Risk Of Injury In Patients Research Articles

Pectus repair after prior sternotomy: clinical practice review and practice recommendations based on a 2,200-patient database.

The minimally invasive repair of pectus excavatum (MIRPE) is widely accepted as a method of pectus excavatum (PE) repair. Repair is rarely performed in patients with a history of median sternotomy. A feared complication of this procedure is iatrogenic cardiac injury; the risk of injury in patients with prior sternotomy is especially high due to the development of post-surgical retrosternal adhesions, which obscures the "critical view" during MIRPE. A 14-center review reported the incidence to be as high as 7% after analyzing 75 patients with history of sternotomy who underwent MIRPE. Little literature exists on how to best prepare for MIRPE in patients with prior sternotomy. A review of the literature and a retrospective review of over 2,200 patients who underwent MIRPE at our institution was performed to analyze 9 patients who underwent MIRPE after prior sternotomy. Iatrogenic cardiac injury occurred in 2 patients. Given the infrequency in our experience and the low numbers reported in the literature, statistical conclusions cannot be drawn. However, prudent strategies based on this experience include thoracoscopy, routine sternal elevation, direct sub-xiphoid retrosternal dissection, coordination with cardio-thoracic surgeons, preparation for cardio-pulmonary bypass, and massive transfusion protocol availability to optimize surgical outcomes in patients undergoing MIRPE with a history of sternotomy.

Efektifitas Senam Kaki Diabetik terhadap Ankle Brachial Index pada Pasien Diabetes Melitus: Literature Review

Diabetes mellitus is known as "the silent killer" because it can affect all body organs and cause complications, including complications in the feet. These complications can increase the rate of amputations and are life-threatening. Prevention can be done by doing foot exercises. In principle, leg exercises are done by moving all the joints of the legs to improve blood circulation. Blood circulation in the leg area can be measured through the Ankle Brachial Index examination. 
 This study was to identify the effectiveness of diabetic foot exercise.
 The article search begins with conducting a PICO analysis, then continues with an electronic search for articles using Google Scholar, the year the article was published from 2016 to 2020. The keywords used are "Diabetes Mellitus" and "Leg exercise.” Screening is carried out through inclusion and exclusion criteria to determine the articles to be reviewed. So that articles were obtained that matched the inclusion criteria for review. 
 Results showed nursing interventions for foot exercise on the ankle-brachial index in patients with type II Diabetes Mellitus can be categorized as safe and effective interventions that are given five times a week or for 30 minutes for 5 days or 6x2 a week to reduce the risk of injury to the ankle. foot. Performing effective foot exercises can increase the value of the Ankle Brachial Index to normal. 30-minute foot exercise for 5 days or 6x2 a week should be promoted and implemented as a routine to reduce the risk of injury in patients with diabetes mellitus.
 In conclusion, foot exercise in type II DM patients can increase the Ankle Brachial Index value which tends to be low to normal.

Risk of injuries requiring hospitalization in attention deficit hyperactivity disorder and the preventive effects of medication

Patients with attention deficit hyperactivity disorder (ADHD) are prone to injury and frequently require treatment with hospital admission. This study aimed to evaluate the risk of injuries requiring hospitalization among children and adolescents with and without ADHD and assess the effects of medication on the risk reduction in patients with ADHD. This is a retrospective population-based cohort study by using data from the Taiwan National Health Insurance Research Database. We compared 4658 6-18year-old ADHD patients with 18 632 sex-, age-, and index day-matched non-ADHD controls between 2005 and 2012. Both groups were followed until the end of 2013 to compare the risk of injuries requiring hospitalization. Cox regression analysis was performed to determine the hazard ratio (HR) with 95% confidence intervals (CI) after adjusting for confounders. Children and adolescents with ADHD had a significantly higher risk of injuries requiring hospitalization than the non-ADHD controls (HR=1.39, 95% CI=1.12-1.72), and a higher risk was especially observed in the male and adolescent subgroups. In ADHD patients, long-term users of ADHD medication were associated with a lower risk of injuries requiring hospitalization than nonusers (HR=0.51, 95% CI=0.30-0.85). Healthcare providers should be aware of the potential risk of injury in patients with ADHD and highlight the importance of the duration and compliance with medication treatment.

