Extracorporeal membrane oxygenation (ECMO) is frequently associated with bleeding and coagulopathy complications, which may lead to the need for transfusion of multiple blood products. However, blood transfusions are known to increase morbidity and mortality, as well as hospital cost, in critically ill patients. In current practice, patients on ECMO receive a transfusion, on average, of 1-5 packed red blood cells (RBCs)/day, with platelet transfusion accounting for the largest portion of transfusion volume. Generally, adult patients require more transfusions than neonates or children, and patients receiving venovenous ECMO for respiratory failure tend to need smaller transfusion volumes compared to those receiving venoarterial ECMO for cardiac failure. Observation studies have reported that a higher transfusion volume was associated with increased mortality. To date, the evidence for transfusion in patients undergoing ECMO is limited; most knowledge on transfusion strategies was extrapolated from studies in critically ill patients. However, current data support a restrictive blood transfusion strategy for ECMO patients, and a low transfusion trigger seems to be safe and reasonable.
Adult ; Blood Transfusion* ; Child ; Critical Illness ; Erythrocytes ; Extracorporeal Membrane Oxygenation* ; Heart Failure ; Hemorrhage ; Hospital Costs ; Humans ; Infant, Newborn ; Mortality ; Platelet Transfusion ; Respiratory Insufficiency

We investigated that the relationship between body fat content and maximal muscle strength when skeletal muscle mass was matched. Muscle mass was measured from 140 preliminary selected people, and 30 males were finally selected and divided into one of four experimental groups: low body fat (group 1, ≤11.9%), low-moderate fat (group 2, 12.0%-16.9%), moderate-high fat (group 3, 17.0%-22.9%), high fat (group 4, ≥23.0%). All subjects undertook one repetition maximum (1RM) test of abdominal and back upper body's and lower body's, and bench press, squat, and back strength dynamometer was used. Repeated oneway analysis of variance and Tukey's post-hoc test was adopted to specify mean differences among groups. Statistical significance level was set at α=0.05. 1RM of bench press was not different among groups (p>0.05) even though values from group 2 was marginally higher (15.9%) than group 1 values (p=0.091). 1RM of squat was higher in group 4 compared to group 2 and group 3 (p<0.05), and maximal back muscular strength was higher in group 1 and group 3 than group 2 (p<0.05). However, total 1RM values, sum of 1RM obtained from different exercises, did not reveal any statistical differences. No notable correlation was found between percent body fat (%BF) and maximal muscular strength. Interestingly, negative correlation of muscular strength was observed between %BF and relative (per kilogram) body mass (p<0.001), but not with between %BF and relative skeletal muscle mass. Therefore, it was concluded that maximal muscular strength is influenced not by fat mass but by skeletal muscle mass.
Adipose Tissue* ; Exercise ; Humans ; Male ; Muscle Strength* ; Muscle, Skeletal

No abstract available.
Autoimmune Diseases/etiology ; Female ; Humans ; Multiple Sclerosis/etiology ; Papillomavirus Infections/*prevention & control ; Papillomavirus Vaccines/*adverse effects/*immunology ; Uterine Cervical Neoplasms/prevention & control

BACKGROUND: Acid-base derangement are commonly encountered in critically ill patients. This study is to investigate underlying mechanisms of acid-base imbalance and also to examine whether they can predict mortality in burn patients. METHODS: We retrospectively reviewed 73 severely burned patients who had admitted to burn intensive care unit, from January to July in 2004. All the patients had inhalation injury, identified by bronchoscopic examination. We analyzed the type and nature of the acid-base imbalances from arterial blood gas analysis, electrolytes and other biological tests between survivors and non-survivors for 30 days after admission. RESULTS: Acidosis was the most common disorder during the early and late hospital periods. Large fractions of those showed decreased strong ion difference (SID), increased anion gap corrected by albumin (AGc) and [Cl-]corrected. Mixed disorder and alkalosis emerged after the 7(th) hospital day. As time went by, albumin, PaO2/FiO2 ratio, pH and SID were more decreased in non-survivors (n=28) than in survivors (n=45) while [Cl-] corrected, alveolar-arterial oxygen tension gradients, peripheral WBC counts and CRP were more increased in non-survivors than in survivors. In the area under the receiver operating characteristic curves for mortality prediction, APACHE II score and % of total body surface area (%TBSA) burn were high: 0.866 (95% CI; 0.785~0.946) for APACHE II score, 0.817 (95% CI; 0.717~0.918) for %TBSA burn. CONCLUSIONS: In burned patients with inhalation injury, various types of acid-base imbalances and electrolytes abnormalities emerged after resuscitation and so, more careful attentions pursued for correcting underlying acid-base derangement.
Acid-Base Equilibrium ; Acid-Base Imbalance* ; Acidosis ; Alkalosis ; APACHE ; Attention ; Blood Gas Analysis ; Body Surface Area ; Burns* ; Critical Illness ; Diagnosis* ; Electrolytes ; Humans ; Hydrogen-Ion Concentration ; Inhalation* ; Intensive Care Units ; Mortality* ; Oxygen ; Resuscitation ; Retrospective Studies ; ROC Curve ; Sudden Infant Death ; Survivors

