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Hoang K, Ly A, Hill D. Effect of glycemic variability on infectious outcomes in critically Ill burn patients. Burns 2024; 50:1555-1561. [PMID: 38604824 DOI: 10.1016/j.burns.2024.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 03/01/2024] [Accepted: 03/31/2024] [Indexed: 04/13/2024]
Abstract
After acute burn injury, patients experience a hypermetabolic state often complicated by a stress-induced hyperglycemia. Recent research points towards glycemic variability as a contributing factor in adverse outcomes in critically ill patients. In burn patients, greater glycemic variability has been associated with increased rates of mortality and sepsis. However, no studies to date have examined the impact of glycemic variability on rates of infection in this population or determined which measure may be most useful. Infection, and subsequent sepsis, remains the leading contributor to morbidity and mortality after burn injury. The primary objective of this study is to evaluate the relationship between different measures of glycemic variability and infectious complications in burn patients. This retrospective study included patients admitted to a single American Burn Association-verified burn center between January 1, 2020 and December 31, 2020 with burn or inhalation injury. The primary outcome was a composite of autograft loss, mortality, and proven infection. Secondary outcomes included hospital length of stay and a further analysis of the proven infection component of the composite primary outcome. In addition to mean glucose, several different measures of glycemic variability were used for comparison, including standard deviation, coefficient of variation, mean amplitude of glycemic excursions, and J-index. Outcomes were analyzed using multiple logistic regression analysis while controlling for revised Baux score. A quantile analysis was performed to do determine the optimal mean threshold. Three hundred and ninety-two patients were admitted and screened for inclusion during the study period. Most patients were excluded due to a LOS less than 72 h. 112 patients were included in the study. Of the 112 patients, 22.3% experienced an infectious complication (25 patients with 28 complications). Mean glucose (OR 1.024; 95% CI 1.004-1.045) and J-index (OR 1.044; 95% CI 1.003-1.087) were associated with occurrence of infectious complications. Regarding target mean glucose threshold, a daily mean glucose above 150 mg/dL showed the strongest association with infectious complications (OR 3.634; 95% CI 1.008-13.101). Mean glucose, standard of deviation, and J-index were all independently associated with proven infection.
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Affiliation(s)
- Kristine Hoang
- Regional One Health, 877 Jefferson Avenue, Memphis, TN 38104, United States.
| | - Austin Ly
- University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN 38163, United States
| | - David Hill
- Regional One Health, 877 Jefferson Avenue, Memphis, TN 38104, United States
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2
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Chandra J, Raby E, Wood FM, Fegan PG, Yeap BB. Associations of Diabetes and Hyperglycaemia with Extent and Outcomes of Acute Burn Injuries. Biomedicines 2024; 12:1127. [PMID: 38791089 PMCID: PMC11118006 DOI: 10.3390/biomedicines12051127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Severe burns may induce hyperglycaemia in the absence of diabetes, but how glucose trajectories relate to burns outcomes is unclear. AIM To assess incidence of hyperglycaemia following acute burn injury, and associations with diabetes history and length of stay (LOS). METHODS Retrospective cohort study of adults admitted with acute burns to tertiary centres. Blood glucose level (BGL), hyperglycaemic episodes (BGL ≥ 11.1 mmol/L) and hyperglycaemic days were recorded. Stress hyperglycaemia was defined as BGL ≥ 11.1 mmol/L without a diabetes history. RESULTS A total of 30 participants had a diabetes history and 260 did not. Participants with known diabetes had higher mean BGLs (9.7 vs. 9.0 mmol/L, p < 0.001), more hyperglycaemic episodes (28.0 vs. 17.2%, p < 0.001) and hyperglycaemic days (51 vs. 21%, p < 0.001), compared to those without diabetes, despite smaller burns (total body surface area 1.0 vs. 14.8%, p < 0.001). Fourteen participants with stress hyperglycaemia had similar BGLs (at admission 10.3 vs. 11.5 mmol/L; during inpatient stay 9.9 vs. 9.8 mmol/L), more severe burns (15.6% vs. 1.0% TBSA) and longer LOS (18 vs. 7 days, p < 0.001) compared to participants with known diabetes. Extent of burns, having NGT nutrition, age, having inpatient BGL monitoring in the setting of diabetes, or having inpatient BGL monitoring in the absence of diabetes were associated with longer LOS. CONCLUSIONS In participants with known diabetes, small burn injuries were associated with hyperglycaemia. Stress hyperglycaemia can be triggered by major burn injuries, with early and sustained elevation of BGLs. Further research is warranted to improve inpatient management of BGL in patients with acute burn injury.
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Affiliation(s)
- Jeffrey Chandra
- Medical School, University of Western Australia, Perth 6009, Australia
| | - Edward Raby
- State Adult Burns Unit, Fiona Stanley Hospital, Perth 6150, Australia
| | - Fiona M. Wood
- Medical School, University of Western Australia, Perth 6009, Australia
- State Adult Burns Unit, Fiona Stanley Hospital, Perth 6150, Australia
| | - P. Gerry Fegan
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth 6150, Australia
- Medical School, Curtin University, Perth 6102, Australia
| | - Bu B. Yeap
- Medical School, University of Western Australia, Perth 6009, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth 6150, Australia
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Grossman H, Cole TJ, Shaw C, Dissanaike S, Dhanasekara CS. Baseline glucose levels moderate the association between burn-related mortality inpatients with obesity. Burns 2023; 49:1893-1899. [PMID: 37357062 DOI: 10.1016/j.burns.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/31/2023] [Accepted: 05/10/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Differing findings concerning outcomes for burn patients with obesity indicate additional factors at play. One possible explanation could lie in determining metabolically healthy versus unhealthy obesity, which necessitates further study. METHODS A retrospective study was conducted using the Cerner Health Facts® Database. Deidentified patient data from 2014 to 2018 with second or third-degree burn injuries were retrieved. A moderator analysis was conducted to determine if the association between increased body mass index (BMI) and mortality is moderated by baseline glucose level, a surrogate marker associated with metabolically unhealthy obesity. RESULTS The study included 4682 adult burn patients. BMI alone was not associated with higher mortality (β = 0.106, p = 0.331). Moderation analysis revealed that baseline glucose level significantly modulated the impact of BMI on burn-related obesity; patients with higher BMI and higher baseline blood glucose levels had higher mortality than those with lower baseline blood glucose levels (β = 0.277, p = 0.009). These results remained unchanged after adjusting for additional covariates (β = 0.285, p = 0.025) and inthe sensitivity analysis. CONCLUSIONS Increased baseline glucose levels indicate increased mortality in obese patients with burn injuries, emphasizing the differentiation between metabolically unhealthy versus healthy obesity.