Increased Risk of Injury in Ménière's Disease and Effects of Treatment: Population-Based Retrospective Cohort Study.

To investigate the risk of injury in patients with Ménière's disease (MD) and the effects of treatment. Population-based retrospective cohort study. Data were collected from the Longitudinal Health Insurance Database 2005, containing the information of 2 million randomly selected individuals in Taiwan. We enrolled 90,481 patients with newly diagnosed MD between 2000 and 2017 and 361,924 matched individuals without MD. The study outcomes were diagnoses of all-cause injuries. The Kaplan-Meier method was used to determine the cumulative incidence rates of injury in the MD and non-MD cohorts, and a log-rank test was used to analyze the differences between the cohorts. Cox proportional hazards models were used to calculate the 18-year hazard ratios of each cohort. A total of 80,151 patients were diagnosed with injuries during the follow-up period: 24,031 and 56,120 from the MD and non-MD cohorts, respectively. The adjusted hazard ratio (aHR) was 2.19 (95% CI, 2.16-2.35) after adjusting for demographic characteristics and comorbidities. Subgroup analysis revealed that MD was associated with an increased incidence of unintentional and intentional injuries (aHR, 2.24 [95% CI, 2.21-2.41] and 2.05 [95% CI, 2.01-2.19], respectively). Treatment with diuretics, antivertigo medications, or surgery did not reduce the risk of injury (aHR, 0.98 [95% CI, 0.59-1.54], 0.94 [95% CI, 0.58-1.50], and 0.99 [95% CI, 0.61-1.54]). MD is independently associated with an increased risk of injuries. Medical or surgical treatment for MD does not reduce the risk of injury in patients with MD. Physicians should counsel patients with MD regarding preventive measures for avoiding subsequent injuries.

S1194 Risk of Drug-Induced Liver Injury in Patients With Chronic Hepatitis B and Active Tuberculosis Co-Infection: A Systematic Review and Meta-Analysis

S1194 Risk of Drug-Induced Liver Injury in Patients With Chronic Hepatitis B and Active Tuberculosis Co-Infection: A Systematic Review and Meta-Analysis

Superior gluteal artery injury risk from third sacral segment transsacral screw insertion.

Iliosacral (IS) and transsacral (TS) screws are commonly used to stabilize pelvic ring injuries. The course of the superior gluteal artery (SGA) can be close to implant insertion paths. The third sacral segment (S3) has been described as a viable osseous fixation pathway (OFP) but the proximity of the SGA to the S3 screw path is unknown. Fifty uninjured patients with contrasted pelvic computed tomograms (CTA) were identified with an S3 path large enough for a 7.0mm TS screw. Starting sites for S1 IS or TS, S2 and S3 TS screws were located on the volume rendered lateral CTA image and transferred onto the surface rendered 3D CTA with the SGA clearly visible. The distance from screw start sites to the SGA was measured. A distance less than 3.5mm was considered likely for injury. The average distances from screw start sites to the SGA were 23.0 ± 7.9mm for S1 IS screws, 14.3 ± 6.4mm for S2 TS screws and 25.9 ± 6.5mm for S3 TS screws. No S1 IS screws, 5 S2 TS screws (10%), and no S3 TS screws were projected to cause injury to the SGA. The osseous start site and soft tissue path for an S3 TS screw is remote from the SGA. The S1 IS and S3 TS pathways are further away from the SGA while the S2 TS pathway is closer and may theoretically pose a higher injury risk in patients with an available S3 OFP.

