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  • 1
    Language: English
    In: American journal of respiratory and critical care medicine, 2014, Vol.190 (3), p.252-257
    Description: The accuracy of pulmonary vascular pressure measurements is of great diagnostic and prognostic relevance. However, there is variability of zero leveling procedures, and the current recommendation of end-expiratory reading may not always be adequate. A review of physiological and anatomical data, supported by recent imaging, leads to the practical recommendation of zero leveling at the cross-section of three transthoracic planes, which are, respectively midchest frontal, transverse through the fourth intercostal space, and midsagittal. As for the inevitable respiratory pressure swings, end-expiratory reading at functional residual capacity allows for minimal influence of elastic lung recoil on pulmonary pressure reading. However, hyperventilation is associated with changes in end-expiratory lung volume and increased intrathoracic pressure, eventually exacerbated by expiratory muscle contraction and dynamic hyperinflation, all increasing pulmonary vascular pressures. This problem is amplified in patients with obstructed airways. With the exception of dynamic hyperinflation states, it is reasonable to assume that negative inspiratory and positive expiratory intrathoracic pressures cancel each other out, so averaging pulmonary vascular pressures over several respiratory cycles is most often preferable. This recommendation may be generalized for the purpose of consistency and makes sense, as pulmonary blood flow measurements are not corrected for phasic inspiratory and expiratory changes in clinical practice.
    Subject(s): Abridged Index Medicus ; Airway Resistance - physiology ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cardiac Catheterization - methods ; Heart Failure - diagnosis ; Humans ; Hypertension, Pulmonary - diagnosis ; Intensive care medicine ; Lung Volume Measurements - methods ; Medical sciences ; Pneumology ; Prognosis ; Pulmonary Disease, Chronic Obstructive - physiopathology ; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases ; Pulmonary Wedge Pressure - physiology
    ISSN: 1073-449X
    E-ISSN: 1535-4970
    Source: ProQuest Central
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  • 2
    Language: English
    In: American journal of respiratory and critical care medicine, 2018-02-15, Vol.197 (4), p.509-516
    Description: Normal mean pulmonary arterial pressure (mPAP) is 14.0 ± 3.3 mm Hg (mean ± SD). The prognostic relevance of mildly elevated mPAP not fulfilling the definition of pulmonary hypertension (PH; mPAP ≥ 25 mm Hg) has not been prospectively evaluated in a real-world setting. To assess the association of resting mPAP with all-cause mortality in a retrospective and a prospective cohort of patients with unexplained dyspnea and/or at risk of PH. Prognostic cutoffs were calculated by means of 1) classification and regression tree (CART) analysis without any preset thresholds, and 2) preset thresholds on the basis of literature data defining mPAP as lower-normal (≤mean + 1 SD), upper-normal (between mean + 1 SD and mean + 2 SD), borderline (between mean + 2 SD and 25 mm Hg), and manifest PH (≥25 mm Hg). We performed univariate and multivariate survival analysis adjusted for age and comorbidities. We enrolled 547 patients, of whom 137, 56, 64, and 290 presented with lower-normal, upper-normal, or borderline mPAP, and manifest PH, respectively. The CART analysis on mPAP discriminated three prognostic groups: mPAP less than 17 mm Hg, 17 to 26 mm Hg, and greater than 26 mm Hg, with significantly decreasing survival. The univariate analysis on the basis of preset thresholds showed that upper-normal mPAP, borderline mPAP, and manifest PH were significantly associated with poor survival compared with lower-normal mPAP. In the multivariate model, considering age and comorbidities, only borderline mPAP (hazard ratio, 2.37; 95% confidence interval, 1.14-4.97; P = 0.022) and manifest PH (hazard ratio, 5.05; 95% confidence interval, 2.79-9.12; P 〈 0.001) were significantly associated with poor survival. In patients at risk for PH and/or with unexplained dyspnea, CART analysis detects prognostic thresholds at a resting mPAP of 17 mm Hg and 26 mm Hg, and values between 20 mm Hg and 25 mm Hg represent an independent predictor of poor survival. Clinical trial registered with www.clinicaltrials.gov (NCT 01607502).