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Affiliation(s)
- Holly Grossman
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Travis J Cole
- Clinical Research Data Warehouse, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Chip Shaw
- Clinical Research Data Warehouse, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Sharmila Dissanaike
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, TX, USA
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Greenhalgh DG, Hill DM, Burmeister DM, Gus EI, Cleland H, Padiglione A, Holden D, Huss F, Chew MS, Kubasiak JC, Burrell A, Manzanares W, Gómez MC, Yoshimura Y, Sjöberg F, Xie WG, Egipto P, Lavrentieva A, Jain A, Miranda-Altamirano A, Raby E, Aramendi I, Sen S, Chung KK, Alvarez RJQ, Han C, Matsushima A, Elmasry M, Liu Y, Donoso CS, Bolgiani A, Johnson LS, Vana LPM, de Romero RVD, Allorto N, Abesamis G, Luna VN, Gragnani A, González CB, Basilico H, Wood F, Jeng J, Li A, Singer M, Luo G, Palmieri T, Kahn S, Joe V, Cartotto R. Surviving Sepsis After Burn Campaign. Burns 2023; 49:1487-1524. [PMID: 37839919 DOI: 10.1016/j.burns.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION The Surviving Sepsis Campaign was developed to improve outcomes for all patients with sepsis. Despite sepsis being the primary cause of death after thermal injury, burns have always been excluded from the Surviving Sepsis efforts. To improve sepsis outcomes in burn patients, an international group of burn experts developed the Surviving Sepsis After Burn Campaign (SSABC) as a testable guideline to improve burn sepsis outcomes. METHODS The International Society for Burn Injuries (ISBI) reached out to regional or national burn organizations to recommend members to participate in the program. Two members of the ISBI developed specific "patient/population, intervention, comparison and outcome" (PICO) questions that paralleled the 2021 Surviving Sepsis Campaign [1]. SSABC participants were asked to search the current literature and rate its quality for each topic. At the Congress of the ISBI, in Guadalajara, Mexico, August 28, 2022, a majority of the participants met to create "statements" based on the literature. The "summary statements" were then sent to all members for comment with the hope of developing an 80% consensus. After four reviews, a consensus statement for each topic was created or "no consensus" was reported. RESULTS The committee developed sixty statements within fourteen topics that provide guidance for the early treatment of sepsis in burn patients. These statements should be used to improve the care of sepsis in burn patients. The statements should not be considered as "static" comments but should rather be used as guidelines for future testing of the best treatments for sepsis in burn patients. They should be updated on a regular basis. CONCLUSION Members of the burn community from the around the world have developed the Surviving Sepsis After Burn Campaign guidelines with the goal of improving the outcome of sepsis in burn patients.
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Affiliation(s)
- David G Greenhalgh
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA.
| | - David M Hill
- Department of Clinical Pharmacy & Translational Scre have been several studies that have evaluatedience, College of Pharmacy, University of Tennessee, Health Science Center; Memphis, TN, USA
| | - David M Burmeister
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Eduardo I Gus
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children; Department of Surgery, University of Toronto, Toronto, Canada
| | - Heather Cleland
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Alex Padiglione
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Dane Holden
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Fredrik Huss
- Department of Surgical Sciences, Plastic Surgery, Uppsala University/Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Michelle S Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - John C Kubasiak
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Aidan Burrell
- Department of Epidemiology and Preventative Medicine, Monash University and Alfred Hospital, Intensive Care Research Center (ANZIC-RC), Melbourne, Australia
| | - William Manzanares
- Department of Critical Care Medicine, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - María Chacón Gómez
- Division of Intensive Care and Critical Medicine, Centro Nacional de Investigacion y Atencion de Quemados (CENIAQ), National Rehabilitation Institute, LGII, Mexico
| | - Yuya Yoshimura
- Department of Emergency and Critical Care Medicine, Hachinohe City Hospital, Hachinohe, Japan
| | - Folke Sjöberg
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Wei-Guo Xie
- Institute of Burns, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, China
| | - Paula Egipto
- Centro Hospitalar e Universitário São João - Burn Unit, Porto, Portugal
| | | | | | | | - Ed Raby
- Infectious Diseases Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | | | - Soman Sen
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Chunmao Han
- Department of Burn and Wound Repair, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Asako Matsushima
- Department of Emergency and Critical Care, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Moustafa Elmasry
- Department of Hand, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
| | - Yan Liu
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Carlos Segovia Donoso
- Intensive Care Unit for Major Burns, Mutual Security Clinical Hospital, Santiago, Chile
| | - Alberto Bolgiani
- Department of Surgery, Deutsches Hospital, Buenos Aires, Argentina
| | - Laura S Johnson
- Department of Surgery, Emory University School of Medicine and Grady Health System, Georgia
| | - Luiz Philipe Molina Vana
- Disciplina de Cirurgia Plastica da Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Nikki Allorto
- Grey's Hospital Pietermaritzburg Metropolitan Burn Service, University of KwaZulu Natal, Pietermaritzburg, South Africa
| | - Gerald Abesamis
- Alfredo T. Ramirez Burn Center, Division of Burns, Department of Surgery, University of Philippines Manila - Philippine General Hospital, Manila, Philippines
| | - Virginia Nuñez Luna
- Unidad Michou y Mau Xochimilco for Burnt Children, Secretaria Salud Ciudad de México, Mexico
| | - Alfredo Gragnani
- Disciplina de Cirurgia Plastica da Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Carolina Bonilla González
- Department of Pediatrics and Intensive Care, Pediatric Burn Unit, Clinical Studies and Clinical Epidemiology Division, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Hugo Basilico
- Intensive Care Area - Burn Unit - Pediatric Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Fiona Wood
- Department of Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - James Jeng
- Department of Surgery, University of California, Irvine, CA, USA
| | - Andrew Li
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Mervyn Singer
- Department of Intensive Care Medicine, University College London, London, United Kingdom
| | - Gaoxing Luo
- Institute of Burn Research, Southwest Hospital, Army (Third Military) Medical University, Chongqing, China
| | - Tina Palmieri
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Steven Kahn
- The South Carolina Burn Center, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Victor Joe
- Department of Surgery, University of California, Irvine, CA, USA
| | - Robert Cartotto
- Department of Surgery, Sunnybrook Medical Center, Toronto, Ontario, Canada
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Abstract
Hypermetabolism is a hallmark of larger burn injuries. The hypermetabolic response is characterized by marked and sustained increases in catecholamines, glucocorticoids, and glucagon. There is an increasing body of literature for nutrition and metabolic treatment and supplementation to counter the hypermetabolic and catabolic response secondary to burn injury. Early and adequate nutrition is key in addition to adjunctive therapies, such as oxandrolone, insulin, metformin, and propranolol. The duration of administration of anabolic agents should be at minimum for the duration of hospitalization, and possibly up to 2 to 3 years postburn.
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Affiliation(s)
- Shahriar Shahrokhi
- Burn Program at Hamilton Health Sciences, Hamilton, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marc G Jeschke
- Burn Program at Hamilton Health Sciences, Hamilton, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada; TaAri Institute, Hamilton Health Sciences Research Institute, Hamilton, Ontario, Canada; David Braley Research Institute, C5-104, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada.
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Wang L, Wang M, Du J, Gong ZC. Intensive insulin therapy in sepsis patients: Better data enables better intervention. Heliyon 2023; 9:e14063. [PMID: 36915524 PMCID: PMC10006498 DOI: 10.1016/j.heliyon.2023.e14063] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023] Open
Abstract
In clinics, sepsis is a critical disease that often develops into shock and multiple organ dysfunction, leading to a serious threat of death. Patients with sepsis are often accompanied by stress hyperglycemia which is an independent risk factor for poor prognosis in sepsis. Thus, the treatment for stress hyperglycemia has attracted more and more attention, among which intensive insulin therapy is widely concerned. However, the benefits and harms of intensive insulin therapy for sepsis patients remain controversial. What the existing literature discusses mostly are the clinical benefit and hypoglycemia risk of intensive insulin therapy, but there is no conclusion on the target range of blood glucose control, the applicable patients, the timing of treatment initiation, and how to avoid the risk. In this study, we have analyzed and summarized the existing literature, hoping to determine the adverse and clinical benefit of intensive insulin therapy in sepsis. And we attempt to assemble better evidence to propose a better recommendation on hyperglycemia intervention for sepsis patients.
