional response and self-efficacy. Chi-squared tests, Fisher's exact tests, independent sample Student's t tests, and Mann-Whitney nonparametric U tests, and Analysis of covariance (ANCOVA) were used to compare the baseline measurements of the demographic characteristics and the dependent variables between the PF and NF groups. RESULTS: The NF group demonstrated a more accurate self-rated assessment than the PF group (p <  0.001). While self-efficacy (p <  0.001) and positive emotions (p <  0.001) were significantly stronger in the PF group than in the NF group, negative emotions were significantly stronger in the NF group than in the PF group (p = 0.001). CONCLUSIONS: Evaluator's verbal feedback exerts a significant influence on the accuracy of self-assessment as well as emotions and self-efficacy. Instructors should pay attention to providing feedback to students, taking into account the impact of positive or negative feedback.

Serum Procalcitonin: An Independent Predictor of Clinical Outcome in Health Care-Associated Pneumonia.

BACKGROUND: Early prediction of the clinical outcomes for health care-associated pneumonia (HCAP) patients is challenging. OBJECTIVES: This is the first study to evaluate procalcitonin (PCT) as a predictor of outcomes in HCAP patients. METHODS: We conducted an observational study based on data for HCAP patients prospectively collected between 2011 and 2014. Outcome variables were intensive care unit (ICU) admission and 30-day mortality. PCT was categorized into three groups: <0.5, 0.5-2.0, and >2.0 ng/ml. We analysed multiple variables including age, sex, comorbidities, clinical findings, and PCT group to assess their association with outcomes. RESULTS: Of 245 HCAP patients, 99 (40.4%) were admitted to an ICU and 44 (18.0%) died within 30 days. The median PCT level was significantly higher in the ICU admission (1.19 vs. 0.4 ng/ml; p < 0.001) and 30-day mortality (3.3 vs. 0.4 ng/ml; p < 0.001) groups. In multivariate analysis, high PCT (>2.0 ng/ml) was strongly associated with ICU admission [odds ratio 3.734, 95% confidence interval (CI) 1.753-7.951; p = 0.001] and 30-day mortality (hazard ratio 2.254, 95% CI 1.250-5.340; p = 0.035). In receiver operating characteristic analysis, PCT had a poor discrimination power regarding ICU admission [0.695 of the area under the curve (AUC)] and a fair discrimination power regarding 30-day mortality in HCAP patients (0.768 of the AUC). CONCLUSIONS: High PCT on admission was strongly associated with ICU admission and 30-day mortality in HCAP patients. However, application of PCT alone seems to be limited to predicting outcomes.

Neurologic outcome of comatose survivors after hanging: a retrospective multicenter study.

PURPOSE: The aim of this study is to identify the neurologic outcome of hanging patients and prognostic factors. MATERIALS AND METHODS: We retrospectively investigated comatose hanging patients who arrived at the emergency departments (EDs) of twelve academic tertiary care centers during a period of seven years (2006-2012). Patients were analyzed separately according to whether out-of-hospital cardiac arrest (OHCA) occurred or not. The neurologic outcome was evaluated using the Cerebral Performance Category (CPC) at the time of hospital discharge. RESULTS: A total of 1118 patients were admitted to the ED after hanging attempts. There were 159 comatose patients who did not experience OHCA. Twelve (7.5%) of 159 patients were discharged from the hospital with a poor neurologic outcome (CPC 3-5). These 12 patients received only conservative management without therapeutic hypothermia. On multivariate logistic regression analysis, mental state upon ED arrival and arterial pH were predicting factors for poor prognosis. One hundred twenty-one patients suffered OHCA and experienced restored spontaneous circulation after cardiopulmonary resuscitation. Among them, only five (4.1%) patients recovered consciousness to the level of CPC 1-2. The initial arterial pH and HCO3(-) were prognostic factors in hanging patients with OHCA. CONCLUSIONS: Even though cardiac arrest did not occur after hanging injuries, 7.5% of patients could not recover consciousness. Therapeutic hypothermia should be considered for such patients. If OHCA occurred after the hanging injury, the proportion of patients with good neurologic outcome was very low at 4.1%.

