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We aimed to test the hypothesis that a lung ultrasound severity score (LUS) and assessment of left ventricular eccentricity index of the interventricular septum (LVEI) by focused heart ultrasound can predict extubation success in mechanically ventilated infants. We conducted a prospective study on premature infants less than 34 weeks' of gestation. LUS was performed on postnatal Days 3 and 7 by an investigator who was masked to infants' ventilator parameters. LVEI and pulmonary artery pressure (PAP) were measured at postnatal Day 3. A receiver operator curve was constructed to assess the ability to predict extubation success. Spearman correlation was performed between LVEI and PAP. A total of 104 studies were performed to 66 infants; of them 39 had mild and 65 had moderate-severe lung disease. LUS predicted extubation success with a sensitivity and a specificity of 91% and 69%, respectively. Area under the curve was 0.83 (CI 0.75-0.91). LVEI did not differ between infants that succeeded and failed extubation. It correlated with PAP during systole (r = .66). We conclude that LUS predicts extubation success in mechanically ventilated preterm infants whereas LVEI correlates with high PAP.
Extubation failure in preterm infants is associated with an increased risk of mortality and morbidity. There is limited evidence to suggest if the increased morbidities are due to inherent differences among infants who fail or succeed; or whether these are due to a true respiratory setback among those who fail extubation. The aim of this study was to evaluate the respiratory status of infants who fail extubation and to assess the time taken for these infants to achieve pre-extubation respiratory status.

This was a retrospective study of infants with birth weight ≤ 1250 g who were born between January 2009 and December 2016. Infants were eligible if they failed first elective extubation. Extubation failure was defined as need for re-intubation within 5 days of extubation. Ventilator settings, blood gas parameters, respiratory severity score (RSS), and ventilation index (VI) were used to assess the respiratory status of infants.

Out of 384 infants, 76% were successful and 24% failed extubation. Among those who failed extubation 91%, 77%, and 56% infants remained intubated at 24 h, 72 h, and 7 days, respectively. Respiratory status was worse at 24and 72 h after re-intubation when compared to pre-extubation levels. The median times for RSS and VI to reach pre-extubation levels were 4and 7 days, respectively.

Among preterm infants, failed elective extubation is associated with a significant setback in the respiratory status. Infants who fail an extubation attempt may not achieve pre-extubation respiratory status for many days after reintubation.
Among preterm infants, failed elective extubation is associated with a significant setback in the respiratory status. KD025 in vitro Infants who fail an extubation attempt may not achieve pre-extubation respiratory status for many days after reintubation.
Long-term childhood asthma studies that investigate adult outcomes other than respiratory morbidity are lacking. This study examines the associations of childhood asthma and the occurrence of cardiovascular disease (CVD) events and mortality in adulthood.

A cohort of 4430 school children (aged 17 years) who attended the Busselton Health Study between 1967 and 1983 were analyzed. Self-reported history of doctor-diagnosed asthma was determined based on the questionnaire. Subsequent CVD events (hospital admissions or death) up to 2014 were identified using the Western Australia Data Linkage System. Cox regression models were used to investigate the impact of childhood asthma on CVD events and mortality in adulthood. A subgroup of 2153 participants who re-attended a survey in young adulthood was also analyzed.

A total of 462 (10%) of the cohort had childhood asthma. During follow-up, 867 participants experienced a CVD event and 22 participants died from CVD. Childhood asthma was not associated with the risk of CVD events in adulthood (HR, 1.12; 95% CI 0.91-1.39; p = .2833) and this persisted after adjustment for confounders. Childhood asthma was not associated with coronary heart disease events (HR, 0.72; 95% CI 0.40-1.30; p = .2761), heart failure events (HR, 0.55; 95% CI 0.07-4.13; p = .5604) or CVD mortality (HR, 0.91; 95% CI 0.21-3.89; p = .8987) in adulthood.

Childhood asthma is not associated with the risk of CVD events and mortality in adulthood.
Childhood asthma is not associated with the risk of CVD events and mortality in adulthood.Glucocorticoids are popular hormones to measure in both biomedical and ecological studies of stress. Many assumptions used to interpret glucocorticoid results are derived from biomedical data on humans or laboratory rodents, but these assumptions often fail for wild animals under field conditions. We discuss five common assumptions often made about glucocorticoids in ecological and conservation research that are not generally supported by the literature. (1) High acute elevations of glucocorticoids indicate an animal in distress. In fact because glucocorticoids are needed to survive stressors, elevated concentrations often reflect adequate coping. (2) Low glucocorticoid concentrations indicate a healthy animal. In fact because glucocorticoids are important in responding to stressors, low glucocorticoid concentrations might indicate the lack of adequate coping. (3) Sustained elevated glucocorticoids indicate chronically stressed animals. In fact glucocorticoid concentrations by themselves have no predictive value in diagnosing chronic stress. (4) Glucocorticoids mobilize energy to survive short-term stressors such as predator attacks. In fact glucocorticoids' primary impact on energy regulation is to remove glucose transporters from cell surfaces. Not only is this process too slow to provide short-term energy, but glucocorticoid-induced increases in glucose reflect decreased, not increased, glucose utilization. (5) Glucocorticoid measurements in non-blood tissues (e.g., feces, hair, feathers, etc.) are equivalent to blood concentrations. In fact these alternative tissues present imperfect reflections of blood concentrations, and it is blood concentrations that interact with receptors to evoke biological change. In summary, proper consideration of these common assumptions will greatly aid in interpreting glucocorticoid data from ecological and conservation studies.
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