Resource use and outcome in critically ill patients with hematological malignancy: a retrospective cohort study

INTRODUCTION: The paucity of data on resource use in critically ill patients with hematological malignancy and on these patients' perceived poor outcome can lead to uncertainty over the extent to which intensive care treatment is appropriate. The aim of the present study was to assess the amount of intensive care resources needed for, and the effect of treatment of, hemato-oncological patients in the intensive care unit (ICU) in comparison with a nononcological patient population with a similar degree of organ dysfunction. METHODS: A retrospective cohort study of 101 ICU admissions of 84 consecutive hemato-oncological patients and 3,808 ICU admissions of 3,478 nononcological patients over a period of 4 years was performed. RESULTS: As assessed by Therapeutic Intervention Scoring System points, resource use was higher in hemato-oncological patients than in nononcological patients (median (interquartile range), 214 (102 to 642) versus 95 (54 to 224), P < 0.0001). Severity of disease at ICU admission was a less important predictor of ICU resource use than necessity for specific treatment modalities. Hemato-oncological patients and nononcological patients with similar admission Simplified Acute Physiology Score scores had the same ICU mortality. In hemato-oncological patients, improvement of organ function within the first 48 hours of the ICU stay was the best predictor of 28-day survival. CONCLUSION: The presence of a hemato-oncological disease per se is associated with higher ICU resource use, but not with increased mortality. If withdrawal of treatment is considered, this decision should not be based on admission parameters but rather on the evolutional changes in organ dysfunctions

A New Stapes-Head Coupler for the Vibrant Soundbridge System

Introduction: The Vibrant Soundbridge (MED-EL Medical Electronics, Austria) is an active middle ear implant with a floating mass transducer (FMT) for patients with conductive, sensorineural, or mixed hearing loss. While the FMT is vertically aligned above the stapes head (SH) with the current Vibroplasty Clip coupler (MED-EL Medical Electronics), the new SH coupler was developed to mount the FMT on the inferior side of the stapes and to fit in the reduced middle ear space after canal-wall-down mastoidectomy. Methods: Using 11 human cadaveric temporal bones (TBs), placements of the new SH couplers on the stapes were examined, and effective stimuli to the cochlea were evaluated by measuring piston-like motion of the stapes footplate with a current of 1 mA on the FMT. The results were assessed in comparison with the Vibroplasty Clip coupler. Results: The new SH coupler showed perfect coupling on the stapes in 9 out of 11 TBs. A small gap between the SH and the plate of the connection link part was unavoidable in 2 TBs but had negligible effect on vibrational motion of the stapes. Vibrational motion of the stapes with the new SH coupler was reduced at frequencies above 3 kHz compared to the corresponding motion with the current Vibroplasty Clip coupler, but the relative attenuation over all 11 cadaveric temporal bones was <10 dB. Conclusions: The new SH coupler provides an alternative with more stable fixation when placement of the current Vibroplasty Clip coupler is limited due to insufficient space after canal-wall-down mastoidectomy, while still delivering effective stimuli to the cochlea

Stronger Short-Term Effects of Mowing Than Extreme Summer Weather on a Subalpine Grassland

Mowing is known to favor plant diversity and influence ecosystem functioning in semi-natural grasslands. This effect could be influenced by climate variability, especially in regions with harsh climate, such as subalpine zones. In particular, short-term extreme weather fluctuations may induce rapid plant responses, affecting in turn the response to mowing. We tested the effects of concomitant summer weather manipulation and mowing on a subalpine grassland in the Central French Alps for two consecutive years. We addressed two questions: (1) How is a subalpine grassland affected by extreme summer weather? (2) Does extreme summer weather alter mowing effects on the grassland plant diversity and functioning? We used a multi-level, integrative approach assessing the responses of six abundant plant species, as well as effects on plant community structure, biomass production, and litter decomposition rates. Extreme summer weather was simulated by increasing summer temperature by 1.1°C, and decreasing summer rainfall by 80%—resulting in a 30% decrease in total annual precipitation. In addition, a heatwave event was simulated during the first year of the experiment. This weather manipulation was combined with a late-summer mowing treatment (mown vs. unmown). Extreme summer weather mainly increased leaf senescence and decreased plant vegetative growth. Leaf litter decomposition was slowed, but only for species characterized by the fastest rates of litter decomposition. Mowing increased plant diversity by restricting the dominant grass species, thereby favoring subordinates. In the short term, this subalpine grassland was rather resistant to extreme summer weather, whereas mowing cessation remained the main factor affecting its biodiversity