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1.
《中华创伤杂志(英文版)》2023,26(2):116-120
PurposePatients with multiple traumas are at high risk of developing respiratory complications, including pneumonia and acute respiratory distress syndrome. Many pulmonary complications are associated with systemic inflammation and pulmonary neutrophilic infiltration. Leukotriene-receptor antagonists are anti-inflammatory and anti-oxidant drugs subsiding airway inflammation. The present study investigates the effectiveness of montelukast in reducing pulmonary complications among trauma patients.MethodsThis randomized, double-blind, placebo-control trial was conducted in patients with multiple blunt traumas and evidence of lung contusion detected via CT scan. We excluded patients if they met at least one of the following conditions: < 16 years old, history of cardiopulmonary diseases or positive history of montelukast-induced hypersensitivity reactions. Patients were allocated to the treatment (10 mg of montelukast) or placebo group using permuted block randomization method. The primary measured outcome was the volume of pulmonary contusion at the end of the trial. The secondary outcomes were intensive care unit and hospital length of stay, ventilation days, multi-organ failure, and the in-hospital mortality rate.ResultsIn total, 65 eligible patients (treatment = 31, placebo = 34) were included for the final analysis. The treatment group had more pulmonary contusion volume (mean (SD), mm3) at the right (68726.97 (93656.54) vs. 59730.27 (76551.74)) and the left side (67501.71 (91514.04) vs. 46502.21 (80604.21)), higher initial C-reactive peptide level (12.16 (10.58) vs. 10.85 (17.87)) compared to the placebo group, but the differences were not statistically significant (p > 0.05). At the end of the study, the mean (SD) of pulmonary contusion volume (mm3) (right side = 116748.74 (361705.12), left side = 64522.03 (117266.17)) of the treatment group were comparable to that of the placebo group (right side = 40051.26 (64081.56), left side = 25929.12 (47417.13), p = 0.228 and 0.082, respectively). Moreover, both groups have statistically similar hospital (mean (SD), days) (10.87 (9.83) vs. 13.05 (10.12)) and intensive care unit length of stays (mean (SD), days) (7.16 (8.15) vs. 7.82 (7.48)). Of note, the frequency of the in-hospital complications (treatment vs. control group) including acute respiratory distress syndrome (12.9% vs. 8.8%, p = 0.71), pneumonia (19.4% vs. 17.6%, p = 0.85), multi-organ failure (12.9% vs. 17.6%, p = 0.58) and the mortality rate (22.6% vs. 14.7%, p = 0.41) were comparable between the groups.ConclusionAdministrating montelukast has no preventive or therapeutic effects on lung contusion or its complications. 相似文献
2.
B. H. Roxburgh H. A. Campbell J. D. Cotter U. Reymann M. J. A. Williams D. Gwynne-Jones K. N. Thomas 《Anaesthesia》2021,76(1):72-81
Cardiopulmonary exercise testing is performed increasingly for cardiorespiratory fitness assessment and pre-operative risk stratification. Lower limb osteoarthritis is a common comorbidity in surgical patients, meaning traditional cycle ergometry-based cardiopulmonary exercise testing is difficult. The purpose of this study was to compare cardiopulmonary exercise testing variables and subjective responses in four different exercise modalities. In this crossover study, 15 patients with osteoarthritis scheduled for total hip or knee arthroplasty (mean (SD) age 68 (7) years; body mass index 31.4 (4.1) kg.m-2) completed cardiopulmonary exercise testing on a treadmill, elliptical cross-trainer, cycle and arm ergometer. Mean (SD) peak oxygen consumption was 20-30% greater on the lower limb modalities (treadmill 21.5 (4.6) (p < 0.001); elliptical cross-trainer (21.2 (4.1) (p < 0.001); and cycle ergometer (19.4 (4.2) ml.min−1.kg−1 (p = 0.001), respectively) than on the arm ergometer (15.7 (3.7) ml.min-1.kg-1). Anaerobic threshold was 25-50% greater on the lower limb modalities (treadmill 13.5 (3.1) (p < 0.001); elliptical cross-trainer 14.6 (3.0) (p < 0.001); and cycle ergometer 10.7 (2.9) (p = 0.003)) compared with the arm ergometer (8.4 (1.7) ml.min−1.kg−1). The median (95%CI) difference between pre-exercise and peak-exercise pain scores was greater for tests on the treadmill (2.0 (0.0-5.0) (p = 0.001); elliptical cross-trainer (3.0 (2.0-4.0) (p = 0.001); and cycle ergometer (3.0 (1.0-5.0) (p = 0.001)), compared with the arm ergometer (0.0 (0.0-1.0) (p = 0.406)). Despite greater peak exercise pain, cardiopulmonary exercise testing modalities utilising the lower limbs affected by osteoarthritis elicited higher peak oxygen consumption and anaerobic threshold values compared with arm ergometry. 相似文献
3.
