Big Data and Clinical Research in Traumatic Brain Injury
داده های بزرگ و تحقیقات بالینی در ضایعات مغزی آسیب دیده-2018
“T alk and die” in traumatic brain injury (TBI) was initially described in 1975 by Reilly et al clinically deteriorated after initial evaluation suggested 1 in patients who signs of mild brain injury. Description of the talk and die phenomenon evolved into theories of secondary injury in TBI, in which postinjury inflammation, edema, and loss of autoregulation exacerbated the primary injury, and was associated with worse outcomes.2 Since the 1970s, advances in medical care have allowed for a much better understanding of TBI as a multifaceted disease process. Initial clinical evaluation is interpreted in a nexus of imaging, neuromonitoring, and critical care. Over time, we have learned that “talking” after TBI tells only a small part of the story.
Key words : Mortality ، Risk factor ، Skull fracture ، Subdural hematoma ، Talk and die ، Traumatic brain injury
Acute adrenal crisis and mortality in adrenal insufficiency: Still a concern in 2018!
بحران و مرگ و میر ناشی از آدرنال در نارسایی بالای آدرنال: در 2018 هنوز نگرانی وجود دارد!-2018
Despite established replacement therapy, mortality in patients suffering from chronic adrenal insufficiency is increasing. This may be partly explained by the fact that lack of adrenal stress hormones impairs the body’s capacity to deal adequately with stress situations, resulting in life threatening adrenal crises. Since many such situations are of rapid onset, concepts that allow for quick response to emergencies are particularly important. Optimal education for patients and relatives, improved awareness on the part of health professionals and the development of new easy-to-use drugs for acute therapy are of prime importance.
Keywords: Adrenal insufficiency; Adrenal crisis; Mortality; Morbidity; Infection; Addison’s disease
The association between plasma big endothelin-1 levels at admission and long-term outcomes in patients with atrial fibrillation
ارتباط بین سطوح بالایی از اندوتلین-1 پلاسما در پذیرش و نتایج درازمدت در بیماران مبتلا به فیبریلاسیون دهلیزی-2018
Background and aims: The prognostic role of big endothelin-1 (ET-1) in atrial fibrillation (AF) is unclear. We aimed to assess its predictive value in patients with AF. Methods: A total of 716 AF patients were enrolled and divided into two groups based on the optimal cut off value of big ET-1 in predicting all-cause mortality. The primary outcomes were all-cause mortality and major adverse events (MAEs). Cox regression analysis and net reclassification improvement (NRI) analysis were performed to assess the predictive value of big ET-1 on outcomes. Results: With the optimal cut-off value of 0.55 pmol/L, 326 patients were classified into the high big ET-1 levels group. Cardiac dysfunction and left atrial dilation were factors related to high big ET-1 levels. During a median follow-up of 3 years, patients with big ET-1 0.55 pmol/L had notably higher risk of all cause death (44.8% vs. 11.5%, p < 0.001), MAEs (51.8% vs. 17.4%, p < 0.001), cardiovascular death, major bleeding, and tended to have higher thromboembolic risk. After adjusting for confounding factors, high big ET-1 level was an independent predictor of all-cause mortality (hazard ratio (HR) 2.11, 95% confidence interval (CI) 1.46e3.05; p < 0.001), MAEs (HR 2.05, 95% CI 1.50e2.80; p ¼ 0.001), and cardiovascular death (HR 2.44, 95% CI 1.52e3.93; p < 0.001). NRI analysis showed that big ET-1 allowed a significant improvement of 0.32 in the accuracy of predicting the risk of both all-cause mortality and MAEs. Conclusions: Elevated big ET-1 levels is an independent predictor of long-term all-cause mortality, MAEs, and cardiovascular death in patients with AF.
