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Extracorporeal cardiopulmonary resuscitation (ECPR) is an advanced technique using extracorporeal membrane oxygenation (ECMO) to support patients with refractory cardiac arrest. Age significantly influences ECPR outcomes, with younger patients generally experiencing better survival and neurological outcomes due to many aspects. This review explores the impact of age on ECPR effectiveness, emphasizing the need to consider age alongside other clinical factors in patient selection. Survival rates differ notably between in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA), highlighting the importance of rapid intervention. The potential of artificial intelligence to develop predictive models for ECPR outcomes is discussed, aiming to improve decision-making. Ethical considerations around age-based treatment decisions are also addressed. This review advocates for a balanced approach to ECPR, integrating clinical and ethical perspectives to optimize patient outcomes across all age groups.
Background: The current study aims at better characterizing the role of reading skills as a predictor of comprehension of relative clauses. Well-established cross-linguistic evidence shows that children are more accurate in the comprehension of subject-extracted relative clauses in comparison to the object-extracted counterpart. Children with reading difficulties are known to perform less accurately on object relatives at the group level compared to typically developing children. Given that children's performance on reading tasks is shown to shape as a continuum, in the current study we attempted to use reading skills as a continuous variable to predict performance on relative clauses. Methods: We examined the comprehension of relative clauses in a group of 30 English children (7-11 years) with varying levels of reading skills. Reading skills varied on a large spectrum, from poor readers to very skilled readers, as assessed by the YARC standardized test. The experimental task consisted of a picture-matching task. Children were presented with subject and object relative clauses and they were asked to choose one picture - out of four - that would best represent the sentence they heard. At the same time, we manipulated whether the subject and object nouns were either matching (both singular or both plural) or mismatching (one singular, the other plural) in number. Results: Our analysis of accuracy shows that subject relatives were comprehended more accurately overall than object relatives, that responses to sentences with noun phrases mismatching in number were more accurate overall than the ones with matching noun phrases and that performance improved as a function of reading skills. Within the match subset, while the difference in accuracy between subject and object relatives is large in poor readers, the difference is reduced with better reading skills, almost disappearing in very skilled readers. Discussion: Beside replicating the well-established findings on the subject-object asymmetry, number facilitation in the comprehension of relative clauses, and a better overall performance by skilled readers, these results indicate that strong reading skills may determine a reduction of the processing difficulty associated with the hardest object relative clause condition (i.e., match), causing a reduction of the subject-object asymmetry.
- Publikační typ
- časopisecké články MeSH
Changes of circulating free plasma DNA (cfDNA) are associated with different types of tissue injury, including those induced by intensive aerobic and anaerobic exercises. Observed changes are dependent from induced inflammation, and thus it may be a potential marker for athletic overtraining. We aimed to identify the response of cfDNA to different types of exercise, with association to exercise intensity as a potential marker of exercise load. Fifty volunteers (25 athletes and 25 physically active men) were assigned to the study and performed maximal aerobic (Bruce test) and anaerobic (Wingate Anaerobic Test) test. Blood samples for cfDNA analysis were collected at four time-points: before, 2-5 min after, 30 min after and 60 min after each type of maximal physical activity. The two-way ANOVA revealed a significant effect of group factor on serum cfDNA concentrations (32.15% higher concentration of cfDNA in the athletes). In turn the results of the post hoc test for the interaction of the repeated measures factor and the group showed that while the concentration of cfDNA decreased by 40.10% in the period from 30 min to 60 min after exercise in the control group, the concentration of cfDNA in the group of athletes remained at a similar level. Our analysis presents different responses depending on the intensity and duration of exercise. Our observations imply that formation of cfDNA is associated with response to physical activity but only during maximal effort.
