Medicine
-
Observational Study
A Systemic Inflammatory Endotype of Asthma With More Severe Disease Identified by Unbiased Clustering of the Serum Cytokine Profile.
Asthma is considered as a clinical and molecularly heterogeneous disorder. Systemic inflammation is suggested to play an important role in a group of asthma patients. We hypothesized that there is a subgroup of patients with asthma characterized by systemic inflammation. ⋯ More female patients were included, with higher circulating neutrophil counts and more severe symptoms. In conclusion, we identified an endotype of asthma characterized by systemic inflammation and severe symptoms. Increased levels of VEGF, leptin and decreased level of sRAGE may contribute to the systemic inflammation of this asthma endotype.
-
Observational Study
"Weekend effect" on stroke mortality revisited: Application of a claims-based stroke severity index in a population-based cohort study.
Previous studies have yielded inconsistent results on whether weekend admission is associated with increased mortality after stroke, partly because of differences in case mix. Claims-based studies generally lack sufficient information on disease severity and, thus, suffer from inadequate case-mix adjustment. In this study, we examined the effect of weekend admission on 30-day mortality in patients with ischemic stroke by using a claims-based stroke severity index. ⋯ This association became null after adjustment for stroke severity (OR, 1.07; 95% CI, 0.95-1.20). The "weekend effect" on stroke mortality might be attributed to higher stroke severity in weekend patients. While claims data are useful for examining stroke outcomes, adequate adjustment for stroke severity is warranted.
-
Case Reports
Prolonged hemidiaphragmatic paresis following continuous interscalene brachial plexus block: A case report.
Interscalene brachial plexus block provides effective anesthesia and analgesia for shoulder surgery. One of the disadvantages of this technique is the risk of hemidiaphragmatic paresis, which can occur as a result of phrenic nerve block and can cause a decrease in the pulmonary function, limiting the use of the block in patients with reduced functional residual capacity or a preexisting pulmonary disease. ⋯ Nerve injuries associated with peripheral nerve blocks may be caused by several mechanisms. Our findings suggest that perioperative nerve injuries can occur as a result of combined mechanical and chemical injuries.
-
Chinese rural-to-urban migrant workers (MWs) who are employed in service industry are a rapidly growing population in urban China. Like other MWs, service industry MWs (SIMWs) are generally excluded from the mainstream of city societies, but unlike other MWs, they are more marginalized in cities. Social isolation increases the feelings of loneliness; however, there are little empirical data on the epidemiology of loneliness of SIMWs. ⋯ Being aged 60 years or older (odds ratio [OR] = 2.30), marital status of "others" (OR = 2.77), being physically ill in the last 2 weeks (OR = 1.46), migrating alone (OR = 1.97), working >8 hours/day (OR = 1.06), MSPSS inside family subscale score ≤18 (OR = 1.80), and MSPSS outside family subscale score ≤38 (OR = 1.50) were significantly associated with increased risk of loneliness in SIMWs. Loneliness is prevalent in Chinese SIMWs and should be seen as a major public health issue. The high prevalence and many negative health consequences of loneliness highlight the importance of routine screening, evaluation, and treatment of loneliness in this vulnerable population.
-
Despite a potentially effective therapy for adult respiratory failure, a general agreement on venovenous extracorporeal membrane oxygenation (VV-ECMO) has not been reached among institutions due to its invasiveness and high resource usage. To establish consensus on the timing of intervention, large ECMO organizations have published the respiratory extracorporeal membrane oxygenation survival prediction (RESP) score and the ECMOnet score, which allow users to predict hospital mortality for candidates with their pre-ECMO presentations. This study was aimed to test the predictive powers of these published scores in a medium-sized cohort enrolling adults treated with VV-ECMO for acute respiratory failure, and develop an institutional prediction model under the framework of the 3 scores if a superior predictive power could be achieved. ⋯ Compared with the 3 scores, the institutional model had a significantly higher AUROC (0.779; P < 0.001). The 3 published scores provide valuable information about the poor prognostic factors for adult respiratory ECMO. Among the score parameters, duration of mechanical ventilation, immunocompromised status, and severity of organ dysfunction may be the most important prognostic factors of VV-ECMO used for adult respiratory failure.