The use of cannabis in response to the opioid crisis: A review of the literature
استفاده از شاهدانه در پاسخ به بحران مواد مخدر:مروری بر ادبیات-2018
Background: A staggering number of Americans are dying from overdoses attrib uted to prescription opioid medications (POMs). In response, states are creating policies related to POM harm reduction strategies, overdose prevention, and al ternative therapies for pain management, such as cannabis (medical marijuana). However, little is known about how the use of cannabis for pain management may be associated with POM use. Purpose: The purpose of this article is to examine state medical cannabis (MC) use laws and policies and their potential association with POM use and related harms. Methods: A systematic literature review was conducted to explore United States policies related to MC use and the association with POM use and related harms. Medline, PubMed, CINAHL, and Cochrane databases were searched to identify peer reviewed articles published between 2010 and 2017. Using the search criteria, 11,513 records were identified, with 789 abstracts reviewed, and then 134 full-text ar ticles screened for eligibility. Findings: Of 134 articles, 10 articles met inclusion criteria. Four articles were cross sectional online survey studies of MC substitution for POM, six were secondary data analyses exploring state-level POM overdose fatalities, hospitalizations related to MC or POM harms, opioid use disorder admissions, motor vehicle fatalities, and Medicare and Medicaid prescription cost analyses. The literature suggests MC laws could be associated with decreased POM use, fewer POM-related hos pitalizations, lower rates of opioid overdose, and reduced national health care expenditures related to POM overdose and misuse. However, available literature on the topic is sparse and has notable limitations. Conclusions: Review of the current literature suggests states that implement MC policies could reduce POM-associated mortality, improve pain management, and significantly reduce health care costs. However, MC research is constrained by federal policy restrictions, and more research related to MC as a potential alter native to POM for pain management, MC harms, and its impact on POM-related harms and health care costs should be a priority of public health, medical, and nursing research.
Keywords: Opioid ، Opioid use disorder ، Medical marijuana ، Medical cannabis ، Chronic pain ، Integrative pain management
Mortality prediction based on imbalanced high-dimensional ICU big data
پیش بینی مرگ و میر بر اساسداده های بزرگ ICU عدم تعادل بعد بالا -2018
With the development of biomedical equipment and healthcare level, large amounts of data have been brought out in hospital, especially in Intensive Care Unit (ICU). However, how to better exploit meaningful information from these rich data still remains a challenge. This paper focuses on ICU mortality prediction, which is a typical example of second use of ICU big data. Patient ICU mortality prediction faces challenges in many aspects, such as high dimensionality, imbalance distribution and time asynchronization etc. To solve these challenges, a series of analytical methods and tools, including variables selection, preprocessing, feature extraction & feature selection and predictive modeling, have been utilized and developed. High-dimensional and unbalanced natures of the ICU data badly affect the performance of classifiers. We modified the cost-sensitive principal component analysis (CSPCA), which is denoted by MCSPCA, to handle these problems in feature extraction stage. As for parameter optimization, a variant of standard particle swarm optimization called chaos particle swarm optimization (CPSO) was adopted for its capacity of finding optimal solution. In order to obtain the best prediction model, different algorithms were investigated and their AUC performances were evaluated in a large real world benchmark data. The final results show that our proposed method improved the performance of the traditional machine learning methods, in which the support vector machine (SVM) reach best AUC performance of 0.7718. This study gives a paradigm to handle similar problems in big health data and helps promote healthcare services.
Keywords: Health data processing ، Analytical tools ، Modified cost-sensitive principal ، component analysis ، Support vector machine ، Chaos particle swarm optimization
مجموعه داده ها از نمونه های ارتش متحد برای مطالعه انتخاب محل و شبکه های اجتماعی
سال انتشار: 2018 - تعداد صفحات فایل pdf انگلیسی: 8 - تعداد صفحات فایل doc فارسی: 15
ما داده های عمومی موجود را که توسط پروژه برنامه های شاخص های اولیه ارزیابی شده NIA اغلب به عنوان داده های ارتش متحد را تهیه کردیم و زیر مجموعه ای از این داده ها را در " شبکه های اجتماعی پایدار" مورد استفاده قرار دادیم: سربازان کارآزموده در جنگ داخلی که در طول زندگی با یکدیگر همکاری می کنند. " (کاستا و همکاران، آینده) . این زیرمجموعه داده می تواند برای تکمیل و تکثیر استفاده شود و همچنین نشان می دهد که چگون داده های اصلی تکمیلی مشتق شده از بایگانی اداری می تواند مورد استفاده قرار گیرد.
