Predictors of mortality of patients with acute respiratory failure secondary to chronic obstructive pulmonary disease admitted to an intensive care unit: A one year study

Background

Patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) commonly require hospitalization and admission to intensive care unit (ICU). It is useful to identify patients at the time of admission who are likely to have poor outcome. This study was carried out to define the predictors of mortality in patients with acute exacerbation of COPD and to device a scoring system using the baseline physiological variables for prognosticating these patients.

Methods

Eighty-two patients with acute respiratory failure secondary to COPD admitted to medical ICU over a one-year period were included. Clinical and demographic profile at the time of admission to ICU including APACHE II score and Glasgow coma scale were recorded at the time of admission to ICU. In addition, acid base disorders, renal functions, liver functions and serum albumin, were recorded at the time of presentation. Primary outcome measure was hospital mortality.

Results

Invasive ventilation was required in 69 patients (84.1%). Fifty-two patients survived to hospital discharge (63.4%). APACHE II score at the time of admission to ICU {odds ratio (95 % CI): 1.32 (1.138–1.532); p < 0.001} and serum albumin (done within 24 hours of admission) {odds ratio (95 % CI): 0.114 (0.03-0.432); p = 0.001}. An equation, constructed using the adjusted odds ratio for the two parameters, had an area under the ROC curve of 91.3%. For the choice of cut-off, sensitivity, specificity, positive and negative predictive value for predicting outcome was 90%, 86.5%, 79.4% and 93.7%.

Conclusion

APACHE II score at admission and SA levels with in 24 hrs after admission are independent predictors of mortality for patients with COPD admitted to ICU. The equation derived from these two parameters is useful for predicting outcome of these patients.     

Molecular systematics and paleobiogeography of the South American sigmodontine rodents [published erratum appears in Mol Biol Evol 1998 Feb;15(2):224]

The murid rodent subfamily Sigmodontinae contains 79 genera which are distributed throughout the New World. The time of arrival of the first sigmodontines in South America and the estimated divergence time(s) of the different lineages of South American sigmodontines have been controversial due to the lack of a good fossil record and the immense number of extant species. The "early-arrival hypothesis" states that the sigmodontines must have arrived in South America no later than the early Miocene, at least 20 MYA, in order to account for their vast present-day diversity, whereas the "late-arrival hypothesis" includes the sigmodontines as part of the Plio-Pleistocene Great American Interchange, which occurred approximately 3.5 MYA. The phylogenetic relationships among 33 of these genera were reconstructed using mitochondrial DNA (mtDNA) sequence data from the ND3, ND4L, arginine tRNA, and ND4 genes, which we show to be evolving at the same rate. A molecular clock was calibrated for these genes using published fossil dates, and the genetic distances were estimated from the DNA sequences in this study. The molecular clock was used to estimate the dates of the South American sigmodontine origin and the main sigmodontine radiation in order to evaluate the "early-" and "late-arrival" scenarios. We estimate the time of the sigmodontine invasion of South America as between approximately 5 and 9 MYA, supporting neither of the scenarios but suggesting two possible models in which the invading lineage was either (1) ancestral to the oryzomyines, akodonts, and phyllotines or (2) ancestral to the akodonts and phyllotines and accompanied by the oryzomyines. The sigmodontine invasion of South America provides an example of the advantage afforded to a lineage by the fortuitous invasion of a previously unexploited habitat, in this case an entire continent.      

Security Analysis and Improvement of ‘a More Secure Anonymous User Authentication Scheme for the Integrated EPR Information System’

Over the past few years, secure and privacy-preserving user authentication scheme has become an integral part of the applications of the healthcare systems. Recently, Wen has designed an improved user authentication system over the Lee et al.’s scheme for integrated electronic patient record (EPR) information system, which has been analyzed in this study. We have found that Wen’s scheme still has the following inefficiencies: (1) the correctness of identity and password are not verified during the login and password change phases; (2) it is vulnerable to impersonation attack and privileged-insider attack; (3) it is designed without the revocation of lost/stolen smart card; (4) the explicit key confirmation and the no key control properties are absent, and (5) user cannot update his/her password without the help of server and secure channel. Then we aimed to propose an enhanced two-factor user authentication system based on the intractable assumption of the quadratic residue problem (QRP) in the multiplicative group. Our scheme bears more securities and functionalities than other schemes found in the literature.     

