Clinical characteristics and outcome of patients admitted to a medico-surgical ICU requiring non invasive ventilation (NIV) for hypercapnic respiratory failure

Introduction: Because it decreases intubation rate and mortality, NIV has become first-line treatment in case of hypercapnic respiratory failure (HRF). Whether this approach is equally successful for all categories of HRF patients is however debated. We assessed if any clinical characteristics of HRF patients were associated with NIV intensity, success, and outcome, in order to identify prognostic factors. Methods: Retrospective analysis of the clinical database (clinical information system and MDSi) of patients consecutively admitted to our medico-surgical ICU, presenting with HRF (defined as PaCO2 >50 mm Hg), and receiving NIV between January 2009 and December 2010. Demographic data, medical diagnoses (including documented chronic lung disease), reason for ICU hospitalization, recent surgical interventions, SAPS II and McCabe scores were extracted from the database. Total duration of NIV and the need for tracheal intubation during the 5 days following the first hypercapnia documentation, as well as ICU and hospital mortality were recorded. Results are reported as median [IQR]. Comparisons with Chi2 or Kruskal-Wallis tests, p <0.05 (*). Results: 164 patients were included, 45 (27.4%) of whom were intubated after 10 [2-34] hours, after having received 7 [2-19] hours of NIV. NIV successful patients received 15 [5-22] hours of NIV for up to 5 days. Intubation was correlated with increased ICU (20% vs. 3%, p <0.001) and hospital (46.7% vs. 30.2, p >0.05) mortality. Conclusions: A majority of patients requiring NIV for hypercapnic respiratory failure in our ICU have no diagnosed chronic pulmonary disease. These patients tend to have increased ICUand hospital mortality. The majority of patients were non-surgical, a feature correlated with increased hospital mortality. Beside usual predictors of severity such as age and SAPS II, absence of diagnosed chronic pulmonary disease and non-operative state appear to be associated with increased mortality. Further studies should explore whether these patients are indeed more prone to an adverse outcome and which therapeutic strategies might contribute to alter this course.

Exclusion of lumbar arteries by aortic endovascular grafts: can angiography demonstrate sealing characteristics?

BACKGROUND: This study evaluates sealing characteristics of two designs of endovascular grafts by angiographic demonstration of exclusion of porcine lumbar arteries. METHODS: 6 endovascular grafts (3 self-expandable with integrated polyurethane wall versus 3 nitinol structures covered with polyester fabric) were implanted in 6 porcine aortae. Perfusion of lumbar arteries was assessed by angiography after implantation and by angiography and dissection at graft explantation after 4 +/- 2 months. Tissue healing was evaluated by light and scanning electron microscopy. RESULTS: Immediate exclusion of the lumbar arteries was achieved in 14/31 vessels (12 by polyurethane grafts and 2 by polyester grafts, p < 0.001). Follow-up angiography and dissection at explantation revealed perfusion of 30/31 lumbar arteries with a collateral network in most cases. Another reason for reperfusion of initially excluded branches was distention of the polyurethane grafts with resulting shortening allowing reperfusion of 8 of the 31 originally covered branches. Histological examination revealed a complete neointimal lining and a tight contact between endovascular grafts and aorta. CONCLUSIONS: The immediate angiographic demonstration of exclusion of lumbar arteries predicts sealing characteristics of endovascular grafts. Later angiographic reappearance is due to development of a collateral network and possible shortening of self-expandable devices.

Changes in spring-mass model characteristics during repeated running sprints.