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Affiliation(s)
- Ling Wang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Min Wang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Clinical Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Du
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Clinical Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Zhi-Cheng Gong
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Clinical Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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7
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Expert consensus on the glycemic management of critically ill patients. JOURNAL OF INTENSIVE MEDICINE 2022; 2:131-145. [PMID: 36789019 PMCID: PMC9923981 DOI: 10.1016/j.jointm.2022.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/21/2022]
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Singh SR, Dhanasekara CS, Tello N, Southerland P, Alhaj Saleh A, Kesey J, Dissanaike S. Variations in insulin requirements can be an early indicator of sepsis in burn patients. Burns 2021; 48:111-117. [PMID: 33714643 DOI: 10.1016/j.burns.2021.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/20/2021] [Accepted: 02/22/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION A >25% increase in daily insulin dosing is suggestive of possible sepsis in burn patients, however, no conclusive evidence is available regarding the time point at which insulin dosing begins to increase. The purpose of this study is to determine the exact time point at which the insulin requirement increases among non-diabetic burn patients with sepsis. METHODS A retrospective chart review in non-diabetic burn patients with ≥20% total body surface area burned (TBSA) during 2010-2018 who received a blood culture for suspected sepsis. Absolute insulin dosing at intervals (0, 24, 48, 72, and 96 h prior to blood culture) were Box-Cox transformed and compared vs.-96 h reference using mixed-effects models accounting for within-patient dependencies. RESULTS Fifty-eight patients (84% males, age 44 ± 17 years, TBSA% 49 ± 17.5) were included. When cube root of daily insulin dosing was regressed on each time point in a mixed-effects model, statistically significant increase in insulin dosing compared to baseline was observed for -48 (p = 0.018), -24 (p = 0.011), and 0 h (p = 0.008). CONCLUSION Daily insulin dosing increases 48 h prior to development of other clinical signs of sepsis and can be used as a sensitive early marker.
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Affiliation(s)
- Simran R Singh
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, TX, USA.
| | | | - Nadia Tello
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, TX, USA.
| | - Parker Southerland
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, TX, USA.
| | - Adel Alhaj Saleh
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, TX, USA.
| | - Jennifer Kesey
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, TX, USA.
| | - Sharmila Dissanaike
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, TX, USA.
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9
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Karpov OE, Grubov VV, Maksimenko VA, Utaschev N, Semerikov VE, Andrikov DA, Hramov AE. Noise amplification precedes extreme epileptic events on human EEG. Phys Rev E 2021; 103:022310. [PMID: 33735967 DOI: 10.1103/physreve.103.022310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Abstract
Extreme events are rare and sudden abnormal deviations of the system's behavior from a typical state. Statistical analysis reveals that if the time series contains extreme events, its distribution has a heavy tail. In dynamical systems, extreme events often occur due to developing instability preceded by noise amplification. Here, we apply this theory to analyze generalized epileptic seizures in the human brain. First, we demonstrate that the time series of electroencephalogram (EEG) spectral power in a frequency band of 1-5 Hz obeys a heavy-tailed distribution, confirming the presence of extreme events. Second, we report that noise on EEG signals gradually increases before the seizure onset. Thus, we hypothesize that generalized epileptic seizures in humans are the extreme events emerging from instability accompanied by preictal noise amplification similar to other dynamical systems.
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Affiliation(s)
- Oleg E Karpov
- National Medical and Surgical Center named after N. I. Pirogov, Ministry of Healthcare of the Russian Federation, 105203 Moscow, Russia
| | - Vadim V Grubov
- Research and Production Company "Immersmed", Moscow 105203, Russia
- Neuroscience and Cognitive Technology Laboratory, Center for Technologies in Robotics and Mechatronics Components, Innopolis University, 420500 Kazan, Russia
| | - Vladimir A Maksimenko
- Research and Production Company "Immersmed", Moscow 105203, Russia
- Neuroscience and Cognitive Technology Laboratory, Center for Technologies in Robotics and Mechatronics Components, Innopolis University, 420500 Kazan, Russia
| | - Nikita Utaschev
- National Medical and Surgical Center named after N. I. Pirogov, Ministry of Healthcare of the Russian Federation, 105203 Moscow, Russia
| | | | - Denis A Andrikov
- Research and Production Company "Immersmed", Moscow 105203, Russia
| | - Alexander E Hramov
- Neuroscience and Cognitive Technology Laboratory, Center for Technologies in Robotics and Mechatronics Components, Innopolis University, 420500 Kazan, Russia
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Abe T, Suzuki T, Kushimoto S, Fujishima S, Sugiyama T, Iwagami M, Ogura H, Shiraishi A, Saitoh D, Mayumi T, Iriyama H, Komori A, Nakada TA, Shiino Y, Tarui T, Hifumi T, Otomo Y, Okamoto K, Umemura Y, Kotani J, Sakamoto Y, Sasaki J, Shiraishi SI, Tsuruta R, Hagiwara A, Yamakawa K, Takuma K, Masuno T, Takeyama N, Yamashita N, Ikeda H, Ueyama M, Gando S. History of diabetes may delay antibiotic administration in patients with severe sepsis presenting to emergency departments. Medicine (Baltimore) 2020; 99:e19446. [PMID: 32176076 PMCID: PMC7220469 DOI: 10.1097/md.0000000000019446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Clinical manifestations of sepsis differ between patients with and without diabetes mellitus (DM), and these differences could influence the clinical behaviors of medical staff. Therefore, we aimed to investigate whether pre-existing DM was associated with the time to antibiotics or sepsis care protocols.This was a retrospective cohort study.It conducted at 53 intensive care units (ICUs) in Japan.Consecutive adult patients with severe sepsis admitted directly to ICUs form emergency departments from January 2016 to March 2017 were included.The primary outcome was time to antibiotics.Of the 619 eligible patients, 142 had DM and 477 did not have DM. The median times (interquartile ranges) to antibiotics in patients with and without DM were 103 minutes (60-180 minutes) and 86 minutes (45-155 minutes), respectively (P = .05). There were no significant differences in the rates of compliance with sepsis protocols or with patient-centred outcomes such as in-hospital mortality. The mortality rates of patients with and without DM were 23.9% and 21.6%, respectively (P = .55). Comparing patients with and without DM, the gamma generalized linear model-adjusted relative difference indicated that patients with DM had a delay to starting antibiotics of 26.5% (95% confidence intervals (95%CI): 4.6-52.8, P = .02). The gamma generalized linear model-adjusted relative difference with multiple imputation for missing data of sequential organ failure assessment was 19.9% (95%CI: 1.0-42.3, P = .04). The linear regression model-adjusted beta coefficient indicated that patients with DM had a delay to starting antibiotics of 29.2 minutes (95%CI: 6.8-51.7, P = .01). Logistic regression modelling showed that pre-existing DM was not associated with in-hospital mortality (odds ratio, 1.26; 95%CI: 0.72-2.19, P = .42).Pre-existing DM was associated with delayed antibiotic administration among patients with severe sepsis or septic shock; however, patient-centred outcomes and compliance with sepsis care protocols were comparable.
