EPIDURALNA ADHEZIOLIZA U LIJEČENJU KRONIČNE KRALJEŽNIČKE BOLI KOD SINDROMA NEUSPJELE OPERACIJE KRALJEŽNICE I KOD LUMBALNE RADIKULARNE BOLI: JEDNOGODIŠNJE ISKUSTVO U OPĆOJ BOLNICI PULA

Aim. The aim was to evaluate the effi cacy and feasibility of percutaneous adhesiolysis to reduce pain, improve daily functions and reduce drug use in patients with chronic pain. Chronic radicular pain can be caused by scar tissue, compression, infl ammation, or swelling disks. Adhesiolysis by placement of a wire-bound catheter into the ventrolateral aspect of the epidural space at the site of the exiting nerve root enables precise application of steroids, hyaluronidase, local anesthetics and saline for to achieve pain relief. Methods: Standard percutaneous epidural adhesiolysis was performed in 54 patients divided into two groups: pain from failed back surgery syndrome (FBSS) versus chronic radicular pain without previous spine surgery. Visual analog scale (VAS) score, change in pharmacotherapy used, subjective satisfaction and evaluation of the lysis procedure were observed in pretreatment, and then in the 4th and 12th week of the intervention. Results: VAS scores for pain were signifi cantly reduced in both groups in the 4th and 12th week. A statistically signifi cant decrease was expressed in the radiculopathy group (VAS0=7.5±0.87/VAS12th=4.6±1.05) versus FBSS group (VAS0=7.6±0.85/VAS12th=5.0±1.58) (p50% was achieved in 27% of FBSS patients and 25% of patients with chronic radicular pain without surgery experience. Conclusion: Considering the small sample size, our results in short-term pain relief suggested that epidurolysis could be an effective method in the treatment of patients with chronic radicular pain as in patients with FBSS.Cilj: Cilj ove randomizirane studije bila je procjena izvodivosti i učinkovitosti adheziolize u liječenju kronične kralježničke boli, njezin utjecaj na poboljšanje kvalitete života, odnosno njezin učinak na kroničnu analgetsku terapiju. Epiduralna adhezioliza omogućava postavljanje posebno dizajniranih katetera u ventrolateralni aspekt epiduralnog prostora, tj. u neposrednoj blizini izlazaćeg živčanog korijena i preciznu primjenu steroida, hijaluronidaze i lokalnih anestetika u cilju smanjenja fenomena boli. Metoda: U studiju su usključena 54 bolesnika podijeljena u dvije skupine: bolesnici s kroničnom boli nakon neuspjele kralježničke operacije (FBSS) naspram bolesnika s kroničnom radikularnom boli bez prethodnog kirurškog iskustva. Nakon 4. odnosno 12. tjedna od postupka praćene su promjene u vizualno analognoj ljestvici boli (VAS), u farmakoterapijiskom unosu, u stupnju subjektivnog životnog zadovoljstva bolesnika, kao i procjena ukupnog učinka adheziolize. Rezultati: Prosječna razina boli (VAS) bila je značajno smanjena u obje skupine i u 4. i u 12. tjednu. Statistički značajno smanjenje izraženo je u skupini radikulopatije (VAS 0 = 7,5 0,87 / VAS 12th = 4,6 1,05) u odnosu na FBSS skupinu (VAS 0 = 7,6 0,85 / VAS 12th = 5,0 1,58) (p 50 % smanjenja inicijalne boli iskazala se u 27 % pacijenata s FBSS i u 25 % bolesnika s kroničnom radikularnom boli. Zaključak: S obzirom na naš mali uzorak, ostvareni rezultati u kratkoročnom ublažavanju boli ukazuju da epiduralna adhezioliza može biti učinkovita metoda u liječenju bolesnika s kroničnom radikularnom boli kao što je to u bolesnika s FBSS

EPIDURALNA ADHEZIOLIZA U LIJEČENJU KRONIČNE KRALJEŽNIČKE BOLI KOD SINDROMA NEUSPJELE OPERACIJE KRALJEŽNICE I KOD LUMBALNE RADIKULARNE BOLI: JEDNOGODIŠNJE ISKUSTVO U OPĆOJ BOLNICI PULA

