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Matthew H. Anstey,Rashmi Rauniyar,Ethan Fitzclarence,Natalie Tran,Emma Osnain,Bianca Mammana,Angela Jacques,Robert N Palmer,Andrew Chapman,Bradley Wibrow 대한중환자의학회 2022 Acute and Critical Care Vol.37 No.3
Background:To explore the feasibility, safety, and potential benefits of administration of the anabolic steroid nandrolone to patients in the recovery phase from critical illness weakness.Methods: In this phase II, double blind, randomized, controlled trial, adult critically ill patients admitted to one of two tertiary Intensive Care Units in Western Australia for longer than 7 days with significant weakness were enrolled. Patients received nandrolone (200 mg males, 100 mg females) intramuscularly or placebo weekly for up to 3 weeks in addition to standard care. The primary outcome measures were improvement in grip strength, Medical Research Council muscle strength sum score, and functional activity level (Chelsea critical care assessment tool [CPAx]).Results: A total of 22 patients was enrolled between September 2017 and May 2019. No significant adverse events were detected. Median grip strength change was non-significantly greater in the nandrolone group (8.5 vs. 13.0, P=0.185), while hospital length of stay (36 vs. 26 days, P=0.023) and duration of mechanical ventilation (377 vs. 168, P=0.032) were lower. The discharge CPAx and intensive care unit mobility scores were higher in the nandrolone group, although there was no difference in the change in CPAx score (17.0 vs. 17.7, P=0.865). There were no changes in ultrasound-detected muscle thickness between the two groups.Conclusions: In patients with prolonged critical illness, nandrolone appears to be safe. However, a larger study, potentially combined with resistance exercise, is needed to definitively address the potential benefits of nandrolone.
Butchart, Neal,Anstey, James A.,Hamilton, Kevin,Osprey, Scott,McLandress, Charles,Bushell, Andrew C.,Kawatani, Yoshio,Kim, Young-Ha,Lott, Francois,Scinocca, John,Stockdale, Timothy N.,Andrews, Martin Copernicus GmbH 2018 Geoscientific model development Vol.11 No.3
<P><p><strong>Abstract.</strong> The Stratosphere-troposphere Processes And their Role in Climate (SPARC) Quasi-Biennial Oscillation initiative (QBOi) aims to improve the fidelity of tropical stratospheric variability in general circulation and Earth system models by conducting coordinated numerical experiments and analysis. In the equatorial stratosphere, the QBO is the most conspicuous mode of variability. Five coordinated experiments have therefore been designed to (i) evaluate and compare the verisimilitude of modelled QBOs under present-day conditions, (ii) identify robustness (or alternatively the spread and uncertainty) in the simulated QBO response to commonly imposed changes in model climate forcings (e.g. a doubling of CO<sub>2</sub> amounts), and (iii) examine model dependence of QBO predictability. This paper documents these experiments and the recommended output diagnostics. The rationale behind the experimental design and choice of diagnostics is presented. To facilitate scientific interpretation of the results in other planned QBOi studies, consistent descriptions of the models performing each experiment set are given, with those aspects particularly relevant for simulating the QBO tabulated for easy comparison.</p> </P>
Jing Xian Quah,Stephanie Sargent,Karen Nel,Christopher M. Anstey,Tony Stanton,Kim Greaves 아시아심장혈관영상의학회 2020 Cardiovascular Imaging Asia Vol.4 No.1
Objective: Epicardial fat (EF) is metabolically active adipose tissue positioned between the epicardial surface of the heart and the pericardium. We investigated whether there is a relationship between EF and Coronary Microvascular Dysfunction (CMD) in patients presenting with chest pain and unobstructed coronary arteries. Materials and Methods: This study recruited patients referred to cardiology clinics for assessment of chest pain who subsequently underwent assessment via CT coronary angiogram (CTA). Myocardial blood flow reserve (MBFR) was assessed using myocardial contrast echocardiography. Epicardial fat volume (EFV) was measured by tracing serial slices on CTA with corresponding Hounsfield units of -195 to -45. Results: We recruited 134 participants with a mean age of 59.2 (9.8) years. CMD was present in 54 (40%) patients, and the measured mean EFV was 128 mm3 (96, 168). Fortythree patients (32%) had a coronary artery calcium score (CACS) of 0, 64 (48%) had a CACS of 1–100, 18 (13%) had a CACS of 101–400, and 9 (7%) had a CACS >400. Univariate regression analysis showed that EFV and MBFR had a correlation coefficient of R=-0.22, with a significant regression slope (β=-0.002, p=0.012). Multivariable linear regression analysis using MBFR as a continuous outcome variable revealed age (β=-0.012, p=0.011) and CACS (β=-0.003, p= 0.023) to be associated with MBFR. EFV was not associated with MBFR (β=-0.0007, p=0.538). Model repetition with MBFR as a dichotomous variable (MBFR ≥2 or <2) revealed no association with EFV. Conclusion: No relationship was found between EFV and MBFR when traditional cardiovascular risk factors and calcium score.
