Functional Capacity Index Research Articles

Insomnia, cardiorespiratory function and quality of life in individuals with post-COVID-19 fatigue

ObjectiveThis study aimed to compare the prevalence of insomnia, lung function, inspiratory muscle function, functional capacity, and quality of life in individuals with and without post-COVID-19 fatigue. MethodsThirty-four post-COVID-19 individuals participated in the study, 20 with fatigue (32 ± 12 years old, 15% male) and 14 without fatigue (31 ± 12 years old, 42.9% male). The Chalder Fatigue Scale (CFS) was employed to categorize the volunteers into two groups: those with fatigue (score ≥ 4) and those without fatigue (score < 4). The Insomnia Severity Index (ISI) and the Epworth Sleepiness Scale (ESS) were used to assess insomnia and excessive daytime sleepiness, respectively. Pulmonary function was evaluated by spirometry, inspiratory muscle strength was assessed by the maximum inspiratory pressure (MIP), and inspiratory endurance was evaluated by maintaining an inspiratory load of 60% of MIP until fatigue. The six-minute walk test (6MWT) was used to evaluated functional capacity, while the WHOQOL-BREF questionnaire assessed quality of life. ResultsIndividuals with post-COVID-19 fatigue demonstrated a higher prevalence of insomnia (80% vs. 49%) and excessive daytime sleepiness (45% vs. 7%), as well as lower MIP, shorter distance covered in the 6MWT, and lower FEV1/FVC (forced expired volume in the first second divided by forced vital capacity), and FEV1/FVC% of predicted. Additionally, they exhibited poorer quality of life in the physical and environmental domains. CFS demonstrated a direct correlation with ISI (r = 0.436, p = 0.01) and ESS (r = 0.593, p = 0.001), as well as an inverse correlation with the distance covered in the 6MWT (r = -0.398, p = 0.022) and FEV1 (r = -0.412, p = 0.01). ISI was an independent predictor of CFS, with 62% of CFS variance explained by ISI variance. ConclusionIndividuals with symptoms of post-COVID-19 fatigue may have a higher prevalence of insomnia, reduced inspiratory muscle strength, functional capacity, and Tiffeneau index, along with impaired quality of life. ISI is an independent predictor of post-COVID-19 fatigue.

ANALISIS KAPASITAS FUNGSIONAL RSU PKU MUHAMMADIYAH BANTUL DALAM PENANGGULANGAN BENCANA

PKU Muhammadiyah Bantul Hospital has been developing a disaster management hospital concept since 2008. A training through HOPE (Hospital Preparedness for Emergency and Disaster) has been conducted successfully. This research was aimed to measure the functional capacity of the PKU Muhammadiyah Bantul hospital in responding disaster and awareness of the staff as in Contingency Plan. The Hospital Safety Index criteria were used as the measurement instrument, which was consisted of five group indices. A descriptive survey technique was applied by means purposive sampling method. The samples were the staff in the Hospital Disaster Management Boards. A number of 61 questions were required by interview, observation and documents identification method. The hospital’s functional capacity index was calculated as 0.66. The scores varied for each group indices from 0.25 to 0.87. The highest score of 0.87 was obtained for group index of the operational plan, preventive maintenance and critical service restoration, whilst, the disaster emergency plan was assigned to the lowest score as 0.25. The mean score of all staffs about their job descriptions in contingency plan was 75.45 out of 100. Knowledge mean score of formulator staffs was 100 (high), while non formulator staffs was 69.7 (average). The core staff positioned in disaster management gained highest score (80.2), while the supporting staff was 74.7 (average). Hospital functional capacity index was 0.66 assessed in A class, indicating deemed to keep functioned during disaster situation. Awareness of the staffs, who designed Contingency Plan, were higher than the others. Deviation in awareness was also found among the staff involved in Contingency Plan. The manager level had a higher understanding in disaster preparedness if compared to the supporting staff.

Wetland functional assessment and uncertainty analysis using fuzzy α-cut-based modified hydrogeomorphic approach.