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Affiliation(s)
- Toshikazu Abe
- Department of General Medicine, Juntendo University, Tokyo
- Health Services Research and Development Center, University of Tsukuba, Tsukuba
| | - Tomoharu Suzuki
- Department of General Medicine, Urasoe General Hospital, Urasoe
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai
| | - Seitaro Fujishima
- Center for General Medicine Education, Keio University School of Medicine
| | - Takehiro Sugiyama
- Health Services Research and Development Center, University of Tsukuba, Tsukuba
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo
| | - Masao Iwagami
- Health Services Research and Development Center, University of Tsukuba, Tsukuba
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka
| | | | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu
| | - Hiroki Iriyama
- Department of General Medicine, Juntendo University, Tokyo
| | - Akira Komori
- Department of General Medicine, Juntendo University, Tokyo
| | - Taka-aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba
| | - Yasukazu Shiino
- Department of Acute Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Takehiko Tarui
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Kitakyushu
| | - Yutaka Umemura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka
| | - Joji Kotani
- Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe
| | - Yuichiro Sakamoto
- Emergency and Critical Care Medicine, Saga University Hospital, Saga
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo
| | - Shin-ichiro Shiraishi
- Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Aizuwakamatsu
| | - Ryosuke Tsuruta
- Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Ube
| | | | - Kazuma Yamakawa
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka
| | - Kiyotsugu Takuma
- Emergency & Critical Care Center, Kawasaki Municipal Kawasaki Hospital, Kawasaki
| | - Tomohiko Masuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo
| | - Naoshi Takeyama
- Advanced Critical Care Center, Aichi Medical University Hospital, Nagakute
| | - Norio Yamashita
- Advanced Emergency Medical Service Center, Kurume University Hospital, Kurume
| | - Hiroto Ikeda
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo
| | - Masashi Ueyama
- Department of Trauma, Critical Care Medicine, and Burn Center Community Healthcare Organization, Chukyo Hospital, Nagoya
| | - Satoshi Gando
- Division of Acute and Critical Care Medicine, Hokkaido University Graduate School of Medicine
- Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
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11
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Du Y, Liu C, Li J, Dang H, Zhou F, Sun Y, Xu F. Glycemic Variability: An Independent Predictor of Mortality and the Impact of Age in Pediatric Intensive Care Unit. Front Pediatr 2020; 8:403. [PMID: 32850528 PMCID: PMC7412867 DOI: 10.3389/fped.2020.00403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 06/11/2020] [Indexed: 12/31/2022] Open
Abstract
Objective: To compare the ability of different indices of glycemic variability (GV) in the prognostic evaluation of critically ill children and investigate whether heterogeneity of glucose control exists within this population group. Methods: We conducted a retrospective study of the GV data collected from patients admitted to the pediatric intensive care unit, Children's Hospital of Chongqing Medical University between January 2016 and December 2016. We calculated the mean glucose level (MGL) and four indices of GV, namely, standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic excursion (MAGE), and glycemic lability index (GLI). The 28-day mortality was considered as the primary endpoint. Results: Survivors and non-survivors showed significant differences in terms of the SD, CV, MAGE, and GLI (P < 0.05, for all). However, GLI was superior to the other indices and showed an independent association with ICU mortality (odds ratio [OR], 1.082; 95% confidence interval [CI], 1.031-1.135; P < 0.01). Sub-group analysis disaggregated by quartiles of MGL and GV revealed that younger subjects (age ≤ 36 months) had significantly higher mortality in the lowest quartile of the MGL and in the highest quartile of GV; the older children (age > 36 months) experienced significantly higher mortality in the highest quartiles of MGL and GV. Conclusion: GV is closely associated with mortality, and among all glucose parameters evaluated, GLI was found to be the strongest predictor of outcomes. This paper is the first report of age being a potentially important modifier of the association between GV, MGL, and mortality in critically ill children.
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Affiliation(s)
- Yuhui Du
- Department of Medicine Intensive Care Unit, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Chengjun Liu
- Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jing Li
- Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongxing Dang
- Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Fang Zhou
- Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yuelin Sun
- Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Feng Xu
- Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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12
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Statistical Properties and Predictability of Extreme Epileptic Events. Sci Rep 2019; 9:7243. [PMID: 31076609 PMCID: PMC6510789 DOI: 10.1038/s41598-019-43619-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 04/26/2019] [Indexed: 01/03/2023] Open
Abstract
The use of extreme events theory for the analysis of spontaneous epileptic brain activity is a relevant multidisciplinary problem. It allows deeper understanding of pathological brain functioning and unraveling mechanisms underlying the epileptic seizure emergence along with its predictability. The latter is a desired goal in epileptology which might open the way for new therapies to control and prevent epileptic attacks. With this goal in mind, we applied the extreme event theory for studying statistical properties of electroencephalographic (EEG) recordings of WAG/Rij rats with genetic predisposition to absence epilepsy. Our approach allowed us to reveal extreme events inherent in this pathological spiking activity, highly pronounced in a particular frequency range. The return interval analysis showed that the epileptic seizures exhibit a highly-structural behavior during the active phase of the spiking activity. Obtained results evidenced a possibility for early (up to 7 s) prediction of epileptic seizures based on consideration of EEG statistical properties.
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13
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Zhang Z. Prediction model for patients with acute respiratory distress syndrome: use of a genetic algorithm to develop a neural network model. PeerJ 2019; 7:e7719. [PMID: 31576250 PMCID: PMC6752189 DOI: 10.7717/peerj.7719] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 08/21/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is associated with significantly increased risk of death, and early risk stratification may help to choose the appropriate treatment. The study aimed to develop a neural network model by using a genetic algorithm (GA) for the prediction of mortality in patients with ARDS. METHODS This was a secondary analysis of two multicenter randomized controlled trials conducted in forty-four hospitals that are members of the National Heart, Lung, and Blood Institute, founded to create an acute respiratory distress syndrome Clinical Trials Network. Model training and validation were performed using the SAILS and OMEGA studies, respectively. A GA was employed to screen variables in order to predict 90-day mortality, and a neural network model was trained for the prediction. This machine learning model was compared to the logistic regression model and APACHE III score in the validation cohort. RESULTS A total number of 1,071 ARDS patients were included for analysis. The GA search identified seven important variables, which were age, AIDS, leukemia, metastatic tumor, hepatic failure, lowest albumin, and FiO2. A representative neural network model was constructed using the forward selection procedure. The area under the curve (AUC) of the neural network model evaluated with the validation cohort was 0.821 (95% CI [0.753-0.888]), which was greater than the APACHE III score (0.665; 95% CI [0.590-0.739]; p = 0.002 by Delong's test) and logistic regression model, albeit not statistically significant (0.743; 95% CI [0.669-0.817], p = 0.130 by Delong's test). CONCLUSIONS The study developed a neural network model using a GA, which outperformed conventional scoring systems for the prediction of mortality in ARDS patients.
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Affiliation(s)
- Zhongheng Zhang
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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14
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Pisarchik AN, Bashkirtseva IA, Ryashko LB. Strange periodic attractor: Extremely high stochastic sensitivity of a parametrically modulated system. ACTA ACUST UNITED AC 2018. [DOI: 10.1209/0295-5075/123/40001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Bila R, Varo R, Madrid L, Sitoe A, Bassat Q. Continuous Glucose Monitoring in Resource-Constrained Settings for Hypoglycaemia Detection: Looking at the Problem from the Other Side of the Coin. BIOSENSORS-BASEL 2018; 8:bios8020043. [PMID: 29693557 PMCID: PMC6023081 DOI: 10.3390/bios8020043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 12/22/2022]
Abstract
The appearance, over a decade ago, of continuous glucose monitoring (CGM) devices has triggered a patient-centred revolution in the control and management of diabetes mellitus and other metabolic conditions, improving the patient’s glycaemic control and quality of life. Such devices, the use of which remains typically restricted to high-income countries on account of their elevated costs, at present show very limited implantation in resource-constrained settings, where many other urgent health priorities beyond diabetes prevention and management still need to be resolved. In this commentary, we argue that such devices could have an additional utility in low-income settings, whereby they could be selectively used among severely ill children admitted to hospital for closer monitoring of paediatric hypoglycaemia, a life-threatening condition often complicating severe cases of malaria, malnutrition, and other common paediatric conditions.
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Affiliation(s)
- Rubao Bila
- Centro de Investigação em Saúde de Manhiça (CISM), CP1929 Maputo, Mozambique.
| | - Rosauro Varo
- Centro de Investigação em Saúde de Manhiça (CISM), CP1929 Maputo, Mozambique.
