Articles: function.
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Sleep is an emerging area of concern in children with juvenile idiopathic arthritis (JIA). Research shows the presence of poor sleep quality and related adverse outcomes in pediatric pain populations, including JIA, but few studies have examined the prospective patterns of association between sleep and associated outcomes. This prospective study evaluated the direction and magnitude of associations between subjective sleep characteristics (sleep quality, difficulty initiating sleep, and sleep duration), pain intensity, and functional limitations in children with JIA. We hypothesized that pain intensity would partially mediate the relationship between sleep and functional limitations. ⋯ Results suggest that sleep is integral to understanding the momentary association between pain intensity and functioning in children with JIA.
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Whether infarct size modifies intra-arterial treatment effect is not certain, particularly in patients with large infarcts. We examined the effect of the baseline Alberta Stroke Program Early CT Score (ASPECTS) on the safety and efficacy of intra-arterial treatment in a subgroup analysis of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN). ⋯ Dutch Heart Foundation, AngioCare, Medtronic/Covidien/EV3, Medac/Lamepro, Penumbra, Stryker, and Top Medical.
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Observational Study
A prospective observational study of the effect of critical illness on ultrastructural and microscopic morphology of duodenal mucosa.
Disturbed intestinal barrier function due to 'leaky' tight junctions may cause secondary sepsis via paracellular translocation across the gut wall. Our objective was to describe the effects of critical illness on duodenal morphology and ultrastructure. ⋯ We did not detect any morphological abnormalities of duodenal tight junctions in critically ill patients. Our results should be interpreted with caution because of the small sample population, but our observations challenge the concept that paracellular translocation facilitates secondary sepsis.
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Minerva anestesiologica · Jun 2016
Cardiac dysfunction and circulating cardiac markers during sepsis.
Among several alterations affecting the cardiovascular system during severe sepsis or septic shock, myocardial depression has been pointed out with increasing attention over the last 30 years as a frequent and often misdiagnosed clinical condition. As expected, patients with cardiac dysfunction during sepsis have a worse prognosis than those without. In the present review, we will first discuss the etiology, pathophysiology, monitoring and clinical manifestations of cardiac dysfunction in patients with severe sepsis or septic shock. ⋯ We will focus on two specific markers of cardiac origin: troponins, which reveal cardiac myocytes injury, and natriuretic peptides, as indicators of cardiac chambers wall stress and fluid homeostasis. The bulk of evidences accumulated so far on cardiac markers support their role as prognostic indicators, with marginal improvement in terms of accuracy, as compared to widely employed clinical scores. Their potential to satisfy unmet needs in the daily care of septic patients is more appealing, in particular for monitoring the cardiovascular system during support therapy.
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Diabetes mellitus and blood glucose level (BGL) are emerging as important prognosticators of outcome in critically ill patients. We evaluated the effect of diabetes and pre-hospital BGL on survival to hospital discharge and on 12-month functional recovery after out-of-hospital cardiac arrest (OHCA). ⋯ Diabetes affects at least one in five patients who have had an OHCA and is associated with poorer survival and 12-month functional recovery after OHCA. In comparison, an elevated pre-hospital BGL is common in the peri-arrest period and may be associated with improved outcomes.