Extracorporeal membrane oxygenation (ECMO) is frequently associated with bleeding and coagulopathy complications, which may lead to the need for transfusion of multiple blood products. However, blood transfusions are known to increase morbidity and mortality, as well as hospital cost, in critically ill patients. In current practice, patients on ECMO receive a transfusion, on average, of 1-5 packed red blood cells (RBCs)/day, with platelet transfusion accounting for the largest portion of transfusion volume. Generally, adult patients require more transfusions than neonates or children, and patients receiving venovenous ECMO for respiratory failure tend to need smaller transfusion volumes compared to those receiving venoarterial ECMO for cardiac failure. Observation studies have reported that a higher transfusion volume was associated with increased mortality. To date, the evidence for transfusion in patients undergoing ECMO is limited; most knowledge on transfusion strategies was extrapolated from studies in critically ill patients. However, current data support a restrictive blood transfusion strategy for ECMO patients, and a low transfusion trigger seems to be safe and reasonable.
Adult ; Blood Transfusion ; Child ; Critical Illness ; Erythrocytes ; Extracorporeal Membrane Oxygenation ; Heart Failure ; Hemorrhage ; Hospital Costs ; Humans ; Infant, Newborn ; Mortality ; Platelet Transfusion ; Respiratory Insufficiency

PURPOSE: This study analyzed the muscle activity changes induced by motions of reaching forward and chest expansion that were examined from the bilateral muscles with rectus abdominis, external oblique, multifidus, and longissimus thoracic using Pilates cadillac instrument. METHODS: Nine young adult women, who have no musculoskeletal disorder and any of chronic diseases, were participated. Surface electromyography system was used for recording of all signals produced by muscles, and then normalized as percentage of maximum voluntary isometric contraction (%MVIC). The paired t-test and repeated measures of analysis of variance was performed. RESULTS: Reaching-forward motion showed a higher muscle activity from non-dominant external oblique muscle than that of the chest-expansion motion. During both reaching-forward motion and chest-expansion motion, MVIC values collected from dominant side of external oblique muscle were shown a significantly lower than the values obtained from non-dominant side (p < 0.05). Conversely, %MVIC values in external oblique muscle collected from dominant side showed a significantly higher than the values obtained from non-dominant side of the same oblique muscle (p < 0.05). Reaching-forward motion was caused a higher %MVIC on non-dominant external oblique muscle than that of the chest-expansion motion (p < 0.05). Regardless of dominant or non-dominant sides, external oblique muscle was shown the highest activation rate of all the other muscles during reaching forward action, and longissimus thoracic muscle was shown the highest activation rate of all the other muscles during chest expansion action. CONCLUSION: Reaching-forward motion is suitable for activating an external oblique muscle, and chest-expansion motion is an effective enough in activating of longissimus thoracic muscle.
Arm* ; Chronic Disease ; Electromyography ; Female ; Humans ; Isometric Contraction ; Muscles ; Paraspinal Muscles ; Rectus Abdominis ; Thorax ; Young Adult

Purpose: A tracheostomy is often used to wean patients off the ventilator, as it helps maintain extracorporeal membrane oxygenation (ECMO) without sedation. A percutaneous dilatational tracheostomy (PDT) performed in critically ill patients is widely accepted, however, its feasibility and safety in ECMO is unclear. Methods: This retrospective observational study included 78 patients who underwent a PDT and ECMO at the surgical intensive care unit (SICU) in a tertiary hospital between January 1, 2016 and December 31, 2019. We analyzed their medical records, including PDT-related complications and clinical variables. Results: The median values of hemoglobin, platelet count, international normalized ratio, partial thromboplastin time, and activated partial thromboplastin time before the tracheostomy were 9.2 (8.5-10.2) g/dL, 81 (56-103) × 103/dL, 1.22 (1.13-1.30), 15.2 (14.3-16.1) seconds, and 55.1 (47.4-61.1) seconds, respectively. No clotting was observed within the extracorporeal circuit, however, minimal bleeding was observed at the tracheostomy site in 10 (12.8%) patients. Of 4 patients with major bleeding, local hemorrhage was controlled in 3 patients, and intratracheal bleeding continued in 1 patient. The mortality rate was 60.9% and 57.1% in the complication and no-complication group, respectively. The durations of SICU stay, hospital stay, and mechanical ventilation were not statistically different between the groups. Conclusion A PDT performed in critically ill patients was associated with a low rate of bleeding. Complications did not appear to significantly affect the patient outcome. PDT can be performed in patients who usually require a tracheostomy to maintain ECMO.

