Radiology findings and non-invasive ventilation response

There is a considerable variation in NIV among hospitals, regions and countries although it is a simple and useful method. Thepatient should be monitored via subjective response (respiratory distress, consciousness, problems related to mask and airflow),physiological responses (respiration rate, respiratory effort, air leakage) and patient-ventilator compliance (gas exchange, pulseoximetry, arterial blood gases). Normalization in respiration rate within 1 or 2 hours after initiation of treatment is one of the mostimportant markers for recovery. The goal is to maintain respiration rate between 20 and 30 breaths/minute. Reduction in intercostaland supraclavicular retractions, paradoxical respiration and sympathetic activity indicate success of treatment. Arterial bloodgases are measured within first 2 hours in order to assess pH and CO2; and as needed thereafter. In general, NIV is assessed byarterial blood gases, hemodynamic parameters and several laboratory tests. There is limited number of studies in NIV. Here, weaimed to assess radiological implications of gas distribution within lung tissue during NIV therapy

Wyniki badań radiologicznych a odpowiedź na nieinwazyjną wentylację

Mimo że nieinwazyjna wentylacja (NIV) jest prostą oraz użyteczną metodą, obserwuje się znaczne zróżnicowanie w jej stosowaniu pomiędzy krajami, regionami czy nawet szpitalami. Pacjent powinien być oceniony zarówno w stosunku do odpowiedzi subiektywnej (niewydolność oddechowa, świadomość, problemy związane z maską oraz przepływem powietrza), fizjologicznej (częstość oddechów, wysiłek oddechowy, przeciek powietrza), jak i zgodności z respiratorem (wymiana gazowa, pulsoksymetria, gazometria krwi tętniczej). Normalizacja częstości oddechów w ciągu 1 lub 2 godzin po rozpoczęciu leczenia jest jednym z najważniejszych wykładników postępów leczenia. Celem jest utrzymanie częstości oddechów między 20 a 30 oddechami na minutę. Zmniejszenie skurczów międzyżebrowych i nadobojczykowych, oddychania paradoksalnego czy aktywności współczulnej wskazują na powodzenie terapii. Gazometrię krwi tętniczej oznacza się w ciągu pierwszych 2 godzin w celu oceny pH i CO2; a w razie potrzeby także później. Ogólnie rzecz ujmując, NIV ocenia się za pomocą gazometrii krwi tętniczej, parametrów hemodynamicznych i kilku testów laboratoryjnych. Liczba badań dotyczących NIV jest ograniczona. Autorzy niniejszej pracy postawili sobie za cel ocenę radiologicznych implikacji dystrybucji gazu w tkance płucnej w trakcie terapii NIV.Mimo że nieinwazyjna wentylacja (NIV) jest prostą oraz użyteczną metodą, obserwuje się znaczne zróżnicowanie w jej stosowaniu pomiędzy krajami, regionami czy nawet szpitalami. Pacjent powinien być oceniony zarówno w stosunku do odpowiedzi subiektywnej (niewydolność oddechowa, świadomość, problemy związane z maską oraz przepływem powietrza), fizjologicznej (częstość oddechów, wysiłek oddechowy, przeciek powietrza), jak i zgodności z respiratorem (wymiana gazowa, pulsoksymetria, gazometria krwi tętniczej). Normalizacja częstości oddechów w ciągu 1 lub 2 godzin po rozpoczęciu leczenia jest jednym z najważniejszych wykładników postępów leczenia. Celem jest utrzymanie częstości oddechów między 20 a 30 oddechami na minutę. Zmniejszenie skurczów międzyżebrowych i nadobojczykowych, oddychania paradoksalnego czy aktywności współczulnej wskazują na powodzenie terapii. Gazometrię krwi tętniczej oznacza się w ciągu pierwszych 2 godzin w celu oceny pH i CO2; a w razie potrzeby także później. Ogólnie rzecz ujmując, NIV ocenia się za pomocą gazometrii krwi tętniczej, parametrów hemodynamicznych i kilku testów laboratoryjnych. Liczba badań dotyczących NIV jest ograniczona. Autorzy niniejszej pracy postawili sobie za cel ocenę radiologicznych implikacji dystrybucji gazu w tkance płucnej w trakcie terapii NIV

Retrospective evaluation of trabectedin use in metastatic soft tissue sarcomas: A single-center experience