Comparison of the problem-solving performance of ChatGPT-3.5, ChatGPT-4, Bing Chat, and Bard for the Korean emergency medicine board examination question bank.

Large language models (LLMs) have been deployed in diverse fields, and the potential for their application in medicine has been explored through numerous studies. This study aimed to evaluate and compare the performance of ChatGPT-3.5, ChatGPT-4, Bing Chat, and Bard for the Emergency Medicine Board Examination question bank in the Korean language. Of the 2353 questions in the question bank, 150 questions were randomly selected, and 27 containing figures were excluded. Questions that required abilities such as analysis, creative thinking, evaluation, and synthesis were classified as higher-order questions, and those that required only recall, memory, and factual information in response were classified as lower-order questions. The answers and explanations obtained by inputting the 123 questions into the LLMs were analyzed and compared. ChatGPT-4 (75.6%) and Bing Chat (70.7%) showed higher correct response rates than ChatGPT-3.5 (56.9%) and Bard (51.2%). ChatGPT-4 showed the highest correct response rate for the higher-order questions at 76.5%, and Bard and Bing Chat showed the highest rate for the lower-order questions at 71.4%. The appropriateness of the explanation for the answer was significantly higher for ChatGPT-4 and Bing Chat than for ChatGPT-3.5 and Bard (75.6%, 68.3%, 52.8%, and 50.4%, respectively). ChatGPT-4 and Bing Chat outperformed ChatGPT-3.5 and Bard in answering a random selection of Emergency Medicine Board Examination questions in the Korean language.

A simple audio-visual prompt device can improve CPR performance.

BACKGROUND: An adjunct to assist cardiopulmonary resuscitation (CPR) might improve the quality of CPR performance. STUDY OBJECTIVES: This study was conducted to evaluate whether a simple audio-visual prompt device improves CPR performance by emergency medical technicians (EMTs). METHODS: From June 2008 to October 2008, 55 EMTs (39 men, mean age 34.9±4.8 years) participated in this study. A simple audio-visual prompt device was developed. The device generates continuous metronomic sounds for chest compression at a rate of 100 beats/min with a distinct 30(th) sound followed by two respiration sounds, each for 1 second. All EMTs were asked to perform a 2-min CPR series on a manikin without the device, and one 2-min CPR series with the device. RESULTS: The average rate of chest compressions was more accurate when the device was used than when the device was not used (101.4±12.7 vs. 109.0±17.4/min, respectively, p=0.012; 95% confidence interval [CI] 97.2-103.8 vs. 104.5-113.5/min, respectively), and hands-off time during CPR was shorter when the device was used than when the device was not used (5.4±0.9 vs. 9.2±3.9 s, respectively, p<0.001; 95% CI 5.2-5.7 vs. 8.3-10.3 s, respectively). The mean tidal volume during CPR with the device was lower than without the device, resulting in the prevention of hyperventilation (477.6±60.0 vs. 636.6±153.4 mL, respectively, p<0.001; 95% CI 463.5-496.2 vs. 607.3-688.9 mL, respectively). CONCLUSION: A simple audio-visual prompt device can improve CPR performance by emergency medical technicians.

Efficacy of the Disposcope endoscope, a new video laryngoscope, for endotracheal intubation in patients with cervical spine immobilisation by semirigid neck collar: comparison with the Macintosh laryngoscope using a simulation study on a manikin.