This study investigated fatigue-induced changes in spring-mass model characteristics during repeated running sprints. Sixteen active subjects performed 12 × 40 m sprints interspersed with 30 s of passive recovery. Vertical and anterior-posterior ground reaction forces were measured at 5-10 m and 30-35 m and used to determine spring-mass model characteristics. Contact (P &lt; 0.001), flight (P &lt; 0.05) and swing times (P &lt; 0.001) together with braking, push-off and total stride durations (P &lt; 0.001) lengthened across repetitions. Stride frequency (P &lt; 0.001) and push-off forces (P &lt; 0.05) decreased with fatigue, whereas stride length (P = 0.06), braking (P = 0.08) and peak vertical forces (P = 0.17) changes approached significance. Center of mass vertical displacement (P &lt; 0.001) but not leg compression (P &gt; 0.05) increased with time. As a result, vertical stiffness decreased (P &lt; 0.001) from the first to the last repetition, whereas leg stiffness changes across sprint trials were not significant (P &gt; 0.05). Changes in vertical stiffness were correlated (r &gt; 0.7; P &lt; 0.001) with changes in stride frequency. When compared to 5-10 m, most of ground reaction force-related parameters were higher (P &lt; 0.05) at 30-35 m, whereas contact time, stride frequency, vertical and leg stiffness were lower (P &lt; 0.05). Vertical stiffness deteriorates when 40 m run-based sprints are repeated, which alters impact parameters. Maintaining faster stride frequencies through retaining higher vertical stiffness is a prerequisite to improve performance during repeated sprinting.

The impact of personality characteristics on the clinical expression in neurodegenerative disorders--a review.

Clinical experience suggests that longstanding personality characteristics as a person's most distinctive features of all are likely to play a role in how someone with dementia copes with his increasing deficiencies. Personality characteristics may have a pathoplastic effect on both behavioral and psychological symptoms (BPS) or on cognition as well as cognitive decline. Cognitive disorders accompanied by BPS are a tremendous burden for both the patient and their proxies. This review suggests that premorbid personality characteristics are co-determinants of BPS in cognitive disorders, but much effort is needed to clarify whether or not specific premorbid personality traits are associated with specific BPS as no strong links have so far emerged. This review further shows that a growing field of research is interested in the links not only between quite short-lived emotional states and cognitive processes, but also between longstanding personality traits and cognition in both healthy individuals and patients with neurodegenerative disorders. Furthermore, a few studies found that specific premorbid personality traits may be risk factors for neurodegenerative diseases. However, research findings in this area remain scarce despite a huge literature on personality and cognitive disorders in general. An important shortcoming that hampers so far the progress of our understanding in these domains is the confusion in the literature between longstanding premorbid personality traits and transient personality changes observed in neurodegenerative diseases. Few studies have based their assessments on accepted personality theories and carefully investigated premorbid personality traits in patients with cognitive disorders, although assessing personality may be complicated in these patients. Studying the impact of personality characteristics in cognitive disorders is an especially promising field of research in particular when concomitantly using neurobiological approaches, in particular structural brain imaging and genetic studies as suggested by as yet rare studies. Improved understanding of premorbid personality characteristics as determinants of both BPS or cognitive capacities or decline is likely to influence our attitudes towards the treatment of demented patients and ultimately to help in alleviating a patient's and their proxies' burden.

Clinical characteristics and outcome of isolated extracerebral relapses of primary central nervous system lymphoma: a case series.

There is very limited data on isolated systemic relapses of primary central nervous system lymphomas (PCNSL). We retrospectively reviewed the clinical characteristics and outcome of 10 patients with isolated systemic disease among 209 patients with PCNSL mainly treated with methotrexate-based chemotherapy (CT) with or without radiation therapy (RT). Isolated systemic relapse remained rare (4.8%, 10/209 patients). Median time from initial diagnosis to relapse was 33 months (range, 3-94). Sites of relapse were mostly extranodal. Three patients presented with early extra-cerebral (EC) relapse 3, 5 and 8 months from the beginning of initial treatment, respectively, and 7 patients had later relapses (range, 17-94 months). Treatment at relapse included surgery alone, RT alone, CT with or without radiotherapy, or CT with autologous stem cell transplantation (ASCT). Median overall survival (OS) after relapse was 15.5 months (range, 5.8-24.5) compared to 4.6 months (range, 3.6-6.5) for patients with central nervous system (CNS) relapse (p = 0.35). In conclusion, isolated systemic relapses exist but are infrequent. Early EC relapse suggests the presence of systemic disease undetectable by conventional evaluation at initial diagnosis. Patient follow-up must be prolonged because systemic relapse can occur as late as 10 years after initial diagnosis. Whether EC relapses of PCNSL have a better prognosis than CNS relapses needs to be assessed in a larger cohort. Copyright © 2010 John Wiley & Sons, Ltd.