ПРЕДИКТОРЫ РАЗВИТИЯ ОСТРОГО ПОВРЕЖДЕНИЯ ПОЧЕК ПОСЛЕ ВЫПОЛНЕНИЯ КАРДИОХИРУРГИЧЕСКИХ ОПЕРАЦИЙ В УСЛОВИЯХ ИСКУССТВЕННОГО КРОВООБРАЩЕНИЯ

Purpose: To identify the incidence of acute kidney injury in the early postoperative period in cardiac surgery patients operated under cardiopulmonary bypass, and to determine possible risk predictors of its development. Material and methods: Analysis of 103 case histories of patients was performed; 39 of these patients developed acute kidney injury of stages 1-3. Clinical and clinical laboratory data were collected and analyzed at the preoperative and intraoperative stages. Results: A total of 37.9% of patients developed signs of acute kidney injury. This group of patients tended to be older, and was initially characterized by statistically significantly higher levels of creatinine and cystatin C and reduced levels of total serum protein and hemoglobin. Analysis of the possible predictors of acute kidney injury revealed that at the preoperative stage, the level of cystatin C had the highest association with the development of kidney damage in the early postoperative period (OR 15.828, 95% CI 1.66-150.54, p=0.016) and exceeded the traditional marker – serum creatinine. Among intraoperative factors, the duration of cardiopulmonary bypass (OR 1.015, 95% CI 1.006-1.023, p=0.001) and severity of intraoperative hemolysis (OR 1.017, 95% CI 1.004-1.030, p=0.008) demonstrated the greatest association with kidney damage. Сonclusion: It has been found that the risk of acute kidney injury in patients with preexisting renal failure is two times higher than in patients with intact renal function. The most significant intraoperative modifiable factors affecting postoperative renal injury are the duration of cardiopulmonary bypass and the level of hemolysis.

Landing biomechanics deficits in anterior cruciate ligament reconstruction patients can be assessed in a non-laboratory setting.

Landing biomechanics provide important information pertaining to second anterior cruciate ligament (ACL) injury risk in patients following ACL reconstruction (ACLR). While traditional motion analysis technologies are often impractical for use in non-laboratory settings, methods to assess landing biomechanics which are inexpensive, portable, and user-friendly have recently been developed and validated. The purpose of this study was to compare landing kinematics and kinetics between ACLR patients and uninjured controls in a non-laboratory setting. Sixteen ACLR patients (7 male/9 female, 6-12 months post-ACLR) and 16 gender-matched controls completed seven bilateral drop vertical jumps and seven unilateral drop landings on each limb. Plantar force was measured bilaterally using force sensing insoles and frontal and sagittal-plane knee kinematics were measured using two tablets, six reflective markers, and automated point tracking software. Plantar force impulse normalized symmetry index (NSI) and knee frontal plane projection angle (FPPA) range of motion were computed during bilateral landing, and knee flexion range of motion NSI was computed during unilateral landing and compared between groups using independent samples t tests. ACLR patients had larger NSIs (reflecting less symmetry) for plantar force impulse during bilateral landing (p < 0.001) and knee flexion range of motion during unilateral landing (p = 0.004). No between-group differences were observed for knee FPPA range of motion (p = 0.111). This study is an important step towards assessing landing biomechanics in non-research settings with the goal of providing quantitative injury risk metrics in a clinical setting that can be used for return to sport decision making.

Hormone therapy use and the risk of acute kidney injury in patients with prostate cancer: a population-based cohort study

BackgroundHormone therapy is widely used in prostate cancer. However, studies have raised concerns that hormone therapy, particularly the use of gonadotropin-releasing hormone agonists, could increase the risk of acute kidney injury.MethodsMen newly diagnosed with non-metastatic prostate cancer, from 2012 to 2017, were identified from the Scottish Cancer Registry. A matched comparison cohort of prostate cancer-free men was also identified. Hormone therapy use was determined from the Prescribing Information System in Scotland. The primary outcome was hospitalisations with acute kidney injury taken from Scottish hospital records (SMR01) up to June 2019. Time-dependent Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for acute kidney injury by hormone therapy use.ResultsThe prostate cancer cohort contained 10,751 patients followed for 41,997 person years, during which there were 618 hospitalisations with acute kidney injury. Prostate cancer patients had higher rates of acute kidney injury compared with cancer-free controls (adjusted HR = 1.47 95% CI 1.29, 1.69). However, prostate cancer patients currently using hormone therapy (adjusted HR = 1.14 95% CI 0.92, 1.41), including gonadotropin-releasing hormone (GnRH) agonists (adjusted HR = 1.13 95% CI 0.90, 1.40), did not appear to have a marked increase in acute kidney injury compared with prostate cancer patients not using hormone therapy after adjusting for potential confounders.ConclusionsIn our cohort, there was little evidence that gonadotropin-releasing hormone agonists were associated with marked increases in acute kidney injury.