Sepsis is a life-threatening condition caused by infection and represents a substantial global health burden. Recent epidemiological studies showed that sepsis mortality rates have decreased, but that the incidence has continued to increase. Although a mortality benefit from early-goal directed therapy (EGDT) in patients with severe sepsis or septic shock was reported in 2001, three subsequent multicenter randomized studies showed no benefits of EGDT versus usual care. Nonetheless, the early administration of antibiotics and intravenous fluids is considered crucial for the treatment of sepsis. In 2016, new sepsis definitions (Sepsis-3) were issued, in which organ failure was emphasized and use of the terms “systemic inflammatory response syndrome” and “severe sepsis” was discouraged. However, early detection of sepsis with timely, appropriate interventions increases the likelihood of survival for patients with sepsis. Also, performance improvement programs have been associated with a significant increase in compliance with the sepsis bundles and a reduction in mortality. To improve sepsis management and reduce its burden, in 2017, the World Health Assembly and World Health Organization adopted a resolution that urged governments and healthcare workers to implement appropriate measures to address sepsis. Sepsis should be considered a medical emergency, and increasing the level of awareness of sepsis is essential.
Anti-Bacterial Agents ; Compliance ; Delivery of Health Care ; Emergencies ; Epidemiologic Studies ; Global Health ; Humans ; Incidence ; Mortality ; Sepsis* ; Shock, Septic ; World Health Organization

PURPOSE: The aim of this study was to investigate the changes of contraction patterns and the differences of activities in trunk muscles during dynamic balance (multidirectional tilting exercise). METHODS: Eight physically active male subjects participated in the study. Tilting exercises were included by four directions (i.e., forward, backward, left, and right side), and were undertaken at three different tilting degrees (i.e., 10°, 20°, and 30°). They performed two occasions of tilting exercise, separated by 6-week time interval. Surface electromyography system was used for record of any signals produced by muscles which normalized as percentage of maximum voluntary isometric contraction. RESULTS: There were no statistically significant different interactive effects in any of muscles between two factors (time vs. degree). However, we identified significant main effects of degrees (among 10°, 20°, and 30°) in muscle activations during maintaining with forward tilting (left and right longissimus, multifidus), backward tilting (left and right rectus abdominis, external oblique), left side tilting (right rectus abdominis, external oblique, longissimus, multifidus), right side tilting (left rectus abdominis, external oblique, longissimus, multifidus). CONCLUSION: Findings from this study allow the multidirectional tilting exercise to be considered as suitable for ameliorate muscle balance by inducing co-contraction in trunk muscles.
Electromyography ; Exercise ; Humans ; Isometric Contraction ; Male ; Muscles ; Rectus Abdominis

Purpose: We investigated the effects of cold water immersion (CWI) treatment during half-time break on performance related physiological indices during second half soccer match. Methods: Twenty-two collegiate soccer players participated in the study. Subjects undertook 3 minutes head out seated with whole body immersion at 19 o C to 21 o C. Total four venous blood samples were collected and analyzed for markers of ionic regulations and inflammatory (interleukin [IL]-1b, IL-6, IL-8, IL-10, tumor necrosis factor-α , and vascular endothelial growth factor) and immune functions (immunoglobulin [Ig] G, IgG2, IgG2, IgG3, IgG4, IgA, and IgM). Results: Partial oxygen concentration and %SO 2 level was lowered in CWI. Hemoglobin and hematocrit values were not significantly different between experimental groups. While there was no notable effect was shown in Na ＋ and Ca 2＋ , K ＋ concentration was higher in CWI during second half match. There were no effects in any of inflammatory and/or anti-inflammatory cytokines and Ig. Conclusion These results suggest that CWI during half time break exert positively affects in buffering capacity and promote oxygen delivery to the actively recruited skeletal muscle, possibly results in improve soccer performance during second half match.