- MeSH
- biologické markery krev MeSH
- fyziologická adaptace * MeSH
- lidé MeSH
- mladý dospělý MeSH
- sporty * MeSH
- studie případů a kontrol MeSH
- volné cirkulující nukleové kyseliny krev MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Loss of muscle strength characterizes the period before total hip arthroplasty (THA). Little is known about whether muscle strength imbalances caused by muscle strength decline could be considered another clinical predictor for THA. This study aimed to determine whether muscle imbalances may be used as a clinical predictor for THA surgery. Thirty-six participants were enrolled in the study. Eighteen patients had THA (THA group), while 18 were healthy elders (CON group). Ipsilateral (H/Q) and bilateral (% Def) muscle imbalances of the knee were assessed. THA patients showed impairment of the extensors on the affected extremity compared to those unaffected. A comparison between the groups proved there were weakened flexors in the THA group on both extremities. A comparison of the imbalances revealed a significant bilateral imbalance of the extensors and ipsilateral imbalance of both extremities in the THA group. We computed two logistic regressions using bilateral and ipsilateral imbalance as the predictors of THA surgery. We found that bilateral extensor imbalance may be used as a predictor for THA (Nagelkerke R2 = 0.22). A decrease of the bilateral extensors imbalance by 8% decreases the probability of THA by 8%. The most interesting finding is that the evaluation of the bilateral extensor imbalance may be used as another clinical predictor for THA.
- MeSH
- koleno MeSH
- lidé MeSH
- náhrada kyčelního kloubu * MeSH
- senioři MeSH
- svalová síla MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: Electric left ventricular lead position, assessed by the electric delay from the beginning of the QRS complex to the local LV electrogram (QLV), was found in previous studies to be a strong predictor of short-term response to cardiac resynchronization therapy. We hypothesized that suboptimum electric position of the left ventricular lead is associated with an excess of heart failure events and mortality. METHODS AND RESULTS: We analyzed the clinical outcome of patients with left bundle branch block or intraventricular conduction delay treated with cardiac resynchronization therapy at our institution during 9 years. Baseline clinical characteristics, QLV/QRS duration (QLV ratio) at cardiac resynchronization therapy implant, and data about heart failure hospitalization and mode of death were collected in 329 patients who were followed for a period of 3.3±1.9 years. Of them, 83 were hospitalized for heart failure and 83 died. Event rates for all-cause mortality, cardiac mortality, noncardiac mortality, heart failure mortality, and sudden death were 25.2%, 14.9%, 10.3%, 12.2%, and 2.1%, respectively. Patients with a QLV ratio ≤0.70 had significantly worse event-free survival for all study end points--hazard ratio, 1.6; 95% confidence interval, 1.0 to 2.4; P=0.05 for heart failure hospitalization; hazard ratio, 2.9; 95% confidence interval, 1.6 to 5.5; P=0.001 for heart failure mortality; hazard ratio, 1.8; 95% confidence interval, 1.1 to 2.7; P=0.01 for cardiac mortality; and hazard ratio, 2.1; 95% confidence interval, 1.2 to 3.7; P=0.01 for all-cause mortality. In multivariable analysis, QLV ratio ≤0.70 remained associated with all study end points. CONCLUSIONS: Electric left ventricular lead position in cardiac resynchronization therapy patients was a significant predictor of heart failure hospitalization and mortality.
- MeSH
- blokáda Tawarova raménka mortalita patofyziologie terapie MeSH
- lidé MeSH
- míra přežití MeSH
- prediktivní hodnota testů MeSH
- převodní systém srdeční abnormality patofyziologie MeSH
- prostředky srdeční resynchronizační terapie * MeSH
- retrospektivní studie MeSH
- senioři MeSH
- srdeční arytmie mortalita patofyziologie terapie MeSH
- srdeční komory patofyziologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: Abdominal obesity is a strong cardiometabolic risk factor that often occurs as early as in childhood. The negative effect of abdominal obesity on the metabolism is partially mediated by changes to the production of the major adipocyte hormones leptin and adiponectin. Leptin/adiponectin imbalance is associated with increased risk of developing obesity and type 2 diabetes mellitus. AIM: To determine whether leptin, adiponectin and the leptin/adiponectin ratio are significant predictors of body weight loss in intensively treated children/adolescents. METHODS: 183 paediatric overweight or obese patients (71 boys and 112 girls), aged 7-16 years, were enrolled in a one-month intensive lifestyle intervention programme. Participants reduced their energy intake and engaged in a supervised exercise programme consisting of 5 physical activity units per day. The subjects were examined both before and after the intervention. RESULTS: The mean BMI decrease achieved was-2.38±0.07 kg/m² (P<0.01). The decrease in plasma leptin concentration was-16.59±0.84 ng/mL (P<0.001) and CRP-0.38±0.04 mg/L (P<0.001). Changes in adiponectin concentrations were not statistically significant. The baseline leptin/adiponectin ratio was a significant predictor of decreases in body weight (P<0.005), BMI (P<0.0001) and waist circumference (P<0.05). CONCLUSION: The leptin/adiponectin ratio at baseline may be a useful predictor of results from interventions focused on decreasing BMIs in children/adolescents.