OBJECTIVE: To evaluate whether endotracheal intubation in patients with cervical spine immobilisation by a semirigid neck collar is easier using the Disposcope endoscope (DE), a new video laryngoscope, than with the Macintosh laryngoscope (ML). METHODS: Sixty-eight medical interns who participated in a training programme for endotracheal intubation using the DE and ML were recruited to the randomised crossover trial 1 week after completing the training programme. In the trial, they used both the DE and the ML to perform intubation on a manikin wearing a semirigid neck collar. The time required to view the vocal cords and to complete intubation, successful endotracheal intubation, modified Cormack-Lehane classification (CL grade) and dental injury were recorded and analysed. RESULTS: The mean (SD) time to view the vocal cords was significantly shorter with the DE than with the ML (10.0 (7.0) vs 20.8 (18.9) s; p<0.0001). There were higher rates of CL grades 1 and 2a (69.1% and 22.1%) using the DE than with the ML (10.3% and 14.7%). All 68 participants had a higher rate of successful endotracheal intubation using the DE than using the ML (68 (100%) vs 47 (69.1%); p<0.0001). It took less time to complete endotracheal intubation with the DE than with the ML (p<0.0001). CONCLUSIONS: In patients with cervical spine immobilisation by a semirigid neck collar, the DE may be a more effective device for endotracheal intubation than the ML.

The S-S.M.A.R.T: A New Prognostic Tool for Patients with Suspected Sepsis in the Emergency Department.

Background: The sepsis screening tool is essential because it enables the rapid identification of high-risk patients and facilitates prompt treatment. Quick Sequential Organ Failure Assessment (qSOFA) is a widely used screening tool for sepsis. However, it has limitations in predicting patient prognosis. We developed the S-S.M.A.R.T (sepsis evaluation with shock index, mental status, age, and ROX index on triage) and aimed at evaluating it as a screening tool for patients with suspected sepsis in the emergency department. Methods: We conducted a single-center retrospective chart review of patients with suspected sepsis in the emergency department. We compared the prognosis prediction abilities of the S-S.M.A.R.T and qSOFA scores in patients with suspected sepsis. The primary outcome was 7-day mortality, and the secondary outcomes included 30-day mortality and ICU admission. The receiver operating characteristic (ROC) curve analysis and the chi-square test were used. Results: In total, 401 patients were enrolled. The mean age of the patients was 72.2 ± 15.6 years, and 213 (53.1%) of them were female. The S-S.M.A.R.T had superior predictive ability for prognosis of patients with suspected sepsis compared to qSOFA (area under the ROC curve (AUC) of 0.789 vs. 0.699; p=0.02 for 7-day mortality, AUC of 0.786 vs. 0.681; p < 0.001 for 30-day mortality, AUC 0.758 vs 0.717; p=0.05 for ICU admission). Conclusion: The S-S.M.A.R.T can be useful in predicting the prognosis of patients with suspected sepsis in the emergency department.

Plasma presepsin level predicts acute kidney injury in patients with sepsis in the emergency department.

Acute kidney injury (AKI) is a common complication in patients with sepsis. We evaluated the potential prognostic value of plasma presepsin to predict AKI in patients with sepsis in the emergency department. A total of 193 patients diagnosed with sepsis based on the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) were included in this observational study. AKI was defined according to the Kidney Disease Improving Global Outcomes clinical practice guideline. Plasma presepsin levels were measured on admission to the emergency department. We compared plasma presepsin levels between patients who did and those who did not develop AKI. AKI occurred in 100 (51.8%) patients. The median plasma presepsin level was significantly higher in patients with AKI than in those without AKI (1061 pg/mL vs 495 pg/mL, P <.001). Plasma presepsin levels were significantly increased in patients with AKI stage 3 compared with those with AKI stages 1 and 2 (P =.001). The area under the curve of presepsin for predicting AKI was 0.793 (95% confidence interval: 0.729-0.848). The optimal presepsin cutoff value for predicting AKI was >572 pg/mL, with a sensitivity of 77.0% and specificity of 81.7%. Plasma presepsin level is a valuable biomarker for the prediction of AKI in patients with sepsis in the emergency department.

Association of Serum Adiponectin Biomarker with Metabolic Syndrome Components in Koreans with Extremely High HDL Cholesterol Levels in General Health Checkup.