Çalışmada metastatik yumuşak doku sarkomu tanısıyla trabektedin tedavisi alan hastaların tedavi yanıtları, sağkalım sonuçları, ilaç yan etkilerinin değerlendirilmesi amaçlanmıştır. Sarkom tanısıyla trabektedin tedavisi alan 16 hastanın dosyaları retrospektif olarak tarandı. Hastaların demografik özellikleri, tedavi süreleri, tedavi yanıtları, ilaç yan etkileri kaydedildi. 16 hastanın 9’u erkek (%56,2), 7’si kadındı (%43,7). Trabektedin için medyan progresyonsuz sağkalım (progression-free survival, PFS) 2,9 ay, genel sağkalım (overall survival, OS) 6,7 ay saptandı. Sağkalım üzerine etkili olan tek faktör trabektedin tedavi sırası olarak belirlendi. Trabektedini 2. ya da 3.sıra tedavi olarak alan hastalar daha iyi PFS süresine (medyan PFS 10,3 aya karşı 1,6 ay, %95 GA: 0-21.9, p= 0.003) ve OS süresine (medyan 26,7 ay’a karşı 5,7 ay, %95 GA: 16.9-36.5, p= 0.003) sahipti. Sarkom çalışmalarında objektif yanıt değerlendirme kriteri olarak kullanılan büyüme modülasyon indeksi (growth modulation index, GMI) değeri 1,33’ün üzerinde olan hastaların PFS ve OS süreleri istatiksel anlamlı olarak daha iyiydi (medyan PFS 19,8 ay, p=0.002; medyan OS 26,7 ay, p=0.047). Tüm hastalarda yan etki gözlendi, grad 3/4 yan etkiler hematolojik yan etkiler %62,5 ve alanin aminotransferaz (ALT)/ aspartat aminotransferaz (AST) artışı %50 sıklıkta oldu. Çalışmada saptanan PFS, OS, yanıt oranları ve yan etkiler diğer çalışmalar ile benzer saptanmış, trabektedini 2.ve 3.sıra tedavi olarak alan hastaların ilaçtan daha fazla fayda gördüğü belirlenmiştir.This study aimed to evaluate the treatment responses, survival results, and drug side effects of patients treated with trabectedin for metastatic soft tissue sarcoma. The files of 16 patients who received trabectedin treatment with the diagnosis of sarcoma were reviewed retrospectively. Demographic characteristics of the patients, duration of treatment, response to treatment, and drug side effects were recorded. Of 16 patients, 9 (56.2%) were male and 7 (43.7%) were female. Median progression-free survival (PFS) for trabectedin was 2.9 months, and overall survival (OS) was 6.7 months. The only factor effective on survival was determined as trabectedin treatment line. Patients receiving trabectedin as second or third-line therapy had better PFS time (median PFS 10.3 vs 1.6 months, 95% CI: 0-21.9, p= 0.003) and OS time (median 26.7 vs 5.7 months, 95% CI: 16.9-36.5, p= 0.003). Patients with a growth modulation index (GMI) value above 1.33, which is used as an objective response evaluation metric in sarcoma studies, had statistically significantly better PFS and OS times (median PFS 19.8 months, p=0.002; median OS 26.7 months, p=0.047). Any grade side effects were observed in all patients, grade 3/4 side effects were hematological side effects in 62.5% and alanine aminotransferase (ALT)/ aspartate aminotransferase (AST) increase in 50%. The PFS, OS, response rates and side effects detected in the study were found to be similar to other studies, and it was determined that the patients who received trabectedin as the second and third-line treatment benefited more from the drug

Evaluation of clinical features and the factors related to nutrition in home care patients with pressure ulcer

Introduction: In this study, we aimed to determine the demographic and clinical characteristics of patients with pressure ulcers who received home health care in Kutahya city and to investigate the relationship between the factors related to nutrition and pressure ulcer grades. Methods: This study is designed as a retrospective and cross-sectional. The files of 500 patients who were registered at home health services unit of Kutahya Health Sciences University Training and Research Hospital between December 2016 and May 2017 were reviewed retrospectively. Of these, sixty-three patients with pressure ulcers were included in the study. Results: In this study, 26 (41.3%) were male and 37 (58.7%) were female. The mean age of the patients with pressure ulcers was 74.41 ± 12.30 (years). 36 patients (57.1%) had cerebrovascular disease, 5 patients (7.9%) had dementia, 9 patients (14.3%) had malignancy, 8 patients (12.7%) had osteoarthritis, 4 patients 6.3%) had peripheral vascular disease, and 1 patient (1.6%) had previous traffic accident. The majority (62.1%) were neurological disease-sequenced and nursing-care group. When all the patients were examined, the region with the most pressure was the sacrum (35.3%). Hemoglobin level was found to be related to pressure ulcer grade (One-way ANOVA, p = 0.019). There was no significant relationship between other nutrition-related parameters and pressure ulcer stage. Conclusion: Patients with cerebrovascular disease constitute a significant proportion of patients receiving home care services. Low hemoglobin increases the severity of the pressure ulcer. Therefore, determining risk factors that contribute to pressure ulcer formation and efforts to prevent them should be the primary target of the home health care unit

