RESUMEN
BACKGROUND: Many studies have been published about critically ill coronavirus disease 2019 (COVID-19) during the early phases of the pandemic but the characteristic or survival of critically ill Japanese patients have not yet been investigated. We sought to investigate the characteristics, inflammatory laboratory finding trends, and outcomes among critically ill Japanese patients who were admitted to the intensive care unit (ICU) with the first wave of COVID-19. METHODS: A retrospective observational study was performed in a single institution in the center of Tokyo. Laboratory-confirmed COVID-19 patients admitted to the ICU from March 19 to April 30, 2020 were included. Trends for significant inflammatory laboratory findings were analyzed. In-hospital death, days of mechanical ventilation or oxygen supplementation, days of ICU or hospital stay were followed until May 26, 2020. RESULTS: Twenty-four patients were included. Median age was 57.5 years, and 79% were male. The neutrophil-to-lymphocyte ratio was elevated to a median of 10.1 on admission and peaked on Day 10 of illness. Seventeen patients were intubated on Day 11 of illness and received mechanical ventilation. One patient underwent extracorporeal membrane oxygenation. The majority (88%) received systemic steroids, including 16 patients who received high dose methylprednisolone (500-1000 mg). Favipiravir was used in 38% of patients. Two patients, including 1 who refused intensive care, died. Eighteen patients were discharged. Median length of ICU and hospital stay for all patients was 6 and 22 days, respectively. Median length of ventilator dependency was 7 days. Four patients underwent a tracheostomy and received prolonged ventilation for more than 21 days. One patient receiving mechanical ventilation died. All survivors discontinued ventilator use. CONCLUSIONS: Mortality was remarkably low in our single institutional study. Three survivors received mechanical ventilation for more than 3 weeks. Trends of clinically significant laboratory markers reflected the clinical course of COVID-19.
Asunto(s)
COVID-19/fisiopatología , COVID-19/terapia , Adulto , Anciano , Anciano de 80 o más Años , Antivirales/uso terapéutico , Proteína C-Reactiva/análisis , COVID-19/inmunología , COVID-19/mortalidad , Enfermedad Crítica , Oxigenación por Membrana Extracorpórea , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Hospitalización , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Recuento de Leucocitos , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Respiración Artificial , Estudios Retrospectivos , TokioRESUMEN
Chronic renal failure (CRF) is related to cardiac diseases. Cardiac surgery is also related to postoperative acute kidney injury (AKI). It means heart and kidney have close relationship. We analyzed recent published data to understand how to manage CRF patients undergoing cardiovascular surgeries. We compared endovascular surgery and open procedure for aortic aneurysm, especially about contrast media-related renal damage, On or Off CABG or PCI for ischemic heart disease. We also discussed the relation between cardiopulmonary bypass and AKI and the risk factors causing AKI after CPB. Finally, we discussed prevention and treatment options of CPB related AKI, including furosemide, hANP mannitol, and statin. Published evidence in this area is still insufficient, but many studies are still carried out focusing on postoperative AKI. In the future we may be able to find the best answer for managing CRF patients undergoing cardiovascular surgeries.
Asunto(s)
Lesión Renal Aguda/prevención & control , Enfermedades Cardiovasculares/cirugía , Procedimientos Quirúrgicos Cardiovasculares , Atención Perioperativa/métodos , Complicaciones Posoperatorias/prevención & control , Insuficiencia Renal Crónica/complicaciones , Procedimientos Quirúrgicos Torácicos , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/cirugía , Factor Natriurético Atrial/administración & dosificación , Puente Cardiopulmonar/efectos adversos , Enfermedades Cardiovasculares/complicaciones , Medios de Contraste/efectos adversos , Puente de Arteria Coronaria , Furosemida/administración & dosificación , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Manitol/administración & dosificación , Isquemia Miocárdica/cirugía , Isquemia Miocárdica/terapia , Intervención Coronaria PercutáneaRESUMEN
We report an effective approach for estimating the dynamic behaviour of molecules in liquid from their core-loss spectra by combining molecular dynamics simulations and first-principles band-structure calculations. The carbon K-edge of the technologically important methanol was calculated, and the experimental spectra were well reproduced using the presented calculation method, which effectively included multiple-molecule interactions. Several peaks arose from the methanol molecules with different C-O bonding modes, and the splitting of those peaks was sensitively altered by the magnitude of the dynamic behaviour of molecules. These findings allow for estimation of the dynamic behaviour of molecules in liquids using core-loss spectroscopy, and the method offers the potential to identify the dynamic behaviour of the molecules in liquids with high spatial resolution, temporal resolution, and sensitivity.
RESUMEN
We report a case of lissencephaly which could be diagnosed by detailed examination during pregnancy. We first found bilateral enlarged ventricles in the fetus by routine abdominal ultrasonography at mid-pregnancy. Fast scanning MRI subsequently allowed confirmation of a diagnosis of lissencephaly during pregnancy.