Adiponectin and high-density lipoprotein cholesterol (HDL-C) are negative predictors for cardio-metabolic disorders. This study explored adiponectin's role in predicting multiple metabolic syndrome components (multi-MetSC) in subjects with extremely high HDL-C levels overall and by sex. We enrolled adults with extremely high HDL-C levels (≥90 mg/dL) in general health checkups and compared adiponectin levels in subjects with and without multi-MetSC. Among 274 subjects (median 44 years, female 79.6%), 19 (6.9%) had a multi-MetSC. The adiponectin level was significantly lower in subjects with multi-MetSC than without (females: 9.2 [6.2-13.3] vs. 12.0 [9.7-15.9] µg/mL, p = 0.039; males: 6.9 ± 2.4 vs. 10.0 ± 5.2 µg/mL, p = 0.013). The optimal cutoff values to predict multi-MetSC were 9.7 µg/mL (sensitivity 64%, specificity 74%) in females and 9.6 µg/mL (sensitivity 100%, specificity 44%) in males. Compared with the high adiponectin group, the low group revealed higher fasting glucose in females and higher waist circumference, visceral fat area, and HDL-C levels in males. Multiple logistic regression analysis confirmed adiponectin as an independent predictor of multi-MetSC (OR 0.85, 95% CI 0.71-0.97). Adiponectin could be a potential biomarker for multi-MetSC in general health checkup subjects with extremely high HDL-C levels. There were sex differences in the metabolic risk factors between low and high adiponectin groups.

Vulnerable individuals and changes in suicidal behaviour during the COVID-19 pandemic in Korea.

BACKGROUND: The COVID-19 pandemic poses a major threat to mental health and is associated with an increased risk of suicide. An understanding of suicidal behaviours during the pandemic is necessary for establishing policies to prevent suicides in such social conditions. AIMS: We aimed to investigate vulnerable individuals and the characteristics of changes in suicidal behaviour during the COVID-19 pandemic. METHOD: We retrospectively reviewed the medical records of patients with suicide attempts who visited the emergency department from February 2019 to January 2021. We analysed the demographic and clinical characteristics, risk factors and rescue factors of patients, and compared the findings between the pre-pandemic and pandemic periods. RESULTS: In total, 519 patients were included. During the pre-pandemic and pandemic periods, 303 and 270 patients visited the emergency department after a suicide attempt, respectively. The proportion of suicide attempts by women (60.1% v. 69.3%, P = 0.035) and patients with a previous psychiatric illness (63.4% v. 72.9%, P = 0.006) increased during the COVID-19 pandemic. In addition, patients' rescue scores during the pandemic were lower than those during the pre-pandemic period (12 (interquartile range: 11-13) v. 13 (interquartile range: 12-14), P < 0.001). CONCLUSIONS: Women and people with previous psychiatric illnesses were more vulnerable to suicide attempts during the COVID-19 pandemic. Suicide prevention policies, such as continuous monitoring and staying in touch with vulnerable individuals, are necessary to cope with suicide risk.

Biomarker Rule-in or Rule-out in Patients With Acute Diseases for Validation of Acute Kidney Injury in the Emergency Department (BRAVA): A Multicenter Study Evaluating Urinary TIMP-2/IGFBP7.

