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1.
Biosens Bioelectron ; 159: 112148, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32291246

RESUMO

Rapid detection of Acinetobacter baumannii (AB) is critical for limiting healthcare-associated infections and providing the best treatment for infected individuals. Herein an integrated microfluidic device for AB diagnosis utilizing a new dual aptamer assay was developed for point-of-care (POC) applications; magnetic beads coated with AB-specific aptamers were used to capture bacteria, and quantum dots (QD) bound to a second aptamer were utilized to quantify the amount of bacteria with a light-emitting diode (LED)-induced fluorescence module integrated into the device. Within a rapid detection of 30 min, a limit of detection of only 100 colony-forming units (CFU)/reaction was obtained, and all necessary microfluidic devices were actuated by a combination of permanent magnets and electromagnets. The pumping rate of the micropump was 270 µL/min at only 10 V, which is amenable for POC applications with lower power consumption, and only 10 µL of sample and reagents were required. Given these attributes, an automatic POC device was demonstrated which could perform a dual aptamer assay to diagnose AB by using electromagnetically-driven microfluidic system. This system provides a rapid, sensitive, low power and reagents consumption and fully automated for AB detection by using a dual aptamer assay. It will allow rapid clinical diagnosis of AB in the near future.

2.
Artigo em Inglês | MEDLINE | ID: mdl-32204448

RESUMO

Within the framework of regulatory focus theory, this study examines the issues of job crafting. This study adopts purposive sampling as a means to collect data. A total of 123 teams with 514 members were invited to participate in the survey, and 91 teams with 354 members provided valid questionnaire responses for data analysis. Mplus 7.0 was applied to conduct data analysis and verification. Data analysis demonstrates that (1) team-member exchange (TMX) exerts a positive influence on team job crafting and individual job crafting; (2) team job crafting positively affects individual job crafting; (3) TMX can positively affect individual job crafting via team job crafting; and (4) a prevention focus has a moderated mediation effect on the indirect relationship between TMX and individual job crafting. Based on its findings, this study has both practical and theoretical implications. Academically, it can be regarded as a pioneering academic endeavor. Practically, this study can enhance teamwork, postulate job flow, and promote the quality of member relationships, thus boosting individual job crafting performance.

4.
Sci Rep ; 10(1): 4604, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32165678

RESUMO

To investigate the association between central obesity and outcomes following in-hospital cardiac arrest (IHCA). A single-centred retrospective study was conducted. Adult patients that experienced IHCA during 2006-2015 were screened. Body mass index (BMI) was calculated at hospital admission. Central obesity-related anthropometric parameters were measured by analysing computed tomography images. A total of 648 patients were included, with mean BMI of 23.0 kg/m2. The proportions of BMI-defined obesity in this cohort were underweight (13.1%), normal weight (41.4%), overweight (31.5%) and obesity (14.0%). The mean waist circumference was 85.9 cm with mean waist-to-height ratio (WHtR) of 0.53. The mean sagittal abdominal diameter was 21.2 cm with mean anterior and posterior abdominal subcutaneous adipose tissue (SAT) depths of 1.6 and 2.0 cm, respectively. Multivariate logistic regression analyses indicated BMI of 11.7-23.3 kg/m2 (odds ratio [OR]: 2.53, 95% confidence interval [CI]: 1.10-5.85; p-value = 0.03), WHtR of 0.49-0.59 (OR: 3.45, 95% CI: 1.56-7.65; p-value = 0.002) and anterior abdominal SAT depth <1.9 cm (OR: 2.84, 95% CI: 1.05-7.74; p-value = 0.04) were positively associated with the favourable neurological outcome. Central obesity was associated with poor IHCA outcomes, after adjusting for the effects of BMI.

