Electrical neuromuscular stimulation and its effect on the muscles of intensive care unit patients

A frequent complication in patients hospitalized in the Intensive Care Unit (ICU) is the decrease in muscle strength and mass from the first days of hospitalization. This study aimed to compare two different NMES protocols, to investigate the optimal parameters for the prevention of muscle atrophy in ICU patients, which were evaluated with the MRC muscle strength scale and the HGD hand dynamometer. Five hundred and forty-three consecutive patients were discharged during the study period and 488 of them were excluded. A total of 55 patients were randomized of which 14 were randomized to the control group, 24 received high frequency NMES (HF - High Frequency) and 17 received medium frequency NMES (MF - Medium Frequency). Intermittent loss of data between measurements was either due to patient death or technical reasons. In the comparison of muscle strength with MRC between the high and the moderate frequency group no statistically significant difference was found upon awakening (T1). In the measurements concerning the discharge from the ICU (T2) and the discharge from the hospital (T3) no statistically significant differences were found between the two groups. Although the two groups did not differ from each other in dynamometry at discharge from the ICU and at all time points of the assessment and at discharge from the hospital. However, there was a trend towards an increase in strength in the patients who received NMES between discharge from the ICU and discharge from the hospital, while a trend towards a decrease in muscle strength was seen in the control group for the same time points. NMES is a safe and effective complementary means of maintaining or increasing muscle strength in patients hospitalized in the ICU. There is no evidence to support the use of high-frequency NMES to increase muscle strength as assessed by the MRC, however further blinded investigation in a larger sample of patients is needed to determine the effect of high-frequency NMES in ICU patients.Εισαγωγή: Μια συχνή επιπλοκή σε ασθενείς που νοσηλεύονται στην Μονάδα Εντατικής Θεραπείας (ΜΕΘ) είναι η μείωση της μυϊκής δύναμης και της μάζας από τις πρώτες μέρες νοσηλείας. Σκοπός: Ο σκοπός της μελέτης είναι η σύγκριση δύο διαφορετικών πρωτοκόλλων ΗΝΜΕ, προς διερεύνηση του βέλτιστου προγράμματος για την πρόληψη της μυϊκής ατροφίας σε ασθενείς της ΜΕΘ, με την κλίμακα μυϊκής ισχύος MRC και τη δυναμομέτρηση χειρός HGD. Μεθοδολογία: Πεντακόσιοι σαράντα τρείς διαδοχικοί ασθενείς εξήλθαν κατά το διάστημα της μελέτης και 488 από αυτούς εξαιρέθηκαν. Στο σχήμα Χ παρουσιάζεται το διάγραμμα ροής της μελέτης και ο αριθμός των αποκλεισμένων ανά κατηγορία ασθενών. Συνολικά τυχαιοποιήθηκαν 55 ασθενείς από τους οποίους oι 14 τυχαιοποιήθηκαν στην ομάδα ελέγχου, 24 έλαβαν HNME υψηλής συχνότητας (HF - High Frequency) και 17 έλαβαν HNME μέτριας συχνότητας (MF - Medium Frequency). Η ενδιάμεση απώλεια στοιχείων μεταξύ των μετρήσεων οφειλόταν είτε στον θάνατο κάποιου ασθενή είτε σε τεχνικούς λόγους. Αποτελέσματα: Στην σύγκριση της μυϊκής δύναμης με την MRC ανάμεσα στην ομάδα υψηλής και στην ομάδα μέτριας συχνότητας φάνηκε τάση οι ασθενείς της ομάδας HF με να έχουν μεγαλύτερη δύναμη στην έξοδο από την ΜΕΘ. Επιπλέον δεν βρέθηκε στατιστικά σημαντική διαφορά κατά την αφύπνιση (Τ1) καθώς και την έξοδο από το νοσοκομείο (Τ3). Οι δύο ομάδες δεν διέφεραν μεταξύ τους στην δυναμομέτρηση κατά την έξοδο από τη ΜΕΘ και σε όλες τις χρονικές στιγμές της αξιολόγησης και κατά την έξοδο από το νοσοκομείο. Φάνηκε ωστόσο τάση για αύξηση της δύναμης στους ασθενείς που εφαρμόστηκε ο ΗΝΜΕ μεταξύ της εξόδου από την ΜΕΘ και την έξοδο από το νοσοκομείο ενώ στην ομάδα ελέγχου φάνηκε τάση για μείωση της μυϊκής δύναμης για τις ίδιες χρονικές στιγμές. Συμπέρασμα: Ο ΗΝΜΕ αποτελεί ένα ασφαλές και αποτελεσματικό συμπληρωματικό μέσο διατήρησης ή και αύξησης της μυϊκής δύναμης σε ασθενείς που νοσηλεύονται στην ΜΕΘ. Δεν υπήρξαν στατιστικά σημαντικά αποτελέσματα που να συνηγορούν υπέρ της χρήσης του ΗΝΜΕ υψηλής συχνότητας για την αύξηση της μυϊκής δύναμης, όπως αυτή αξιολογήθηκε με την MRC, ωστόσο απαιτείται περαιτέρω διερεύνηση σε μεγαλύτερο δείγμα ασθενών με τυφλές μελέτες για τον καθορισμό της επίδρασης ΗΝΜΕ υψηλής συχνότητας σε ασθενείς της ΜΕΘ