Carbon dynamics and budget in a Zoysia japonica grassland, central Japan

The ecosystem carbon budget was estimated in a Japanese Zoysia japonica grassland. The green biomass started to grow in May and peaked from mid-July to September. Seasonal variations in soil CO₂ flux and root respiration were mediated by changes in soil temperature. Annual soil CO₂ flux was 1,121.4 and 1,213.6 g C m⁻² and root respiration was 471.0 and 544.3 g C m⁻² in 2007 and 2008, respectively. The root respiration contribution to soil CO₂ flux ranged from 33% to 71%. During the growing season, net primary production (NPP) was 747.5 and 770.1 g C m⁻² in 2007 and 2008, respectively. The biomass removed by livestock grazing (GL) was 122.1 and 102.7 g C m⁻², and the livestock returned 28.2 and 25.6 g C m⁻² as fecal input (FI) in 2007 and 2008, respectively. The decomposition of FI (DL, the dry weight loss due to decomposition) was very low, 1.5 and 1.4 g C m⁻², in 2007 and 2008. Based on the values of annual NPP, soil CO₂ flux, root respiration, GL, FI, and DL, the estimated carbon budget of the grassland was 1.7 and 22.3 g C m⁻² in 2007 and 2008, respectively. Thus, the carbon budget of this Z. japonica grassland ecosystem remained in equilibrium with the atmosphere under current grazing conditions over the 2 years of the study.     

Measurement of net ecosystem production and ecosystem respiration in a Zoysia japonica grassland,central Japan,by the chamber method

Measuring light, temperature, soil moisture, and growth provides a better understanding of net ecosystem production (NEP), ecosystem respiration (R _eco), and their response functions. Here, we studied the variations in NEP and R _eco in a grassland dominated by a perennial warm-season C₄ grass, Zoysia japonica. We used the chamber method to measure NEP and R _eco from August to September 2007. Biomass and leaf area index (LAI) were also measured to observe their effects on NEP and R _eco. Diurnal variations in NEP and R _eco were predicted well by light intensity (PPFD) and by soil temperature, respectively. Maximum NEP (NEP_max) values on days of year 221, 233, 247, and 262, were 2.44, 2.55, 3.90, and 4.17 μmol m⁻² s⁻¹, respectively. Throughout the growing period, the apparent quantum yield (α) increased with increasing NEP_max that ranged from 0.0154 to 0.0515, and NEP responded to the soil temperature changes by 44% and R _eco changes by 48%, and R _eco responded from 88 to 94% with the soil temperature diurnally. NEP’s light response and R _eco’s temperature response were affected by soil water content; more than 27% of the variation in NEP and 67% of the variation in R _eco could be explained by this parameter. NEP was strongly correlated with biomass and LAI, but R _eco was not, because environmental variables affected R _eco more strongly than growth parameters. Using the light response of NEP, the temperature response of R _eco, and meteorological data, daily NEP and R _eco were estimated at 0.67, 0.81, 1.17, and 1.56 g C m⁻², and at 2.88, 2.50, 3.51, and 3.04 g C m⁻², respectively, on days of year 221, 233, 247, and 262. The corresponding daily gross primary production (NEP + R _eco) was 3.5, 3.3, 4.6, and 4.6 g C m⁻².     

The induction of allophanate lyase during the vegetative cell cycle in light-synchronized cultures of Chlamydomonas reinhardi.

Allophanate lyase can be induced by urea or acetamide 20-40-fold within 4 h in NH4 + -deprived cultures of Chlamydomonas reinhardi. In light-synchronized cultures, allophanate lyase induction appeared to be limited to the light phase of the cell cycle, provided that culture samples were induced under ongoing illumination conditions (i.e. light induction of light phase cells and dark induction of dark phase cells). However, when culture samples were induced under constant light conditions this cell cycle pattern was abolished. Light was found to be required for allophanate lyase induction and this was shown to be due, in part, to the light requirement for inducer uptake. The relationship between allophanate lyase induction and gametogenesis is discussed.