Wetlands are significant ecosystems which perform several functions such as ground water recharge, flood control, carbon sequestration, and pollution reduction. Accurate evaluation of wetland functions is challenging, due to uncertainty associated with variables such as vegetation, soil, hydrology, land use, and landscape. Uncertainty is due to the factors such as the cost of evaluating quality parameters, measurement, and human errors. This study proposes an innovative framework based on modified hydrogeomorphic approach (HGMA) using fuzzy α-cut technique. HGMA has been used for wetland functional assessment and α-cut technique is used to characterize uncertainty corresponding to the input variables and wetland functions. The most uncertain variables were found to be the density of wetlands and basin count in the landscape assessment area with the scores of 4.38% and 3.614% respectively. Among the functions, the highest uncertainty is found in functional capacity index (FCI) corresponding to water storage (1.697%) and retain particulate (1.577%). The quantified uncertainty can help the practitioners to make informed decisions regarding planning best management practices for preserving and restoring the wetland functionality.

The effect of oxygen and carbon dioxide cross-sensitivity sensor error in the Eco Medics Exhalyzer D device on measures of conductive and acinar airway function

IntroductionThe multiple breath nitrogen washout (MBNW) test provides important clinical information in obstructive airways diseases. Recently, a significant cross-sensitivity error in the O2 and CO2 sensors of a widely used commercial MBNW device (Exhalyzer D, Eco Medics AG, Duernten, Switzerland) was detected, which leads to overestimation of N2 concentrations. Significant errors in functional residual capacity (FRC) and lung clearance index (LCI) have been reported in infants and children. This study investigated the impact in adults, and on additional important indices reflecting conductive (Scond) and acinar (Sacin) ventilation heterogeneity, in health and disease.MethodsExisting MBNW measurements of 27 healthy volunteers, 20 participants with asthma and 16 smokers were reanalysed using SPIROWARE V 3.3.1, which incorporates an error correction algorithm. Uncorrected and corrected indices were compared using paired t-tests and Bland–Altman plots.ResultsCorrection of the sensor error significantly lowered FRC (mean difference 9%) and LCI (8–10%) across all three groups. Scond was higher following correction (11%, 14% and 36% in health, asthma and smokers, respectively) with significant proportional bias. Sacin was significantly lower following correction in the asthma and smoker groups, but the effect was small (2–5%) and with no proportional bias.DiscussionThe O2 and CO2 cross-sensitivity sensor error significantly overestimated FRC and LCI in adults, consistent with data in infants and children. There was a high degree of underestimation of Scond but minimal impact on Sacin. The presence of significant proportional bias indicates that previous studies will require reanalysis to confirm previous findings and to allow comparability with future studies.

The effectiveness of short-term pulmonary rehabilitation program in patients with comorbid asthma, chronic obstructive pulmonary disease and obesity.

The effectiveness of pulmonary rehabilitation (PR) has not yet been established in patients with asthma – chronic obstructive pulmonary disease overlap (ACO) depending on their nutritional status. We aimed to evaluate the effectiveness of a short-term PR program in patients with comorbid asthma, chronic obstructive pulmonary disease (COPD), and obesity. We included 40 ACO patients and divided them into 3 groups according to body mass index (BMI) and then subdivided them into PR (n=21) and control (n=19) groups. The COPD Assessment Test (CAT), the Asthma Control Test (ACT), and the modified Medical Research Council dyspnea scale (mMRS) were used to evaluate symptoms levels. BODE index (body mass index, forced expiratory volume in one second, dyspnoea, and 6-min walk distance) was used to evaluate the effectiveness of pulmonary rehabilitation. In addition, spirometry and bioimpedansometry were performed. All measurements were done before and after a 6-month PR program. A significantly lower decline in the BODE index was observed in overweight patients (decreased by 43.6% compared to baseline and lower by 40.7% compared to the control group). The six-minute walking test (6MWT) significantly increased in all groups (p<0.001). There was a decrease in total CAT score by 25.4% and by 31.2% in the overweight group (p<0.001). The BMI decreased more in the obese group (by 9.4% compared to baseline). Our study result showed that early use of PR program significantly improves functional capacity and BODE index, leads to dyspnea and CAT scores reduction and improvement in pulmonary function, cause a decrease in BMI, body fat percentage, and visceral fat level, and an increase in muscle mass in overweight and obese patients with ACO.