5.
Sci Rep ; 10(1): 4338, 2020 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-32152413

RESUMO

Ultrasound (US) has been found to rejuvenate and invigorate the hair follicles, increase the size of hair shafts, and promote new hair growth. Our present study found that dual-frequency US-mediated microbubble (MB) cavitation significantly enhanced minoxidil (Mx) delivery in both in vitro and in vivo models, while increasing the hair growth efficacy compared to single-frequency US sonication. The in vitro experiments showed that cavitation activity was enhanced more significantly during dual-frequency sonication than single-frequency sonication in higher concentration of MBs. The pigskin penetration depth in the group in which dual-frequency US was combined with MBs was 1.54 and 2.86 times greater than for single-frequency US combined with MBs and in the control group, respectively; the corresponding increases in the release rate of Mx at 18 hours in in vitro Franz-diffusion-cell experiments were 24.9% and 43.7%. During 21 days of treatment in C57BL/6J mice experiments, the growth rate at day 11 in the group in which dual-frequency US was combined with MBs increased by 2.07 times compared to single-frequency US combined with MBs. These results indicate that dual-frequency US-mediated MB cavitation can significantly increase both skin permeability and transdermal drug delivery. At the same US power density, hair growth was greater in the group with dual-frequency US plus MBs than in the group with single-frequency US plus MBs, without damaging the skin in mice.

6.
Contemp Nurse ; : 1-15, 2020 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-32124658

RESUMO

Background: The proportion of frailty in older adults is increasing in many countries. Demand for institutional long-term care followed by an increasing globally.Aims: The effects of leisure-time physical activity (LTPA) interventions on frail older adults in long-term care facilities (LTCFs) of randomized controlled trials.Design: A literature searches of the published articles indexed in CINAHL, MEDLINE, PsycINFO, ProQuest, and Google Scholar between 2000 and 2017 was conducted.Methods: The inclusion criteria were divided into four sections: (1) design: randomized controlled trials; (2) sample population: LTCF adults aged 60 years or over with frailty; (3) intervention: LTPA; and (4) body composition: physical, functional or neuropsychological tests as either the primary or the secondary outcomes.Results: Three main themes were identified (the particular monitor, intervention duration and outcome measurement dimensions).Impact statement and conclusions: LTPA interventions effectively improved the physical performance and body composition of frail older adults in LTCFs. Nevertheless, an optimal combination of intensity, duration and frequency is crucial.

7.
Int J Mol Sci ; 21(3)2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32033477

RESUMO

Antibiotics are one of the greatest medical advances of the 20th century, however, they are quickly becoming useless due to antibiotic resistance that has been augmented by poor antibiotic stewardship and a void in novel antibiotic discovery. Few novel classes of antibiotics have been discovered since 1960, and the pipeline of antibiotics under development is limited. We therefore are heading for a post-antibiotic era in which common infections become untreatable and once again deadly. There is thus an emergent need for both novel classes of antibiotics and novel approaches to treatment, including the repurposing of existing drugs or preclinical compounds and expanded implementation of combination therapies. In this review, we highlight to utilize alternative drug targets/therapies such as combinational therapy, anti-regulator, anti-signal transduction, anti-virulence, anti-toxin, engineered bacteriophages, and microbiome, to defeat antibiotic-resistant bacteria.