The Ki-67 proliferation index predicts recurrence-free survival in patients with dermatofibrosarcoma protuberans

Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue sarcoma that originates from the dermis or subcutaneous tissue in the skin. While its prognosis is generally favorable, disease recurrence is relatively frequent. Because morbidity after repeated surgery may be significant, an optimized prediction of recurrence-free survival (RFS) has the potential to improve current management strategies. The purpose of this study was to investigate the prognostic value of the Ki-67 proliferation index with respect to RFS in patients with DFSP. We retrospectively analyzed data from 45 patients with DFSP. We calculated the Ki-67 proliferation index as the percentage of immunostained nuclei among the total number of tumor cell nuclei regardless of the intensity of immunostaining. We constructed univariate and multivariate Cox proportional hazards regression models to identify predictors of RFS. Among the 45 patients included in the study, 8 developed local recurrences and 2 had lung metastases (median follow-up: 95.0 months; range: 5.2−412.4 months). The RFS rates at 60, 120, and 240 months of follow-up were 83.8%, 76.2%, and 65.3%, respectively. The median Ki-67 proliferation index was 14%. Notably, we identified the Ki-67 proliferation index as the only independent predictor for RFS in multivariate Cox proportional hazards regression analysis (hazard ratio = 1.106, 95% confidence interval = 1.019−1.200, p = 0.016). In summary, our results highlight the potential usefulness of the Ki-67 proliferation index for facilitating the identification of patients with DFSP at higher risk of developing disease recurrences

Comparison of Survival Rates, Tumor Stages, and Localization in between Obese and Nonobese Patients with Gastric Cancer

Purpose. In this study we tried to determine the association between body-mass index (BMI), survival rate, and the stage of tumor at the time of diagnosis in patients with gastric cancer. Methods. A total of 270 gastric cancer patients’ hospital records were retrospectively evaluated. Patients were grouped according to their BMI at the time of tumor diagnosis. Tumor stages at admission were compared according to their BMI values. Results. There were no differences in OS among BMI subgroups (p=0.230). The percent of patients with stage III tumor was significantly higher in nonobese while the percent of stage IV tumor was surprisingly higher in obese patients (p was 0.011 and 0.004, resp.). Percent of patients who did not have any surgical intervention was significantly lower in overweight and obese patients than normal and/or underweight patients. Conclusions. At the time of diagnosis, obese patients had significantly higher percent of stage IV tumor than nonobese patients. Despite of that, there were no differences in survival rates among BMI subgroups. Our study results are consistent with “obesity paradox” in gastric cancer patients. We also did not find any relationship between BMI and localization of gastric tumor

The impact of Ki-67 index, squamous differentiation, and several clinicopathologic parameters on the recurrence of low and intermediate-risk endometrial cancer

Endometrial endometrioid carcinoma (EEC) represents approximately 75-80% of endometrial carcinoma cases. Three hundred and thirty-six patients with EEC followed-up in the authors’ medical center between 2010 and 2018 were included in our study. Two hundred and seventy-two low and intermediate EEC patients were identified using the European Society for Medical Oncology criteria and confirmed by histopathological examination. Recurrence was reported in 17 of these patients. The study group consisted of patients with relapse. A control group of 51 patients was formed at a ratio of 3:1 according to age, stage, and grade, similar to that in the study group. Of the 17 patients with recurrent disease, 13 patients (76.5%) were Stage 1A, and 4 patients (23.5%) were Stage 1B. No significant difference was found in age, stage, and grade between the case and control groups (p > 0.05). Body mass index, parity, tumor size, lower uterine segment involvement, SqD, and Ki-67 index with p<0.25 in the univariate logistic regression analysis were included in the multivariate analysis. Ki-67 was statistically significant in multivariate analysis (p = 0.018); however, there was no statistical significance in SqD and other parameters. Our data suggest that the Ki-67 index rather than SqD needs to be assessed for recurrence in patients with low- and intermediate-risk EEC

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