Mean Body Surface Research Articles

A Systematic Review of Efficacy and Safety of Monotherapy and Combination Therapy With Biologic for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.

Biologic drugs have the potential to halt the progression of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) by decreasing concentrations of tumor necrosis factor-α, a cytokine implicated in epithelial cell death. The objective of this systematic review is to investigate the efficacy and safety of biologic monotherapy and combination therapy for SJS/TEN. MEDLINE and EMBASE in OVID were searched on October 28, 2020. Inclusion criteria were original studies containing human participants diagnosed with SJS/TEN and treated with biologics. Studies were excluded if they were literature reviews, systematic reviews, letters to the editor, or conference abstracts. The 38 articles reviewed included 27 (71.1%) case reports, 6 (15.8%) case series, 3 (7.9%) retrospective reviews, and 2 (5.3%) RCTs. The age range of the included studies was 2 to 85 years, the mean age was 46.4 years. The mean body surface (BSA) across the 38 included articles was 31.0%. The average actual mortality reported within the 38 included articles was 9.2%. Both biologic monotherapy and combination therapy were associated with improved outcomes in SJS/TEN. Furthermore, anti TNF-alpha therapy, specifically etanercept, showed improved outcomes as monotherapy. Overall, reviewed studies presented a strong case for biologic treatment, both monotherapy and combination use, in SJS/TEN treatment. Based on the number of fatal adverse events observed, biologic monotherapy may be safer compared to combination therapy. Further research with a larger sample size and a randomized control trial design is required.

Half-wave frequency response phenomenon of a tightly moored submerged sphere under monochromatic wave action simulated by using the body-exact approach

A nonlinear time-domain numerical model based on a body-exact approach is applied to study the problem of large amplitude motion of a tightly moored submerged sphere. In this model, the exact body condition on the instantaneous wetted body surface is satisfied as well as the linear condition on the still water surface. Numerical simulations were carried out for two wave steepness, each with various incident wave frequencies. It was found that for a smaller wave steepness, the oscillation frequency of the sphere is always the same as the wave frequency, while for a larger steepness, the sphere may oscillate with a large amplitude at the frequency that is half of the incident waves. The linear model satisfying both the linearized boundary conditions on the mean body surface and still water surface fails to capture this significant nonlinear phenomenon. This phenomenon is induced by a self-amplifying process in which the wave frequency potential and half-wave frequency body motion generate a half-wave frequency nonlinear wave force, while the half-frequency force in turn enhances the half-wave frequency motion.

Six Month Recovery Following Musculoskeletal Injuries in Motor Vehicle Collisions

To provide standardized physical examination interim results from an ongoing study on the natural history of recovery from musculoskeletal injuries in motor vehicle accidents. Repeated measures. McMaster University and Toronto Rehabilitation Institute. 24 adult (15 women, 9 men) occupants of motor vehicles. who reported any pain following collisions. Patients were examined by a physical medicine specialist at 2 weeks and 6 weeks following motor vehicle collisions. Changes over time were analyzed by correlated t-tests. 1. Self-reported pain on pain diagrams using 200 equal size regions, 2. Goniometer ranges in all symptomatic joints, 3. Examination tenderness (scaled 0, 1, 2) at all spinous processes, paraspinal muscles and symptomatic limb joint structures, 4. Work Status. In sub-acute assessment, mean body surface in pain was 25% (SD=23%) and mean tenderness was 2.3 (SD = 1.7). Improvement in pain distribution was significant (p < .05) but only averaged 30% of the affected body area. Mean tenderness did not improve. Imaging showed fractures in 4 patients and tendon tears in 2. Among the 18 with normal imaging, 13 had joint range loss compared to published values, creating a subgroup of 19 with measurable impairments. In this group, ranges remained impaired at 6 months in 11 subjects. Of the 23 working at the time of injury, 19 had returned to work by 6 months. Within the clinical range studied, there was only modest clinical improvement in pain and joint movement, but most returned to work.

Assessment of right ventricular geometry and mechanics in chronic obstructive pulmonary disease patients living at high altitude.