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain.
| | - Lola Madrid
- Centro de Investigação em Saúde de Manhiça (CISM), CP1929 Maputo, Mozambique.
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain.
| | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça (CISM), CP1929 Maputo, Mozambique.
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), CP1929 Maputo, Mozambique.
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain.
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluís Companys 23, 08010 Barcelona, Spain.
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), 08950 Barcelona, Spain.
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Zhao D, Ma L, Shen C, Li D, Cheng W, Shang Y, Liu Z, Wang X, Yin K. Long-lasting Glucagon-like Peptide 1 Analogue Exendin-4 Ameliorates the Secretory and Synthetic Function of Islets Isolated From Severely Scalded Rats. J Burn Care Res 2018; 39:545-554. [PMID: 29579298 DOI: 10.1093/jbcr/irx014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Dongxu Zhao
- Department of Burn and Plastic Surgery, Burns Institute, the First Affiliated Hospital of General Hospital of PLA, Beijing, China
| | - Li Ma
- Department of Burn and Plastic Surgery, Burns Institute, the First Affiliated Hospital of General Hospital of PLA, Beijing, China
| | - Chuanan Shen
- Department of Burn and Plastic Surgery, Burns Institute, the First Affiliated Hospital of General Hospital of PLA, Beijing, China
| | - Dawei Li
- Department of Burn and Plastic Surgery, Burns Institute, the First Affiliated Hospital of General Hospital of PLA, Beijing, China
| | - Wenfeng Cheng
- Department of Burn and Plastic Surgery, Burns Institute, the First Affiliated Hospital of General Hospital of PLA, Beijing, China
| | - Yuru Shang
- Department of Burn and Plastic Surgery, Burns Institute, the First Affiliated Hospital of General Hospital of PLA, Beijing, China
| | - Zhaoxing Liu
- Department of Burn and Plastic Surgery, Burns Institute, the First Affiliated Hospital of General Hospital of PLA, Beijing, China
| | - Xin Wang
- Department of Burn and Plastic Surgery, Burns Institute, the First Affiliated Hospital of General Hospital of PLA, Beijing, China
| | - Kai Yin
- Department of Burn and Plastic Surgery, Burns Institute, the First Affiliated Hospital of General Hospital of PLA, Beijing, China
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17
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Zhu Z, Hu T, Wang Z, Wang J, Liu R, Yang Q, Zhang X, Xiong Y. Anti-inflammatory and organ protective effect of insulin in scalded MODS rats without controlling hyperglycemia. Am J Emerg Med 2018; 36:202-207. [DOI: 10.1016/j.ajem.2017.07.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/16/2017] [Accepted: 07/20/2017] [Indexed: 11/16/2022] Open
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Salazar-Tamayo G, López-Jácome LE, Resendiz-Sanchez J, Franco-Cendejas R, Rodriguez-Zulueta P, Corzo-León DE. Higher In vitro Proliferation Rate of Rhizopus oryzae in Blood of Diabetic Individuals in Chronic Glycaemic Control Compared with Non-diabetic Individuals. Mycopathologia 2017; 182:1005-1014. [PMID: 28685375 PMCID: PMC5684257 DOI: 10.1007/s11046-017-0174-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 06/29/2017] [Indexed: 11/17/2022]
Abstract
Metabolic control improves outcomes associated with mucormycosis. The aim of this study was to compare the in vitro proliferation of Rhizopus oryzae in blood of individuals with and without diabetes at different glycaemic levels. Ninety-five individuals were included. Blood samples from each participant were incubated with sporangiospores of R. oryzae. The germination, filamentation and growth of R. oryzae were compared at different time points. Four groups were defined, one without (group A, n = 30) and three with diabetes: group B (HbA1c ≤7%, N = 24), group C (HbA1c 7.1-9%, N = 20) and group D (HbA1c > 9%, N = 21). The percentage of germinated sporangiospores was higher in the group A after 6 h (group A 56% ± 3, group B 35% ± 4, group C 48% ± 4, group D 46% ± 1.4, p = 0.01), 12 h (group A 54% ± 1.4, group B 19% ± 4, group C 16% ± 1, group D 9.5% ± 5, p < 0.001) and 24 h (group A 29% ± 1, group B 12% ± 4, group C 13.5% ± 3.5, group D 12% ± 1, p < 0.01). The filamentation was higher in groups with diabetes. Group B showed higher filamentation grade than group A at 6 h (0.4 ± 0.04 vs 1 ± 0.09, p < 0.001) and 24 h (1.6 ± 0.05 vs 2.1 ± 0.1, p = 0.05). In conclusion, R. oryzae proliferation was higher among diabetic individuals, including good glycaemic control, than among non-diabetic individuals.
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Affiliation(s)
- Grace Salazar-Tamayo
- Department of Infectious Diseases and Hospital Epidemiology, Hospital General Dr Manuel Gea González, Mexico City, Mexico
| | - Luis E López-Jácome
- Laboratory of Microbiology and Department of Infectious Diseases, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | | | - Rafael Franco-Cendejas
- Laboratory of Microbiology and Department of Infectious Diseases, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Patricia Rodriguez-Zulueta
- Department of Infectious Diseases and Hospital Epidemiology, Hospital General Dr Manuel Gea González, Mexico City, Mexico
| | - Dora E Corzo-León
- Department of Infectious Diseases and Hospital Epidemiology, Hospital General Dr Manuel Gea González, Mexico City, Mexico.
- Aberdeen Fungal Group. MRC Centre of Medical Mycology, Wellcome Trust Strategy Award. Institute of Medical Sciences, University of Aberdeen, Aberdeen City, Scotland, UK.
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Tottman AC, Alsweiler JM, Bloomfield FH, Pan M, Harding JE. Relationship between Measures of Neonatal Glycemia, Neonatal Illness, and 2-Year Outcomes in Very Preterm Infants. J Pediatr 2017. [PMID: 28647271 DOI: 10.1016/j.jpeds.2017.05.052] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To investigate relationships between early neonatal glycemia, neonatal characteristics, neonatal illness, and developmental outcomes in very preterm infants. STUDY DESIGN A retrospective, observational cohort study of 443 infants born weighing <1500 g or <30 weeks of gestation, and admitted within 24 hours to National Women's Hospital, Auckland, New Zealand. Glucose variability was defined as the standard deviation around the mean after log transformation of all blood glucose concentrations. Absolute glycemic excursions in the first week were used to divide the infants into 4 groups: normoglycemic; hypoglycemic; hyperglycemic, and unstable. RESULTS Compared with normoglycemic infants, hypoglycemic and unstable infants had lower birth weight z-scores, and hyperglycemic and unstable infants were of lower birth weight. Hypoglycemic infants had similar outcomes to normoglycemic infants. Hyperglycemic and unstable infants were less likely to survive without neonatal morbidity and less likely to survive without neurodevelopmental impairment at 2 years of age. Higher mean blood glucose concentration was seen in the hyperglycemic and unstable groups, and was associated with worse neonatal and 2-year outcomes. Greater glucose variability was seen in the hypoglycemic and unstable groups, and was associated with worse neonatal illness but not outcome at 2 years. No associations between measures of neonatal glycemia and neonatal or 2-year outcomes remained after correction for gestation, birth weight z-score, and socioeconomic status. CONCLUSIONS In very preterm infants, measures of neonatal glycemia are markers of gestational age and intrauterine growth, and are not independent predictors of neonatal illness or outcomes at 2 years of age.