Proton pump inhibitors associated acute kidney injury and chronic kidney disease: data mining of US FDA adverse event reporting system

Proton pump inhibitors (PPIs) were widely used. Observational studies suggested increasing risk of kidney injury in patients with PPIs treatment. We gathered six PPI regimens and adverse reports of acute kidney injury (AKI) and chronic kidney disease (CKD) based on US FDA Adverse Event Reporting System (FAERS) database from 2004 to 2019. We employed reporting odds ratio (ROR) to detect signals. Finally, we identified 3187 PPIs-associated AKI cases and 3457 PPIs-associated CKD cases. We detected significant signals between PPIs and AKI as well as CKD. The signal strength was stronger for CKD (ROR = 8.80, 95% CI 8.49–9.13) than AKI (ROR = 3.95, 95% CI 3.81–4.10), while dexlansoprazole performed stronger association for CKD (ROR = 34.94, 95% CI 30.89–39.53) and AKI (ROR = 8.18, 95% CI 7.04–9.51) than the other five PPIs. The median time from PPIs use to event occurrence was 23 days for AKI and 177 days for CKD. PPIs-associated AKI resulted larger proportion of death, life-threatening, hospitalization and disability events than PPIs-associated CKD. By mining the FAERS big data, we provided more information between PPIs use and the AKI and CKD events. PPIs rational use should be repeatedly stressed.

Risk of acute kidney injury in patients with ischemic heart disease and concomitant metabolic syndrome after on-pump coronary bypass grafting

Risk of acute kidney injury in patients with ischemic heart disease and concomitant metabolic syndrome after on-pump coronary bypass grafting

Contrast-induced acute kidney injury in chronic coronary artery disease patients with diabetes mellitus and obesity

To assess the influence of diabetes mellitus and obesity on contrast-induced acute kidney injury risk in patients with chronic coronary artery disease requiring percutaneous coronary intervention. 1023 patients with chronic coronary artery disease were enrolled in a prospective, open, cohort study (ClinicalTrials.gov ID NCT04014153). Contrast-induced acute kidney injury was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dl or more in serum creatinine from baseline value, assessed at 48 hours following the administration of the contrast. The majority of the patients were overweight male ones with BMI 29.25.5 kg/m2. The primary endpoint of the study was the development of contrast-induced acute kidney injury according to KDIGO criteria. The prevalence of contrast-induced acute kidney injury was 12.9% (132 patients). 21.2% suffered from diabetes mellitus, 43% were obese and 12.9% had both diabetes mellitus and obesity. Diabetes wasnt a statistically significant independent risk factor of the contrast-induced acute kidney injury, as well as the combination of diabetes and obesity. In the group of obese patients the prevalence of contrast-induced acute kidney injury was higher (13.4%vs12.5%), but didnt meet statistical significance (p=0.7, OR 0.924, 95% CI 0.641.325). According to the multiple logistic regression model, female gender, age, BMI, weight, arterial hypertension, baseline creatinine were the risk factors of the contrast-induced acute kidney injury development (AUC 0.742,p0.0001). Diabetes mellitus was not associated with higher incidence of contrast-induced acute kidney injury. The prevalence of contrast-induced kidney injury was higher in the group of patients with BMI30 kg/m2, but didnt meet statistical significance and needs further evaluation in larger studies.

Acute Kidney Injury Risk in Patients Treated with Vancomycin Combined with Meropenem or Cefepime.

