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BackgroundExperimentally, ultra-protective ventilation (UPV, tidal volumes [VT]

Abstract Background Estimating the risk of intubation and mortality among COVID-19 patients can help clinicians triage these patients and allocate resources more efficiently. Thus, here we sought to identify the risk factors associated with intubation and intra-hospital mortality in a cohort of COVID-19 patients hospitalized due to hypoxemic acute respiratory failure (ARF). Results We included retrospectively a total of 187 patients admitted to the subintensive and intensive care units of the University Hospital “Maggiore della Carità” of Novara between March 1st and April 30th, 2020. Based on these patients’ demographic characteristics, early clinical and laboratory variables, and quantitative chest computerized tomography (CT) findings, we developed two random forest (RF) models able to predict intubation and intra-hospital mortality. Variables independently associated with intubation were C-reactive protein (p < 0.001), lactate dehydrogenase level (p = 0.018) and white blood cell count (p = 0.026), while variables independently associated with mortality were age (p < 0.001), other cardiovascular diseases (p = 0.029), C-reactive protein (p = 0.002), lactate dehydrogenase level (p = 0.018), and invasive mechanical ventilation (p = 0.001). On quantitative chest CT analysis, ground glass opacity, consolidation, and fibrosis resulted significantly associated with patient intubation and mortality. The major predictors for both models were the ratio between partial pressure of arterial oxygen and fraction of inspired oxygen, age, lactate dehydrogenase, C-reactive protein, glycemia, CT quantitative parameters, lymphocyte count, and symptom onset. Conclusions Altogether, our findings confirm previously reported demographic, clinical, hemato-chemical, and radiologic predictors of adverse outcome among COVID-19-associated hypoxemic ARF patients. The two newly developed RF models herein described show an overall good level of accuracy in predicting intra-hospital mortality and intubation in our study population. Thus, their future development and implementation may help not only identify patients at higher risk of deterioration more effectively but also rebalance the disproportion between resources and demand.

Liwei Cui,1 Xiuli Ji,2 Mengshuang Xie,1 Shuang Dou,1 Wei Wang,1 Wei Xiao1 1Department of Respiratory Disease, Qilu Hospital, Shandong University, 2Department of Pulmonary Disease, Jinan Traditional Chinese Medicine Hospital, Jinan, People’s Republic of China Background: Since forced expiratory volume in 1 second (FEV1) shows a weak correlation with patients’ symptoms in COPD, some volume parameters may better reflect the change in dyspnea symptoms after treatment. In this article, we investigated the role of inspiratory capacity (IC) on dyspnea evaluation among COPD patients with or without emphysematous lesions.Methods: In this prospective study, 124 patients with stable COPD were recruited. During the baseline visit, patients performed pulmonary function tests and dyspnea evaluation using the modified Medical Research Council (mMRC) scale. Partial patients underwent quantitative computerized tomography scans under physicians’ recommendations, and emphysematous changes were assessed using the emphysema index (EI; low attenuation area [LAA]% −950). These subjects were then divided into the emphysema-predominant group (LAA% −950≥9.9%) and the non-emphysema-predominant group (LAA% −9501 were more likely to exhibit a marked increase in IC (≥300 mL) than those with absolute ∆mMRC ≤1 (74.36% versus 35.29%; odds ratio [OR], 5.317; P0.05).Conclusion: IC could serve as an effective complement to FEV1 in COPD patients undergoing dyspnea evaluation after treatment. For COPD patients with predominant emphysematous lesions, an increase in IC is particularly more suitable for explaining dyspnea relief than FEV1. Keywords: IC, COPD, mMRC score, quantitative computerized tomography, emphysema index

Background: Experimentally, ultra-protective ventilation (UPV, tidal volumes [V T ] < 4 mL.kg -1 ) strategies in conjunction with veno-venous extracorporeal membrane oxygenation (VV-ECMO) are associated with lesser ventilator-induced lung injuries (VILI) during acute respiratory distress syndrome (ARDS). However, whether these strategies reduce lung inflammation more effectively than protective ventilation (PV) remains unclear. We aimed to demonstrate that a UPV strategy decreases acute lung inflammation in comparison with PV in an experimental swine model of ARDS., Methods: ARDS was induced by tracheal instillation of chlorhydric acid in sedated and paralyzed animals under mechanical ventilation. Animals were randomized to receive either UPV (V T 1 mL.kg -1 , positive end-expiration pressure [PEEP] set to obtain plateau pressure between 20 and 25 cmH 2 O and respiratory rate [RR] at 5 min -1 under VV-ECMO) or PV (V T 6 mL.kg -1 , PEEP set to obtain plateau pressure between 28 and 30 cmH 2 O and RR at 25 min -1 ) during 4 h. After 4 h, a positron emission tomography with [ 11 C](R)-PK11195 (ligand to TSPO-bearing macrophages) injection was realized, coupled with quantitative computerized tomography (CT). Pharmacokinetic multicompartment models were used to quantify regional [ 11 C](R)-PK11195 lung uptake. [ 11 C](R)-PK11195 lung uptake and CT-derived respiratory variables were studied regionally across eight lung regions distributed along the antero-posterior axis., Results: Five pigs were randomized to each study group. Arterial O 2 partial pressure to inspired O 2 fraction were not significantly different between study groups after experimental ARDS induction (75 [68-80] mmHg in a PV group vs. 87 [69-133] mmHg in a UPV group, p  = 0.20). Compared to PV animals, UPV animals exhibited a significant decrease in the regional non-aerated compartment in the posterior lung levels, in mechanical power, and in regional dynamic strain and no statistical difference in tidal hyperinflation after 4 h. UPV animals had a significantly lower [ 11 C](R)-PK11195 uptake, compared to PV animals (non-displaceable binding potential 0.35 [IQR, 0.20-0.59] in UPV animals and 1.01 [IQR, 0.75-1.59] in PV animals, p  = 0.01). Regional [ 11 C](R)-PK11195 uptake was independently associated with the interaction of regional tidal hyperinflation and regional lung compliance., Conclusion: In an experimental model of ARDS, 4 h of UPV strategy significantly decreased lung inflammation, in relation to the control of V T -derived determinants of VILI., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Deniel, Dhelft, Lancelot, Orkisz, Roux, Mouton, Benzerdjeb, Richard and Bitker.)