Degree of increase in pulmonary artery pressure (PAP) and adaptive responses in right ventricular morphology and mechanics play an important role in the prognosis of chronic obstructive pulmonary disease (COPD) patients. Three dimensional echocardiography and deformation imaging are recent advancements in echocardiography that allow more through assessment of right ventricle. We aimed to investigate right ventricular geometry and mechanics in a stable COPD population living at moderately high altitude. A total of 26 stable COPD patients with variable disease severity were included to this study. Pulmonary function tests, six minutes walking test (6MWT) and two- and three-dimensional echocardiography were performed for evaluation and data collection. Both systolic (43.06 ± 11.79 mmHg) and mean (33.38 ± 9.75 mmHg) PAPs were significantly higher in COPD patients compared to controls (p < 0.05, p < 0.001; respectively). Right ventricular volumes were similar between groups, although right ventricular free wall thickness was significantly increased in COPD group. The number of subjects with a sub-normal (<40 %) right ventricular ejection fraction was significantly higher in COPD group (45.8 vs. 17.4 %, p < 0.05), and the mean right ventricular strain was significantly lower (-21.05 ± 3.80 vs. -24.14 ± 5.37; p < 0.05). Only mean PAP and body surface area were found as independent predictors for 6MWT distance. Increased PAP and reduced right ventricular contractility were found in COPD patients living at moderately high altitude, although right ventricular volumes were normal. Similar findings can be expected in other COPD patients with high PAP, since these findings probably represents the effect of increased PAP on right ventricular mechanics.

Patient–prosthesis mismatch may be irrelevant after aortic valve replacement with the 19-mm Perimount pericardial bioprosthesis in patients aged 65 years or older

The prevalence of patient-prosthesis mismatch (PPM) and its influence on clinical midterm results were examined in elderly patients whose activity was supposed to be less than that of younger patients. We evaluated valve function and the effects of PPM on the midterm results of the 19-mm Carpentier-Edwards Perimount (CEP) pericardial aortic valve in patients aged 65 years or older. Between August 1996 and May 2005, 51 patients underwent aortic valve replacement with the 19-mm CEP valve. The mean follow-up was 2.4 +/- 1.8 years, involving a total of 134.4 patient-years. The mean age and body surface area at operation were 74.0 +/- 5.0 years and 1.41 +/- 0.14 m(2). There were two (3.9%) operative deaths. Three patients (5.9%) underwent enlargement of their small aortic annuli. The actuarial survival rate at 8 years, including operative mortality, averaged 90.2% +/- 4.7%. The freedom from thromboembolism, reoperation, and valve-related mortality averaged 75.0% +/- 21.7%, 97.8% +/- 2.2%, and 95.3% +/- 3.2%, respectively, at 8 years. High preoperative peak and mean transvalvular pressure gradients were significantly improved after the operation (peak, 93 +/- 35 versus 28 +/- 12 mmHg; mean, 58 +/- 19 versus 17 +/- 7 mmHg, respectively; P < 0.01). The mean left ventricular mass index was reduced from 192 +/- 44 to 142 +/- 46 g/m(2) at late follow-up (P < 0.01). The prevalence of PPM was low (17.6%) when an indexed effective orifice area of less than 0.85 cm(2)/m(2) was taken as the definition of PPM. The clinical results, postoperative pressure gradients, and reduction in left ventricular mass index were not different between the PPM and no-PPM groups. The 19-mm CEP valve produced satisfactory midterm clinical outcomes in patients aged 65 years or older whose activity was supposed to be less than that of younger patients, regardless of the presence or absence of PPM. Moderate PPM was rare and it did not adversely impact on the midterm results. The application of annulus enlargement could be limited to the small number of patients for whom the 19-mm CEP valves are not able to be inserted.

Sepsis in burned patients.