    Subject(s): Abridged Index Medicus ; Age ; Chronic obstructive pulmonary disease ; Confidence intervals ; Disease ; Dyspnea ; Gender differences ; Health risk assessment ; Heart ; Intubation ; Medical prognosis ; Mortality ; Patients ; Physiology ; Pulmonary arteries ; Pulmonary hypertension ; Studies ; Survival analysis ; Transplants & implants ; Veins & arteries
    ISSN: 1073-449X
    E-ISSN: 1535-4970
    Source: ProQuest Central
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  • 3
    Language: English
    In: The Journal of pediatrics, 2013, Vol.163 (6), p.1558-1563
    Description: Objective To define reference ranges for regional cerebral tissue oxygen saturation (crSO2 ) and regional cerebral fractional tissue oxygen extraction (cFTOE) during the first 15 minutes after birth in neonates requiring no medical support. Study design The crSO2 was measured using near infrared spectroscopy (Invos 5100 cerebral/somatic oximeter monitor; Somanetics Corp, Troy, Michigan) during the first 15 minutes after birth for term and preterm neonates. The near infrared spectroscopy sensor was placed on the left forehead. Peripheral oxygen saturation and heart rate were continuously measured by pulse oximetry, and cFTOE was calculated. Neonates were excluded if they required any medical support. Results A total of 381 neonates were included: 82 term neonates after vaginal delivery, 272 term neonates after cesarean delivery, and 27 preterm neonates after cesarean delivery. In all neonates, median (10th-90th percentiles) crSO2 was 41% (23-64) at 2 minutes, 68% (45-85) at 5 minutes, 79% (65-90) at 10 minutes, and 77% (63-89) at 15 minutes of age. In all neonates, median (10th-90th percentiles) cFTOE was 33% (11-70) at 2 minutes, 21% (6-45) at 5 minutes, 15% (5-31) at 10 minutes, and 18% (7-34) at 15 minutes of age. Conclusion We report reference ranges of crSO2 and cFTOE in neonates requiring no medical support during transition immediately after birth. The use of cerebral oxygenation monitoring and use of these reference ranges in neonates during transition may help to guide oxygen delivery and avoid cerebral hypo-oxygenation and hyperoxygenation.
    Subject(s): Abridged Index Medicus ; Brain - metabolism ; Humans ; Infant, Newborn ; Infants (Newborn) ; Medical informatics ; Monitoring, Physiologic - methods ; Oxygen - analysis ; Oxygen - metabolism ; Pediatrics ; Prospective Studies ; Reference Values ; Spectroscopy, Near-Infrared ; Time Factors
    ISSN: 0022-3476
    E-ISSN: 1097-6833
    Source: Backfile Package - All of Back Files EBS [ALLOFBCKF]
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  • 4
    Language: English
    In: Pediatrics international, 2020-05, Vol.62 (5), p.637-639
    Subject(s): Adolescent ; Child ; Child, Preschool ; Clinical Notes ; Echocardiography - methods ; Humans ; Hypertension, Pulmonary - diagnostic imaging ; Hypertension, Pulmonary - physiopathology ; Infant ; New York Heart Association Functional class ; pulmonary hypertension ; Severity of Illness Index ; Systole ; tricuspid annular plane systolic excursion ratio ; tricuspid regurgitation velocity ; tricuspid regurgitation velocity/ tricuspid annular plane systolic excursion ratio ; Tricuspid Valve - diagnostic imaging ; Tricuspid Valve - physiopathology ; Ventricular Dysfunction, Right - diagnostic imaging ; Ventricular Function, Right
    ISSN: 1328-8067
    E-ISSN: 1442-200X
    Source: Alma/SFX Local Collection
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  • 5
    Language: English
    In: Clinical orthopaedics and related research, 2013-08, Vol.471 (8), p.2621-2628