Background: Urine tissue inhibitor of metalloproteinases-2/insulin-like growth factor-binding protein 7 (TIMP-2/IGFBP7) (NephroCheck, Ortho Clinical Diagnostics, Raritan, NJ, USA) is a US Food and Drug Administration-approved biomarker for risk assessment of acute kidney injury (AKI) in critically ill adult patients in intensive care units; however, its clinical impact in the emergency department (ED) remains unproven. We evaluated the utility of NephroCheck for predicting AKI development and short-term mortality in the ED. Methods: This was a prospective, observational, five-center international study. We consecutively enrolled ED patients admitted with ≥30% risk of AKI development (assessed by ED physician: ED score) or acute diseases. Serum creatinine was tested on ED arrival (T0), day 1, and day 2 (T48); urine for NephroCheck was collected at T0 and T48. We performed ROC curve and reclassification analyses. Results: Among the 529 patients enrolled (213 females; median age, 65 years), AKI developed in 59 (11.2%) patients. The T0 NephroCheck value was higher in the AKI group than in the non-AKI group (median 0.77 vs. 0.29 (ng/m)2/1,000, P=0.001), and better predicted AKI development than the ED score (area under the curve [AUC], 0.64 vs. 0.53; P=0.04). In reclassification analyses, adding NephroCheck to the ED score improved the prediction of AKI development (P<0.05). The T0 NephroCheck value predicted 30-day mortality (AUC, 0.68; P<0.001). Conclusions: NephroCheck can predict both AKI development and short-term mortality in at-risk ED patients. NephroCheck would be a useful biomarker for early ruling-in or ruling-out of AKI in the ED.

Lidocaine induces endoplasmic reticulum stress-associated apoptosis in vitro and in vivo.

We demonstrated that upregulation of both gene expression of endoplasmic reticulum (ER) stress chaperones (BiP, calnexin, calreticulin, and PDI) and ER stress sensors (ATF6, IRE1 and PERK) was induced by lidocaine, a local anesthetic, in PC12 cells. In addition to gene regulation, lidocaine also induced typical ER stress phenomena such as ART6 proteolytic cleavage, eIF2 alpha phosphorylation, and XBP1 mRNA splicing. In in vivo experiments, while lidocaine downregulated gene expression of antiapoptotic factors (Bcl-2 and Bcl-xl), pro-apoptotic factor (Bak and Bax) gene expression was upregulated. Furthermore, lidocaine induced apoptosis, as measured histochemically, and upregulated PARP1, a DNA damage repair enzyme. These results are the first to show that lidocaine induces apoptosis through ER stress in vitro and in vivo.

Silkworm hemolymph down-regulates the expression of endoplasmic reticulum chaperones under radiation-irradiation.

We demonstrated that up-regulation of gene expression of endoplasmic reticulum (ER) chaperones (BiP, calnexin, calreticulin, ERp29) and ER membrane kinases (IRE1, PERK, ATF6) was induced by radiation in neuronal PC12 cells. However, addition of silkworm, Bombyx mori, hemolymph to irradiated cells resulted in an obvious decrease in expression of these genes, compared with a single radiation treatment. In contrast, one of the ER chaperones, "ischemia-responsive protein 94 kDa" (irp94), was up-regulated by radiation. However, addition of silkworm hemolymph resulted in no change in the expression of irp94, with an expression pattern that differed from that of ER chaperones. Based on these results, we propose that silkworm hemolymph contains factors that regulate a decrease in the expression of ER chaperones under radiation-irradiation conditions, with the exception of irp94, which is not down-regulated. We suggest that this difference in the molecular character of irp94 may provide a clue to the biological functions associated with ER stress pathways, particularly the effects of radiation.

Prognostic value of red blood cell distribution width in predicting 3-month functional outcome of patients undergoing thrombolysis treatment for acute ischemic stroke.

ABSTRACT: This study was performed to determine whether red blood cell distribution width (RDW) is associated with 3-month poor functional outcome in patients undergoing thrombolytic therapy for acute ischemic stroke.RDW was measured in patients with thrombolytic therapy in emergency department. Functional outcome was assessed after 3 months and poor functional outcome was defined as modified Rankin scale 3 to 6.A total of 240 patients were enrolled, and 82 (34.2%) had a poor functional outcome. The median RDW was significantly elevated in patients with a poor functional outcome compare with those with a good outcome. RDW was independently associated with a 3-month poor functional outcome (odds ratio 3.369, 95% confidence interval 2.214-5.125). The optimal RDW cutoff for predicting 3-month poor functional outcome was 12.8%, and the area under the curve for RDW was 0.818 (95% confidence interval 0.761-0.876). The area under the curve for RDW was higher in male patients than in female patients. The RDW correlated positively with the modified Rankin scale score after 3 months and the initial National Institutes of Health Stroke Scale score.Initial higher RDW level is related to a 3-month poor functional outcome in patients undergoing thrombolytic therapy for acute ischemic stroke.