MP02-15 THE VOIDING FREQUENCY INDEX AND FUNCTIONAL BLADDER CAPACITY INDEX: TWO NEW INDICES DERIVED FROM BLADDER DIARIES

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I (MP02)1 Sep 2021MP02-15 THE VOIDING FREQUENCY INDEX AND FUNCTIONAL BLADDER CAPACITY INDEX: TWO NEW INDICES DERIVED FROM BLADDER DIARIES Kevin Rychik, Max Edeson, Jeffrey Weiss, Wade Bushman, and Jerry Blaivas Kevin RychikKevin Rychik More articles by this author , Max EdesonMax Edeson More articles by this author , Jeffrey WeissJeffrey Weiss More articles by this author , Wade BushmanWade Bushman More articles by this author , and Jerry BlaivasJerry Blaivas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001963.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The functional bladder capacity (FBC) is the largest voided volume recorded in a bladder diary. We define the minimum number of times a person must void based on their FBC and their 24-hour urine output as the voiding frequency index (VFI). We define the number of “extra voids”, the difference between the actual number of voids in 24 hours and the VFI, as the functional bladder capacity index (FBCI). The purpose of this study was to describe the normal and mean values for persons without LUTS and to evaluate how these values differ over the spectrum of lower urinary tract disorders. METHODS: This is a retrospective study of 511 patients with LUTS who completed a 24-hour bladder diary (BD) and lower urinary tract symptom score (LUTSS) questionnaire using a smartphone app* from 2015-2019. From the BD, we extracted the 24-hour voided volume (24HVV), FBC, as expressed by the maximum voided volume (MVV), and actual number of voids (ANV). Based on the LUTSS, patients were placed into 4 subgroups; overactive bladder (OAB), incontinence, nocturia and voiding dysfunction. Exclusion criteria included incomplete or inaccurate bladder diary or LUTSS entries. VFI was calculated as the ratio between the 24HVV and the FBC. FBCI was calculated by subtracting the VFI from the ANV. LUTS subgroup assignments were made based on the LUTSS questionnaire. These included OAB, urinary incontinence, nocturia and voiding dysfunction. Comparisons were made to calculate normative indices from previously published data sets. *weShare® URO from Symptelligence.com RESULTS: A total 487 patients provided adequate BD data for analysis (table 1). Larger FBCI as compared to normative values were found in patients with OAB, incontinence, and nocturia. CONCLUSIONS: FBCI is a quantitative metric for the “extra voids” in a 24-hour period. Our observations validate a commonly recognized pattern among patients with LUTS; voiding before feeling full in order to avoid being caught in a social or public situation where a bathroom is not available (anticipatory voids). Empirically, the larger the FBCI, the greater the likelihood a patient voids because of reasons unrelated related to functional bladder capacity. This metric may be useful in studies to quantitate the effect of behavior in evaluation and treatment of LUTS and prompting research into why people void as often as they do. Source of Funding: Institute for Bladder & Prostate Research © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e17-e17 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Rychik More articles by this author Max Edeson More articles by this author Jeffrey Weiss More articles by this author Wade Bushman More articles by this author Jerry Blaivas More articles by this author Expand All Advertisement Loading ...

Hyperpolarized 3 helium MRI measured apparent diffusion coefficient and its correlations with pulmonary functions tests in patients with chronic obstructive pulmonary disease: A meta-analysis.

This study evaluates role of hyperpolarized 3 helium (3 He) MRI measured apparent diffusion coefficient (ADC) in examining pulmonary function of chronic obstructive pulmonary disease (COPD) patients. After literature search in electronic databases, studies were selected by following precise eligibility criteria. Meta-analyses were performed to estimate mean difference in ADC between COPD patients and healthy individuals and to seek correlations between lung ADC and pulmonary function. Metaregression analyses were performed to seek relationships between ADC and age, gender, BMI, cigarette pack-years, and pulmonary function tests. Twenty-five studies (622 COPD patients and 469 healthy controls) were included. Lung ADC was 0.402 (95% confidence interval [CI]: 0.374, 0.429) in COPD patients and 0.228 (95% CI: 0.205, 0.252) in healthy individuals (mean difference 0.160 [95% CI: 0.127, 0.193]; p < 0.001). In metaregression, age (coefficient: 0.006; p = 0.004), pack-years (coefficient: 0.005; p = 0.018), forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio (coefficient: -1.815; p = 0.007), percent predicted diffusion capacity of carbon monoxide (DLCO) (coefficient: -0.004; p = 0.008), and percent predicted inspiratory capacity (coefficient: -0.004; p = 0.012) were significantly associated with ADC in COPD patients. In meta-analysis of correlation coefficients, ADC was significantly correlated with FEV1 (r = -0.62; p < 0.00001), FEV1/FVC (r = -0.80; p < 0.00001), DLCO (r = -0.85; p < 0.00001), functional residual capacity (r = 0.71; p < 0.00001), reserve volume (r = 0.53; p = 0.0001), and emphysema index (r = 0.89; p < 0.00001). Hyperpolarized 3 He MRI measured ADC was higher in COPD patients than in healthy individuals and was inversely associated with FEV1, FEV1/FVC, DLCO, and inspiratory capacity.