8.
Resuscitation ; 149: 74-80, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32068026

RESUMO

OBJECTIVES: To determine the association of focused transthoracic echocardiography (ECHO) related interruption during cardiopulmonary resuscitation (CPR) with patient outcomes in the Emergency Department (ED). METHODS: This was a retrospective, single center, cohort study, conducted in an urban community teaching ED. Eligible study subjects were adult patients in the ED with sustained cardiac arrest. Exclusion criteria include traumatic cardiac arrest and age less than 18. All resuscitations were video recorded and were subsequently reviewed by 2 study investigators. The no-flow time from chest compression interruption was analyzed using video review and separated into ECHO-related and non-ECHO related. Our primary outcome was patient survival to hospital discharge and the secondary outcome was the rate of return of spontaneous circulation (ROSC). Multivariate logistic regression analyses were performed to examine the associations between independent variables and outcomes. RESULTS: From January 2016 to May 2017, a total of 210 patients were included for final analysis. The median total no-flow time observed on video was 99.5 s (IQR: 54.0-160.0 s). Among these, a median of 26.5 s (IQR: 0.0-59.0 s) was ECHO-related and a median of 60.5 s (IQR: 34.0-101.9) was non-ECHO-related. The ECHO-related no-flow time between 77 and 122 s (OR: 7.31, 95 % confidence interval [CI]: 1.59-33.59; p-value = 0.01) and ECHO-related interruption ≦ 2 times (OR: 8.22, 95% CI: 1.51-44.64; p-value = 0.01) were positively associated with survival to hospital discharge. ECHO-related interruption ≦ 2 times (OR: 5.55, 95% CI: 2.44-12.61; p-value < 0.001) was also positively associated with ROSC. CONCLUSION: Short ECHO-related interruption during CPR was positively associated with ROSC and survival to hospital discharge. While ECHO can be a valuable diagnostic tool during CPR, the no-flow time associated with ECHO should be minimized.

9.
Ann Emerg Med ; 75(5): 627-636, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31983493

RESUMO

STUDY OBJECTIVE: We compare effectiveness of different airway interventions during cardiopulmonary resuscitation for patients with out-of-hospital cardiac arrest. METHODS: We systematically searched the PubMed and EMBASE databases from their inception through August 2018 and selected randomized controlled trials or quasi randomized controlled trials comparing intubation, supraglottic airways, or bag-valve-mask ventilation for treating adult out-of-hospital cardiac arrest patients. We performed a network meta-analysis along with sensitivity analyses to investigate the influence of high intubation success rate on meta-analytic results. RESULTS: A total of 8 randomized controlled trials and 3 quasi randomized controlled trials were included in the network meta-analysis: 7,361 patients received intubation, 7,475 received supraglottic airway, and 1,201 received bag-valve-mask ventilation. The network meta-analysis indicated no differences among these interventions for survival or neurologic outcomes at hospital discharge. Rather, network meta-analysis suggested that supraglottic airway improved the rate of return of spontaneous circulation compared with intubation (odds ratio 1.11; 95% confidence interval 1.03 to 1.20) or bag-valve-mask ventilation (odds ratio 1.35; 95% confidence interval 1.11 to 1.63). Furthermore, intubation improved the rate of return of spontaneous circulation compared with bag-valve-mask ventilation (odds ratio 1.21; 95% confidence interval 1.01 to 1.44). The sensitivity analyses revealed that the meta-analytic results were sensitive to the intubation success rates across different out-of-hospital care systems. CONCLUSION: Although there were no differences in long-term survival or neurologic outcome among these airway interventions, these system-based comparisons demonstrated that supraglottic airway was better than intubation or bag-valve-mask ventilation and intubation was better than bag-valve-mask ventilation in improving return of spontaneous circulation. The intubation success rate greatly influenced the meta-analytic results, and therefore these comparison results should be interpreted with these system differences in mind.


Assuntos
Manuseio das Vias Aéreas , Reanimação Cardiopulmonar/métodos , Intubação Intratraqueal , Parada Cardíaca Extra-Hospitalar/terapia , Manuseio das Vias Aéreas/métodos , Serviços Médicos de Emergência , Humanos , Intubação Intratraqueal/métodos , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
J Affect Disord ; 263: 367-372, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31969266