Proteinuria as a predictor of disease progression in children with hypodysplastic nephropathy 总被引:6,自引:5,他引:1
Ardissino G Testa S Daccò V Viganò S Taioli E Claris-Appiani A Procaccio M Avolio L Ciofani A Dello Strologo L Montini G;Ital Kid Project 《Pediatric nephrology (Berlin, Germany)》2004,19(2):172-177
Little is known about the role of proteinuria in the progression of childhood renal diseases. We analyzed the decline in creatinine clearance (C
Cr) and kidney survival in 225 children (185 males) with chronic renal failure (CRF) due to isolated hypodysplasia or hypodysplasia associated with urological abnormalities. The data were based on the information available in the Italian Pediatric Registry of CRF (ItalKid Project), which includes patients from all of Italy aged <20 years with C
Cr levels of <75 ml/min per 1.73 m2. Patients aged <2 years and those with C
Cr levels of <20 ml/min per 1.73 m2 or a follow-up of <1 year were excluded from the analysis, as were those receiving angiotensin-converting enzyme inhibitors. At baseline, the patients had a mean age of 7.8±4.2 years, a mean C
Cr of 50±16.3 ml/min per 1.73 m2, a median urinary protein/urinary creatinine (uPr/uCr) ratio of 0.38 (range 0.02–7.21), and a mean duration of follow-up of 3.5±1.1 years. The patients were divided into three groups on the basis of their baseline proteinuria levels: group A normal (uPr/uCr <0.2) n=83; group B low (uPr/uCr 0.2–0.9) n=71; and group C mild (uPr/uCr >0.9) n=71. Patients in groups A and B showed a significantly slower decline in C
Cr than those in group C (slope +0.16±3.64 and –0.54±3.67 vs. –3.61±5.47, P<0.0001) and a higher rate of kidney survival after 5 years (96.7% and 94.1% vs. 44.9%, P<0.01). By multivariate analysis, the baseline uPr/uCr ratio (P<0.01) and age (P<0.0001) correlated with a faster decline in C
Cr irrespective of baseline C
Cr. There was no correlation with mean arterial blood pressure. We conclude that proteinuria is an independent predictor of progression to end-stage renal failure also in children whose renal impairment is due to congenital hypodysplasia.This paper was written on behalf of all the members of the ItalKid Project whose contribution has been essential. Members of the ItalKid Project:G. Aceto (Bari), G. Airoldi (Borgomanero), G. Amici (Ancona), A. Ammenti (Parma), B. Andretta (Padova), G. Ardissino (Milano), F. Ardito (Bologna), B. Assael (Verona), L. Avolio (Pavia), S. Bassi (Montichiari), F. Battaglino (Vicenza), R. Bellantuono (Bari), A. Bettinelli (Merate), C. Bigi (Lecco), S. Binda (Varese), C. Bini (Como), D. Bissi (Gallarate), R. Boero (Torino), R. Bonaudo (Torino), A. Bordugo (Pordenone), M. Borzani (Milano), M. Bosio (Milano), A. Bottelli (Varese), G. Bovio (Pavia), A. Bracone (Bra), G. Capasso (Napoli), M. Capizzi (Milano), D. Caringella (Bari), I. Carnera (Siracusa), M.R. Caruso (Bergamo), D. Cattarelli (Brescia), V. Cecchetti (Milano), M. Cecconi (Ancona), V. Cecinati (Bari), A. Ciofani (Pescara), A. Claris-Appiani (Milano), R. Coppo (Torino), F. Corona (Milano), A. Corsini (Bentivoglio), R. Costanzo (Ragusa), P. Cussino (Savigliano), M. DAgostino (Bergamo), V. Daccò (Milano), G. Daidone (Siracusa), R. DallAmico (Thiene), L. Dardanelli (Cuneo), R. De Castro (Bologna), V. De Cristofaro (Sondrio), M. De Gennaro (Roma), S. De Pascale (Bergamo), N. De Santo (Napoli), D. Delfino (R. Calabria), C.A. DellAgnola (Milano), L. Dello Strologo (Roma), L. Dertenois (Genova), A. Dessanti (Sassari), A. Di Benedetto (Catania), A. Di Leone (Cosenza), F. Di Lorenzo (Bologna), P. Di Turi (Bologna), A. Edefonti (Milano), W. Erckert (Silandro), A. Fabris (Verona), V. Fanos (Verona), C. Fede (Messina), A. Fella (Napoli), R. Ferraro (Scorrano), M.T. Ferrazzano (Anzio), R. Ferré (Breno), A. Ferretti (Napoli), B. Fogazzi (Brescia), P. Formentin (Cittadella), C. Fortini (Ferrara), E. Fossali (Milano), G. Fossati Bellani (Milano), M. Gaido (Torino), R. Galato (Milano), G. Gargano (Modena), V. Georgacopulo (Ferrara), L. Ghio (Milano), R. Giachino (Ivrea), M. Giani (Milano), S. Gianni (Siracusa), B. Gianoglio (Torino), M. Girodano (Bari), V. Goj (Milano), F. Grancini (Milano), G. Grott (Chieri), S. Guez (Milano), R. Gusmano (Genova), A. Iovino (Napoli), C. Isimbaldi (Lecco), A. La Manna (Napoli), G. Lama (Napoli), R. Landoni (Cinisello B.), S. Li Volti (Catania), A. Liardo (Caltagirone), V. Lotti (Cesena), R. Lubrano (Roma), I. Luongo (Napoli), E. Mancini (Bologna), N. Manganaro (Messina), M. Marangella (Torino), C. Marchesoni (Trento), K. Marenzi (Segrate), S. Maringhini (Palermo), G. Marra (Milano), E. Marras (Torino), V. Mei (Bologna), F. Menni (Milano), N. Miglietti (Brescia), R. Mignani (Rimini), P. Minelli (Bologna), R. Moioli (Milano), P. Molinari (Bologna), G. Montini (Padova), M. Montis (Cagliari), G. Mosiello (Roma), L. Murer (Padova), G. Nebbia (Milano), M. Neunhauserer (Brunico), P. Nitsch (Parma), M. Noto (Palermo), C. Oppezzo (Milano), F. Paolillo (Lodi), T. Papalia (Cosenza), R. Parini (Milano), L. Parola (Magenta), F. Passione (Foggia), L. Pavanello (CastelfrancoV.), C. Pecoraro (Napoli), M. Pedron (Bolzano), I. Pela (Firenze), A. Pellegatta (Busto Arsizio), P. Pelliccia (Chieti), M. Pennesi (Trieste), C. Pennetta (Manduria), R. Penza (Bari), L. Peratoner (Pordenone), F. Perfumo (Genova), G. Perino (Torino), C. Pesce (Vicenza), L. Pisanello (Padova), M. Pitter (Mirano), L. Pontesilli (Roma), M. Porcellini (Torino), A. Pota (Napoli), R. Prandini (Bologna), F. Puteo (Bari), I. Ratsch (Ancona), E. Ravaioli (Rimini), G. Remuzzi (Bergamo), G. Riccipetitoni (Cosenza), G. Ripanti (Pesaro), G. Rizzoni (Roma), N. Roberto (Milano), A. Rosini (Ancona), M. Rossi Doria (Bologna), S. Rota (Bergamo), M. Ruzza (Milano), D. Scorrano (Belluno), A. Selicorni (Milano), G. Selvaggio (Milano), F. Sereni (Milano), O. Sernia (Savigliano), C. Setzu (Cagliari), C. Sforzini (Milano), L. Stallone (S. Giovanni Rotondo), M. Tagliaferri (Treviglio), L. Tampieri (Lugo), A. Testagrossa (Messina), A. Turrisi (Trapani), G. Vallini (Cinisello Balsamo), E. Verrina (Genova), S. Viola (Pavia), G. Visconti (Palermo), A. Voghenzi (Ferrara), G. Zacchello (Padova) 相似文献
4.