Correction of sensor crosstalk error in Exhalyzer D multiple-breath washout device significantly impacts outcomes in children with cystic fibrosis.

Nitrogen multiple-breath washout is an established technique to assess functional residual capacity and ventilation inhomogeneity in the lung. Accurate measurement of gas concentrations is essential for the appropriate calculation of clinical outcomes. We investigated the accuracy of oxygen and carbon dioxide gas sensor measurements used for the indirect calculation of nitrogen concentration in a commercial multiple-breath washout device (Exhalyzer D, Eco Medics AG, Duernten, Switzerland) and its impact on functional residual capacity and lung clearance index. High-precision calibration gas mixtures and mass spectrometry were used to evaluate sensor output. We assessed the impact of corrected signal processing on multiple-breath washout outcomes in a data set of healthy children and children with cystic fibrosis using custom analysis software. We found inadequate correction for the cross sensitivity of the oxygen and carbon dioxide sensors in the Exhalyzer D device. This results in an overestimation of expired nitrogen concentration and consequently, multiple-breath washout outcomes. Breath-by-breath correction of this error reduced the mean (SD) cumulative expired volume by 19.6% (5.0%), functional residual capacity by 8.9% (2.2%), and lung clearance index by 11.9% (4.0%). It also substantially reduced the level of the tissue nitrogen signal at the end of measurements. Inadequate correction for cross sensitivity in the oxygen and carbon dioxide gas sensors of the Exhalyzer D device leads to an overestimation of functional residual capacity and lung clearance index. Correction of this error is possible and could be applied by reanalyzing the measurements in an updated software version.NEW & NOTEWORTHY We investigated the sensor accuracy of a prominent nitrogen multiple-breath washout (N2MBW) device (Eco Medics AG, Duernten, Switzerland) as a possible cause of lack of comparability between outcomes of different MBW devices and methods. We identified an error in the nitrogen concentration calculation of this device, which results in a 10%-15% overestimation of primary outcomes, functional residual capacity, and lung clearance index. It also leads to a significant overestimation of nitrogen back-diffusion into the lungs.

Improved agreement between N2 and SF6 multiple-breath washout in healthy infants and toddlers with improved EXHALYZER D sensor performance.

Recent studies indicate limited utility of nitrogen multiple-breath washout (N2MBW) in infancy and advocate for using sulfur hexafluoride (SF6) MBW in this age-group. Modern N2MBW systems, such as EXHALYZER D (ECO MEDICS AG, Duernten, Switzerland), use O2 and CO2 sensors to calculate N2 concentrations (in principle, N2% = 100 - CO2% - O2%). High O2 and CO2 concentrations have now been shown to significantly suppress signal output from the other sensor, raising apparent N2 concentrations. We examined whether improved EXHALYZER D N2 signal, accomplished after thorough examination of this CO2 and O2 interaction on gas sensors and its correction, leads to better agreement between N2MBW and SF6MBW in healthy infants and toddlers. Within the same session, 52 healthy children aged 1-36 mo [mean = 1.30 (SD = 0.72) yr] completed SF6MBW and N2MBW recordings (EXHALYZER D, SPIROWARE version 3.2.1) during supine quiet sleep. SF6 and N2 SPIROWARE files were reanalyzed offline with in-house software using identical algorithms as in SPIROWARE with or without application of the new correction factors for N2MBW provided by ECO MEDICS AG. Applying the improved N2 signal significantly reduced mean [95% confidence interval (CI)] differences between N2MBW and SF6MBW recorded functional residual capacity (FRC) and lung clearance index (LCI): for FRC, from 26.1 (21.0, 31.2) mL, P < 0.0001, to 1.18 (-2.3, 4.5) mL, P = 0.5, and for LCI, from 1.86 (1.68, 2.02), P < 0.001, to 0.44 (0.33, 0.55), P < 0.001. Correction of N2 signal for CO2 and O2 interactions on gas sensors resulted in markedly closer agreement between N2MBW and SF6MBW outcomes in healthy infants and toddlers.NEW & NOTEWORTHY Modern nitrogen multiple-breath washout (N2MBW) systems such as EXHALYZER D use O2 and CO2 sensors to calculate N2 concentrations. New corrections for interactions between high O2 and CO2 concentrations on the gas sensors now provide accurate N2 signals. The correct N2 signal led to much improved agreement between N2MBW and sulfur hexafluoride (SF6) MBW functional residual capacity (FRC) and lung clearance index (LCI) in 52 sleeping healthy infants and toddlers, suggesting a role for N2MBW in this age-group.