Total Stem Biomass Estimation Using Sentinel-1 and -2 Data in a Dense Coniferous Forest of Complex Structure and Terrain

Accurate above-ground biomass (AGB) estimation across multiple spatial and temporal scales is essential for mitigating climate change and optimizing forest management strategies. The aim of the present study was to investigate the potential of Sentinel optical and Synthetic Aperture Radar (SAR) data in reliably estimating the plot-level total stem biomass (TSB), which constitutes the dominant material among the different tree components of AGB (stem, branches, and leaves). The study area was located in a dense coniferous forest characterized by an uneven-aged structure and intense topography. A random forest (RF) regression analysis was performed to develop TSB predictive models using Sentinel-1 and -2 images in an individual and combined manner. Consequently, three RF models were produced and evaluated for their predictive performance through the k-fold cross-validation (CV) method. The results showcased that the individual use of Sentinel-1 contributed to the production of the most accurate plot-level TSB estimates (i.e., coefficient of determination-R2 = 0.74, relative mean square error (RMSE) = 1.76 Mg/1000 m2, mean absolute error (MAE) = 1.48 Mg/1000 m2), compared to the use of Sentinel-2 data individually and the Sentinel-1 and -2 combination. In fact, the synergistic use of optical and SAR data led to the generation of an RF model that only marginally underperformed the SAR model (R2 = 0.73 and R2 = 0.72, respectively)

Total Stem Biomass Estimation Using Sentinel-1 and -2 Data in a Dense Coniferous Forest of Complex Structure and Terrain

Accurate above-ground biomass (AGB) estimation across multiple spatial and temporal scales is essential for mitigating climate change and optimizing forest management strategies. The aim of the present study was to investigate the potential of Sentinel optical and Synthetic Aperture Radar (SAR) data in reliably estimating the plot-level total stem biomass (TSB), which constitutes the dominant material among the different tree components of AGB (stem, branches, and leaves). The study area was located in a dense coniferous forest characterized by an uneven-aged structure and intense topography. A random forest (RF) regression analysis was performed to develop TSB predictive models using Sentinel-1 and -2 images in an individual and combined manner. Consequently, three RF models were produced and evaluated for their predictive performance through the k-fold cross-validation (CV) method. The results showcased that the individual use of Sentinel-1 contributed to the production of the most accurate plot-level TSB estimates (i.e., coefficient of determination-R2 = 0.74, relative mean square error (RMSE) = 1.76 Mg/1000 m2, mean absolute error (MAE) = 1.48 Mg/1000 m2), compared to the use of Sentinel-2 data individually and the Sentinel-1 and -2 combination. In fact, the synergistic use of optical and SAR data led to the generation of an RF model that only marginally underperformed the SAR model (R2 = 0.73 and R2 = 0.72, respectively)

Dabigatran in the Treatment of Warfarin-Induced Skin Necrosis: A New Hope

Warfarin-induced skin necrosis is an infrequent and well-recognized complication of warfarin treatment. The incidence was estimated between 0.01% and 0.1% whereas a paradoxal prothrombotic state that arises from warfarin therapy seems to be responsible for this life-threatening disease. To the best of our knowledge we present the first case of an old woman diagnosed with warfarin-induced skin necrosis, in whom novel oral anticoagulants and extensive surgical debridement were combined safely with excellent results

Superior Mesenteric Artery Dissection after Extracorporeal Shockwave Lithotripsy

The use of shockwave lithotripsy is currently the mainstay of treatment in renal calculosis. Several complications including vessel injuries have been implied to extracorporeal shockwave lithotripsy. We report an isolated dissection of the superior mesenteric artery in a 60-year-old male presenting with abdominal pain which occurred three days after extracorporeal shockwave lithotripsy. The patient was treated conservatively and the abdominal pain subsided 24 hours later. The patient's history, the course of his disease, and the timing may suggest a correlation between the dissection and the ESWL