《Foot and Ankle Surgery》2022,28(8):1241-1247
BackgroundIn Europe, fixed-bearing implants predominate again in total ankle replacement (TAR). The present single-center single-surgeon study assesses the Hintegra® mobile-bearing implant (NEWDEAL).MethodsBetween November 2008 and November 2015, 97 Hintegra® were implanted in 94 patients: mean age, 62.4±10.9 years (26?83); 59% (57/97) male; normal mean body-mass index (BMI), 27.5 ± 4.3 kg/m2. Indications mainly comprised posttraumatic (40.2%), instability (29.9%) and primary osteoarthritis (16.5%). 17.5% of patients had prior surgery during the previous 6 months (9 fusions, 8 ligament reconstructions, and 4 osteotomies); in 59.8%, other procedures were associated to TAR. Functional, clinical and radiological follow-up was conducted at 1 year, 2 years and last follow-up (>5 years).ResultsNinety-four TARs were analyzed at a mean 81 ± 21.6 months (19?124). Revision-free survival was 76% (95% confidence interval (95%CI): 0.66–0.8), and explantation-free survival 92% (95%CI: 0.85–1) with 10 cases of curettage and 5 explantations.Mean AOFAS score improved from 41.8 ± 12.5 (21?69) to 77.5 ± 16.5 (24?100) up (p < 0.001); 75% of patients had no or only mild pain (p < 0.001). Clinical ranges of motion were 8.0 ± 7.1° dorsiflexion (p < 0.001) and 35.1 ± 9.4° plantar flexion (preoperatively, 34.1 ± 7.9°) (p = 0.71).Radiologically, tibial components were well-positioned; 87% of talar components were well-centered. Global ankle range of motion was 23.5 ± 10.2° (5?48) (p = 0.17). 54.6% of TARs showed posterior tibial calcification at follow-up. Risk of severe cyst (>1 cm) on CT was 36% (95%CI: 23–47) at a mean 77 ± 21.9 months (18?123).ConclusionHintegra® TAR incurred a low risk of revision, and is a reliable option for ankle osteoarthritis.Level of evidenceIV 相似文献
5.
D. H. Wittmann W. Teichmann M. Müller 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》1987,372(1):834-835
Zusammenfassung Anhand unseres Peritonitiskrankengutes von 567 Patienten wurde über die Diskriminanzanalyse der Einfluss verschiedener, bei Erstoperation erhobenen Patientenvariablen auf die Zielvariablen LEBT-TOT mathematisch exakt definiert und daraus Peritonitisindex mit folgenden Variablen (score) entwickelt: Alter über 60 Jahre (–0,61), männlich (–0,61), Anamnese über 24 h (–0,40), Herzinsuffiziens (–0,47), insulinbedürftiger Diabetes mellitus (–1,36), Kreatinin über 4 mg/dl (–0,75), Leukocyten unter/über 5000 und 26 000/nl (–2,47), Ausbreitung diffus (–0,34), Durchwanderung bei Ileus (–2,74), Mesenterialverschluss (–4,19), Ulcusperforation Magen/Duodenum (0,49), Ursprung Colon (0,77), Konstante (2,02), Mittelpunkt ist Null; bei einem Score von –1,315 ist die Wahrscheinlichkeit zu sterben 97,5%. Die Klassifikationsgenauigkeit des Index beträgt 87,4%. Die Validierung am unbekannten Kontrollkollektiv ergab 81,4% richtig klassifizierte Fälle. 相似文献
6.