Background: No previous studies have determined the incidence of acute kidney injury (AKI) in trauma patients treated with vancomycin + meropenem (VM) versus vancomycin + cefepime (VC). The purpose of this study was to fill this gap. Methods: A series of 99 patients admitted to an American College of Surgeons-verified level 1 trauma center over a two-year period who received VC or VM for >48 hours were reviewed retrospectively. Exclusion criteria were existing renal dysfunction or on renal replacement therapy. The primary outcome was AKI as defined by a rise in serum creatinine (SCr) to 1.5 times baseline. Multi-variable analysis was performed to control for factors associated with AKI (age, obesity, gender, length of stay [LOS], nephrotoxic agent(s), and baseline SCr), with significance defined as p < 0.05. Results: The study population was 50 ± 19 years old, 76% male, with a median LOS of 21 [range 15-39] days, and baseline SCr of 0.9 ± 0.2 mg/dL. Antibiotics, diabetes mellitus, and Injury Severity Score were independent predictors of AKI (odds ratio [OR] 4.4; 95% confidence interval [CI] 1.4-12; OR 9.3; 95% CI 1-27; OR 1.2; 95% CI 1.023-1.985, respectively). The incidence of AKI was higher with VM than VC (10/26 [38%] versus 14/73 [19.1%]; p = 0.049). Conclusions: The renal toxicity of vancomycin is potentiated by meropenem relative to cefepime in trauma patients. We recommend caution when initiating vancomycin combination therapy, particularly with meropenem.

Oral anticoagulants and risk of acute liver injury in patients with nonvalvular atrial fibrillation: a propensity-weighted nationwide cohort study

Insufficient real-world data on acute liver injury (ALI) risk associated with oral anticoagulants (OACs) exist in patients with nonvalvular atrial fibrillation (NVAF). Using the French national healthcare databases, a propensity-weighted nationwide cohort study was performed in NVAF patients initiating OACs from 2011 to 2016, considering separately those (1) with no prior liver disease (PLD) as main population, (2) with PLD, (3) with a history of chronic alcoholism. A Cox proportional hazards model was used to estimate the hazard ratio with 95% confidence interval (HR [95% CI]) of serious ALI (hospitalised ALI or liver transplantation) during the first year of treatment, for each non-vitamin K antagonist (VKA) oral anticoagulant (NOAC: dabigatran, rivaroxaban, apixaban) versus VKA. In patients with no PLD (N = 434,015), only rivaroxaban new users were at increased risk of serious ALI compared to VKA initiation (adjusted HR: 1.41 [1.05–1.91]). In patients with chronic alcoholism history (N = 13,173), only those initiating dabigatran were at increased risk of serious ALI compared to VKA (2.88 [1.74–4.76]) but an ancillary outcome suggested that differential clinical follow-up between groups might partly explain this association. In conclusion, this study does not suggest an increase of the 1-year risk of ALI in NOAC versus VKA patients with AF.

Predictive Modeling of Pressure Injury Risk in Patients Admitted to an Intensive Care Unit.

Pressure injuries are an important problem in hospital care. Detecting the population at risk for pressure injuries is the first step in any preventive strategy. Available tools such as the Norton and Braden scales do not take into account all of the relevant risk factors. Data mining and machine learning techniques have the potential to overcome this limitation. To build a model to detect pressure injury risk in intensive care unit patients and to put the model into production in a real environment. The sample comprised adult patients admitted to an intensive care unit (N = 6694) at University Hospital of Torrevieja and University Hospital of Vinalopó. A retrospective design was used to train (n = 2508) and test (n = 1769) the model and then a prospective design was used to test the model in a real environment (n = 2417). Data mining was used to extract variables from electronic medical records and a predictive model was built with machine learning techniques. The sensitivity, specificity, area under the curve, and accuracy of the model were evaluated. The final model used logistic regression and incorporated 23 variables. The model had sensitivity of 0.90, specificity of 0.74, and area under the curve of 0.89 during the initial test, and thus it outperformed the Norton scale. The model performed well 1 year later in a real environment. The model effectively predicts risk of pressure injury. This allows nurses to focus on patients at high risk for pressure injury without increasing workload.