Functional endurance capacity is associated with multiple other physical fitness components in 7\u201314-year-olds: a cross-sectional study

BackgroundAlthough evidence suggests that functional endurance capacity is the most important component associated with future health, little is known of how it is associated with multiple other physical fitness components. Since various physical fitness aspects do not change the same as functional endurance capacity during childhood, it is necessary to establish possible associations between functional endurance capacity and other physical fitness components in children. Therefore, the main purpose of the study was to test the associations between functional endurance capacity with other physical fitness components in 7–14-year-old children, stratified by gender.MethodsIn this cross-sectional study, we recruited 1612 children [mean age ± standard deviation (SD) = 9.72 ± 2.37 years; 52.5% girls). Health-related physical fitness components included: 1) body-mass index (kg/m2) calculated from height and weight (measure of body size), 2) sit-and-reach test (measure of flexibility), 3) standing broad jump (measure of explosive strength of lower extremities), 4) sit-ups in 30 s (measure of repetitive strength of the trunk), 5) 10 × 5 shuttle run test (measure of agility) and 6) 20-m shuttle run test (measure of functional endurance capacity). The associations were performed using generalized estimating equations with beta (β) coefficients.ResultsAfter adjusting for age, functional endurance capacity was associated with sit-and-reach test (β = 0.13, p < 0.001), standing broad jump (β = 0.59, p < 0.001), sit-ups in 30 s (β = 0.53, p < 0.001) and 10 × 5 shuttle run test (β = − 0.56, p < 0.001) in boys. In girls, functional endurance capacity was associated with body-mass index (β = − 0.12, p < 0.001), sit-and-reach test (β = 0.21, p < 0.001), standing broad jump (β = 0.25, p < 0.001), sit-ups in 30 s (β = 0.36, p < 0.001) and 10 × 5 shuttle run test (β = − 0.40, p < 0.001). No significant associations between functional endurance capacity and body-mass index in boys were observed.ConclusionsAlthough significant, functional endurance capacity is weakly to moderately associated with other physical fitness components, pointing out that such measure should be tested separately from other aspects of physical fitness in school-aged children.

Functional Capacity Index: cultural adaptation and measurement of validity and reliability.

To carry out a cultural adaptation of the Functional Capacity Index (FCI) into Portuguese and to verify its reliability and validity in traffic accident victims. Methodological study for cultural adaptation of the FCI. Reliability and validity were verified in a convenience sample of traffic accident victims, in São Paulo city. Data from the patient's medical record were collected retrospectively in 2015. Reliability verified by Cronbach's alpha coefficient and validity by Spearman's correlation and Mann-Whitney test. The FCI in Portuguese was applied to 50 traffic accident victims. The internal consistency reached Cronbach's alpha values >0.70. The FCI correlated with the Katz index, did not correlate with the severity of trauma and the FCI of trauma patients was higher compared to those without trauma. The FCI in Portuguese showed satisfactory internal consistency, allowing the measurement of functional capacity, discriminating against people with and without traumatic injuries.

Long-term Cardiac Maintenance Programming: A SINGLE-SITE ANALYSIS OF MORE THAN 200 PARTICIPANTS.

