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

A new genus and species of enantiornithine bird from the Early Cretaceous of Brazil

<div><p>The fossil record of birds in Gondwana is almost restricted to the Late Cretaceous. Herein we describe a new fossil from the Araripe Basin, Cratoavis cearensis nov. gen et sp., composed of an articulated skeleton with feathers attached to the wings and surrounding the body. The present discovery considerably extends the temporal record of the Enantiornithes birds at South America to the Early Cretaceous. For the first time, an almost complete and articulated skeleton of an Early Cretaceous bird from South America is documented.</p></div

A new genus and species of enantiornithine bird from the Early Cretaceous of Brazil

The fossil record of birds in Gondwana is almost restricted to the Late Cretaceous. Herein we describe a new fossil from the Araripe Basin, Cratoavis cearensis nov. gen et sp., composed of an articulated skeleton with feathers attached to the wings and surrounding the body. The present discovery considerably extends the temporal record of the Enantiornithes birds at South America to the Early Cretaceous. For the first time, an almost complete and articulated skeleton of an Early Cretaceous bird from South America is documented.</p

Data from: Fossil evidence of the avian vocal organ from the Mesozoic

From complex songs to simple honks, birds produce sounds using a unique vocal organ called the syrinx1, 2. Located close to the heart at the tracheobronchial junction, vocal folds or membranes attached to modified mineralized rings vibrate to produce sound1, 2, 3, 4, 5, 6, 7. Syringeal components were not thought to commonly enter the fossil record6, and the few reported fossilized parts of the syrinx are geologically young8, 9, 10, 11 (from the Pleistocene and Holocene (approximately 2.5 million years ago to the present)). The only known older syrinx is an Eocene specimen that was not described or illustrated12. Data on the relationship between soft tissue structures and syringeal three-dimensional geometry are also exceptionally limited5. Here we describe the first remains, to our knowledge, of a fossil syrinx from the Mesozoic Era, which are preserved in three dimensions in a specimen from the Late Cretaceous (approximately 66 to 69 million years ago) of Antarctica. With both cranial and postcranial remains, the new Vegavis iaai specimen is the most complete to be recovered from a part of the radiation of living birds (Aves). Enhanced-contrast X-ray computed tomography (CT) of syrinx structure in twelve extant non-passerine birds, as well as CT imaging of the Vegavis and Eocene syrinxes, informs both the reconstruction of ancestral states in birds and properties of the vocal organ in the extinct species. Fused rings in Vegavis form a well-mineralized pessulus, a derived neognath bird feature, proposed to anchor enlarged vocal folds or labia5. Left-right bronchial asymmetry, as seen in Vegavis, is only known in extant birds with two sets of vocal fold sound sources. The new data show the fossilization potential of the avian vocal organ and beg the question why these remains have not been found in other dinosaurs. The lack of other Mesozoic tracheobronchial remains, and the poorly mineralized condition in archosaurian taxa without a syrinx, may indicate that a complex syrinx was a late arising feature in the evolution of birds, well after the origin of flight and respiratory innovations

New transitional fossil from late Jurassic of Chile sheds light on the origin of modern crocodiles

We describe the basal mesoeucrocodylian Burkesuchus mallingrandensis nov. gen. et sp., from the Upper Jurassic (Tithonian) Toqui Formation of southern Chile. The new taxon constitutes one of the few records of non-pelagic Jurassic crocodyliforms for the entire South American continent. Burkesuchus was found on the same levels that yielded titanosauriform and diplodocoid sauropods and the herbivore theropod Chilesaurus diegosuarezi, thus expanding the taxonomic composition of currently poorly known Jurassic reptilian faunas from Patagonia. Burkesuchus was a small-sized crocodyliform (estimated length 70 cm), with a cranium that is dorsoventrally depressed and transversely wide posteriorly and distinguished by a posteroventrally flexed wing-like squamosal. A well-defined longitudinal groove runs along the lateral edge of the postorbital and squamosal, indicative of a anteroposteriorly extensive upper earlid. Phylogenetic analysis supports Burkesuchus as a basal member of Mesoeucrocodylia. This new discovery expands the meagre record of non-pelagic representatives of this clade for the Jurassic Period, and together with Batrachomimus, from Upper Jurassic beds of Brazil, supports the idea that South America represented a cradle for the evolution of derived crocodyliforms during the Late Jurassic.We are grateful to C. Alsina, M. Milani, N. Chimento, M. Aranciaga, F. Brissón-Egli, G. Muñoz, and S. Miner for field assistance and technical preparation of Burkesuchus specimens. Special thanks to D. Pol for his comments on an early version of the manuscript. We are indebted to the Agencia Nacional de Promoción Científica y Tecnológica (PICT 2010-066 to F.E.N.), Fondo Nacional de Desarrollo Científico y Tecnológico (no. 1121140 to M.S. the Proyect FIC N° 40000501 to M. S., Conselho Nacional de Desenvolvimento Científico e Tecnológico), National Geographic (NGS Grant CP-075ER-17 to S.R.) and Mr. Coleman Burke for financial support. Special thanks to the editor J. O´Connor and two anonymous reviewers for their enlightening comments which greatly improved the quality of the present contribution