- MeSH
- abdominální obezita * krev patologie terapie MeSH
- adiponektin krev MeSH
- behaviorální terapie * MeSH
- cvičení * MeSH
- dítě MeSH
- index tělesné hmotnosti * MeSH
- leptin krev MeSH
- lidé MeSH
- mladiství MeSH
- obezita dětí a dospívajících * krev patologie terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
BACKGROUND: This study aimed to investigate changes of corrected QT (QTc) interval during acute ischemic stroke and its correlation with high-sensitivity troponin I (hsTnI), brain natriuretic peptide (BNP), neurological outcome, and 1-year mortality. METHODS: We registered electrocardiogram in 69 patients immediately after admission to the intensive care unit and then after 24 and 48 hours. Computed tomography was performed on admission to determine brain infarct size and localization. Neurological outcome was assessed by modified Rankin scale (mRS) at discharge. RESULTS: Forty-five (65.2%) patients had prolonged QTc at baseline; only 18 (26.1%) patients had prolonged QTc after 48 hours. Baseline QTc was not associated with neurological outcome (P = .27). However, prolonged QTc after 48 hours was associated with worse mRS at discharge (4.5 [4.0-6.0] versus 2.0 [1.0-3.0]; P < .0001). Patients who deceased during hospitalization (n = 7 [10.1%]) as compared with survivors had more frequently prolonged QTc after 48 hours (38.9 versus 0%; P < .0001), higher level of hsTnI (48.4 [36.1-75.0] versus 8.6 [3.4-26.5]; P = .003), and BNP (334 [224-866] versus 109 [30-190]; P = .014). In univariate analysis, 1-year mortality was associated with prolonged QTc after 48 hours, hsTnI, and BNP. In multivariate analysis, only BNP remained to be associated with 1-year mortality (odds ratio 3.41, 95% confidence interval 1.06-11.03). CONCLUSIONS: QTc interval in patients with acute ischemic stroke is a dynamic parameter. Prolonged QTc after 48 hours, but not baseline QTc, correlated with neurological outcome and 1-year mortality. Patients with prolonged QTc had higher level of hsTnI.
- MeSH
- akční potenciály MeSH
- biologické markery krev MeSH
- časové faktory MeSH
- cévní mozková příhoda diagnóza mortalita patofyziologie terapie MeSH
- CT angiografie MeSH
- dospělí MeSH
- elektrokardiografie * MeSH
- ischemie mozku diagnóza mortalita patofyziologie terapie MeSH
- jednotky intenzivní péče MeSH
- lidé středního věku MeSH
- lidé MeSH
- logistické modely MeSH
- mortalita v nemocnicích MeSH
- mozková angiografie metody MeSH
- multivariační analýza MeSH
- natriuretický peptid typu B krev MeSH
- neurologické vyšetření MeSH
- obnova funkce MeSH
- odds ratio MeSH
- posuzování pracovní neschopnosti MeSH
- prediktivní hodnota testů MeSH
- převodní systém srdeční patofyziologie MeSH
- příjem pacientů MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- srdeční frekvence * MeSH
- troponin I krev MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
