AimTo examine lymphocyte counts as a predictive prognostic marker in patients with coma after cardiac arrest.MethodsWe retrospectively evaluated patients with coma after cardiac arrest admitted to the intensive care unit of Shiga University of Medical Science (Otsu, Japan). Lymphocyte counts were measured for 6 days from admission. Neurological outcome was assessed as favorable or unfavorable using cerebral performance categories. Associations between lymphocyte count and prognosis were investigated using multivariate logistic regression analysis and receiver operating characteristic curves.ResultsForty‐six patients were assessed from February 2012 to December 2016. Survivors had significantly higher lymphocyte counts than non‐survivors on days 2 and 5. Multivariate analysis showed that lymphocyte count was not associated with 90‐day mortality. Patients with favorable neurological outcome at discharge had significantly higher lymphocyte counts on days 2–6 than patients with unfavorable outcomes. Multivariate logistic regression analysis, including possible confounders, showed that lymphocyte counts on days 2–4 and 6 were associated with neurological outcome (day 2: odds ratio [OR] = 0.75, 95% confidence interval [CI] = 0.58–0.97, P = 0.029; day 3: OR = 0.68, 95% CI = 0.47–0.98, P = 0.04; day 4: OR = 0.4, 95% CI = 0.16–1.00, P = 0.05; day 6: OR = 0.69, 95% CI = 0.48–0.99, P = 0.046). Receiver operating characteristic curve analysis indicated high accuracy for predicting neurological outcome for each lymphocyte count on days 2–6 using the area under the curve, day 4 values being most accurate (day 2: 0.776, day 3: 0.787, day 4: 0.909, day 5: 0.774, day 6: 0.839).ConclusionLymphocyte counts on days 2–4 and 6 after cardiac arrest are associated with neurological outcome; counts on day 4 most accurately predict neurological outcome.

Background: Recently, dynamic chest radiography (DCR) was developed to evaluate pulmonary function using a flat-panel detector (FPD), which can evaluate blood flow in the pulmonary artery without injection of contrast agents. This study investigated the ability of a FPD to measure physiological changes in blood flow and to detect pulmonary embolism (PE) in monkeys.Methods and Results: DCR was performed in 5 monkeys using a FPD. Regions of interest (ROI) were placed in both lung fields of the image, and maximum changes in pixel value (∆pixel value) in the ROI were measured during 1 electrocardiogram cardiac cycle. Next, a PE model was induced using a Swan-Ganz catheter and additional images were taken. The ∆pixel value of the lungs in normal and PE models were compared in both supine and standing positions. The lung ∆pixel value followed the same cycle as the monkey electrocardiogram. ∆pixel values in the upper lung field decreased in the standing as compared to the supine position. In the PE model, the ∆pixel value decreased in the area of pulmonary blood flow occlusion and increased in the contralateral lung as compared to the normal model (normal model 1.287±0.385, PE model occluded side 0.428±0.128, PE model non-occluded side 1.900±0.431). Conclusions:A FPD could detect postural changes in pulmonary blood flow and its reduction caused by pulmonary artery occlusion in a monkey model.

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We aimed to investigate the association between aortic calcification and 90-day mortality in sepsis patients admitted to the intensive care unit. Methods:We evaluated adult patients (≥18 years) diagnosed with sepsis based on the Sepsis-3 criteria and admitted to our intensive care unit between April 2011 and March 2015. They were classified according to the degree of abdominal aortic calcification (severe and non-severe), grouped per age (<65, 65-75, and >75 years), and matched. Survival curves were generated, and betweengroup differences were evaluated.Results: Overall, 164 patients were included. The Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were not significantly different between the severity groups, whereas there were significant differences in age (P < 0.001), sex (P = 0.017), and presence of diabetes mellitus (P < 0.001), hypertension (P < 0.001), dyslipidemia (P = 0.048), and maintenance dialysis (P = 0.001). The severe abdominal aortic calcification group showed significantly poorer prognosis than the nonsevere group (log-rank P = 0.009). The adjusted odds ratio of severe calcification was the highest in patients aged <65 years (7.167; 95% confidence interval, 1.042-49.28, P = 0.045). Twenty-eight patients from each group were matched. The 90-day survival rate of the severe calcification group remained significantly lower than that of the non-severe calcification group (53.6% [15/28] versus 82.1% [23/28], P = 0.022). Conclusions:Severe abdominal aortic calcification is associated with the 90-day mortality of sepsis patients, particularly among those aged <65 years. Thus, caution is necessary in patients younger than 65 years; they may need to be treated with as much care as the elderly.

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