Aim. The aim was to evaluate the effi cacy and feasibility of percutaneous adhesiolysis to reduce pain, improve daily functions and reduce drug use in patients with chronic pain. Chronic radicular pain can be caused by scar tissue, compression, infl ammation, or swelling disks. Adhesiolysis by placement of a wire-bound catheter into the ventrolateral aspect of the epidural space at the site of the exiting nerve root enables precise application of steroids, hyaluronidase, local anesthetics and saline for to achieve pain relief. Methods: Standard percutaneous epidural adhesiolysis was performed in 54 patients divided into two groups: pain from failed back surgery syndrome (FBSS) versus chronic radicular pain without previous spine surgery. Visual analog scale (VAS) score, change in pharmacotherapy used, subjective satisfaction and evaluation of the lysis procedure were observed in pretreatment, and then in the 4th and 12th week of the intervention. Results: VAS scores for pain were signifi cantly reduced in both groups in the 4th and 12th week. A statistically signifi cant decrease was expressed in the radiculopathy group (VAS0=7.5±0.87/VAS12th=4.6±1.05) versus FBSS group (VAS0=7.6±0.85/VAS12th=5.0±1.58) (p50% was achieved in 27% of FBSS patients and 25% of patients with chronic radicular pain without surgery experience. Conclusion: Considering the small sample size, our results in short-term pain relief suggested that epidurolysis could be an effective method in the treatment of patients with chronic radicular pain as in patients with FBSS.Cilj: Cilj ove randomizirane studije bila je procjena izvodivosti i učinkovitosti adheziolize u liječenju kronične kralježničke boli, njezin utjecaj na poboljšanje kvalitete života, odnosno njezin učinak na kroničnu analgetsku terapiju. Epiduralna adhezioliza omogućava postavljanje posebno dizajniranih katetera u ventrolateralni aspekt epiduralnog prostora, tj. u neposrednoj blizini izlazaćeg živčanog korijena i preciznu primjenu steroida, hijaluronidaze i lokalnih anestetika u cilju smanjenja fenomena boli. Metoda: U studiju su usključena 54 bolesnika podijeljena u dvije skupine: bolesnici s kroničnom boli nakon neuspjele kralježničke operacije (FBSS) naspram bolesnika s kroničnom radikularnom boli bez prethodnog kirurškog iskustva. Nakon 4. odnosno 12. tjedna od postupka praćene su promjene u vizualno analognoj ljestvici boli (VAS), u farmakoterapijiskom unosu, u stupnju subjektivnog životnog zadovoljstva bolesnika, kao i procjena ukupnog učinka adheziolize. Rezultati: Prosječna razina boli (VAS) bila je značajno smanjena u obje skupine i u 4. i u 12. tjednu. Statistički značajno smanjenje izraženo je u skupini radikulopatije (VAS 0 = 7,5 0,87 / VAS 12th = 4,6 1,05) u odnosu na FBSS skupinu (VAS 0 = 7,6 0,85 / VAS 12th = 5,0 1,58) (p 50 % smanjenja inicijalne boli iskazala se u 27 % pacijenata s FBSS i u 25 % bolesnika s kroničnom radikularnom boli. Zaključak: S obzirom na naš mali uzorak, ostvareni rezultati u kratkoročnom ublažavanju boli ukazuju da epiduralna adhezioliza može biti učinkovita metoda u liječenju bolesnika s kroničnom radikularnom boli kao što je to u bolesnika s FBSS

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

EPIDURAL ADHESIOLYSIS IN THE MANAGEMENT OF CHRONIC LOW BACK PAIN IN FAILED BACK SURGERY SYNDROME AND IN LUMBAR RADICULAR PAIN: FIRST YEAR OF EXPERIENCE AT PULA GENERAL HOSPITAL, PULA, CROATIA – A RANDOMIZED TRIAL