    Description: A periprosthetic joint infection is one of the most challenging complications associated with THA and TKA. In the diagnostic process for detecting a periprosthetic joint infection, one of the most important steps is analysis of laboratory infection biomarkers.We investigated the sensitivity and specificity of the biomarkers procalcitonin, interleukin 6 (IL-6), and interferon α (IFN-α) as compared with conventional biomarkers (C-reactive protein [CRP], leukocyte level) for a periprosthetic joint infection associated with revision arthroplasties.We prospectively included and analyzed 84 patients (124 revision arthroplasties). The blood parameters of interest were procalcitonin, IL-6, IFN-α, leukocyte level, and CRP. Samples were taken preoperatively and on the first, third, and seventh postoperative days. The sensitivity and specificity of these biomarkers then were calculated.Considering the preoperative values of 84 patients (124 operations), procalcitonin, IL-6, CRP, and leukocyte level correlated with periprosthetic joint infection, whereas IFN-α did not. A procalcitonin cut-off level of 0.35 ng/mL revealed a sensitivity of 80% and specificity of 37%. An IL-6 cut-off level of 2.55 pg/mL had a sensitivity of 92% and specificity of 59%.In this study procalcitonin and IL-6 were helpful for detecting periprosthetic joint infections in revision arthroplasties, although CRP generally was superior. Procalcitonin and IL-6 may be considered adjuvant tests when the diagnosis of a periprosthetic joint infection is in doubt. This study showed, in addition to conventional biomarkers such as CRP and leukocyte level, procalcitonin and IL-6 were helpful for detecting infections associated with revision arthroplasties.Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
    Subject(s): Abridged Index Medicus ; Aged ; Analysis ; Arthroplasty, Replacement, Hip - adverse effects ; Arthroplasty, Replacement, Hip - instrumentation ; Arthroplasty, Replacement, Knee - adverse effects ; Arthroplasty, Replacement, Knee - instrumentation ; Biological markers ; Biological response modifiers ; Biomarkers - blood ; C-reactive protein ; C-Reactive Protein - metabolism ; Calcitonin - blood ; Calcitonin Gene-Related Peptide ; Clinical Research ; Conservative Orthopedics ; Female ; Health aspects ; Hip Prosthesis - adverse effects ; Humans ; Inflammation Mediators - blood ; Interferon alpha ; Interferon-alpha - blood ; Interleukin-6 - blood ; Knee Prosthesis - adverse effects ; Leukocyte Count ; Male ; Medicine & Public Health ; Medicine/Public Health, general ; Middle Aged ; Orthopedics ; Predictive Value of Tests ; Prospective Studies ; Prosthesis-Related Infections - blood ; Prosthesis-Related Infections - diagnosis ; Prosthesis-Related Infections - immunology ; Protein Precursors - blood ; Reoperation ; Sensitivity and Specificity ; Sports Medicine ; Surgery ; Surgical Orthopedics ; Time Factors
    ISSN: 0009-921X
    E-ISSN: 1528-1132
    Source: PubMed Central
    Source: Journals@Ovid - LWW Extended Archive Collection
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  • 6
    Language: English
    In: The American journal of cardiology, 2012, Vol.109 (1), p.116-121
    Description: The tricuspid annular peak systolic velocity (TAPSV) is an echocardiographic measurement assessing right ventricular systolic function in children and adults. We determined the growth-related changes of the TAPSV to establish the references values for the entire pediatric age group. A prospective study was conducted of a group of 860 healthy pediatric patients (age 1 day to 18 years; body surface area [BSA] 0.14 to 2.30 m2 ). We determined the effects of age, gender, and BSA on the TAPSV values. Stepwise linear multiple regression analysis was used to estimate the TAPSV from the age, BSA, and gender. A correlation of normal TAPSV with normal tricuspid annular plane systolic excursion values was performed. The TAPSV ranged from a mean of 7.2 cm/s (z score ± 2: 4.8 to 9.5 cm/s) in the newborn to 14.3 cm/s (z score ± 2: 10.6 to 18.6 cm/s) in the 18-year-old adolescent. The TAPSV values showed a positive correlation with age and BSA, with a nonlinear course. No significant difference was found in the TAPSV values according to gender. A significant correlation was found between the TAPSV and tricuspid annular plane systolic excursion values in our pediatric population. In conclusion, the z scores of the TAPSV values were calculated, and percentile charts were established to serve as reference data for patients with congenital heart disease.
