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Intermittent suction of oral secretions before each positional change may reduce VAP occurrence in ICU patients.

SummaryBackground: Cardiac troponin I (cTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and highsensitivity C-reactive protein (hsCRP) each predict adverse cardiac events in chronic heart failure (CHF). However, little is known about the utility of these novel biomarkers of CHF in combination.Hypothesis: We hypothesized that simultaneous assessment of the three biomarkers would enable clinicians to stratify risk more effectively among patients with advanced CHF.Methods: Measurements of the biomarkers were performed on 152 patients with symptomatic advanced CHF. Major adverse cardiac events during a median follow-up period of 186 days were determined.Results: Univariate and multivariate analysis revealed that elevations of each biomarker were significant predictors of clinical outcome independently of clinical variables. When patients were categorized on the basis of the number of elevated biomarkers, patients with one, two and three elevated biomarkers respectively had a 2.7-(p = 0.125), 8.6-(p < 0.0001) and 23.4-(p < 0.0001) fold increase in the risk of adverse events.

Objective. The suspended microbubble sign is defined as the image seen on ultrasonography consisting of a pleural effusion strewn with numerous hyperechoic pinpoints and more or less linear shadows that move synchronously with respiration. In this study, we intended to evaluate the clinical usefulness of the suspended microbubble sign in differentiating empyemic and nonempyemic hydropneumothorax. Methods. This series consisted of 8 patients with empyemic hydropneumothorax and 23 patients with nonempyemic hydropneumothorax. The finding of the presence of the suspended microbubble signs on ultrasonography was recorded. To further elucidate the generation of the suspended microbubble sign, the interaction between air and pleural fluid of different types was investigated in vitro. Results. The suspended microbubble sign was shown on ultrasonography in all 8 patients with empyemic hydropneumothorax but was absent in the 23 patients with nonempyemic hydropneumothorax. These findings were supported by the observation that the pus seemed to mix with and trap the air more easily than did the nonpurulent pleural fluid, as shown in vitro. In this selected population, the sensitivity and specificity of the suspended microbubble sign in aiding a diagnosis of empyemic hydropneumothorax were both 100%. Conclusion. The suspended microbubble sign shown on ultrasonography might be of considerable value in differentiating empyemic and nonempyemic hydropneumothorax. Key words: ultrasonography; empyema; hydropneumothorax; pneumothorax. Recently, ultrasonography has proved valuable in detecting PN and has been applied widely to various pleural disorders. [3][4][5][6][7][8][9][10][11] To the best of our knowledge, the role of ultrasonography in HPN has not been well investigated, except for 1 study by Targhetta and colleagues in 1992.2 Their results indicated that the curtain sign, the movement of the airfluid level observed during real-time ultrasonography, and loss of the gliding sign (also called lung or pleural sliding) above the air-fluid level were of considerable value in detecting HPN. Furthermore, a peculiar ultrasonographic finding, an image caused by air microbubbles within the pleural fluid, was reported in 2 of 11 patients with HPN; however, its clinical significance remained unknown. The authors called this ultrasono-

This retrospective multicenter cohort study aimed to compare the outcome of haploidentical hematopoietic stem cell transplantation (HID‐HSCT) with matched sibling donor (MSD) and unrelated donor (URD) transplantation in severe aplastic anemia (SAA) patients 40 years of age and older. With a median follow‐up time of 17.6 months, 85 consecutive patients were enrolled in the study, and the median patient age was 45 years (40, 58). The cumulative engraftment rates of neutrophil and platelet were 98.8 ± 0.0% and 92.9 ± 0.1%. The cumulative incidences of Grade 2‐4 acute graft‐versus‐host disease (aGvHD) and chronic graft‐versus‐host disease (cGvHD) at 3 years were 14.1 ± 0.1% and 17.3 ± 0.2%. The 3‐year estimated overall survival (OS) and failure‐free survival (FFS) were 91.2 ± 3.2% and 89.7 ± 3.5%. In multivariate analysis, the only factor associated with inferior survival was an ECOG score ≥2. HID‐HSCT was associated with a higher incidence of GvHD, but the difference of 3‐year estimated OS between HID group and the other two cohorts was not significant (86.7 ± 6.4% for HID vs 92.1% ± 4.4% for MSD and 100% for URD, P = .481). HID‐HSCT might be a feasible alternative option for selected SAA patients aged 40 years and older without a matched donor.

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