Lista de recomendações do Exame PET/CT com 18F-FDG em Oncologia: consenso entre a Sociedade Brasileira de Cancerologia e a Sociedade Brasileira de Biologia, Medicina Nuclear e Imagem Molecular Recommendations on the use of 18F-FDG PET/CT in Oncology: consensus between the Brazilian Society of Cancerology and the Brazilian Society of Biology, Nuclear Medicine and Molecular Imaging

Apresentamos uma lista de recomendações sobre a utilização de 18F-FDG PET em oncologia, no diagnóstico, estadiamento e detecção de recorrência ou progressão do câncer. Foi realizada pesquisa para identificar estudos controlados e revisões sistemáticas de literatura composta por estudos retrospectivos e prospectivos. As consequências e o impacto da 18F-FDG PET no manejo de pacientes oncológicos também foram avaliados. A 18F-FDG PET deve ser utilizada como ferramenta adicional aos métodos de imagem convencionais como tomografia computadorizada e ressonância magnética. Resultados positivos que sugiram alteração no manejo clínico devem ser confirmados por exame histopatológico. A 18F-FDG PET deve ser utilizada no manejo clínico apropriado para o diagnóstico de cânceres do sistema respiratório, cabeça e pescoço, sistema digestivo, mama, melanoma, órgão genitais, tireoide, sistema nervoso central, linfoma e tumor primário oculto.<br>The authors present a list of recommendations on the utilization of 18F-FDG PET/CT in oncology for the diagnosis, staging and detection of cancer, as well as in the follow-up of the disease progression and possible recurrence. The recommendations were based on the analysis of controlled studies and a systematic review of the literature including both retrospective and prospective studies regarding the clinical usefulness and the impact of 18F-FDG PET/CT on the management of cancer patients. 18F-FDG PET/CT should be utilized as a supplement to other conventional imaging methods such as computed tomography and magnetic resonance imaging. Positive results suggesting changes in the clinical management should be confirmed by histopathological studies. 18F-FDG PET should be utilized in the diagnosis and appropriate clinical management of cancer involving the respiratory system, head and neck, digestive system, breast, genital organs, thyroid, central nervous system, besides melanomas, lymphomas and occult primary tumors

An enigmatic plant-eating theropod from the Late Jurassic period of Chile

Theropod dinosaurs were the dominant predators in most Mesozoic era terrestrial ecosystems. Early theropod evolution is currently interpreted as the diversification of various carnivorous and cursorial taxa, whereas the acquisition of herbivorism, together with the secondary loss of cursorial adaptations, occurred much later among advanced coelurosaurian theropods. A new, bizarre herbivorous basal tetanuran from the Upper Jurassic of Chile challenges this conception. The new dinosaur was discovered at Aysén, a fossil locality in the Upper Jurassic Toqui Formation of southern Chile (General Carrera Lake). The site yielded abundant and exquisitely preserved three-dimensional skeletons of small archosaurs. Several articulated individuals of Chilesaurus at different ontogenetic stages have been collected, as well as less abundant basal crocodyliforms, and fragmentary remains of sauropod dinosaurs (diplodocids and titanosaurians).Fil: Novas, Fernando Emilio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; ArgentinaFil: Salgado, Leonardo. Universidad Nacional de Río Negro. Sede Alto Valle. Instituto de Investigaciones en Paleobiología y Geología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; ArgentinaFil: Suárez, Manuel. Universidad Andrés Bello; ChileFil: Agnolin, Federico. Fundación de Historia Natural Félix de Azara; Argentina. Universidad Maimónides; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; ArgentinaFil: Ezcurra, Martin Daniel. University of Birmingham; Reino Unido. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Chimento, Nicolás Roberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; ArgentinaFil: De La Cruz, Rita. Servicio Nacional de Geologia y Mineria (sernageomin);Fil: Isasi, Marcelo Pablo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; ArgentinaFil: Vargas, Alexander O.. Universidad de Chile; ChileFil: Rubilar Rogers, David. Museo Nacional de Historia Natural de Santiago; Chile. Universidad de Chile; Chil