Прогнозирование исходов лечения новорожденных, требующих медицинской эвакуации по шкале TRIPS: наблюдательное когортное ретроспективное исследование

АКТУАЛЬНОСТЬ: Объективизация оценки тяжести состояния и прогнозирование исходов остаются важными задачами на этапе предтранспортной подготовки и относятся к сложнейшим разделам деятельности транспортных бригад. Значительное разнообразие шкал и различные требования к их применению свидетельствуют об отсутствии единого мнения относительно выбора конкретного угрозометрического и прогностического инструмента. ЦЕЛЬ ИССЛЕДОВАНИЯ: Изучить исходы лечения новорожденных, перенесших межгоспитальную транспортировку, в зависимости от оценки по шкале TRIPS (Transport Risk Index of Physiologic Stability for Newborn Infants). МАТЕРИАЛЫ И МЕТОДЫ: Наблюдательное когортное ретроспективное исследование включает данные 604 выездов транспортной бригады к новорожденным детям, находившимся на дистанционном наблюдении реанимационно-консультативного центра в период с 1 августа 2017 г. по 31 декабря 2018 г. Выполнено разделение общей выборки на группы в зависимости от оценки по исследуемой шкале с последующим сравнением объема и параметров интенсивной терапии и исходов в данных группах. РЕЗУЛЬТАТЫ: При разделении исследуемой выборки на группы в соответствии с оценкой по шкале TRIPS наблюдается достоверное различие по массе при рождении и гестационному возрасту. Увеличение оценки по шкале TRIPS среди эвакуированных новорожденных ассоциировано с увеличением риска смерти с максимальным относительным риском 21,4 (3,35–136,72) (между группами 6 и 1). По прочим исходам наблюдаются достоверные различия между группами с минимальными и максимальными значениями оценки по TRIPS. ВЫВОДЫ: Шкала TRIPS позволяет стратифицировать новорожденных, требующих межгоспитальной транспортировки, по риску развития летального исхода и осложнений предстоящего госпитального этапа

Mortality Risk Factors in Neonates Requiring Interhospital Transport

Objective. To identify predictors of newborn infants mortality before medical evacuation. Materials and methods. The observational, cohort, retrospective study included 564 newborns: 526 patients survived and 38 died after 604 visits of the resuscitation-consultation Center transport team (critical care transport — CCT team). Patient’s anamnesis, objective data of a patient at the time of examination by CCT team, the volume of intensive care provided and treatment adjustments during preparation for the transfer, records of patient’s monitored parameters and indicators of prognosis were analyzed. Results. Compared to survivors, non-survivors neonates exhibited significant increases in premature newborns (gestation period <29 weeks in 55.26% vs 10.27% in survivors, P<0.001) and significantly increased need in a high-frequency ventilation (7.89% [1.66–21.38] vs 0.57% [0.12–1.66] in survivors, P=0.005), and in catecholamines support (use of adrenaline was 13.51% [4.54–28.77] in non-survivors vs 0.76% [0.21–1.94] in survivors, P<0.001). Both early and late neonatal infections predominated in non-survivors: ([26.32% [13.40–43.10] vs 8,75% [6,47–11,49, early infection, non-survivors vs. survivors, respectively, P=0.002) and (23.6% 8 [11.44–40.24] vs 10.46% [7.97–13.39], late infection, non-survivors vs. survivors, respectively, P=0.028). Significant differences in the fraction of inspired oxygen (30% [30–30] vs 45% [30–60], P<0.001), oxygenation saturation index (2.71 [2.54–3.03] vs 4.48 [2.55–7.67], P<0.001), and SpO₂/FiO₂ ratio (316.67 [313.33–320] vs 207.25 [151.67–313.33] P<0.001) were found between the groups of survived vs. non-survived neonates, respectively. Logistic regression model revealed following markers of neonatal mortality: birth weight, development of early and late neonatal infection, and the oxygenation saturation index. Conclusion. Low birth weight, development of early or late neonatal infection and an increase in the oxygenation saturation index are the risk factors of death in newborns requiring medical evacuation. © 2023, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved

Medical evacuation of non-transportable newborns after re-evaluation

BACKGROUND: Early admission or birth in a high-level neonatal care facility is associated with lower morbidity in preterm infants. Assessment of transportability remains a problem of the pre-transport evaluation. The literature data lacks the pos-sibility of subsequent evacuation of patients recognized as non-transportable at the first examination. AIM: This study compares intensive care during the first and second examinations of patients recognized as non-transport-able and evacuated after re-departure. MATERIALS AND METHODS: The cohort study included data from patients recognized as non-transportable at the first examination and evacuated after the second examination (18 patients). Comparison of intensive care, assessments by scales, correction of intensive care by the transport team during the first and repeated examinations of the patient was performed. Descriptive statistics methods, Wilcoxon’s test, and McNemar’s test were applied. RESULTS: Patients evacuated on the second attempt had a birth weight of less than 1500 grams. The median birth weight was 1125 [740–3240] grams. The patients were reliably more often on traditional mechanical ventilation and less on high-frequency ventilation at the second examination. The infusion of adrenaline and prostaglandins was more often performed. The average number of corrective actions per patient at the first examination was 1.33 (SD 0.77), at the second examination — 0.5 (SD 0.62), p = 0.003. During the first attempt at evacuation, patients significantly more often required the administration or correction of the catecholamine dose, tracheal reintubation, and blood transfusion. CONCLUSION: The data obtained indicate the inadequacy of the therapy performed before the arrival of the transport team contributes to the decision on the patient’s non-transportability. © Authors, 2021

Solitons in nonlocal nonlinear media: exact results

We investigate the propagation of one-dimensional bright and dark spatial solitons in a nonlocal Kerr-like media, in which the nonlocality is of general form. We find an exact analytical solution to the nonlinear propagation equation in the case of weak nonlocality. We study the properties of these solitons and show their stability.Comment: 9 figures, submitted to Phys. Rev.

The association study of polymorphic variants of hypothalamic-pituitary-adrenal system genes (AVPR1B, OXTR) and aggressive behavior manifestation: a focus on social environment

Considering a multifactorial nature of developing aggression, the present study is aimed to estimate both the genetic- and haplotype-based effects of the OXTR and AVPR1B genes and gene-by-environment interactions in developing A

Modulational instability in nonlocal nonlinear Kerr media

We study modulational instability (MI) of plane waves in nonlocal nonlinear Kerr media. For a focusing nonlinearity we show that, although the nonlocality tends to suppress MI, it can never remove it completely, irrespectively of the particular profile of the nonlocal response function. For a defocusing nonlinearity the stability properties depend sensitively on the response function profile: for a smooth profile (e.g., a Gaussian) plane waves are always stable, but MI may occur for a rectangular response. We also find that the reduced model for a weak nonlocality predicts MI in defocusing media for arbitrary response profiles, as long as the intensity exceeds a certain critical value. However, it appears that this regime of MI is beyond the validity of the reduced model, if it is to represent the weakly nonlocal limit of a general nonlocal nonlinearity, as in optics and the theory of Bose-Einstein condensates.Comment: 8 pages, submitted to Phys. Rev.

RENAL HEMODYNAMICS EVALUATION IN PATIENTS SUFFERING FROM RHEUMATOID ARTHRITIS WITH AND WITHOUT COMORBID HYPERTENSION

Aim. To study the features of renal arterial blood flow in patients suffering from rheumatoid arthritis, its interaction with visual markers of atherosclerosis in the presence of comorbid hypertension.Materials and methods. 113 patients with rheumatoid arthritis (RA) were enrolled into this study. Depending on the comorbidity of hypertension the patients were divided into two groups: without (n=53) and with hypertension (n=60). The comparison group consisted of 41 patients with arterial hypertension without RA. Clinical characteristics and blood biochemistry of all the patients were measured. Renal arterial resistance index (RI), presence of atherosclerotic plaques (ASP) in the carotid arteries were assessed by ultrasound scan.Results. In this investigation we report the correlation of the of renal resistive index (RI) and ultrasound signs of carotid atherosclerosis with hypertension in patients with RA. It was found out that there is the increase of RI in RA associated with the age of patients, the onset of the disease at a later age, the presence of atherosclerotic plaques in the carotid arteries and hypertension. In addition, patients with RA had a high frequency of bilateral RI increase by more than 0.7 (64%). Patients with bilateral high RI had a two-fold increase in the registration rate of atherosclerotic plaques in both group of patients with RA.Conclusion. Increased renal arteries RI in patients with RA is a factor associated with the comorbid hypertension and accompanied by more significant atherosclerotic changes in the carotid arteries in the form of an increased incidence of atherosclerotic plaques