SummaryBackground & aimsTo develop a five grade score (0–4 points) for the assessment of gastrointestinal (GI) dysfunction in adult critically ill patients.MethodsThis prospective multicenter observational study enrolled consecutive adult patients admitted to 11 intensive care units in nine countries. At all sites, daily clinical data with emphasis on GI clinical symptoms were collected and intra-abdominal pressure measured. In five out of 11 sites, the biomarkers citrulline and intestinal fatty acid-binding protein (I-FABP) were measured additionally. Cox models with time-dependent scores were used to analyze associations with 28- and 90-day mortality. The models were estimated with stratification for study center.ResultsWe included 540 patients (224 with biomarker measurements) with median age of 65 years (range 18–94), the Simplified Acute Physiology Score II score of 38 (interquartile range 26–53) points, and Sequential Organ Failure Assessment (SOFA) score of 6 (interquartile range 3–9) points at admission. Median ICU length of stay was 3 (interquartile range 1–6) days and 90-day mortality 18.9%.A new five grade Gastrointestinal Dysfunction Score (GIDS) was developed based on the rationale of the previously developed Acute GI Injury (AGI) grading. Citrulline and I-FABP did not prove their potential for scoring of GI dysfunction in critically ill. GIDS was independently associated with 28- and 90-day mortality when added to SOFA total score (HR 1.40; 95%CI 1.07–1.84 and HR 1.40; 95%CI 1.02–1.79, respectively) or to a model containing all SOFA subscores (HR 1.48; 95%CI 1.13–1.92 and HR 1.47; 95%CI 1.15–1.87, respectively), improving predictive power of SOFA score in all analyses.ConclusionsThe newly developed GIDS is additive to SOFA score in prediction of 28- and 90-day mortality. The clinical usefulness of this score should be validated prospectively.Trial registrationNCT02613000, retrospectively registered 24 November 2015.
From 2004 to 2012 a study of the flora and floral communities at Cabin Creek Raised Bog (Cabin Creek) was conducted. Cabin Creek, designated a National Natural Landmark by the National Park Service in December, 1974, is privately owned. It is located in west-central Randolph County, Indiana. An inventory of the vascular flora revealed 478 taxa representing 282 genera and 91 families. The 12 families containing approximately 62% of the documented species (in order by number of species) were Asteraceae, Cyperaceae, Poaceae, Rosaceae, Liliaceae, Lamiaceae, Scrophulariaceae, Apiaceae, Fabaceae, Ranunculaceae, Brassicaceae, and Polygonaceae. Of the 478 documented species, 400 were native, 78 were exotics, and 118 represented new Randolph County records. There were three species with Indiana Rare-Threatened-Endangered status, including Veratrum virginicum (endangered), Triantha glutinosa (rare), and Melica nitens (threatened). A physiognomic analysis (i.e., summary of plant form or habit) is presented. The floristic quality index (FQI) for native species is 85.6 (78.3 for all species) and the mean coefficient of conservatism (mean C) for native species is 4.3 (3.6 for all species). These numbers clearly signify the “paramount importance” of the floral natural heritage of the approximately 7 ha Cabin Creek site and indicate that it is among the highest floristic quality sites in the state. The flora occurring in the major community types (wetland border/marshes, sedge meadow–calcareous fen complex, moist prairie, mesic to dry woodland, moist woodland and hardwood swamp) is described.
Craniopharyngioma-related hypothalamic obesity is a devastating complication with limited data on whether long-term follow-up should focus on problems other than endocrine deficiencies and weight gain. The primary endpoint was the assessment of predictors of hypothalamic obesity development; the secondary endpoint was the assessment of functional outcome (endocrine deficiencies, visual acuity) at long-term follow-up.This retrospective case-note study examined craniopharyngioma patients with at least 2 years of follow-up. Clinical, radiological and biochemical characteristics were assessed at diagnosis, postoperatively, and at last follow-up.Thirty-two patients met the inclusion criteria. Median follow-up period was 9.8 years (range 2.2-33 years). Longitudinal changes in body mass index (BMI) were substantial (median ΔBMI/year was +0.48 kg/m2/year, interquartile range 0.28-1.33). The prevalence of patients with hypothalamic obesity had significantly increased at last follow-up (45 vs 4%; p = 0.003). Long-term pituitary deficiencies remained high. Diabetes insipidus was common (66% vs 34%, p<0.001), with postoperative diabetes insipidus but not hypothalamic involvement, being an independent predictor for hypothalamic obesity (odds ratio 15.2, 95% confidence interval 1.3-174.8, p = 0.03). Osteodensitometry in two thirds of patients at last follow-up revealed a pathological bone density in 53% of those tested.Rates of hypothalamic obesity and long-term pituitary deficiencies are substantial, with postoperative diabetes insipidus being a potential marker for hypothalamic obesity development. Besides long-term monitoring of endocrine deficiencies with consideration of osteodensitometry, early weight control programmes and continuing multidisciplinary care are mandatory in craniopharyngioma patients.