Absolute Change in High-Sensitivity Cardiac Troponin I at Three Hours After Presentation is Useful for Diagnosing Acute Myocardial Infarction in the Emergency Department.

BACKGROUND: A rise and/or fall in cardiac troponin value with at least one value above the 99th percentile upper reference limit is essential for acute myocardial infarction (AMI) diagnosis. We evaluated the clinical usefulness of serial high-sensitivity cardiac troponin I (hs-cTnI) measurements in AMI diagnosis, in terms of the predictability of absolute and relative changes. METHODS: For this retrospective, forward observational study, we enrolled 281 patients older than 18 years who presented with chest pain at the emergency department (ED) between August 2015 and December 2016. The patients were grouped as AMI and non-AMI, and 73 (26%) were diagnosed as having AMI. Hs-cTnI (Abbott Diagnostics, Abbott Park, IL, USA) was measured at presentation and 3 hours later. We assessed the diagnostic performance of the absolute and relative changes in hs-cTnI. RESULTS: The cut-off values to predict AMI were 16.2 ng/L and 42.1% for the absolute and relative hs-cTnI changes, respectively. The area under the curve of hs-cTnI for AMI diagnosis was larger for absolute changes than for relative changes [0.96 (95% confidence interval [CI], 0.92-0.98) vs 0.89 (95% CI, 0.85-0.93)] (P=0.014). CONCLUSIONS: The absolute hs-cTnI change at 3 hours after presentation was superior to the relative change, and a rise and/or fall in hs-cTnI of >16.2 ng/L at 3 hours after presentation was useful to identify AMI in patients presenting at the ED.

Efficacy of Amflow®, a Real-Time-Portable Feedback Device for Delivering Appropriate Ventilation in Critically Ill Patients: A Randomised, Controlled, Cross-Over Simulation Study.

OBJECTIVE: The aim of this study was to test whether Amflow® (a newly designed portable ventilation feedback device) can assist rescuers in delivering target tidal volume (V T) and respiration rate (RR) during self-inflating bag (SB) ventilations in various clinical scenarios. METHOD: This was a simulation study with a prospective cross-over design. A total of 40 trained participants who underwent training for SB ventilation were recruited. Using a SB with or without Amflow® alternately, participants delivered ventilations to test lungs connected to a gas flow analyser in each of three different scenarios: acute respiratory distress syndrome (ARDS; 315-385 ml ranges for 350 ml target V T, with 20 breaths/min); cardiopulmonary resuscitation (CPR; 450-550 ml ranges for 500 ml target V T with 10 breaths/min); and adult head trauma (630-770 ml ranges for 700 ml target V T with 15 breaths/min). RESULTS: The feedback group (SB with Amflow®) demonstrated a significantly higher percentage of delivering the appropriate V T ranges than the no-feedback group for both ARDS (58.6% versus 23.5%, respectively) and CPR (85.4% versus 41.0%, respectively) (all p < 0.05). However, there was no significant difference between the two groups in the percentage of delivering the appropriate V T ranges in head trauma patients (65.9% versus 68.3%, respectively; p=0.092). In all three scenarios, a higher percentage of target RR delivered was achieved in the feedback group (88.3%, 99.2%, and 96.3%, respectively) compared with the no-feedback group (5.8%, 12.5%, and 10.0%, respectively) (all p < 0.05). CONCLUSION: The Amflow® device could be useful for rescuers in delivering SB ventilation with appropriate V T and RR simultaneously in various critical situations, except for clinical cases that demand greater delivered V T.