Greater than 65% of all cardiac mortality is related to coronary artery disease (CAD). Cardiac rehabilitation (CR) aims to reduce cardiovascular risk and number of hospital readmissions. Cardiac maintenance programs (CMPs) are designed to sustain or improve health after completing early CR. Although CMPs are supported by most national health guidelines, few long-term studies on these diverse programs have been performed. This was a retrospective repeated-measures analysis with case-controlled subanalysis. Within-subject differences for CMP participants were examined between enrollment and last clinical visit. Assessments included medical history, anthropometry, blood analysis, and cardiopulmonary exercise testing. A subset of 20 CMP participants were compared with 20 patients with CAD who chose not to participate in CMP, matched for age, sex, and follow-up duration. A total of 207 patients (60 ± 9 yr, 16% female) were included for the primary analyses. Average follow-up was 6.3 ± 4.8 yr (range 4-20 yr). CMP participants reduced peak workload (1.76 ± 0.56 to 1.60 ± 0.58 W/kg; P < .001) and aerobic capacity (26.1 ± 6.2 to 24.6 ± 7.1 mL/kg/min; P = .003). High-density lipoprotein-cholesterol increased significantly (48 ± 12 to 51 ± 14 mg/dL; P < .001), whereas all other metabolic risk factors remained unaffected. Matched controls had higher functional capacity (2.35 ± 0.81 vs 1.56 ± 0.52 W/kg; P < .001) and lower body mass index (25.3 ± 3.6 vs 28.6 ± 3.9 kg/m2) at baseline, but no significant differences with respect to long-term efficacy were observed. Long-term participation in CMP did not result in maintaining functional capacity or cardiovascular risk profile in patients with CAD. However, compared with matched nonparticipants, CMP participants (are more deconditioned at baseline) but do not seem to deteriorate as quickly.

Monte carlo method for estimating whole-body injury metrics from pedestrian impact simulation results

The goal of the current study was to develop a method to estimate whole-body injury metrics (WBIMs), which measure the overall impact of injuries, using stochastic injury prediction results from a computational human surrogate. First, hospitalized pedestrian data was queried to identify injuries sustained by pedestrians and their frequencies. Second, with consideration for an understanding of injury mechanisms and the capability of the computational human surrogate, the whole-body was divided into 17 body regions. Then, an injury pattern database was constructed for each body region for various maximum abbreviated injury scale (MAIS) levels. Third, a two-step Monte Carlo sampling process was employed to generate N virtual pedestrians with an assigned list of injuries in AIS codes. Then, the expected values of WBIMs such as injury severity score (ISS), probability of death, whole-body functional capacity index (WBFCI), and lost years of life (LYL), were estimated. Lastly, the proposed method was verified using injury information from the inpatient pedestrian database. Also, the proposed method was applied to pedestrian impact simulations with various impact speeds to estimate the probability of death with respect to the impact speed. The probability of death from the proposed method was compared with those from epidemiological studies.The proposed method accurately estimated WBIMs such as ISS and WBFCI using either for a given distribution of injury risk or MAIS levels. The predicted probability of death with respect to the impact speed showed a good correlation with those from the epidemiological study. These results imply that if we have a human surrogate that can predict the risk of injury accurately, we can accurately estimate WBIMs using the proposed method. The proposed method can simplify a vehicle design optimization process by transforming the multi-objective optimization problem into the single-objective one. Lastly, the proposed method can be applied to other human surrogates such as occupant models.

End-expiratory lung volume remains stable during N2 MBW in healthy sleeping infants.

We have previously shown that functional residual capacity (FRC) and lung clearance index were significantly greater in sleeping healthy infants when measured by N2 (nitrogen) washout using 100% O2 (oxygen) versus 4% SF6 (sulfur hexafluoride) washout using air. Following 100% O2 exposure, tidal volumes decreased by over 30%, while end‐expiratory lung volume (EELV, i.e., FRC) rose markedly based on ultrasonic flow meter assessments. In the present study to investigate the mechanism behind the observed changes, N2 MBW was performed in 10 separate healthy full‐term spontaneously sleeping infants, mean (range) 26 (18–31) weeks, with simultaneous EELV monitoring (respiratory inductance plethysmography, RIP) and oxygen uptake (V´O2) assessment during prephase air breathing, during N2 washout by exposure to 100% O2, and subsequently during air breathing. While flow meter signals suggested a rise in ELLV by mean (SD) 26 (9) ml over the washout period, RIP signals demonstrated no EELV change. V'O2/FRC ratio during air breathing was mean (SD) 0.43 (0.08)/min, approximately seven times higher than that calculated from adult data. We propose that our previously reported flow meter‐based overestimation of EELV was in fact a physiological artifact caused by rapid and marked movement of O2 across the alveolar capillary membrane into the blood and tissue during 100% O2 exposure, without concomitant transfer of N2 to the same degree in the opposite direction. This may be driven by the high observed O2 consumption and resulting cardiac output encountered in infancy. Furthermore, the low resting lung volume in infancy may make this error in lung volume determination by N2 washout relatively large.