RESUMO

BACKGROUND: Previous studies have presented an unclear association between major depressive disorder (MDD) and tinnitus. Therefore, in this study, we aimed to demonstrate the actual association between MDD and new-onset tinnitus using a large, population-based dataset in Taiwan. METHOD: This case-control study used the data from the National Health Insurance Database. In total, 18,365 patients with tinnitus were recruited as cases, and 18,365 propensity score-matched patients without tinnitus were identified as controls. Logistic regression models were constructed to calculate the odds ratios (ORs) and to estimate the association between prior MDD and tinnitus. RESULTS: MDD was found in 396 (2.16%) patients with tinnitus and 228 (1.24%) controls without tinnitus. The logistic regression model indicated that prior MDD was associated with tinnitus (adjusted OR, 1.74; 95% CI, 1.47-2.05). Moreover, MDD was positively associated with tinnitus among most subgroups. Notably, a significant association between MDD and tinnitus was observed among patients with diabetes (adjusted OR, 2.05) and hyperlipidemia (adjusted OR, 1.94). Furthermore, sensitivity analyses consistently found a relationship between prior MDD and tinnitus. LIMITATIONS: The database used in this study does not provide information regarding the lifestyle and gene factors. CONCLUSIONS: Our results showed a positive association between prior MDD and tinnitus. In addition, MDD may be one of the risk factors for tinnitus onset. Therefore, we recommended that the clinicians should be alert about the tinnitus condition among patients with MDD and provide appropriate interventions for them.

11.
Resuscitation ; 148: 83-89, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31945424

RESUMO

INTRODUCTION: Following cardiac arrest, return of spontaneous circulation (ROSC) in patients may be followed by spontaneous neurological recovery, which may decrease the potential adverse effects of treatments in post-cardiac arrest care, including those of Targeted Temperature Management (TTM). We investigated the percentage of post-arrest patients who experienced spontaneous neurological recovery, and the characteristics and neurological outcomes of these patients. METHODS: A total of 540 patients with ROSC were retrospectively enrolled in this single-center observational study. The patients' motor responses were documented immediately and at 3 h following ROSC. Predictors of spontaneous neurological recovery were assessed by multiple logistic regression analysis. RESULTS: A total of 221 patients (41%) showed a change in their GCS (Glasgow Coma Score) M score (motor score) during the 3-h interval following ROSC, with improvement evident in 215 patients. Among 96 patients with GCS M6 at 3 h, 83 (86%) were discharged with a favorable neurological outcome. GCS M6 at 3 h post ROSC, was an independent predictor for a favorable neurological outcome, but GCS M6 at ROSC was not. There were four factors predicting the GCS M6 at 3 h; including in-hospital cardiac arrest (OR 3.057; 95% CI: 1.370-6.824, P = 0.006); bystander CPR (OR 13.311; 95% CI: 6.455-27.447, P < 0.0001); the CPR duration (OR, 0.941; 95% CI: 0.91-0.974; P < 0.0001), and the initial shockable rhythm (OR, 4.41; 95% CI: 2.44-7.95; P < 0.0001). CONCLUSIONS: A significant portion of patients had spontaneous neurological recovery to GCS M6 within 3 h post ROSC, and had a favorable neurological outcome. Close monitoring of GCS and later initiation of TTM should be considered in those patients with a substantial likelihood of neurological recovery.

12.
Resuscitation ; 148: 108-117, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31978453

RESUMO

AIM: To summarise and compare the prognostic accuracy of the blood biomarkers of brain injury, including NSE and S-100B, for neurological outcomes in adult post-cardiac arrest patients. METHODS: We systematically searched PubMed and Embase databases from their inception to March 2019. We selected studies providing sufficient data of prognostic values of NSE or S-100B to predict neurological outcomes in adult post-cardiac arrest patients. We adopted QUADAS-2 to assess risk of bias and a Bayesian bivariate random-effects meta-analysis model to synthesise the prognostic data. The study protocol was registered with PROSPERO (CRD42018084933). RESULTS: We included 42 studies involving 4806 patients in the meta-analysis. The NSE was associated with a pooled sensitivity of 0.56 (95% credible interval [CrI], 0.47-0.65) and pooled specificity of 0.99 (95% CrI, 0.98-1.00). The S-100B was associated with a pooled sensitivity of 0.63 (95% CrI, 0.46-0.78) and pooled specificity of 0.97 (95% CrI, 0.92-1.00). The heterogeneity for NSE (I2, 22.4%) and S-100B (I2, 16.1%) was low and publication bias was not significant. In subgroup analyses, both biomarkers were associated with high specificity across all subgroups with regard to different populations (i.e. whether patients were out-of-hospital cardiac arrest or whether patients received targeted temperature management), different timings of measurement, and different timings of outcome assessment. CONCLUSIONS: The prognostic performance was comparable between NSE and S-100B. Both biomarkers may be integrated into a multimodal neuroprognostication algorithm for post-cardiac arrest patients and institution-specific cut-off points for both biomarkers should be established.

