An Increase in Admission RDW Value Is Associated with Excess Short-Term Mortality Rates in Patients with Severe Burns.

The predictive value of red blood cell distribution width (RDW) in severely burned patients remains unclear. This study aimed to investigate the potential association between admission RDW and outcomes in patients with severe burns. Data of severely burned patients in the burn center of Changhai Hospital were retrospectively evaluated. The relationship between admission RDW and mortality was analyzed and displayed using the receiver operating characteristic curve, Kaplan-Meier curve, Cox proportional hazards regression, and the nomogram method. A total of 342 patients were identified according to the filter criteria. The 30-day mortality was 12.9%, and the mortality rates in 7 days and 90 days were 2.9% and 16.7%, respectively. Patients with high admission RDW value were more likely to die than those with low RDW value. Multivariate analysis revealed that higher admission RDW, age, full-thickness burned area, and inhalation injury were independent risk factors with 30-day mortality. The nomogram based on these risk factors was established to predict survival probability in severe burn patients. The C-index of different follow-up times was computed between 0.867 and 0.904, and the nomogram model list fits the data well. Admission RDW played a valuable role in predicting short-term mortality in patients with severe burns. The nomogram containing admission RDW was established to predict mortality, which helps burn care providers identify the patients at higher risk of short-term mortality after severe burns. More attention should be paid to the application of these easy and inexpensive biochemical indicators in the early prediction of disease progression.

Portable Ultrasonography Onboard Deployment in the PLA(N) Peace Ark Hospital Ship in Mission Harmony 2018.

From June 28 to November 22, 2018, the Chinese People's Liberation Army Navy - PLA(N) - Peace Ark hospital ship had conducted Mission Harmony 2018, providing humanitarian medical assistance and carrying out international cooperation, in 4 Pacific island countries and 6 Central and South American countries. Compared with its application only in onshore outreach medical teams in the previous Mission Harmony, portable ultrasonography was used both onboard and onshore in Mission Harmony 2018. The purpose of this study was to assess the performance of onboard portable ultrasonography in PLA(N) Peace Ark hospital ship during Mission Harmony-2018, share our onboard working experience, and provide a reference for humanitarian assistance missions in the future. A retrospective review was performed on a cohort of patients checked by onboard portable ultrasonography. Patients' gender, age, the distribution of examined organs, and multiple applications of the portable ultrasonography were analyzed. Some limitations of portable ultrasonography on the mission and possible improvements in the future were also discussed. A total of 5277 cases (mean age: 43.74 years; range: 2 months-105 years) of ultrasound examinations were performed during the mission; among them, 3126 (59.2%) cases were performed by portable ultrasonography, including 3024 onboard cases and 102 onshore cases. The portable ultrasonography had been applied in many scenarios, for example, onboard emergency triage process, onboard bedside medical support, and onshore outreach medical service, which had become one of the indispensable auxiliary examination methods for its compatibility, portability, and flexibility. The onboard deployment of portable ultrasonography played a versatile and irreplaceable role in the humanitarian medical assistance and medical cooperation carried out by the PLA(N) Peace Ark hospital ship, and will contribute to such kind of missions in the future.

Improvement of LV Reverse Remodeling Using Dynamic Programming of Fusion-Optimized Atrioventricular Intervals in Cardiac Resynchronization Therapy.

Background: The patient-tailored SyncAV algorithm shortens the QRS duration (QRSd) beyond what conventional biventricular (BiV) pacing can. However, evidence of the ability of SyncAV to improve the cardiac resynchronization therapy (CRT) response is lacking. The aim of this study was to evaluate the impact of CRT enhanced by SyncAV on echocardiographic and clinical responses. Methods and Results: Consecutive heart failure (HF) patients from three centers treated with a quadripolar CRT system (Abbott) were enrolled. The total of 122 patients were divided into BiV+SyncAV (n = 68) and BiV groups (n = 54) according to whether they underwent CRT with or without SyncAV. Electrocardiographic, echocardiographic, and clinical data were assessed at baseline and during follow-up. Echocardiographic response to CRT was defined as a ≥15% decrease in left ventricular end-systolic volume (LVESV), and clinical response was defined as a NYHA class reduction of ≥1. At the 6-month follow-up, the baseline QRSd and LVESV decreased more significantly in the BiV+SyncAV than in the BiV group (QRSd -36.25 ± 16.33 vs. -22.72 ± 18.75 ms, P < 0.001; LVESV -54.19 ± 38.87 vs. -25.37 ± 36.48 ml, P < 0.001). Compared to the BiV group, more patients in the BiV+SyncAV group were classified as echocardiographic (82.35 vs. 64.81%; P = 0.036) and clinical responders (83.82 vs. 66.67%; P = 0.033). During follow-up, no deaths due to HF deterioration or severe procedure related complications occurred. Conclusion: Compared to BiV pacing, BiV combined with SyncAV leads to a more significant reduction in QRSd and improves LV remodeling and long-term outcomes in HF patients treated with CRT.

Preliminary Evaluation of Virtual Touch Tissue Imaging Quantification for Differential Diagnosis of Metastatic and Nonmetastatic Cervical Lymph Nodes.

OBJECTIVES: Virtual Touch tissue imaging quantification (VTIQ; Siemens Medical Solutions, Mountain View, CA) is useful for assessing tissue hardness. This study aimed to investigate the value of VTIQ in differential diagnosis of cervical lymph nodes. METHODS: We retrospectively analyzed conventional sonograms and VTIQ images of 85 pathologically confirmed patients with superficial lymph node lesions. Conventional sonography was first performed, with 2-dimensional images described. Then VTIQ shear wave velocity (SWV) values of superficial lymph nodes were measured. With pathologic diagnosis as the reference standard, a receiver operating characteristic curve was generated to evaluate VTIQ efficacy in differential diagnosis of metastatic and nonmetastatic cervical lymph nodes. RESULTS: Of the 85 nodes, 44 and 41 were metastatic and nonmetastatic, respectively. The latter group included 24 and 17 hematologic/lymphatic system disease and reactive hyperplastic nodes, respectively. Shear wave velocity values of metastatic nodes were significantly higher than those of their nonmetastatic counterparts (P < .001). With an area under the curve (AUC) of 0.953 and SWV cutoff of 3.27 m/s, accuracy, sensitivity, and specificity were 89.4%, 88.6%, and 90.2%, respectively, for distinguishing metastatic and nonmetastatic nodes. An AUC of 0.943 and SWV cutoff of 3.23 m/s yielded accuracy, sensitivity, and specificity of 88.2%, 88.6%, and 87.5% for differentiating metastatic from hematologic/lymphatic system disease nodes. Finally, an AUC of 0.968 and SWV cutoff of 3.27 m/s yielded accuracy, sensitivity, and specificity of 90.2%, 88.6%, and 94.1% for differentiating metastatic from reactive hyperplastic nodes. CONCLUSIONS: Virtual Touch tissue imaging quantification is efficient in differential diagnosis of metastatic and nonmetastatic cervical lymph nodes.