    Subject(s): Abridged Index Medicus ; Adolescent ; Analysis ; Biological and medical sciences ; Cardiac patients ; Cardiology. Vascular system ; Cardiovascular ; Child ; Child, Preschool ; Children ; Congenital heart disease ; Echocardiography, Doppler ; Female ; Follow-Up Studies ; Genetic disorders ; Health aspects ; Heart diseases ; Humans ; Infant ; Infant, Newborn ; Male ; Medical informatics ; Medical sciences ; Myocardial Contraction - physiology ; Pediatrics ; Prospective Studies ; Reference Values ; Systole ; Tricuspid Valve - diagnostic imaging ; Tricuspid Valve - physiology ; Ventricular Function, Right - physiology
    ISSN: 0002-9149
    E-ISSN: 1879-1913
    Source: Backfile Package - All of Back Files EBS [ALLOFBCKF]
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  • 7
    Language: English
    In: The American journal of cardiology, 2014, Vol.114 (10), p.1590-1598
    Description: Determination of right ventricular (RV) size and function has gained more interest in recent years in adults and children, especially in patients with congenital heart disease. Data on normal RV size parameters in children are scant. The aim of this study was to investigate growth-related changes in RV internal dimensions in a healthy pediatric cohort and the predictive value of RV parameters in identifying enlarged right ventricles in children with secundum-type atrial septal defects (ASD). A prospective study was conducted in a group of 576 healthy children (aged 1 day to 18 years) and 37 children (aged 1.4 to 17.7 years) with moderate-sized to large ASDs. The effects of age, body length, body weight, and body surface area were determined on the following RV parameters: end-diastolic basal diameter, end-diastolic midcavity diameter, end-diastolic length, end-systolic length, end-diastolic area, and end-systolic area. The predictive value of normal values stratified for age, body weight, body length, and body surface area was tested in children with ASDs. RV end-diastolic basal diameter, end-diastolic midcavity diameter, end-diastolic length, end-systolic length, end-diastolic area, and end-systolic area showed positive correlations with age, body length, body surface area, and body weight. In this population, RV z scores showed high specificity for detecting patients with ASDs, with sensitivity up to 89%, especially in children 〈8 years of age. In conclusion, the normal ranges of pediatric RV internal dimensions are provided. The z scores of these RV parameters were also calculated. Normal RV z scores might be important predictors in identifying enlarged right ventricles in patients with ASDs.
    Subject(s): Abridged Index Medicus ; Adolescent ; Cardiac patients ; Cardiovascular ; Child ; Child, Preschool ; Echocardiography - methods ; Female ; Follow-Up Studies ; Genetic disorders ; Heart diseases ; Heart Ventricles - diagnostic imaging ; Humans ; Infant ; Infant, Newborn ; Male ; Measurement ; Pediatrics ; Physiological aspects ; Reference Values ; Reproducibility of Results ; Ventricular Function, Right - physiology
    ISSN: 0002-9149
    E-ISSN: 1879-1913
    Source: Backfile Package - All of Back Files EBS [ALLOFBCKF]
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  • 8
    Language: English
    In: European spine journal, 2011-07, Vol.20 (7), p.1182-1187
    Description: The medical profession is increasingly confronted with the epidemic phenomenon of obesity. Its impact on spine surgery is not quite clear. Published data concerning the use of minimally invasive surgery (MIS) in the spine among obese patients is scarce. The purpose of the present retrospective study was to evaluate perioperative as well as postoperative complication rates in MIS fusion of the lumbar spine in obese, overweight and normal patients classified according to their body mass index. Lumbar MIS fusion was performed by means of TLIF procedures and/or posterolateral fusion alone. A laminotomy was performed in patients with spinal stenosis. Of 72 patients, 39 underwent additional laminotomy for spinal stenosis. No differences were registered in respect of the numbers of fused segments or cages. Any harmful event occurring peri- or postoperatively was noted and included in the statistical analysis. No infection at the site of surgery or severe wound healing disorder was encountered. We registered no difference in blood loss, drainage, or the length of the hospital stay between the three BMI groups. We also observed no difference in complication rates between the three groups. This study confirms the low soft tissue damage of minimal access surgery techniques, which is an important type of surgery in obese patients. The smaller approach helps to minimize infections and wound healing disorders. Moreover, deeper regions of wounds are clearly visualized with the aid of tubular retractors.