Association Between Gout and Injury Risk: A National Retrospective Cohort Study.

The association between gout and injury remains unclear. This study aimed to investigate the injury risk in patients with gout. Using the Longitudinal Health Insurance Database (LHID) from 2000 to 2010 in Taiwan, patients with gout (group CFG) and those without gout (group C) were enrolled for further analysis. The CFG group was separated into two subgroups (with and without medication) to determine whether the risk of injury was reduced with drug intervention. The follow-up period was defined as the time from the initial diagnosis of gout to the date of injury. A total of 257,442 individuals were enrolled in this study, with 85,814 people in group CFG and 171,628 people in group C. Using Cox regression analysis, group CFG showed a significant increase in the risk of injury. Traffic injuries, poisoning, falls, crushing/cutting/piercing injury, and suicides were prominent among these injuries. Furthermore, when urate-lowing drugs were used to treat the CFG group, there were no significant differences in the occurrence of injury. Patients with gout had an increased risk of injury overall, and drug intervention did not lower the risk of injury in these patients.

Nonlinear vector decomposed neural network based EEG signal feature extraction and detection of seizure

Electroencephalography is one of the important medical methods to evaluate and treat neurophysiology to combat disease related to seizure. The automatic seizure detection system aims to provide a balanced mechanism by excavating deep knowledge of the basic signal and kinetic domains. Contingent alert is given to initiate treatment to reduce the risk of injury in patients with epilepsy and to overcome contingencies. Moreover, the multi-channel Electroencephalogram (EEG) data of seizure detection in conventional machine learning algorithms cannot effectively accommodate both global and spatial information. Therefore in this work proposed a Nonlinear Vector Decomposed Neural Network (NVDN) to detect the seizure from EEG signal. The proposed NVDN based seizure detection system consist of three major stages they are as follows i) EEG preprocessing ii) Feature Extraction and iii) NVDN Classification. In this work, the NVDN technique is applied to improve the accuracy of seizure detection after using frequency domain feature to obtain the results from EEG waves. The performance of the proposed system is validate through MATLAB simulation. The results of the simulation show that the proposed NVDN method is able to effectively detect the seizure with a sensitivity of 94.7%. Specificity of 94.1% and accuracy 95.60%. As compared with conventional methods the proposed system achieve high detecting ratio.

Risk of Burn Injury in Patients With Narcolepsy: A Nationwide Population-Based Cohort Study.

Narcolepsy is a rare brain disorder characterized by excessive daytime sleepiness (EDS), cataplexy, hypnagogic hallucinations, and sleep paralysis. Stimulants have been used to relieve the symptoms of EDS. Narcolepsy symptoms may pose a risk to burn injury. The study aimed to investigate the risk of burn injury in narcolepsy patients and to examine the relationship between the use of stimulants and the risk of burn injury. In all, 507 narcolepsy patients and 504 controls matched by gender, age, index year, and Charlson Comorbidity Index (CCI) score were enrolled between 1998 and 2012, then followed until the end of 2013 using Taiwan's National Health Insurance Research Database. During the follow-up period, participants who developed burn injury were identified. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence interval (CI) of the burn incidence rate between narcolepsy patients and unaffected controls. Narcolepsy patients had a significantly increased risk of burn injury compared to unaffected controls (5.37 versus 2.69 per 1,000 person-years, HR: 2.04, 95% CI: 1.13-3.67) after adjusting for gender, age, CCI score, urbanization degree, and duration of stimulants use. Also, the use of stimulants in narcolepsy patients was associated with a lower incidence rate of developing burn injury, but the risk estimate was not statistically significant after adjusting for the above-mentioned variables. This study shows narcolepsy patients have an increased risk of burn injury and the use of stimulants may reduce the burn incidence rate, providing a reference for developing prevention interventions.

