BACKGROUND: The SpO2/FiO2 is a useful oxygenation parameter with prognostic capacity in patients with ARDS. We investigated the prognostic capacity of SpO2/FiO2 for mortality in patients with ARDS due to COVID-19.METHODS: This was a post-hoc analysis of a national multicenter cohort study in invasively ventilated patients with ARDS due to COVID-19. The primary endpoint was 28-day mortality.RESULTS: In 869 invasively ventilated patients, 28-day mortality was 30.1%. The SpO2/FiO2 on day 1 had no prognostic value. The SpO2/FiO2 on day 2 and day 3 had prognostic capacity for death, with the best cut-offs being 179 and 199, respectively. Both SpO2/FiO2 on day 2 (OR, 0.66 [95%-CI 0.46-0.96]) and on day 3 (OR, 0.70 [95%-CI 0.51-0.96]) were associated with 28-day mortality in a model corrected for age, pH, lactate levels and kidney dysfunction (AUROC 0.78 [0.76-0.79]). The measured PaO2/FiO2 and the PaO2/FiO2 calculated from SpO2/FiO2 were strongly correlated (Spearman's r = 0.79).CONCLUSIONS: In this cohort of patients with ARDS due to COVID-19, the SpO2/FiO2 on day 2 and day 3 are independently associated with and have prognostic capacity for 28-day mortality. The SpO2/FiO2 is a useful metric for risk stratification in invasively ventilated COVID-19 patients.
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Imagery Rehearsal Therapy (IRT) is effective for trauma-related nightmares and is also a challenge to patients in finding access to their traumatic memories, because these are saved in non-verbal, visual, or audiovisual language. Art therapy (AT) is an experiential treatment that addresses images rather than words. This study investigates the possibility of an IRT-AT combination. Systematic literature review and field research was conducted, and the integration of theoretical and practice-based knowledge resulted in a framework for Imagery Rehearsal-based Art Therapy (IR-AT). The added value of AT in IRT appears to be more readily gaining access to traumatic experiences, living through feelings, and breaking through avoidance. Exposure and re-scripting take place more indirectly, experientially and sometimes in a playlike manner using art assignments and materials. In the artwork, imagination, play and fantasy offer creative space to stop the vicious circle of nightmares by changing theme, story line, ending, or any part of the dream into a more positive and acceptable one. IR-AT emerges as a promising method for treatment, and could be especially useful for patients who benefit least from verbal exposure techniques. This description of IR-AT offers a base for further research.
Knowledge of the time of deposition is pivotal in forensic investigations. Recent studies show that changes in intrinsic fluorescence over time can be used to estimate the age of body fluids. These changes have been attributed to oxidative modifications caused by protein–lipid interactions. This pilot study aims to explore the impact of these modifications on body fluid fluorescence, enhancing the protein–lipid model system for age estimation. Lipid and protein oxidation markers, including protein carbonyls, dityrosine, advanced glycation end-products (AGEs), malondialdehyde (MDA), and 4-hydroxynonenal (HNE), were studied in aging semen, urine, and saliva over 21 days. Surface plasmon resonance imaging (SPRi), enzyme-linked immunosorbent assay (ELISA), and fluorescence spectroscopy were applied. Successful detection of AGE, dityrosine, MDA, and HNE occurred in semen and saliva via SPRi, while only dityrosine was detected in urine. Protein carbonyls were measured in all body fluids, but only in saliva was a significant increase observed over time. Additionally, protein fluorescence loss and fluorescent oxidation product formation were assessed, showing significant decreases in semen and saliva, but not in urine. Although optimization is needed for accurate quantification, this study reveals detectable markers for protein and lipid oxidation in aging body fluids, warranting further investigation.
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