Abstract: Bone mineral density (BMD) and geometric bone measures are individually associated with prevalent osteoporotic fractures. Whether an aggregate of these measures would better associate with fractures has not been examined. We examined relationships between self-reported fractures and selected bone measures acquired by quantitative computerized tomography (QCT), a composite bone score, and QCT-acquired dual-energy X-ray absorptiometry–like total femur BMD in 2110 men and 2682 women in the Age, Gene/Environment Susceptibility-Reykjavik Study. The combined bone score was generated by summing gender-specific Z-scores for 4 QCT measures: vertebral trabecular BMD, femur neck cortical thickness, femur neck trabecular BMD, and femur neck minimal cross-sectional area. Except for the latter measure, lower scores for QCT measures, singly and combined, showed positive (p < 0.05) associations with fractures. Results remained the same in stratified models for participants not taking bone-promoting medication. In women on bone-promoting medication, greater femur neck cortical thickness and trabecular BMD were significantly associated with fracture status. However, the association between fracture and combined bone score was not stronger than the associations between fracture and individual measures or total femur BMD. Thus, the selected measures did not all similarly associate with fracture status and did not appear to have an additive effect on fracture status. [Copyright &y& Elsevier]

Background:Bone mineral density (BMD) of the lumbar spine (L-spine) has been reported to be normal or increased in persons with chronic spinal cord injury (SCI).Objective:To determine BMD of the L-spine by dual-energy X-ray absorptiometry (DXA) and quantitative computerized tomography (qCT) in men with chronic SCI compared with able-bodied controls.Design:Cross-sectional, comparative study.Setting:Clinical research unit, Veterans Affairs Medical Center, Bronx, NY, USA and Kessler Institute of Rehabilitation, West Orange, NJ, USA.Methods:Measurements of the L-spine were made in 20 men with SCI and compared with 15 able-bodied controls. The DXA images were acquired on a GE Lunar DPX-IQ. The qCT images of the L-spine were acquired on a Picker Q series computerized tomographic scanner.Results:The mean ages for the SCI and control groups were 44±13 vs 42±9 years, and the duration of injury of the group with SCI was 14±11 years. There were no significant differences between the SCI and control groups for L-spine DXA BMD (1.391±0.210 vs 1.315±0.178 g/m2) or for L-spine DXA T-score (1.471±1.794 vs 0.782±1.481). L-spine qCT BMD was significantly lower in the SCI compared with the control group (1.296±0.416 vs 1.572±0.382 g/m2, P=0.05); the T-score approached significance (−1.838±1.366 vs −0.963±1.227, P=0.059). Subjects with moderate degenerative joint disease (DJD) had significantly higher T-scores by DXA than those without or with mild DJD.Conclusion:Individuals with SCI who have moderate to severe DJD may have bone loss of the L-spine that may be underestimated by DXA, reducing awareness of the risk of fracture.Spinal Cord (2009) 47, 628–633; doi:10.1038/sc.2008.169; published online 20 January 2009 [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to investigate vertebral body bone mineral density (BMD) changes following posterolateral fusion with transpedicular screw fixation using quantitative computerized tomography (QCT) in short and relatively long-term periods., Patients and Methods: A retrospective study was performed to investigate vertebral body BMD changes in the patients who underwent posterolateral fusion with transpedicular screw fixation at thoracic and lumbar spine. A total of 160 patients were enrolled into the study. According to the follow-up period, patients were divided into two subgroups (group 1, early follow-up, mean follow-up period, 279.3±162.3 days and group 2, later follow-up, mean follow-up period, 969.1±274.2 days). The trabecular BMDs (mg/cm³) were measured from T12 to L5 as screw free levels by using QCT measurement software. Comparisons between preoperative and postoperative BMD values were assessed using paired t-test., Results: The mean postoperative BMD values of both group 1 and 2 weresignificantly lower, compared with the preoperative values (79.2±31.3mg/cm³ vs. 91.5±31.4mg/cm(3), 76.1±25.5mg/cm(3) vs. 89.3±30.4mg/cm(3), p<0.001 and p<0.001, respectively). There was no significant correlation between BMD loss and number of fused segments. Vertebral BMD loss was significantly higher in the L3 vertebra when located caudally to the operation site than when located cranially (-27.7±19.8% vs. -12.8±27.1%; p<0.01)., Conclusions: The vertebral body BMD values are decreased at the adjacent of the posterolateral fusion with transpedicular screw fixation levels in both cephalad and caudad sides at an average of 9-months-follow-up postoperatively. This BMD loss persisted, but not worsened at an average of 32-months-follow-up. Vertebral BMD loss was significantly higher in the L3 vertebra when located caudally versus cranially to the surgery site., (Copyright © 2016 Elsevier B.V. All rights reserved.)