Fiona Stanley Hospital (FSH) is a state government hospital and teaching facility in Murdoch, Western Australia. Completed in December 2013, the hospital is the largest building project ever undertaken for the Government of Western Australia. It is immediately adjacent to the private non-profit St John of God Murdoch Hospital, with the distance between the entrances to the emergency departments of these two hospitals being approximately 390 metres (430 yd).
Leukocyte count is widely available and included in Intensive Care Unit prognostic systems. We hypothesised that the relationship between leukocytosis and mortality risk might differ in critically ill patients admitted with infection, where leukocytosis may be an adaptive response. We performed a registry-based study using the Australian and New Zealand Intensive Care Society Adult Patient Database between 2010 and 2023, across 212 Intensive Care Units. Using descriptive statistics and mixed-effects multivariable logistic regression, we evaluated the association between early peak leukocyte count and mortality, according to whether infection was the primary diagnosis. We examined 2,016,578 patients, of whom 1,742,195 had non-infective illnesses (86.4
QuestionIn patients at increased risk of pulmonary complications undergoing cardiac surgery, does prophylactic high-flow nasal oxygen therapy (HFNOT) initiated at the time of extubation have important clinical benefits vs the use of standard oxygen therapy (SOT)?FindingsIn this randomized clinical trial that included 1280 adults, HFNOT did not improve clinical outcomes compared with SOT.MeaningThese findings do not support the routine implementation of prophylactic HFNOT for noninvasive respiratory support following cardiac surgery. This randomized clinical trial investigates the use of high-flow nasal oxygen therapy in patients at high risk of pulmonary complications following nonemergent cardiac surgery and assesses the clinical benefits of this technique compared with standard oxygen therapy. ImportanceHigh-flow nasal oxygen therapy (HFNOT) is used for noninvasive respiratory support following cardiac surgery despite uncertainty about its clinical effectiveness or associated costs.ObjectiveTo determine whether prophylactic HFNOT in patients at increased risk of respiratory complications following cardiac surgery has clinical benefits compared with standard oxygen therapy (SOT).Design, Setting, and ParticipantsThis adaptive, parallel group, randomized clinical trial collected and analyzed data from 17 cardiac surgery centers in 3 countries between October 7, 2020, and June 19, 2024. Eligible participants included adults undergoing nonemergent cardiac surgery with any of the following risk factors for pulmonary complications: chronic obstructive pulmonary disease, asthma, lower respiratory tract infection in the last 4 weeks, a body mass index of 35 or greater, or currently or recently smoking for longer than 10 pack-years. Outcome assessors were blinded. A preplanned sample size re-estimation was conducted after 300 participants completed the 90-day follow-up.InterventionParticipants were randomized at a 1:1 ratio with concealed allocation to HFNOT or SOT administered for at least 16 hours immediately after postoperative extubation.Main Outcomes and MeasuresThe primary effectiveness outcome was days alive and at home (DAH) without increased support compared with baseline in the first 90 days (DAH90). Any day of increased support, including at home, would provide a value of 0 for that day. Secondary outcomes included DAH90 without considering the additional support component.ResultsA total of 1280 patients were recruited (mean [SD] age, 62.9 [10.5] years; 892 [69.7%] men; 640 in each group), of whom 1224 (95.6%) had complete DAH90 data. The primary outcome of median DAH90 was 0 (IQR, 0-79) for the HFNOT group and 0 (IQR, 0-87) for the SOT group (median difference, 0 [95% CI, 0-0]; P = .75). Secondary clinical outcomes, including DAH90 without considering whether additional support was required, were similar between groups.Conclusions and RelevanceIn this randomized clinical trial of HFNOT in patients at increased risk of postoperative pulmonary complications after nonemergent cardiac surgery, HFNOT did not improve DAH90 without increased support. These findings do not support the implementation of routine prophylactic HFNOT after cardiac surgery.Trial Registrationisrctn.org Identifier: ISRCTN14092678
Conjugates of 4-(N-(S-glutathionylacetyl)amino)phenylarsonous acid (GSAO) with optical or radionuclide probes are able to image cell death in vivo. GSAO conjugates are retained in the cytosol of dying and dead cells via the formation of covalent bonds between the As(III) ion and the thiol groups of proximal cysteine residues. Here we describe the method for preparing a NODAGA-GSAO conjugate and its radiolabeling with gallium-68 (68Ga-NODAGA-GSAO) for positron-emission tomography (PET) imaging of cell death.
To document the occurrence of radiation-induced vasculopathy as a delayed complication in the treatment of head and neck cancers. We present the case history and review the imaging findings in a 51-year-old man with a history of nasopharyngeal cancer, treated with radiotherapy 10 years prior to admission, who presented with a stroke syndrome. The pathophysiology, clinical and imaging features, and development of collateral pathways due to radiation-induced vasculopathy are discussed. The patient had occlusion of the right and left common carotid arteries, as well as of the left internal carotid artery and the right subclavian artery. The proximally occluded vessels ended in tapered “stumps”. CT angiography with Maximum Intensity Projection (MIP) and 3D Volume Rendering Technique (VRT) displayed the collateralisation of the occluded arteries via the thyrocervical trunks and ascending cervical arteries. Radiation therapy for head and neck cancer is associated with a significantly increased incidence of radiation-induced vasculopathy and cerebrovascular ischaemic events. Carotid stump syndrome should be considered as a rare but serious cause of recurrent stroke and stroke-like symptoms
OBJECTIVES:To compare incidence, risk factors and outcomes for interstitial lung disease (ILD) between patients with SLE and controls. METHODS:We performed a population-level cohort study using state-wide longitudinal hospital data from Western Australia (WA) for patients with SLE (n = 1854, median age 40 years, 86% female) and matched hospitalized controls (n = 12107, median age 40 years, 88% female) over the period 1985-2014. We estimated ILD incidence rate (IR), determined independent risk factors for ILD using multivariate logistic regression and assessed outcomes including mortality rate (MR) and cause of death. Results presented as median, frequency, IR or MR per 1000 person years (PY) with 95% CIs and IR or MR ratios (IRR or MRR). RESULTS:ILD occurred in 3.8% of SLE patients with a higher IR in SLE than the controls (3.11, 95% CI 2.44-3.91 vs 0.12, 95% CI 0.08-0.16; IRR 26.8) that was stable over time. Time to ILD from index was shorter in SLE and risk factors for ILD included older age, smoking and serositis. SLE-ILD patients experienced higher MRs (MR 52.0, 95% CI 37.0-71.1) than both SLE patients without ILD (MR 17.7, 95% CI 16.0-19.6; MRR 2.94) and controls with ILD (MR 22.8, 95% CI 12.1-38.9; MRR 2.28). ILD decreased survival for SLE and control cohorts and respiratory causes of death predominated in both the ILD groups. CONCLUSION:ILD occurred more frequently in SLE than the controls with older age, smoking and serositis as risk factors. As SLE-ILD adversely impacts prognosis with increased mortality, greater awareness and earlier management is warranted.