Comparison of revised Functional Capacity Index scores with Abbreviated Injury Scale 2008 scores in predicting 12-month severe trauma outcomes

IntroductionAnatomical injury as measured by the AIS often accounts for only a small proportion of variability in outcomes after injury. The predictive Functional Capacity Index (FCI) appended to the 2008...

К вопросу о клинической значимости прямого обезболивающего эффекта таргетных препаратов у больных ревматоидным артритом

Aim: to evaluate the possibility of clinically significant analgesic effect of tofacitinib in patients with rheumatoid arthritis (RA) under the conditions of actual clinical practice. Patients and Methods: data of patients with RA from the Moscow Unified Register of Arthritis (MERA) were analyzed. The subjective indica-tors included tender joint count (TJC), the HAQ (Health Assessment Questionnaire) Functional Capacity Index, the RAPID3 (Routine Assess-ment of Patient Index Data 3) Disease Activity Index. Swollen joint count (SJC) and the level of C-reactive protein (CRP) were analyzed as objective indicators of inflammatory activity. The estimation was conducted of the quotient obtained when subjective indicators were divided by objective indicators in all possible combinations for various targeted medications used in the studied group of patients. Given the observa-tional nature of the study, the search was carried out for confounding factors for all of these quotients. The calculated indices were compared during treatment with various targeted medications, adjusted for detected confounding factors. The process of selecting confounding factors was carried out in 2 stages — preliminary selection of indicators that have a significant one-factor association with the dependent variable, and subsequent reverse stepwise selection of variables within the framework of a generalized linear model.Results: the analysis included 944 episodes of treatment in 832 patients. The duration of episodes was 1312±1006 days. In particular, 93 epi-sodes of tofacitinib treatment were analyzed (average duration — 836±453 days). When the analysis was adjusted for the detected confound-ing factors, it was found that the indicators of TJC/(SJC+1), HAQ/(SJC+1) and RAPID3/(SJC+1) during tofacitinib therapy were significantly lower than the average values obtained with target medications. There were no significant differences between the medications in relation to the studied subjective indicators and the level of CRP.Conclusions: the severity of subjective perceptions and functional disorders in patients treated with tofacitinib may be less with the same severity of arthritis objective indicators compared to genetically engineered anti-inflammatory drugs.KEYWORDS: targeted medication, genetically engineered anti-inflammatory drug, tofacitinib, rheumatoid arthritis, real clinical practice.FOR CITATION: Zhilyaev E.V., Lukina G.V., Koltsova E.N. et al. Clinical significance of the direct analgesic effect of targeted medications in patients with rheumatoid arthritis. Russian Medical Review. 2020;4(8):483–486. DOI: 10.32364/2587-6821-2020-4-8-483-486.

Quality of life after multiple trauma: results from a patient cohort treated in a certified trauma network.

Besides mortality, the patient-reported outcome (PRO) in survivors of multiple trauma is of increasing interest. So far, no data on patient-reported outcome measures (PROMs) after multiple trauma from an entire trauma network are available. Within this study, the course of the PRO over time and differences between level I and level II trauma centers within an entire trauma network was evaluated. Multiple injured patients, treated in a rural trauma network over 2years, were prospectively included in this study. After 6, 12 and 24months the results of the European Quality of Life (EuroQoL) EQ-5D outcome instrument were evaluated. To adjust for differences in trauma severity between level I and level II centers, the Revised Injury Severity Classification II (RISC II) and the Functional Capacity Index (FCI) were used to adjust the life-quality results of patients. 501 patients were included, 118 patients with an ISS < 16 points, 383 patients reached 16 points or more. Despite a steady increase of EQ-5D index over time (6months: 0.71 ± 0.31; 12months: 0.74 ± 0.28; 24months: 0.76 ± 0.27; p < 0.001), the values of a reference population could not be reached even 2 years after trauma (EQ-5D reference population: 0.9). After adjustment for trauma severity, no significant differences in PROMs between level I and level II centers could be detected (p = 0.188). The consistently low EQ-5D index relative the reference population and the lack of a difference between level I and II centers suggest that improved strategies for polytrauma aftercare are called for.