Cilj: Cilj ove randomizirane studije bila je procjena izvodivosti i učinkovitosti adheziolize u liječenju kronične kralježničke boli, njezin utjecaj na poboljšanje kvalitete života, odnosno njezin učinak na kroničnu analgetsku terapiju. Epiduralna adhezioliza omogućava postavljanje posebno dizajniranih katetera u ventrolateralni aspekt epiduralnog prostora, tj. u neposrednoj blizini izlazaćeg živčanog korijena i preciznu primjenu steroida, hijaluronidaze i lokalnih anestetika u cilju smanjenja fenomena boli. Metoda: U studiju su usključena 54 bolesnika podijeljena u dvije skupine: bolesnici s kroničnom boli nakon neuspjele kralježničke operacije (FBSS) naspram bolesnika s kroničnom radikularnom boli bez prethodnog kirurškog iskustva. Nakon 4. odnosno 12. tjedna od postupka praćene su promjene u vizualno analognoj ljestvici boli (VAS), u farmakoterapijiskom unosu, u stupnju subjektivnog životnog zadovoljstva bolesnika, kao i procjena ukupnog učinka adheziolize. Rezultati: Prosječna razina boli (VAS) bila je značajno smanjena u obje skupine i u 4. i u 12. tjednu. Statistički značajno smanjenje izraženo je u skupini radikulopatije (VAS 0 = 7,5 0,87 / VAS 12th = 4,6 1,05) u odnosu na FBSS skupinu (VAS 0 = 7,6 0,85 / VAS 12th = 5,0 1,58) (p 50 % smanjenja inicijalne boli iskazala se u 27 % pacijenata s FBSS i u 25 % bolesnika s kroničnom radikularnom boli. Zaključak: S obzirom na naš mali uzorak, ostvareni rezultati u kratkoročnom ublažavanju boli ukazuju da epiduralna adhezioliza može biti učinkovita metoda u liječenju bolesnika s kroničnom radikularnom boli kao što je to u bolesnika s FBSS.Aim. The aim was to evaluate the effi cacy and feasibility of percutaneous adhesiolysis to reduce pain, improve daily functions and reduce drug use in patients with chronic pain. Chronic radicular pain can be caused by scar tissue, compression, infl ammation, or swelling disks. Adhesiolysis by placement of a wire-bound catheter into the ventrolateral aspect of the epidural space at the site of the exiting nerve root enables precise application of steroids, hyaluronidase, local anesthetics and saline for to achieve pain relief. Methods: Standard percutaneous epidural adhesiolysis was performed in 54 patients divided into two groups: pain from failed back surgery syndrome (FBSS) versus chronic radicular pain without previous spine surgery. Visual analog scale (VAS) score, change in pharmacotherapy used, subjective satisfaction and evaluation of the lysis procedure were observed in pretreatment, and then in the 4th and 12th week of the intervention. Results: VAS scores for pain were signifi cantly reduced in both groups in the 4th and 12th week. A statistically signifi cant decrease was expressed in the radiculopathy group (VAS0=7.5±0.87/VAS12th=4.6±1.05) versus FBSS group (VAS0=7.6±0.85/VAS12th=5.0±1.58) (p50% was achieved in 27% of FBSS patients and 25% of patients with chronic radicular pain without surgery experience. Conclusion: Considering the small sample size, our results in short-term pain relief suggested that epidurolysis could be an effective method in the treatment of patients with chronic radicular pain as in patients with FBSS

Extracellular Vesicles from Human Cerebrospinal Fluid Are Effectively Separated by Sepharose CL-6B—Comparison of Four Gravity-Flow Size Exclusion Chromatography Methods

Extracellular vesicles (EVs) are a versatile group of cell-secreted membranous nanoparticles present in body fluids. They have an exceptional diagnostic potential due to their molecular content matching the originating cells and accessibility from body fluids. However, methods for EV isolation are still in development, with size exclusion chromatography (SEC) emerging as a preferred method. Here we compared four types of SEC to isolate EVs from the CSF of patients with severe traumatic brain injury. A pool of nine CSF samples was separated by SEC columns packed with Sepharose CL-6B, Sephacryl S-400 or Superose 6PG and a ready-to-use qEV10/70 nm column. A total of 46 fractions were collected and analysed by slot-blot followed by Ponceau staining. Immunodetection was performed for albumin, EV markers CD9, CD81, and lipoprotein markers ApoE and ApoAI. The size and concentration of nanoparticles in fractions were determined by tunable resistive pulse sensing and EVs were visualised by transmission electron microscopy. We show that all four SEC techniques enabled separation of CSF into nanoparticle- and free protein-enriched fractions. Sepharose CL-6B resulted in a significantly higher number of separated EVs while lipoproteins were eluted together with free proteins. Our data indicate that Sepharose CL-6B is suitable for isolation of EVs from CSF and their separation from lipoproteins

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study (Intensive Care Medicine, (2021), 47, 2, (160-169), 10.1007/s00134-020-06234-9)

The original version of this article unfortunately contained a mistake. The members of the ESICM Trials Group Collaborators were not shown in the article but only in the ESM. The full list of collaborators is shown below. The original article has been corrected