13.
JCI Insight ; 5(3)2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-31895697

RESUMO

Ultrasound-induced microbubble (USMB) cavitation is widely used to promote drug delivery. Our previous study investigated USMB targeting the round window membrane by applying the ultrasound transducer to the tympanic bulla. In the present study, we further extended the use of this technology to enhance drug delivery to the inner ear by introducing the ultrasound transducer into the external auditory canal (EAC) or applying it to the skull. Using a 3-dimensional-printed diffusion apparatus mimicking the pathway for ultrasound passing through and reaching the middle ear cavity in vitro, the models simulating the transcanal and transcranial approach demonstrated 4.8-fold- and 3.7-fold-higher delivery efficiencies, respectively. In an in vivo model of guinea pigs, by filling tympanic bulla with microbubbles and biotin-FITC, USMB applied transcanally and transcranially induced 2.8-fold and 1.5-fold increases in biotin-FITC delivery efficiencies, respectively. In addition, the gentamicin uptake by cochlear and vestibular hair cells and gentamicin-induced hair cell loss were significantly enhanced following transcanal application of USMB. On the 28th day after transcanal USMB, safety assessment showed no significant changes in the hearing thresholds and the integrity of cochlea. These are the first results to our knowledge to demonstrate the feasibility and support the potential clinical application of applying USMB via EAC to facilitate drug delivery into the inner ear.

14.
J Formos Med Assoc ; 119(2): 644-651, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31493983

RESUMO

BACKGROUND: Resuscitation guidelines list acidaemia as a potentially reversible cause of cardiac arrest without specifying the threshold defining acidaemia. We examined the association between early intra-arrest arterial blood gas (ABG) data and outcomes of in-hospital cardiac arrest (IHCA). METHODS: This single-centred retrospective study reviewed patients with IHCA between 2006 and 2015. Early intra-arrest ABG data were measured within 10 min of initiating cardiopulmonary resuscitation. The ABG analysis included measurements of blood pH, PaCO2, and HCO3-. RESULTS: Among the 1065 included patients, 60 (5.6%) achieved neurologically intact survival. Mean blood pH was 7.2. Mean PaCO2 and HCO3- levels were 59.7 mmHg and 22.1 mmol/L, respectively. A blood pH of 7.2 was identified by a generalised additive models plot to define severe acidaemia. The PaCO2 level was higher in patients with severe acidaemia (mean: 74.5 vs. 44.1 mmHg) than in those without. Multivariable logistic regression analyses indicated that blood pH > 7.2 was associated with a favourable neurological recovery (odds ratio [OR]: 2.79, 95% confidence interval [CI]: 1.43-5.46; p-value = 0.003) and blood pH was positively associated with survival at hospital discharge (OR: 5.80, 95% CI: 1.62-20.69; p-value = 0.007). CONCLUSION: Early intra-arrest blood pH was associated with IHCA outcomes, while levels of PaCO2 and HCO3- were not. A blood pH of 7.2 could be used as the threshold defining severe acidaemia during arrest and help profile patients with IHCA. Innovative interventions should be developed to improve the outcomes of patients with severe acidaemia, such as novel ventilation methods.