Predicting health status in the first year after trauma.

Although mortality rates following major trauma are continuing to decline, a growing number of patients are experiencing long-term disability. The aim of this study was to identify factors associated with health status in the first year following trauma and develop prediction models based on a defined trauma population. The Brabant Injury Outcome Surveillance (BIOS) study was a multicentre prospective observational cohort study. Adult patients with traumatic injury were included from August 2015 to November 2016 if admitted to one of the hospitals of the Noord-Brabant region in the Netherlands. Outcome measures were EuroQol Five Dimensions 5D-3L (EQ-5D™ utility and visual analogue scale (VAS)) and Health Utilities Index (HUI) 2 and 3 scores 1 week and 1, 3, 6 and 12 months after injury. Prediction models were developed using linear mixed models, with patient characteristics, preinjury health status, injury severity and frailty as possible predictors. Predictors that were significant (P < 0·050) for one of the outcome measures were included in all models. Performance was assessed using explained variance (R2 ). In total, 4883 patients participated in the BIOS study (50·0 per cent of the total), of whom 3366 completed the preinjury questionnaires. Preinjury health status and frailty were the strongest predictors of health status during follow-up. Age, sex, educational level, severe head or face injury, severe torso injury, injury severity, Functional Capacity Index score, co-morbidity and duration of hospital stay were also relevant in the multivariable models predicting health status. R2 ranged from 35 per cent for EQ-VAS to 48 per cent for HUI 3. The most important predictors of health status in the first year after trauma in this population appeared to be preinjury health status and frailty.

High inspired oxygen fraction impairs lung volume and ventilation heterogeneity in healthy children: a double-blind randomised controlled trial

BackgroundAlthough a high inspired oxygen fraction (FiO2) is commonly used in paediatric anaesthesia, the impact on postoperative lung function is unclear. We compared lung volume, ventilation heterogeneity, and respiratory mechanics in anaesthetised children randomised to receive low or high FiO2 intraoperatively. MethodsIn a double-blind randomised controlled trial, children scheduled for elective surgery were randomly assigned FiO2 100% (n=29) or FiO2 80% (n=29) during anaesthesia induction and emergence. During maintenance of anaesthesia, participants assigned FiO2=100% at induction/emergence received FiO2=80% (FiO2>0.8 group); those randomised to FiO2=80% at induction/emergence received FiO2=35% intraoperatively (FiO2 [0.8→0.35 group]). During spontaneous breathing, we measured the (i) functional residual capacity (FRC) and lung clearance index (ventilation inhomogeneity) by multiple-breath nitrogen washout; and (ii) airway resistance and respiratory tissue elastance by forced oscillations, before operation, after discharge from the recovery room, and 24 h after operation. Mean (95% confidence intervals) are reported. ResultsFifty eight children (12.9 [12.3–13.5] yr) were randomised; 22/29 (high group) and 21/29 (low group) children completed serial multiple-breath nitrogen washout measurements. FRC decreased in the FiO2>0.8 group after discharge from recovery (–12.0 [–18.5 to –5.5]%; P=0.01), but normalised 24 h later. Ventilation inhomogeneity increased in both groups after discharge from recovery, but persisted in the FiO2>0.8 group 24 h after surgery (6.1 [2.5–9.8%]%; P=0.02). Airway resistance and respiratory elastance did not differ between the groups at any time point. ConclusionsFiO2>0.8 decreases lung volume in the immediate postoperative period, accompanied by persistent ventilation inhomogeneity. These data suggest that FiO2>0.8 should be avoided in anaesthetised children with normal lungs. Clinical trial registrationNCT02384616.

Impact of leaks in sulfur hexafluoride and nitrogen multiple-breath washout systems.

Sulfur hexafluoride multiple-breath washout is insensitive to inspiratory leaks http://ow.ly/Y3o830lKOpY