    Subject(s): Analysis ; Complications ; Complications and side effects ; Degenerative lumbar disease ; Female ; Health aspects ; Humans ; Intervertebral Disc Degeneration - complications ; Intervertebral Disc Degeneration - surgery ; Intraoperative Complications - epidemiology ; Lumbar Vertebrae - surgery ; Male ; Medical informatics ; Medicine & Public Health ; Methods ; Middle Aged ; Minimally invasive spinal surgery ; Minimally Invasive Surgical Procedures - adverse effects ; Neurosurgery ; Obesity ; Obesity - complications ; Obesity - surgery ; Original ; Orthopedic surgery ; Postoperative Complications - epidemiology ; Spinal Fusion - adverse effects ; Spinal Fusion - methods ; Surgery ; Surgical Orthopedics
    ISSN: 0940-6719
    E-ISSN: 1432-0932
    Source: PubMed Central
    Source: Alma/SFX Local Collection
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  • 9
    Language: English
    In: The American heart journal, 2012, Vol.164 (1), p.125-131
    Description: Background Longitudinal myocardial function has gained more interest in the last years. The mitral annular plane systolic excursion (MAPSE) is an echocardiographic measurement to assess left ventricular (LV) long-axis function in adults. The aim of this study was to evaluate MAPSE values in a healthy pediatric population and to propose reference values. Methods A prospective study was conducted in a group of 558 healthy children and adolescents (age day 1 to 18 years) (body surface area [BSA] 0.18-2.21 m²). We determined the effects of age and BSA on MAPSE values and a possible correlation of MAPSE values with LV ejection fraction values. Results The MAPSE ranged from a mean of 0.57 cm (z-score ± 2: 0.38-0.76 cm) in neonates to 1.63 cm (z-score ± 2: 1.31-1.95 cm) in 18-year-old adolescents. The MAPSE values showed a positive correlation with age ( r = 0.87, P 〈 .001) and BSA ( r = 0.89, P 〈 .001) with a nonlinear course. There was no significant difference in MAPSE values between females or males. A positive correlation was found between MAPSE values and LV ejection fraction values ( r = 0.28, P 〈 .001). Conclusions Z-scores of MAPSE values were calculated, and percentile charts were established to serve as reference data in patients with congenital heart disease or heart failure in the future.
    Subject(s): Abridged Index Medicus ; Adolescent ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiovascular ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Medical sciences ; Mitral Valve - physiology ; Prospective Studies ; Reference Values ; Systole ; Ventricular Function, Left
    ISSN: 0002-8703
    E-ISSN: 1097-6744
    Source: Backfile Package - All of Back Files EBS [ALLOFBCKF]
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  • 10
    Language: English
    In: Journal of medical systems, 2021-03-10, Vol.45 (4), p.52-52
    Description: A Correction to this paper has been published: Author Affiliation: (1) Steiermarkische Krankenanstaltengesellschaft m.b.H. (KAGes), Information and Process Management, Graz, Austria (2) Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria (a) stefanie.jauk@kages.at Article History: Registration Date: 03/08/2021 Online Date: 03/10/2021 Byline:
    Subject(s): Algorithms ; Data mining ; Delirium ; Machine learning ; Medical informatics ; Methods ; Publisher
    ISSN: 0148-5598
    E-ISSN: 1573-689X
    Source: Alma/SFX Local Collection
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