Background Serum lactate and central venous oxygen saturation (ScvO 2 ) are commonly used and commonly recommended as markers of tissue oxygenation in shock states. Medical literature has both explicitly stated and implied that the two biomarkers are interchangeable in the management of patients with shock. However, there have been relatively few direct comparisons of these tests in clinical circumstances, and the relationship between them is uncertain. The objective of our study was to evaluate whether simultaneous or near-simultaneous measurements of lactate and ScvO 2 reveal a consistent relationship between these two biomarkers. Methods A retrospective cohort study was conducted in an urban, academic US hospital. All adults in ICUs between March 2007 and March 2017 who had a lactate measurement and ScvO 2 or mixed venous oxygen saturation (SvO 2 ) measurement made +/− 1 h from the lactate were included. Linear and non-linear correlations of ScvO 2 and lactate were assessed in a variety of shock states. Results Two thousand sixty-two patients were included. Lactate and ScvO 2 correlated poorly ( r 2 = 0.0041, p = 0.0019). This was true for patients with ScvO 2 ≤ 65% ( r 2 = 0.0431, p < 0.001), patients with normal kidney and liver function ( r 2 = 0.0517, p < 0.001), and septic shock patients ( r 2 = 0.0037, p = 0.17). For patients with an O 2 extraction ratio ≥ 50%, lactate and ScvO 2 were strongly correlated ( r 2 = 0.93, p = 0.0019), but these patients represented only 2.8% of patients in whom the ratio could be calculated. Conclusions Lactate can predict ScvO 2 when patients are at or below the critical oxygen delivery threshold, but relatively few shock patients meet this criterion. In the overall population of critically ill patients, serum lactate predicts ScvO 2 poorly, even after controlling for factors that may affect lactate production. Lactate and ScvO 2 should not be assumed to be interchangeable markers of tissue oxygenation/perfusion. Electronic supplementary material The online version of this article (10.1186/s40560-019-0401-5) contains supplementary material, which is available to authorized users.
Objective This article evaluates the current availability of information on residency program Web sites that may be of interest to residency applicants. Design Cross-sectional analysis of 117 Accreditation Council for Graduate Medical Education (ACGME)-accredited ophthalmology residency program Web sites from October 17, 2018 to December 17, 2018. Methods Programs were identified through the ACGME-specialty search, and the URL links provided by the program were evaluated for directing the user to the institution, department, or residency program. If a link was not functional or not provided, programs were identified through a Google search. Web sites were evaluated for having information on how to apply, application requirements and eligibility, and providing a link to the San Francisco (SF) Match. Educational content included: didactic instruction, rotation overview, research requirement information, active and/or past research, institutional conferences, academic conferences, call schedules, and charitable work. Recruitment content included current residents and faculty and their biographies, graduate placement, salary, benefits, surrounding area information, message from the Program Director, Chair, and/or Chief Residents, surgical statistics, affiliated hospital information, selection criteria, and association links. Data was stratified by program size, geographic region, and top 20 hospitals in ophthalmology by the U.S. News & World Report. Results Nonfunctional links were provided by 16.2% of programs, and 3.4% did not provide a link. Application instructions were presented by 83% of programs and 77% provided a link to the SF Match. Greater than 80% provided didactic instruction, rotation overviews, research expectations of residents, and faculty and resident listings. Up to half of programs listed information about application requirements and eligibility, call schedules, surgical statistics, academic conferences, charitable work, salary, and selection criteria. A message to applicants was displayed by 48% of programs, and 16% of programs provided association links. Programs with more than 15 residents provided more educational content than programs with less than 12 (p = 0.042). Differences in recruitment content were observed among programs in the Northeast and West, (p = 0.003) and programs in the South and West (p = 0.037). No other differences were observed. Conclusion The Internet is frequently consulted during the residency application process. Many programs provide basic information, but this can be further optimized to maximize the utility of residency Web sites.
A 3-year-old girl presented to the emergency department with 1 day of abnormal gait and bilateral mydriasis. Repeat magnetic resonance imaging demonstrated diffuse enhancement of the lower thoracic and cauda equina nerve roots and enhancement of the left oculomotor nerve.
A 57-year-old female presented with macula-involving retinal detachment secondary to degenerative retinoschisis. She was repaired with transscleral cryotherapy to both inner and outer retinoschisis breaks followed by intravitreal sulfur hexafluoride (SF 6 ) gas injection and anterior chamber paracentesis. Postoperative imaging at 4 months showed preserved fovea and completely attached retina. To the best of the authors' knowledge, this is the first report in the literature treating retinoschisis-related detachment with this minimally invasive technique without subretinal fluid drainage. [ Ophthalmic Surg Lasers Imaging Retina . 2019;50:791–794.]
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