کلمات کلیدی: شبکه های اجتماعی | مهاجرت | مرگ و میر
|مقاله ترجمه شده|
Perioperative Management of Pregnant Women With Idiopathic Pulmonary Arterial Hypertension: An Observational Case Series Study From China
مدیریت بعد از عمل زنان باردار مبتلا به ایدیوپاتیک ریوی فشار خون شریانی: مطالعه موردی مورد بررسی از چین-2018
Objectives: The mortality of pregnant women with idiopathic pulmonary arterial hypertension (PAH) is very high. There are limited data on the management of idiopathic PAH during pregnancy. The authors aimed to examine systematically the characteristics of parturient women with idiopathic PAH, to explore the adverse effects of idiopathic PAH on pregnancy outcomes, and to report the multidisciplinary perioperative management strategy from the largest comprehensive cardiac hospital in China. Design: Observational case series study. Setting: Tertiary referral acute care hospital in Beijing, China. Participants: The cases of 17 consecutive pregnant idiopathic PAH patients undergoing abortion or parturition at Anzhen Hospital were reviewed retrospectively. Interventions: Preoperative characteristics, anesthesia method, intensive care management, PAH-specific therapy, and maternal and neonatal outcomes were analyzed in this case series study. Measures and Main Results: Maternal and neonatal outcomes were the main measures. The mean ages of the 17 parturient women with idiopathic PAH were 28.3 7 5.4 years, and the mean systolic pulmonary arterial pressure was 97.9 7 18.6 mmHg. Fifteen patients (88.2%) received PAH-specific therapy before delivery, including sildenafil, iloprost, and treprostinil. All except 1 parturient received epidural anesthesia for surgery due to an emergency Caesarean section. Three patients experienced pulmonary hypertension crisis that necessitated conversion to general anesthesia. Ten parturients underwent Caesarean delivery at a median gestational age of 31 weeks. Three patients developed acute pulmonary hypertensive crisis intraoperatively. Two patients underwent cardiopulmonary resuscitation and extracorporeal membrane oxygenation support. The maternal mortality was 17.6% (3/17). Of the 10 delivered neonates, 9 (90.0%) survived. Conclusions: The maternal mortality of the idiopathic PAH parturient was high in this case series from China. The authors applied epidural anesthesia, early management with multidisciplinary approaches, PAH-specific therapy, avoidance of oxytocin, and timely delivery or pregnancy termination to improve maternal and neonatal outcomes.
Key Words: idiopathic pulmonary arterial hypertension; outcome; pregnancy
Systemic sclerosis: clinical features and management
اسکلروز سیستمیک: ویژگی های بالینی و مدیریت-2018
Systemic sclerosis (SSc) differs from other multisystem connective tis sue/autoimmune diseases in that its clinical features result mainly from a combination of fibrosis and vascular abnormality (rather than from inflammation). This has major implications for management. SSc is associated with high morbidity and mortality, and is often very painful and disabling. There are two major subtypes, defined on the basis of the extent of skin involvement: limited (often previously referred to as CREST) and diffuse cutaneous. The two subtypes have very different natural histories, autoantibody associations and prognoses, and require different approaches to management, at least in their early stages. The two most characteristic features of SSc are Ray naud’s phenomenon (which can be very severe) and skin thickening (ʻsclerodermaʼ). Although both cause troublesome, often disabling symptoms, it is the internal organ involvement of the disease that can be life-threatening. This article discusses recent advances in early diagnosis, clinical features and the approach to investigation and management. It is an exciting time for clinicians with an interest in SSc, because following on from the development of new treatments for several organ-based complications (e.g. pulmonary arterial hyper tension, digital ulceration), several promising ʻdisease-modifyingʼ ther apies (including antifibrotics) are currently being studied in clinical trials.
Keywords: MRCP; pulmonary fibrosis; pulmonary hypertension; Raynaud’s phenomenon; scleroderma; scleroderma renal crisis; sys temic sclerosis
Management of congenital diaphragmatic hernia
مدیریت فتق دیافراگم مادرزادی-2018
Congenital diaphragmatic hernia (CDH) is a challenging condition. It is commonly associated with high mortality due to associated lung hy poplasia, pulmonary hypertension and co-existent anomalies. This re view highlights recent progress in the perinatal management of CDH and addresses long term outcome issues for survivors indicating the need for multidisciplinary follow up.
Keywords : congenital diaphragmatic hernia; fetal therapies; mini mally invasive surgery; outcomes
Vortex: What is the expected contribution of this novel approach to airway management?
Vortex: سهم مورد انتظار این رویکرد جدید به مدیریت راه هوایی چیست؟-2018
Airway management is an essential area in Anesthesia and anesthesiologists are considered the most expert professionals to manage airway tasks. However, complications related to inadequate airway management remain the most frequent cause of morbidity and mortality. Algorithmic strategy to solve difficulties fails due to several factors related to its structure and clinical application. The Vortex Approach emerges as a response to the limitations found in the algorithmic strategy of managing the difficult airway, using a cognitive aid strategy to reduce cognitive load and fixation error. This new strategy may represent a solution to the elusive problem of the challenging airway and reduce complications rate.
Keywords: Difficult airway ، Algorithm ، Management ، Guideline ، Vortex approach