A prospective study was conducted from June 2001 to May 2002 at the Burns Unit of Hospital Regional da Asa Norte, Brasília, Brazil. During the period of the study, 252 patients were treated at the Burns Unit, 49 (19.4%) developed clinically and microbiologically proven sepsis. Twenty-six (53.1%) were males and 23 (46.9%) females with a mean age of 22 years (range one to 89 years) and mean burned body surface area of 37.7 +/- 18.4% (range 7 to 84%). Forty-three patients had flame burns, five a scald and one an electric burn. These 49 patients had a total of 62 septic episodes. Forty (81.6%) patients had only one and nine (18.4%) had up to three episodes of sepsis. Thirty (61.2%) patients had their first septicemic episode either earlier or by one week postburn. Out of 62 septic episodes, 58 were due to bacteria and four due to Candida sp. The most common bacteria isolated from blood culture were Staphylococccus aureus, coagulase-negative Staphylococcus, Acinetobacter baumannii, Enterobacter cloacae and Klebsiella pneumoniae. Eleven (18.9%) episodes were due to oxacillin resistant Staphylococcus aureus. Acinetobacter baumannii was sensitive to ampicillin/sulbactam in 71.4% and to imipenem in 85.7% of the cases. The primary foci of sepsis were the burn wound in 15 (24.2%) episodes. The most common clinical findings of sepsis in these patients were fever, dyspnea, hypotension and oliguria. The most common laboratory findings of these patients were anemia, leukocytosis, hypoalbuminemia and thrombocytopenia. Twelve (24.5%) patients died. The appropriate knowledge of clinical, epidemiological, laboratorial and microbiological aspects of sepsis in burned patients permits an adequate diagnosis and treatment of this complication.

Volumeric analysis of in-stent intimal hyperplasia in diabetic patients treated with or without abciximab: Results of the DANTE randomized trial

required a small increase in core temperature to 33.6*0.15”C. Meperidine and buspirone did not cause respiratory depression or other complications. Patients with shivering were younger (54 * 10 years vs. 59 * 12 years. p=O.O4), and received a higher total bolus dose of meperidine than those without shivering (156 f 66mg vs. 120 f 66mg, p=O.Ol). Mean patient weight and body surface area were similar in bath groups and no other demographic, clinical or hemodynamlc predictors of shivering were identified. Conclusion: Our results indicate that combination treatment with surface warming, buspirone and meperidine is safe and effective in patients with AMI, and provides a novel method for counteracting thermoregulatory defenses to systemic hypothermia during endovascular cooling. SES to control bare stents (CS), 462 pts (44%) had single vessel LAD treatment. In this cohort, reference vessel size was 2.74mm and lesion length was 14.0 mm. Results: Clinical (@ 9 months) and angiographic (@ 8 months) outcomes were compared in the SES and CS LAD subgroups (see table). Conclusions: The SIRIUS LAD substudy indicates striking improvement after SES in all clinical and angiographic efficacy parameters compared with CS. These SES results are equivalent to those reported after LIMA surgery, and thus, SES should be considered the new standard of care for stngle vessel LAD therapy.

The influence of recipient body mass on the outcome of cadaver kidney transplants.

Background. It is well known that a cadaver kidney transplant from an aged donor will result in lower graft survival. However, such marginal kidneys should not be easily given up, and it is important to explore ways to make the best use of them. Against this background, the present study was carried out to examine the relationship between recipient body mass and cadaver kidney transplant outcome. Methods. All 63 cadaver kidney transplant recipients at our institutions were studied. These patients were divided into two groups according to the age of the donor: group A (under age 60 years; n = 48) and group B (age 60 years and over; n = 15). Each of the groups was subdivided into two groups according to the mean body mass index (BMI) and body surface area (BSA) values, and the effects of BMI and BSA on graft survival were also studied. Results. There was no correlation between BMI and lowest serum creatinine (nadir S-Cr) in group A, but there was a positive correlation in group B. Similarly, there was a positive correlation between BSA and nadir S-Cr only in group B. In group A, there was no difference in graft survival between the recipients with a smaller BMI (BMI < 21.0) and larger BMI (BMI ≧ 21.0) or BSA. However, in group B, the 5-year graft survival of the recipients with a smaller BMI was 60.0%, and it was significantly better than that of the recipients with a larger BMI. Similarly, the 5-year graft survival of the recipients with a smaller BSA (BSA < 1.54 m(2)) was 62.5%, which was also significantly better than that of the recipients with a larger BSA (BSA ≧ 1.54 m(2)). Conclusions. In the recipients whose donor was aged 60 and over, recipient BMI and BSA affected posttransplant kidney function and graft survival. These results strongly suggest that the lower graft survival due to an aged donor can be improved if a recipient with a smaller body size can be selected.