15.
J Formos Med Assoc ; 119(1 Pt 2): 327-334, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31255419

RESUMO

BACKGROUND: To determine the association between amiodarone or lidocaine and outcomes in adult in-hospital cardiac arrest (IHCA) with shock-refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). METHODS: A retrospective study in a single medical centre was conducted. Patients experiencing an IHCA between 2006 and 2015 were screened. Shock-refractory ventricular tachyarrhythmias were defined as VF/pVT requiring more than one defibrillation attempt. A multivariate logistic regression analysis was used to study the associations between the independent variables and outcomes. RESULTS: A total of 130 patients were included. Among these, 113 patients (86.9%) were administered amiodarone as the first antiarrhythmic agent (amiodarone first) following VF/pVT, and the other patients were administered lidocaine (lidocaine first). The median time to the first defibrillation and first antiarrhythmic drug administration were 2 and 9 min, respectively. The analysis demonstrated that the amiodarone-first group experienced a higher likelihood of terminating the VF/pVT within three shocks (odds ratio: 11.61, 95% confidence interval: 1.34-100.84; p-value = 0.03), as compared with the lidocaine-first group. However, there were no significant differences between the amiodarone- and lidocaine-first groups in sustained return of spontaneous circulation, survival for 24 h, survival, or favourable neurological outcomes at hospital discharge. CONCLUSION: For patients with IHCA and shock-refractory VF/pVT, the adoption of an amiodarone-first strategy seemed to be associated with the termination of VF/pVT using fewer shocks. Nonetheless, because of the small sample size, additional large-scale studies should be conducted to investigate whether this advantage could be translated into a long-term benefit in survival or neurological outcomes.

16.
Resuscitation ; 146: 103-110, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31786236

RESUMO

AIM: We attempted to examine the association between intra-arrest blood glucose (BG) level and outcomes of in-hospital cardiac arrest (IHCA). The interaction between diabetes mellitus (DM) and BG level as well as between dextrose administration and BG level were investigated. METHODS: This single-centred retrospective study reviewed IHCA patients between 2006 and 2015. Patients with measured intra-arrest BG levels were included. Multivariable logistic regression analyses were conducted. Generalised additive models were used to identify appropriate cut-off points for continuous variables. Interactions between independent variables were assessed during the model-fitting process. RESULTS: Among the 580 included patients, 34 (5.9%) achieved neurologically intact survival. There were 197 DM patients (34.0%). The mean intra-arrest BG level was 191.5 mg/dl, with 57 patients (9.8%) experiencing hypoglycaemia (BG level ≤ 70 mg/dl). A total of 165 patients (28.4%) received a dextrose injection. An intra-arrest BG level ≤ 150 mg/dl was inversely associated with favourable neurological outcomes at hospital discharge (odds ratio [OR]: 0.28, 95% confidence interval [CI]: 0.11-0.73; p-value = 0.01). In analyses of interactions, non-DM × BG level ≤ 168 mg/dl was inversely associated with favourable neurological outcomes (OR: 0.30, 95% CI: 0.11-0.80; p-value = 0.02). There were no significant interactions between BG level and dextrose administration. CONCLUSION: IHCA patients with intra-arrest BG level ≤ 150 mg/dl had worse neurological recovery. Intra-arrest hypoglycaemia might be a marker of critical illness. Dextrose administration was not shown to improve outcomes of IHCA patients with intra-arrest BG level ≤ 150 mg/dl, indicating the need to develop new therapeutics other than dextrose administration for these patients.

17.
Artigo em Inglês | MEDLINE | ID: mdl-31661785

RESUMO

Objectives: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes the diagnostic criteria for Internet gaming disorder (IGD). This study evaluated (1) the screening, diagnostic, and prevalence-estimated cutoff points of the Chen Internet Addiction Scale-Gaming Version (CIAS-G) for IGD in the DSM-5; and (2) the differences in the CIAS-G and subscale scores among individuals with IGD, regular gamers (RGs), and other control subjects. Methods: We recruited 69 participants with IGD, 69 RGs, and 69 healthy participants based on diagnostic interviews conducted by a psychiatrist according to DSM-5 IGD criteria. All participants completed the CIAS-G and were assessed using the clinical global impression scale. Results: The optimal screening and diagnostic cutoff points were 68 or more (sensitivity, 97.1%; specificity, 76.8%) and 72 or more (sensitivity, 85.5%; specificity, 87.0%) for IGD based on DSM-5 criteria, respectively. The 76 or more cutoff point had the highest number needed to misdiagnose and was the optimal prevalence estimated cutoff point. Conclusions: The screening cutoff point could be used to identify individuals with IGD for further diagnostic interviewing to confirm the diagnosis in the clinical setting or for two-stage epidemiological evaluation. The diagnostic cutoff point provides a provisional diagnosis of IGD when diagnostic interviewing is unavailable. The prevalence-estimated cutoff point could be used to estimate the prevalence of IGD in large-scale epidemiological investigations when further diagnostic interviewing is impractical. The clinical and epidemiological utility of CIAS-G warrants further study.