John S. Zorbas,Kwok M. Ho,Edward Litton,Bradley Wibrow,Edward Fysh,Matthew H. Anstey 대한중환자의학회 2021 Acute and Critical Care Vol.36 No.2
Background: Evidence prior to the coronavirus disease 2019 (COVID-19) pandemic suggested that, compared with conventional ventilation strategies, airway pressure release ventilation (APRV) can improve oxygenation and reduce mortality in patients with acute respiratory distress syndrome. We aimed to assess the association between APRV use and clinical outcomes among adult patients receiving mechanical ventilation for COVID-19 and hypothesized that APRV use would be associated with improved survival compared with conventional ventilation. Methods: A total of 25 patients with COVID-19 pneumonitis was admitted to intensive care units (ICUs) for invasive ventilation in Perth, Western Australia, between February and May 2020. Eleven of these patients received APRV. The primary outcome was survival to day 90. Secondary outcomes were ventilation-free survival days to day 90, mechanical complications from ventilation, and number of days ventilated. Results: Patients who received APRV had a lower probability of survival than did those on other forms of ventilation (hazard ratio, 0.17; 95% confidence interval, 0.03–0.89; P=0.036). This finding was independent of indices of severity of illness to predict the use of APRV. Patients who received APRV also had fewer ventilator-free survival days up to 90 days after initiation of ventilation compared to patients who did not receive APRV, and survivors who received APRV had fewer ventilator-free days than survivors who received other forms of ventilation. There were no differences in mechanical complications according to mode of ventilation. Conclusions: Based on the findings of this study, we urge caution with the use of APRV in COVID-19.
Kim, Young-Ha,Kiladis, George N.,Albers, John R.,Dias, Juliana,Fujiwara, Masatomo,Anstey, James A.,Song, In-Sun,Wright, Corwin J.,Kawatani, Yoshio,Lott, Franç,ois,Yoo, Changhyun Copernicus GmbH 2019 Atmospheric Chemistry and Physics Vol.19 No.15
<P>Abstract. Equatorial Kelvin and mixed Rossby-gravity (MRG) waves in the tropical tropopause layer and stratosphere represented in recent reanalyses for the period of 1981-2010 are compared in terms of spectral characteristics, spatial structures, long-term variations, and their forcing of the quasi-biennial oscillation (QBO). For both wave types, the spectral distributions are broadly similar among most of the reanalyses, while the peak amplitudes exhibit considerable spread. The longitudinal distributions and spatial patterns of wave perturbations show reasonable agreement between the reanalyses. A few exceptions to the similarity of the spectral shapes and spatial structures among them are also noted. While the interannual variations of wave activity appear to be coherent for both the Kelvin and MRG waves, there is substantial variability in long-term trends among the reanalyses. Most of the reanalyses which assimilate satellite data exhibit large increasing trends in wave variance (∼15 %-50 % increase in 30 years at 100-10 hPa), whereas one reanalysis (Japanese 55-year Reanalysis assimilating conventional observations only; JRA-55C) produced without satellite data does not. Several discontinuities are found around 1998 in the time series of the Kelvin and MRG wave variances, which manifest in different ways depending on the reanalysis, and are indicative of impacts of the transition of satellite measurements during that year. The equatorial wave forcing of the QBO, estimated by the Eliassen-Palm (EP) flux divergence, occurs in similar phase-speed ranges in the lower stratosphere among the reanalyses. However, the EP flux and its divergence are found to be dependent on the zonal-mean winds represented in reanalyses, exhibiting different magnitudes, altitudes, and phase-speed ranges of the Kelvin wave forcing between the reanalyses, especially at 20-10 hPa. In addition, at around 20 hPa, a wave signal which appears only in easterly mean winds with westward phase speeds is found and discussed. </P>