Objective: While myriads of studies have suggested that a survey of wound pH environment could indicate wound healing activities, it is not clear whether wound alkalinity can be used as a prognostic indicator of nonhealing wounds. Currently available systems cannot reliably assess the pH environment across wounds, which is the objective of this study. Approach: A disposable device, DETEC Ò pH, was developed and characterized on its ability to map wound alkalinity by pressing a freshly recovered wound dressing against its test surface. By comparing the wound's alkalinity and size reduction rates (*7 days) following pH measurement, we assessed the capability of wound alkalinity to prognosticate subsequent short-term wound size reduction rates. Results: The device had high accuracy and specificity in determining the alkalinity of simulated wound fluids soaked onto wound dressing. The type of wound dressing type had an insignificant effect on its detection sensitivity. Upon testing discarded wound dressings from human patients, the device quickly determined alkaline and acidic wounds. Finally, statistical analyses of wound size reduction rates in wounds with various alkalinities confirmed that wound alkalinity has a strong influence on, at least, short-term wound healing activity. Innovation: Without directly contacting the patient, this device provides a quick assessment of wound alkalinity to prognosticate immediate and short-term wound healing activities. Conclusion: DETEC Ò pH may serve as a prognosis device for wound care specialists during routine wound assessment to predict wound healing progress. This information can assist the decision-making process in a clinical setting and augur well for chronic wound treatment. DETEC Ò pH can also be used as an aid for home health care nurses or health care providers to screen nonhealing wounds outside clinics.
Background: Heart failure (HF) is a severe clinical syndrome caused by diversed etiologies. Classically left ventricle ejection fraction (LVEF) has been used as a diagnostic marker as well as to subdivide HF into 3 groups (HFpEF, HFmEF and HFrEF). However, the prognostic value of this index is not consistent in comparison to LV strain (GLS, GCS) which are not only able to detect heart failure at a very early stage (precede to EF change) but also to predict the primary outcome including HF readmission and death. The prognostic role of LV strain is independent and incremental to conventional echocardiographic parameters. Methods: 67 patients diagnosed with chronic HFrEF (EF < 40%) in Vietnam National Heart Institute were consecutively enrolled in our study from January 2016 to September 2016. Clinical data were comprehensively evaluated and conventional echocardiographic parameters and two LV strain indices (GLS & GCS) were measured using speckle-tracking. All patients were followed-up for all-cause 12-month readmission or death after discharge. The relation between echocardiographic parameters and clinical events was analyzed in Cox proportional hazard model. Results: GLS had a prognostic value of composite events after being adjusted with age, sex, heart rate, SBP, DBP, NT-ProBNP, renal clearance, LVEF and LVDd. GLS (cut-off = -7.5%; AUC = 0.738; p = 0.003) was a stronger predictor of composite event compared to LVEF (AUC= 0.66, p = 0.042) LVDd (AUC = 0.637; p = 0.025), LA diameter (AUC = 0.614, p = 0.03), NT-ProBNP (AUC = 0.663; p = 0.04) and hs-Troponin T (AUC = 0.592; p = 0.039). Conclusion: Global longitudinal strain is and strong and independent predictor of readmission and death in patients with heart failure with reduced ejection fraction.
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