Relation between central venous pressure values and outcome in critically ill patients

Background Central venous pressure (CVP) was the most commonly used parameter to guide fluid responsiveness. However, recent studies showed that there is no correlation between CVP and circulating blood volume, and CVP more than 8 mmHg is independently associated with a higher mortality and increased risk of acute kidney injury in patients with sepsis and heart failure. Objective The aim of this study was to assess the effect of CVP over 7 days after ICU admission on clinical prognosis and mortality. Patients and methods The study was conducted on 218 patients in whom hemodynamic monitoring was required, and CVP was measured from the first day of ICU admission. Three values of CVP were selected to be measured (the values once inserted, the peak values, and the mean values of CVP) throughout the monitoring process over 7 days of ICU admission. Acute Physiology and Chronic Health Evaluation II score was calculated on admission, and Sequential Organ Failure Assessment (SOFA) score was calculated every other day. Length of ICU stay, mechanical ventilation days, and mortality at days 7 and 28 were recorded. Results Although the initial CVP values were only correlated with mean of SOFA scores, mean and peak CVP values were correlated with Acute Physiology and Chronic Health Evaluation II score, mean SOFA score, mechanical ventilation days, and mortality. Only peak CVP showed correlation with mean creatinine, and only mean CVP values were correlated with length of ICU stay. According to mean CVP values, patients were classified as low CVP ( 12 mmHg). The elevated mean CVP group was associated with increased 28-day mortality, and regarding further investigations such as renal function, duration of mechanical ventilation, and laboratory results related to organ dysfunction, it also demonstrated that higher mean CVP group was associated with poor ICU outcome for patients in ICU settings. Conclusion The study showed that for patients in ICU settings, elevated mean CVP load was associated with poor clinical outcome and prolonged treatment in ICU. Level and duration of elevated mean CVP should be evaluated, and more effort should be made to establish the cause and appropriate treatment for elevated mean CVP.

89. 3D evaluation and classification of the anatomy variations of vertebral artery at the craniovertebral junction

BACKGROUND CONTEXT Patients with basilar invagination (BI) and atlas occipitalization usually present abnormal anatomy of the vertebral arteries (VAs) at the craniovertebral junction (CVJ). PURPOSE To describe and further classify different types of VA variations at the CVJ with 3D visualization technology. STUDY DESIGN/SETTING To display the 3D structures of the VA and bone with different colors to summarize different types of VA variations. PATIENT SAMPLE A total of 120 patients with BI and atlas occipitalization who had undergone 3D-CTA were retrospectively studied. OUTCOME MEASURES Abnormal anatomy of the VA at the CVJ was categorized and related anatomic parameters were measured. METHODS Imaging data were processed via the separating, fusing, opacifying and false coloring-volume rendering (SFOF-VR) technique. RESULTS Seven different types were classified. Type I, the VA enters the cranium after leaving the VA groove on the posterior arch of atlas (26.7% of 240 sides). Type II, the VA enters an extraosseous canal created in the assimilated atlas lateral mass-occipital condyle complex before reaching the cranium (53.3%). Type III, the VA course above the axis facet or curves below the atlas lateral mass then enters the cranium (11.7%). Type IV, the VA enters the spinal canal under the axis lamina (1.3%). Type V, high-riding VA (31.3%). Type VI, fenestrated VA (2.9%). Type VII, absent VA (4.2%). Distance from the canal of Type II VA to the posterior facet surface of atlas lateral mass(5.51±2.17mm) means a 3.5 mm screw can be safely inserted usually. Shorter distance from the midline (13.50±4.35) illustrates potential Type III VA injury during exposure. Decreased height and width of axis isthmus in Type V indicate increased VA injury risks. CONCLUSIONS The courses of VA variations in patients with BI and atlas occipitalization were described and classified into seven different types utilizing the SFOF-VR technique, which is highly recommended as a convenient and concise method for the preoperative evaluation. This new classification system and related anatomical parameters allow for improved understanding of the 3D relationship between the course of VA variations and CVJ anatomy, which is important for minimizing the risk of intraoperative VA injury in patients with congenital anomalies at the CVJ. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.