An investigation of the relationship between job characteristics and the gender wage gap

This paper re-examines gender wage differences, taking into account notonly worker characteristics but also job characteristics. Considerationof a wide set of job quality indicators can explain a fraction of thewage gap that would otherwise be attributed to pure wage discrimination.In any case, the fraction of the wage gap that remains associated todifferential rewards for identical factors across sexes is stillsubstantial. Our results suggest that in order to avoid overestimationof the fraction of the wage gap attributable to discrimination, it isnecessary to control for job characteristics.

HACEK infective endocarditis: characteristics and outcomes from a large, multi-national cohort.

The HACEK organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) are rare causes of infective endocarditis (IE). The objective of this study is to describe the clinical characteristics and outcomes of patients with HACEK endocarditis (HE) in a large multi-national cohort. Patients hospitalized with definite or possible infective endocarditis by the International Collaboration on Endocarditis Prospective Cohort Study in 64 hospitals from 28 countries were included and characteristics of HE patients compared with IE due to other pathogens. Of 5591 patients enrolled, 77 (1.4%) had HE. HE was associated with a younger age (47 vs. 61 years; p<0.001), a higher prevalence of immunologic/vascular manifestations (32% vs. 20%; p<0.008) and stroke (25% vs. 17% p = 0.05) but a lower prevalence of congestive heart failure (15% vs. 30%; p = 0.004), death in-hospital (4% vs. 18%; p = 0.001) or after 1 year follow-up (6% vs. 20%; p = 0.01) than IE due to other pathogens (n = 5514). On multivariable analysis, stroke was associated with mitral valve vegetations (OR 3.60; CI 1.34-9.65; p<0.01) and younger age (OR 0.62; CI 0.49-0.90; p<0.01). The overall outcome of HE was excellent with the in-hospital mortality (4%) significantly better than for non-HE (18%; p<0.001). Prosthetic valve endocarditis was more common in HE (35%) than non-HE (24%). The outcome of prosthetic valve and native valve HE was excellent whether treated medically or with surgery. Current treatment is very successful for the management of both native valve prosthetic valve HE but further studies are needed to determine why HE has a predilection for younger people and to cause stroke. The small number of patients and observational design limit inferences on treatment strategies. Self selection of study sites limits epidemiological inferences.

O poder local em Timor em contexto multicultural

O trabalho que agora se apresenta é fruto, antes de mais, de uma relação especial com Timor. Não necessariamente pela dimensão histórica das várias presenças naquele território mas, e acima de tudo, pela relação pessoal e afectiva com alguns dos responsáveis políticos e religiosos daquele jovem país. Um convite, formulado em 2007 por Xanana Gusmão, levou-nos a calcorrear todo o território num curto espaço de três semanas, corria o Verão de 2008. O objectivo era a análise, no terreno, da viabilidade da instalação de um poder local num país recentemente tornado independente. Timor, fruto da sua história e, muito em especial, das características antropológicas do seu povo, é uma nação assumidamente multicultural. Das origens ancestrais das suas comunidades, dos reinos dispersos que pulverizam o pequeno território, das suas lideranças e dos vários dilectos, associados à longa e marcante presença portuguesa, bem como outras ocupações de países estrangeiros, com destaque para a Indonésia, resulta um caldo cultural, a todos os níveis peculiar. Aqui e acolá ouvimos o povo, entrevistámos e reunimos com os 432 chefes de suco existentes no país, entrevistámos chefes de aldeia e anciãos, reunimos com políticos, sacerdotes, professores e jornalistas. Interpretámos, ou tentámos interpretar, as condicionantes e os cuidados que se devem observar na preparação do quadro jurídico para reger a municipalidade em Timor: as suas vertentes electivas, funcionais, financeiras e fiscalizadoras. Revistámos a História de Timor e passámos por Cabo Verde, país de referência internacional ao nível da sua gestão pública, muito em especial a autárquica. Fizemos, também, óbvia referência à história do poder local em Portugal. Das consultas, do muito que observámos e estudámos, resulta um desinteressado contributo para a implementação do poder local em Timor, com as conclusões que incorporam alertas e sugestões.