18.
J Formos Med Assoc ; 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31526656

RESUMO

BACKGROUND: The role of body mass index (BMI) in clinical outcomes in patients resuscitated from cardiac arrest (CA) has recently drawn attention. We evaluated the effect of BMI on the prognosis of patients successfully resuscitated from cardiogenic arrest. METHODS: This retrospective cohort study included 273 non-traumatic adult cardiogenic arrest survivors receiving coronary angiography after return of spontaneous circulation in three hospitals from January 2011 to September 2017. These patients were classified as underweight, normal-weight, overweight, and obese, based on BMI (<18.5; 18.5-24.9; 25.0-29.9; and ≥30 kg/m2, respectively). In-hospital mortality and poor neurological outcomes were compared among groups. RESULTS: The obese group had significantly higher rates of in-hospital mortality and poor neurological outcomes (cerebral performance scale = 3-5) than did the other groups (for underweight, normal-weight, overweight, and obese groups, in-hospital mortality rates were 38.5%, 29.8%, 39.0%, and 64.1%, respectively, p = 0.002; poor neurological outcomes were 53.9%, 43.8%, 47.0%, and 71.8%, respectively, p = 0.02). The obese group exhibited higher risks of in-hospital mortality and poor neurological outcomes than did the normal-weight group (in-hospital mortality: adjusted hazard ratio (aHR) = 5.21, 95% confidence interval (CI) 2.16-10.32, p < 0.001; poor neurological outcomes: aHR = 3.77, 95% CI 1.69-8.36, p = 0.002). CONCLUSION: Obesity was associated with higher risks of in-hospital mortality and poor neurological recovery.

19.
Resuscitation ; 143: 42-49, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31422106

RESUMO

AIM: The simplified cardiac arrest hospital prognosis (sCAHP) score is a validated tool for predicting neurological outcomes after out-of-hospital cardiac arrest (OHCA). We used the sCAHP score to evaluate whether the effects of early coronary angiography (CAG) and targeted temperature management (TTM) for OHCA were modulated by immediate neuroprognosis. METHODS: This was a single-centre retrospective observational study. Consecutive OHCA patients were screened between 2011 and 2017. Multivariate logistic regression analysis and generalised additive models (GAMs) were used to examine the associations between independent variables and outcomes. Early CAG was defined as CAG performed within 24 h after return of spontaneous circulation (ROSC). RESULTS: A total of 412 patients were included in the study, and 94 (22.8%) patients had neurologically intact survival. The GAM plot identified a sCAHP score of 185 as the cut-off point to differentiate high-risk (sCAHP score ≧185) from low-risk (sCAHP score <185) patients. Regression models indicated that early CAG was significantly associated with favourable neurological [odds ratio (OR) 4.43, 95% confidence interval (CI) 2.28-8.60, p < 0.001] and survival outcomes (OR 3.47, 95% CI 1.93-6.25, p < 0.001), independent of the sCAHP score. Although TTM was associated with favourable neurological outcome only in low-risk patients (OR 2.13, 95% CI 1.10-4.13, p = 0.02), TTM was associated with improved survival for all patients (OR 2.66, 95% CI 1.54-4.59, p < 0.001), independent of the sCAHP score. CONCLUSIONS: Early CAG and TTM should be considered for all OHCA patients as suggested by guidelines, irrespective of the immediately predicted neuroprognosis after ROSC.

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