Assessment of prognosis in patients with community-acquired pneumonia who require mechanical ventilation.

STUDY OBJECTIVES: Knowing that mortality is high in patients who require mechanical ventilation patients with community-acquired pneumonia (CAP), we hypothesized that the severity of acute lung injury could be used along with nonpulmonary factors to identify patients with the highest risk of death. We formulated a prediction model to quantitate the risk of hospital mortality in this population of patients. DESIGN: Historical prospective study using data collected over the first 24 h of mechanical ventilation. We utilized a hypoxemia index-(1 - lowest [PaO(2)/PAO(2)]) x (minimum fraction of inspired oxygen to maintain PaO(2) at > 60 mm Hg) x 100], where PAO(2) is the alveolar partial pressure of oxygen-to grade the severity of acute lung injury on a scale from 0 to 100. SETTING: Tertiary care university hospital ICU. PATIENTS: One hundred forty-four adult patients mechanically ventilated for respiratory failure caused by CAP. MEASUREMENTS AND RESULTS: Hospital mortality was 46% (n = 66). Multivariate logistic regression analysis revealed five independent predictors of hospital mortality: (1) the extent of lung injury assessed by the hypoxemia index; (2) the number of nonpulmonary organs that failed; (3) immunosuppression; (4) age > 80 years; and (5) medical comorbidity with a prognosis for survival < 5 years. At a 50% mortality threshold, the prediction model correctly classified outcome in 88% of cases. All patients with > 95% predicted probability of death died in hospital. CONCLUSIONS: Based on clinical parameters measured over the first 24 h of mechanical ventilation, this model accurately identified critically ill, mechanically ventilated patients with CAP for whom prolonged intensive care may not be of benefit.

[Validity of modified radiological views to detect screw protrusion at the distal radius. A comparative study with computerized tomography]. / Validez de la radiología simple con proyecciones especiales para detectar la protrusión de tornillos en el radio distal. Estudio comparativo con tomografía axial computarizada.

Volar fixed-angle plates (VFAP) are currently widely used for the treatment of extra-articular distal radius fractures. Using these plates has a high risk of articular and dorsal screw protrusion due to their special configuration. The aim of this study is to assess the validity of the standard X-rays, performed with the help of wedged supports, in order to detect articular and dorsal screw protrusion. A comparison with computed tomography (CT) scan imaging has been made. The outcome of 26 patients with distal radius articular fracture, treated with a VFAP, is reported. Good correlation between modified X-rays and CT scan was observed. A sensitivity of 100% for articular protrusion and 66% for dorsal have been obtained. When detecting screw protrusion at the distal radius, the use of wedged supports to perform special X-rays intraoperatively is an effective tool.

Nitric oxide-releasing agents and cGMP analogues inhibit murine erythroleukemia cell differentiation and suppress erythroid-specific gene expression: correlation with decreased DNA binding of NF-E2 and altered c-myb mRNA expression.

Differentiation of murine erythroleukemia (MEL) cells induced by hexamethylene bisacetamide (HMBA) and DMSO was inhibited by several structurally unrelated nitric oxide (NO)-releasing agents and two membrane-permeable cGMP analogues. Since the effect of the NO-releasing agents was augmented by a cGMP phosphodiesterase inhibitor, at least some of their effect appeared to be mediated by activation of cytosolic guanylate cyclase. The drugs did not globally block differentiation since hemin-induced differentiation was undisturbed. In HMBA-treated cells, the NO-releasing agents and cGMP analogues reduced beta-globin and delta-aminolevulinate synthetase mRNA expression and inhibited the late down-regulation of c-myb mRNA that is required for HMBA-induced differentiation of MEL cells; the regulation of c-myc mRNA was not changed by the drugs. Nuclear run-off analyses showed that the drugs inhibited the HMBA-induced changes in beta-globin and c-myb transcription rates, and transient transfection of a reporter gene construct demonstrated that the drugs inhibited HMBA-inducible enhancer function of the alpha-globin control region, which contains binding sites for the erythroid transcription factors NF-E2 and GATA-1. The NO-releasing agents and cGMP analogues largely prevented HMBA-induced increases in DNA binding of NF-E2, whereas DNA binding of GATA-1 and SP-1 was not affected. The inhibition of erythroid gene expression by NO and cGMP analogues may be physiologically important under conditions of high NO production by endothelial cells and macrophages, i.e. during acute or chronic inflammation.

Validez de la radiología simple con proyecciones especiales para detectar la protrusión de tornillos en el radio distal. Estudio comparativo con tomografía axial computarizada / Validity of modified radiological views to detect screw protrusion at the distal radius. A comparative study with computerized tomography

El tratamiento de las fracturas intraarticulares del radio distal mediante placas volares de ángulo fijo (PVAF) está ampliamente difundido en la actualidad. El uso de estas placas, debido a su peculiar configuración, conlleva un elevado riesgo de protrusión de los tornillos a nivel intraarticular y dorsal. El objetivo de nuestro trabajo es determinar la validez de las proyecciones radiológicas habituales, realizadas con la ayuda de soportes en forma de cuña, para detectar la protrusión de los tornillos a nivel intraarticular y dorsal, utilizando la tomografía axial computarizada (TAC) como prueba de referencia. En el estudio se presentan los resultados obtenidos en 26 pacientes tratados de una fractura articular de radio distal mediante una PVAF, modelo DVR®. Se ha observado una correlación satisfactoria entre los resultados de las radiografías con soportes cuando han sido comparadas con la TAC, con una sensibilidad del 100% para las protrusiones intraarticulares y del 66% para las protrusiones dorsales. Se recomienda la realización de estas proyecciones especiales de muñeca como una herramienta intraoperatoria útil para detectar la protrusión de los tornillos en las PVAF(AU)

Volar fixed-angle plates (VFAP) are currently widely used for the treatment of extra-articular distal radius fractures. Using these plates has a high risk of articular and dorsal screw protrusion due to their special configuration. The aim of this study is to assess the validity of the standard X -rays, performed with the help of wedged supports, in order to detect articular and dorsal screw protrusion. A comparison with computed tomography (CT) scan imaging has been made. The outcome of 26 patients with distal radius articular fracture, treated with a VFAP, is reported. Good correlation between modified X -rays and CT scan was observed. A sensitivity of 100% for articular protrusion and 66% for dorsal have been obtained. When detecting screw protrusion at the distal radius, the use of wedged supports to perform special X -rays intraoperatively is an effective tool(AU)