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Affiliation(s)
| | - Jane Marie Alsweiler
- Department of Pediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand; National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - Frank Harry Bloomfield
- Liggins Institute, University of Auckland, Auckland, New Zealand; National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - Maggie Pan
- Department of Pediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
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20
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Hill DM, Sinclair SE, Hickerson WL. Rational Selection and Use of Antimicrobials in Patients with Burn Injuries. Clin Plast Surg 2017; 44:521-534. [DOI: 10.1016/j.cps.2017.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Fernandez-de-Cossio-Diaz J, De Martino A, Mulet R. Microenvironmental cooperation promotes early spread and bistability of a Warburg-like phenotype. Sci Rep 2017; 7:3103. [PMID: 28596605 PMCID: PMC5465218 DOI: 10.1038/s41598-017-03342-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/27/2017] [Indexed: 12/31/2022] Open
Abstract
We introduce an in silico model for the initial spread of an aberrant phenotype with Warburg-like overflow metabolism within a healthy homeostatic tissue in contact with a nutrient reservoir (the blood), aimed at characterizing the role of the microenvironment for aberrant growth. Accounting for cellular metabolic activity, competition for nutrients, spatial diffusion and their feedbacks on aberrant replication and death rates, we obtain a phase portrait where distinct asymptotic whole-tissue states are found upon varying the tissue-blood turnover rate and the level of blood-borne primary nutrient. Over a broad range of parameters, the spreading dynamics is bistable as random fluctuations can impact the final state of the tissue. Such a behaviour turns out to be linked to the re-cycling of overflow products by non-aberrant cells. Quantitative insight on the overall emerging picture is provided by a spatially homogeneous version of the model.
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Affiliation(s)
| | - Andrea De Martino
- Soft and Living Matter Lab, Istituto di Nanotecnologia (CNR-NANOTEC), Rome, Italy.
- Human Genetics Foundation, Turin, Italy.
| | - Roberto Mulet
- Group of Complex Systems and Statistical Physics, Department of Theoretical Physics, Physics Faculty, University of Havana, La Habana, Cuba
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22
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Strilka RJ, Stull MC, Clemens MS, McCaver SC, Armen SB. Simulation and qualitative analysis of glucose variability, mean glucose, and hypoglycemia after subcutaneous insulin therapy for stress hyperglycemia. Theor Biol Med Model 2016; 13:3. [PMID: 26819233 PMCID: PMC4728764 DOI: 10.1186/s12976-016-0029-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 01/20/2016] [Indexed: 02/03/2023] Open
Abstract
Background The critically ill can have persistent dysglycemia during the “subacute” recovery phase of their illness because of altered gene expression; it is also not uncommon for these patients to receive continuous enteral nutrition during this time. The optimal short-acting subcutaneous insulin therapy that should be used in this clinical scenario, however, is unknown. Our aim was to conduct a qualitative numerical study of the glucose-insulin dynamics within this patient population to answer the above question. This analysis may help clinicians design a relevant clinical trial. Methods Eight virtual patients with stress hyperglycemia were simulated by means of a mathematical model. Each virtual patient had a different combination of insulin resistance and insulin deficiency that defined their unique stress hyperglycemia state; the rate of gluconeogenesis was also doubled. The patients received 25 injections of subcutaneous regular or Lispro insulin (0-6 U) with 3 rates of continuous nutrition. The main outcome measurements were the change in mean glucose concentration, the change in glucose variability, and hypoglycemic episodes. These end points were interpreted by how the ultradian oscillations of glucose concentration were affected by each insulin preparation. Results Subcutaneous regular insulin lowered both mean glucose concentrations and glucose variability in a linear fashion. No hypoglycemic episodes were noted. Although subcutaneous Lispro insulin lowered mean glucose concentrations, glucose variability increased in a nonlinear fashion. In patients with high insulin resistance and nutrition at goal, “rebound hyperglycemia” was noted after the insulin analog was rapidly metabolized. When the nutritional source was removed, hypoglycemia tended to occur at higher Lispro insulin doses. Finally, patients with severe insulin resistance seemed the most sensitive to insulin concentration changes. Conclusions Subcutaneous regular insulin consistently lowered mean glucose concentrations and glucose variability; its linear dose-response curve rendered the preparation better suited for a sliding-scale protocol. The longer duration of action of subcutaneous regular insulin resulted in better glycemic-control metrics for patients who were continuously postprandial. Clinical trials are needed to examine whether these numerical results represent the glucose-insulin dynamics that occur in intensive care units; if present, their clinical effects should be evaluated.
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Affiliation(s)
- Richard J Strilka
- Department of Trauma and Critical Care Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, San Antonio, TX, USA.
| | - Mamie C Stull
- Department of Trauma and Critical Care Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, San Antonio, TX, USA.
| | - Michael S Clemens
- Department of Trauma and Critical Care Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, San Antonio, TX, USA.
| | - Stewart C McCaver
- Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD, USA.
| | - Scott B Armen
- Division of Trauma, Acute Care and Critical Care Surgery, Pennsylvania State College of Medicine, 500 University Drive, Hershey, PA, USA.
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Liu WY, Lin SG, Zhu GQ, Poucke SV, Braddock M, Zhang Z, Mao Z, Shen FX, Zheng MH. Establishment and Validation of GV-SAPS II Scoring System for Non-Diabetic Critically Ill Patients. PLoS One 2016; 11:e0166085. [PMID: 27824941 PMCID: PMC5100948 DOI: 10.1371/journal.pone.0166085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 10/21/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS Recently, glucose variability (GV) has been reported as an independent risk factor for mortality in non-diabetic critically ill patients. However, GV is not incorporated in any severity scoring system for critically ill patients currently. The aim of this study was to establish and validate a modified Simplified Acute Physiology Score II scoring system (SAPS II), integrated with GV parameters and named GV-SAPS II, specifically for non-diabetic critically ill patients to predict short-term and long-term mortality. METHODS Training and validation cohorts were exacted from the Multiparameter Intelligent Monitoring in Intensive Care database III version 1.3 (MIMIC-III v1.3). The GV-SAPS II score was constructed by Cox proportional hazard regression analysis and compared with the original SAPS II, Sepsis-related Organ Failure Assessment Score (SOFA) and Elixhauser scoring systems using area under the curve of the receiver operator characteristic (auROC) curve. RESULTS 4,895 and 5,048 eligible individuals were included in the training and validation cohorts, respectively. The GV-SAPS II score was established with four independent risk factors, including hyperglycemia, hypoglycemia, standard deviation of blood glucose levels (GluSD), and SAPS II score. In the validation cohort, the auROC values of the new scoring system were 0.824 (95% CI: 0.813-0.834, P< 0.001) and 0.738 (95% CI: 0.725-0.750, P< 0.001), respectively for 30 days and 9 months, which were significantly higher than other models used in our study (all P < 0.001). Moreover, Kaplan-Meier plots demonstrated significantly worse outcomes in higher GV-SAPS II score groups both for 30-day and 9-month mortality endpoints (all P< 0.001). CONCLUSIONS We established and validated a modified prognostic scoring system that integrated glucose variability for non-diabetic critically ill patients, named GV-SAPS II. It demonstrated a superior prognostic capability and may be an optimal scoring system for prognostic evaluation in this patient group.