O poder local em Timor em contexto multicultural

This study, now on presentation, comes as a result of a special relationship established with East Timor. Not necessarily through the several historical presences in that territory but, above all, through the emotional and personal relationships with some of the political and religious leaders of this young country. An invitation, made in 2007 by Xanana Gusmão, led us throughout the whole territory in a short time of three weeks, running the summer of 2008. Its purpose was the analysis, on the ground, of the possibility of installing local administration in a country which had recently became independent. Timor, as a result of its history, but mostly of the anthropological characteristics of its people, is an openly multicultural nation. The ancestral origins of their communities, its scattered kingdoms that spray along such a small territory, its leaders and many dialects, associated with the long portuguese presence, as well as other occupations made by foreign countries, especially Indonesia, became a cultural melting pot truly unique. Here and there we heard the people and interviewed and met the 432 local elected leaders of the country. We interviewed village elders and meet with politicians, priests, teachers and journalists. We have interpreted, or tried to, the actual conditions and cautions that must be observed in preparing the legal framework to govern the municipality in East Timor: its elective, functional, financial and oversight aspects. We have reviewed Timor’s history and took Cape Verde’s example as an international reference on its public administration, mostly its local authorities. We made also the obvious reference to the portuguese local government’s history. From search, and much of the observed and studied, remains a selfless contribution to the implementation of local government in East Timor, with alerts that incorporate conclusions and suggestions.

Asessing public policies. The case of education in Europe and the interaction between personal and institutional factors

The paper deals with the comparative study of European citizens satisfaction with thestate of education in their respective countries. Individual and contextual effects aretested applying multilevel analysis. The results show that educational public policies(level of decentralization, degree of comprehensiveness and public spending) as well asthe students social environment (socioeconomic and cultural status) have a soundimpact on the opinions about the state of education.

Biological characteristics and parasitism capacity of Trichogramma pretiosum Riley (Hymenoptera, Trichogrammatidae) on eggs of Spodoptera frugiperda (J. E. Smith) (Lepidoptera, Noctuidae)

This study aimed at evaluating the biological characteristics and the capacity of parasitism of a Trichogramma pretiosum Riley, 1869 (Hymenoptera, Trichogrammatidae) strain (T. pretiosum RV) collected in Rio Verde County, State of Goiás, Brazil. The study was carried out on eggs of Spodoptera frugiperda (J. E. Smith, 1797) (Lepidoptera, Noctuidae) and conducted under controlled environmental conditions at different constant temperatures. The biological parameters determined were: developmental time (egg-adult; days); emergence (%); sex ratio; number of progeny/egg; number of generation/year; thermal constant (K); temperature threshold (Tb); daily number of parasitized eggs; cumulative parasitism (%); total number of eggs parasitized by T. pretiosum; and female longevity. To study the T. pretiosum parasitism capacity, 20 S. frugiperda eggs (< 24 h old) were placed into 8.0 cm x 2.0 cm glass vials containing one female (< 24 h old) each. Trials were carried out in a completely randomized experimental design, with 20 replications at each temperature. The environmental chambers (BOD type) were set at 18ºC, 20ºC, 22ºC, 25ºC, 28ºC and 32ºC ± 1ºC, 70 ±10% relative humidity, and 14/10 h (L:D) photoperiod. The eggs of S. frugiperda were replaced daily until parasitoid death. Results have shown an inverse correlation between developmental time and temperature, with statistically significant differences among means, except at 25ºC and 28ºC (10 days). Parasitoid emergence (%) was also influenced by temperature. The lowest percent emergence was observed at 32ºC, and the highest ones at 18ºC and 20ºC temperatures. The temperature did not affect T. pretiosum sex ratio and number of parasitoids per egg, thus allowing changes in the temperature to control insect mass production in the laboratory to meet the needs for field releases.