Carbon black set to reach 195 000 tonnes in 2001

A nonlinear time-domain numerical model based on a body-exact approach is applied to study the problem of large amplitude motion of a tightly moored submerged sphere. In this model, the exact body condition on the instantaneous wetted body surface is satisfied as well as the linear condition on the still water surface. Numerical simulations were carried out for two wave steepness, each with various incident wave frequencies. It was found that for a smaller wave steepness, the oscillation frequency of the sphere is always the same as the wave frequency, while for a larger steepness, the sphere may oscillate with a large amplitude at the frequency that is half of the incident waves. The linear model satisfying both the linearized boundary conditions on the mean body surface and still water surface fails to capture this significant nonlinear phenomenon. This phenomenon is induced by a self-amplifying process in which the wave frequency potential and half-wave frequency body motion generate a half-wave frequency nonlinear wave force, while the half-frequency force in turn enhances the half-wave frequency motion.

Estimation of cardiac index by means of the arterial and the mixed venous oxygen content and pulmonary oxygen uptake determination in the early post-operative period following surgery of congenital heart disease

To assess the reliability of estimation of cardiac index based on the mixed venous oxygen saturation and methods of improving the estimation of cardiac index. PICU in an university hospital. In the post-operative period following complete repair of congenital heart disease we carried out 55 measurements of blood gases in 25 infants and children (mean age 16.1 months, mean body surface 0.43 m2) from a systemic artery (arterial) and the pulmonary artery (mixed venous). We also determined the pulmonary oxygen uptake and calculated the cardiac index (CI) using Fick's principle. In the analysis we compared the CI with the mixed venous oxygen saturation (SvO2) and with the quotient of the arterial oxygen content (CaO2) and the oxygen extraction (Ca-vDO2). This quotient is equal to arterial oxygen delivery (DO2) divided by the oxygen consumption (VO2). Pearson's correlation coefficient was 0.77 when SvO2 was compared to CI in a linear regression model. Assuming an inverse relationship between SvO2 and CI the correlation was much better (r = 0.90). However, the best estimation of CI provides the quotient CaO2/Ca-vDO2 (r = 0.93). CaO2/Ca-vDO2 correlates much better with CI than the SvO2, therefore CI could be better estimated based on CaO2/Ca-vDO2. Furthermore CaO2/Ca-vDO2 provides good information about the oxygen supply situation of the body.

Is there a relationship between supine systemic blood pressure and orthostatic hypotension in the elderly?

The relationship between blood pressure and orthostatic hypotension was studied in 48 elderly patients with orthostatic hypotension and 29 healthy age-matched controls. Individuals were designated as hypertensive (systolic > 160 and or diastolic > 90 mmHg) or normotensive on the basis of supine blood pressure levels. Systolic, diastolic and mean blood pressures, heart rate, stroke volume, cardiac output, cardiac index and total peripheral resistance were measured every 5 min before, during and after 10 min head-up tilt to 70 degrees. Eighteen orthostatic hypotension subjects and six controls were hypertensive, while 30 orthostatic hypotension subjects and 23 controls were normotensive. There were no differences between hypertensive and normotensive patients in mean age, weight, height or body surface area. Mean systolic blood pressure in orthostatic hypotension subjects was higher than in controls (148.8 +/- 3.6 vs. 137.5 +/- 3.34 mmHg). Mean diastolic pressure was not different (79.1 +/- 2.0 vs. 79.0 +/- 2.0 mmHg). There were no differences between patients with or without hypertension in the haemodynamic changes produced by head-up tilt. Heart rates in orthostatic hypotension subjects with hypertension were significantly lower throughout the study when compared with normotensive orthostatic hypotension patients. Further, the increases in heart rate on tilting were significantly smaller (8.4 +/- 1.9 vs. 14.5 +/- 1.8 beats/min). Control hypertensive subjects had significantly higher mean cardiac output and cardiac index compared with non-hypertensives from before and during tilt. We conclude that hypertension is not related to the development or the degree of orthostatic hypotension in the elderly.(ABSTRACT TRUNCATED AT 250 WORDS)