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Affiliation(s)
- Wen-Yue Liu
- Department of Endocrinology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Shi-Gang Lin
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, 325000, China
| | - Gui-Qi Zhu
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, 325000, China
- Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Sven Van Poucke
- Dept of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Martin Braddock
- Global Medicines Development, AstraZeneca R&D, Loughborough, United Kingdom
| | - Zhongheng Zhang
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua, 321000, China
| | - Zhi Mao
- Department of Critical Care Medicine, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Fei-Xia Shen
- Department of Endocrinology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- * E-mail: (MHZ); (FXS)
| | - Ming-Hua Zheng
- Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- Institute of Hepatology, Wenzhou Medical University, Wenzhou, 325000, China
- * E-mail: (MHZ); (FXS)
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Madrid L, Acacio S, Nhampossa T, Lanaspa M, Sitoe A, Maculuve SA, Mucavele H, Quintó L, Sigaúque B, Bassat Q. Hypoglycemia and Risk Factors for Death in 13 Years of Pediatric Admissions in Mozambique. Am J Trop Med Hyg 2015; 94:218-26. [PMID: 26503282 DOI: 10.4269/ajtmh.15-0475] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 09/08/2015] [Indexed: 01/18/2023] Open
Abstract
Hypoglycemia is a life-threatening complication of several diseases in childhood. We describe the prevalence and incidence of hypoglycemia among admitted Mozambican children, establishing its associated risk factors. We retrospectively reviewed clinical data of 13 years collected through an ongoing systematic morbidity surveillance in Manhiça District Hospital in rural Mozambique. Logistic regression was used to identify risk factors for hypoglycemia and death. Minimum community-based incidence rates (MCBIRs) for hypoglycemia were calculated using data from the demographic surveillance system. Of 49,089 children < 15 years hospitalized in Manhiça District Hospital, 45,573 (92.8%) had a glycemia assessment on admission. A total of 1,478 children (3.2%) presented hypoglycemia (< 3 mmol/L), of which about two-thirds (972) were with levels < 2.5 mmol/L. Independent risk factors for hypoglycemia on admission and death among hypoglycemic children included prostration, unconsciousness, edema, malnutrition, and bacteremia. Hypoglycemic children were significantly more likely to die (odds ratio [OR] = 7.11; P < 0.001), with an associated case fatality rate (CFR) of 19.3% (245/1,267). Overall MCBIR of hypoglycemia was 1.57 episodes/1,000 child years at risk (CYAR), significantly decreasing throughout the study period. Newborns showed the highest incidences (9.47 episodes/1,000 CYAR, P < 0.001). Hypoglycemia remains a hazardous condition for African children. Symptoms and signs associated to hypoglycemia should trigger the verification of glycemia and the implementation of life-saving corrective measures.
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Affiliation(s)
- Lola Madrid
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Sozinho Acacio
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Miguel Lanaspa
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Sónia Amós Maculuve
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Helio Mucavele
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Llorenç Quintó
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Betuel Sigaúque
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
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Abstract
Ascorbic acid (vitamin C) decreases systemic inflammation and lowers fluid requirements after thermal injury; therefore it has been adopted in many burn centers as an adjunct to resuscitation. However, recent concerns have been expressed over clinically significant hypoglycemic events caused by vitamin C interference with the point-of-care (POC) glucose measurements. This case series presents a direct comparison of POC and laboratory reference glucose values in the patients receiving vitamin C infusion. Vitamin C was administered at 66 mg/kg/hour in seven patients with burns >30% TBSA. The baseline characteristics and burn characteristics were recorded. POC glucose measurements were made with a commonly used hand-held device, and the laboratory values were obtained using standard spectrophotometric methods. POC and laboratory glucose values drawn within the same hour were compared. Hemoglobin, which is known to cause interference in POC testing, was also recorded. All the patients demonstrated falsely elevated POC glucose values during and/or immediately after the infusion period, with discrepancies ranging from 10 to 200 mg/dl. These findings were irregular, unpredictable and unrelated to hemoglobin levels. The findings suggest an idiosyncratic reaction that cannot be easily corrected at the bedside using mathematical equations. POC glucose monitoring should be avoided during and after vitamin C therapy.
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Chiu PF, Wu CL, Huang CH, Liou HH, Chang CB, Chang HR, Chang CC. Lower blood glucose and variability are associated with earlier recovery from renal injury caused by episodic urinary tract infection in advanced type 2 diabetic chronic kidney disease. PLoS One 2014; 9:e108531. [PMID: 25259806 PMCID: PMC4178173 DOI: 10.1371/journal.pone.0108531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 08/22/2014] [Indexed: 02/07/2023] Open
Abstract
PURPOSE In our previous study, type 2 diabetic chronic kidney disease (CKD) patients with glomerular filtration rates of <30 mL/min upon hospitalization for urinary tract infection (UTI) were at a risk for acute kidney injury. This study aimed to clarify the effect of glucose and its variability on renal outcomes during admission for the treatment of UTI. MATERIALS AND METHODS Based on the date of renal recovery (RIFLE criteria: acute kidney injury occurred within 1-7 days and was sustained over 1 day), we divided these patients into early- (≤9 days, Group A) and late-recovery (>9 days, Group B) groups. The differences in the continuous and categorical variables of the two groups were assessed separately. The mean glucose levels and their variability (using the standard deviation and the coefficient of standard deviation) were compared at the fasting, midday pre-meal, evening pre-meal, and evening post-meal time points during hospitalization. We have organized the manuscript in a manner compliant with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement. RESULTS Acute kidney injury occurred within the two groups (p = 0.007 and p = 0.001, respectively). The early-morning blood glucose levels (149.7±44.0 mg/dL) and average blood glucose levels (185.6±52.0 mg/dL) were better in Group A (p = 0.01, p = 0.02). Group A patients also had lower glucose variability than Group B at the different time points (p<0.05). Group A also had earlier renal recovery. More relevant pathogens were identified from blood in Group B (p = 0.038). CONCLUSIONS Early-morning fasting and mean blood glucose levels and their variability can be good indicators of severe infection and predictors of renal outcome in type 2 diabetic patients with CKD and UTI.
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Affiliation(s)
- Ping-Fang Chiu
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Chia-Lin Wu
- Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ching-Hui Huang
- Division of Cardiology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Hung-Hsiang Liou
- Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Chirn-Bin Chang
- Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Horng-Rong Chang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chia-Chu Chang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
- Ph.D. Program for Aging, College of Medicine, China Medical University, Taichung, Taiwan
- * E-mail:
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27
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Pisarchik AN, Jaimes-Reátegui R, Magallón-García CDA, Castillo-Morales CO. Critical slowing down and noise-induced intermittency in bistable perception: bifurcation analysis. BIOLOGICAL CYBERNETICS 2014; 108:397-404. [PMID: 24852078 DOI: 10.1007/s00422-014-0607-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 04/21/2014] [Indexed: 06/03/2023]
Abstract
Stochastic dynamics and critical slowing down were studied experimentally and numerically near the onset of dynamical bistability in visual perception under the influence of noise. Exploring the Necker cube as the essential example of an ambiguous figure, and using its wire contrast as a control parameter, we measured dynamical hysteresis in two coexisting percepts as a function of both the velocity of the parameter change and the background luminance. The bifurcation analysis allowed us to estimate the level of cognitive noise inherent to brain neural cells activity, which induced intermittent switches between different perception states. The results of numerical simulations with a simple energy model are in good qualitative agreement with psychological experiments.
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Affiliation(s)
- Alexander N Pisarchik
- Centro de Investigaciones en Optica, Loma del Bosque 115, Lomas del Campestre, 37150 , Leon, Guanajuato, Mexico,
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Abstract
Glycemic control targets in intensive care units (ICUs) have three distinct domains. Firstly, excessive hyperglycemia needs to be avoided. The upper limit of this varies depending on the patient population studied and diabetic status of the patients. Surgical patients particularly cardiac surgery patients tend to benefit from a lower upper limit of glycemic control, which is not evident in medically ill patient. Patient with premorbid diabetic status tends to tolerate higher blood sugar level better than normoglycemics. Secondly, hypoglycemia is clearly detrimental in all groups of critically ill patient and all measures to avoid this catastrophe need to be a part of any glycemic control protocol. Thirdly, glycemic variability has increasingly been shown to be detrimental in this patient population. Glycemic control protocols need to take this into consideration and target to reduce any of the available metrics of glycemic variability. Newer technologies including continuous glucose monitoring techniques will help in titrating all these three domains within a desirable range.
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Affiliation(s)
- Subhash Todi
- Director, Critical Care and Emergency Medicine, AMRI Hospitals, P4 & 5, CIT Scheme - LXXII, Block- A, Gariahat Road, Kolkatta, West Bengal, India
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29
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Glucose control in pediatric burn patients: refining the search for the "sweet spot". Crit Care Med 2014; 42:1315-7. [PMID: 24736355 DOI: 10.1097/ccm.0000000000000200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yoo DS, Chang J, Kim JT, Choi MJ, Choi J, Choi KH, Park MS, Cho KH. Various blood glucose parameters that indicate hyperglycemia after intravenous thrombolysis in acute ischemic stroke could predict worse outcome. PLoS One 2014; 9:e94364. [PMID: 24747428 PMCID: PMC3991642 DOI: 10.1371/journal.pone.0094364] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/14/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hyperglycemia is common after stroke, and it is well known to worsen its outcome. However, it is important to consider that blood glucose (BG) levels can undergo dynamic changes during the acute stage of ischemic stroke. We sought to investigate the clinical significance of various glucose parameters within first 24 hours in acute ischemic stroke (AIS). The study focused on hyperacute stage patients who underwent IVT and investigated which parameters of glucose demonstrated to be helpful for predicting outcome. METHODS This was a retrospective study of consecutive patients with AIS at a single stroke center. Patients were consecutively enrolled if they were treated with IV-tPA within 3 hours of symptom onset. BG was measured immediately upon arrival in ER, after IVT and every 6-8 hours during the first 24 hours after IVT. The various parameters of BG were the following: BG before IVT, BG after IVT, mean BG (mBG), maximal BG (max BG), standard deviation of BG (sdBG), and standard deviation of mean BG (sdmBG). RESULTS 207 patients (127 men and 80 women) were included in this study. Seventy seven of 207 patients had favorable outcomes at 3 months. High BG after IVT, mBG and max BG were independently associated with mRS>2 at 3 months (adjusted by age, NIHSS, and atrial fibrillation). Several parameters of BG were also independently associated with early mortality within 3 months (BG after IVT, mBG, and max BG). BG after IVT and mBG over 180 mg/dL were independently associated with early mortality within 3 months. CONCLUSION Serial measurements of BG might be a better predictor of clinical outcome in patients with AIS treated with IVT than single BG measurements before IVT. Therefore, these results suggest that variable parameters of BG could be important for the prediction of clinical outcome in AIS treated with IVT.
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Affiliation(s)
- Deok-Sang Yoo
- Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Jane Chang
- Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Joon-Tae Kim
- Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea
- * E-mail:
| | - Min-Ji Choi
- Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Jina Choi
- Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Kang-Ho Choi
- Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Man-Seok Park
- Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Ki-Hyun Cho
- Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea
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31
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Abstract
Approximately 2457 research articles were published with burns in the title, abstract, and/or keyword in 2012. This number continues to rise through the years; this article reviews those selected by the Editor of one of the major journals in the field (Burns) and his colleague that are most likely to have the greatest likelihood of affecting burn care treatment and understanding. As done previously, articles were found and divided into these topic areas: epidemiology of injury and burn prevention, wound and scar characterization, acute care and critical care, inhalation injury, infection, psychological considerations, pain and itching management, rehabilitation, long-term outcomes, and burn reconstruction. Each selected article is mentioned briefly with comment from the authors; readers are referred to the full papers for further details.
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Affiliation(s)
- Steven E Wolf
- Division of Burn, Trauma, and Critical Care, Department of Surgery, University of Texas - Southwestern Medical Center, Dallas, TX 75390-9158, United States.
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32
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Hashiba M, Ono M, Hyogo H, Ikeda Y, Masuda K, Yoshioka R, Ishikawa Y, Nagata Y, Munekage K, Ochi T, Hirose A, Nozaki-Fujimura Y, Noguchi S, Okamoto N, Chayama K, Suganuma N, Saibara T. Glycemic variability is an independent predictive factor for development of hepatic fibrosis in nonalcoholic fatty liver disease. PLoS One 2013; 8:e76161. [PMID: 24223115 PMCID: PMC3819352 DOI: 10.1371/journal.pone.0076161] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/20/2013] [Indexed: 02/08/2023] Open
Abstract
Patients with nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) often have metabolic disorders including insulin resistance and type 2 diabetes mellitus (T2DM). We clarified the predictive factors in glucose metabolism for progression of hepatic fibrosis in patients with NAFLD by the 75-g oral glucose tolerance test (75gOGTT) and a continuous glucose monitoring system (CGMS). One hundred sixty-nine patients (68 female and 101 male patients) with biopsy-proven NAFLD with performance with 75gOGTT were enrolled and divided into four groups according to the stage of hepatic fibrosis (F0–3). The proportion of patients with T2DM significantly gradually increased, HbA1c and the homeostasis model assessment of insulin resistance were significantly elevated, and 1,5-anhydroglucitol (1,5-AG) was remarkably decreased with the progression of fibrosis. In the 75gOGTT, both plasma glucose and insulin secretion were remarkably increased with the progression of fibrosis. The only factor significantly associated with advanced fibrosis was 1,5-AG (P = 0.008) as determined by multivariate logistic regression analysis. We next evaluated the changes in blood glucose during 24 hours by monitoring with the CGMS to confirm the relationship between glycemic variability and progression of fibrosis. Variability of median glucose, standard deviation of median glucose (P = 0.0022), maximum blood glucose (P = 0.0019), and ΔMin–max blood glucose (P = 0.0029) were remarkably higher in severe fibrosis than in mild fibrosis. Conclusion Hyperinsulinemia and hyperglycemia, especially glycemic variability, are important predictive factors in glucose impairment for the progression of hepatic fibrosis in NAFLD.
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Affiliation(s)
- Motoi Hashiba
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
| | - Masafumi Ono
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
- * E-mail:
| | - Hideyuki Hyogo
- Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukio Ikeda
- Diabetes Center, Kochi Memorial Hospital, Kochi, Japan
| | - Kosei Masuda
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
| | - Reiko Yoshioka
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
| | - Yoichi Ishikawa
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
| | - Yuri Nagata
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
| | - Kensuke Munekage
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
| | - Tsunehiro Ochi
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
| | - Akira Hirose
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
| | | | - Shuhei Noguchi
- Department of Environmental Medicine, Kochi Medical School, Kochi, Japan
| | - Nobuto Okamoto
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
| | - Kazuaki Chayama
- Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Narufumi Suganuma
- Department of Environmental Medicine, Kochi Medical School, Kochi, Japan
| | - Toshiji Saibara
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
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Jeschke MG. Clinical review: Glucose control in severely burned patients - current best practice. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:232. [PMID: 23890278 PMCID: PMC4056030 DOI: 10.1186/cc12678] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Tight glucose control changed the way many burn centers practice burn ICU care. However, after the initial impressive data, various clinical trials followed that showed mixed results. The objective of the present review is to discuss recent studies in the area of burn and critical care, and to identify the current best practice for current burn care providers. We reviewed relevant publications from PubMed and selected high-impact publications on tight glycemic control in various patient populations with a focus on burn patients. We conclude that in burns there seems to be a signal that insulin administration to a target range of 130 to 150 mg/dl is beneficial in terms of morbidity and mortality without the risk of hypoglycemia.
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