Ahmet Sahan Alkan Cubuk Orkunt Ozkaptan Tuncay Toprak Tolga Ozcan Kasım Ertas Onder Canguven Fatih Tarhan 《Andrologia》2020,52(11):e13854
This study compared the safety and efficacy of the on-demand (OD) use of sertraline (50 mg), sertraline (100 mg) and dapoxetine (30 mg), and the daily use of sertraline (50 mg) in the treatment of patients with premature ejaculation (PE). This prospective randomised study involved 120 lifelong PE patients (intravaginal ejaculatory latency time [IELT]: <1 min; Arabic Index of Premature Ejaculation [AIPE] score: < 30) without secondary causes of PE, identified between March 2018 and May 2020. Patients were divided into 4 groups (30 patients per group) and treated for 8 weeks. Assessments were conducted using the AIPE form as a diagnostic tool. Sertraline (50 mg, daily; 196.7 ± 115.5 s) and sertraline (100 mg, OD; 173.3 ± 97.0 s) had similar IELT and AIPE scores. The latter groups had better results in comparison with sertraline (50 mg, OD; 100.5 ± 54.4 s) and dapoxetine (93.7 ± 53.5 s; p < 0.01). Sertraline (100 mg, OD) had a similar efficacy to that of sertraline (50 mg, daily) and was more effective than sertraline (50 mg, OD) and dapoxetine (30 mg, OD). Sertraline (100 mg, OD) can be considered in the treatment of lifelong PE treatment, having tolerable side effects. 相似文献
7.
Michael S. Ingber Ibrahim A. Ibrahim Kim A. Killinger Ananias C. Diokno Kenneth M. Peters 《International urogynecology journal》2009,20(9):1055-1059
Introduction and hypothesis Women undergoing InterStim implantation for overactive bladder (OAB) or painful bladder syndrome (PBS) were prospectively
evaluated to determine if neuromodulation has any effect on female sexual function (FSF).
Methods Sexually active women in our InterStim database completed a female sexual function index (FSFI) preoperatively and at 6 months.
Results Of 105 women, 54 have 6-month follow-up data. Of these, 27 were sexually active preoperatively and at follow-up. The mean
(standard deviation (SD)) FSFI improved from 18.7 (6.8) preoperatively to 21.0 (6.0) postoperatively; however, this was not
statistically significant (p = 0.220). Subgroup analysis of patients with OAB revealed that mean (SD) FSFI preoperatively was 18.6 (8.0) and 22.4 (6.4)
at 6 months (p = 0.257). In the PBS group, mean (SD) FSFI was 18.8 (6.3) preoperatively and 18.7 (5.8) at 6 months (p = 0.98).
Conclusions Neuromodulation does not significantly improve FSF in a heterogenous population. Additional studies are needed to confirm
the findings in our study. 相似文献
8.
Anesthetized, paralyzed and mechanically ventilated pigs were exposed to extreme hypercapnia (Paco2-20 kPa) at Fio2 0.4 for 480 min, with (n = 6) or without (n = 6) continuous infusion of isotonic buffers (bicarbonate and trometamol). Arterial pH was higher in buffered animals than controls, 7.21 ±0.01 vs 7.01±0.01 (mean ± s.e.mean, P < 0.01). Serum osmolality and Paco2 did not differ between groups throughout the experiment. The hemodynamic response to hypercapnia was attenuated in the buffered group, who had lower heart rate, 133 ± 6 vs 189±12 min-1 (P < 0.01), mean arterial pressure (MAP) 109 ± 4 vs 124 ± 4 mmHg (14.5 ± 0.5 vs 16.5 ± 0.5 kPa) (P < 0.05), mean pulmonary arterial pressure 16±1 vs 23 ± 1 mmHg (2.1 ±0.1 vs 3.1 ±0.1 kPa) (P < 0.01), and pulmonary vascular resistance (PVR) 249 ± 21 vs 343 ± 20 dyn s-cm-5 (2490±210 vs 3430±200 μN-s-cm-5) (P < 0.01), compared with the control group. Subsequently, both groups were exposed to hypercapnic hypoxemia by stepwise increases in Fio2 (0.15, 0.10, 0.05) at 30-min intervals, while Fico2 was kept at 0.2. PVR increased in both groups (P < 0.05) but, except for heart rate, all hemodynamic differences between the groups disappeared during hypoxia. At Fio2 0.15, buffered animals had higher arterial oxygen saturation (73 ± 5%) than the controls (55 ± 5%), (P < 0.05). The control animals died after 1–29 min (mean 14 min) at Fio2 0.10, while all buffered animals survived Fio2 0.10 with stable MAP (122 ± 14 mmHg (16.3 ± 1.9 kPa). The buffered animals died after 4–22 min (mean 15 min) at Fio2 0.05. We conclude that buffering to a pH of 7.21 attenuates the observed hemodynamic response in extreme hypercapnia and improves survival in hypercapnic hypoxemia. 相似文献
9.
10.
Differential risks for adverse outcomes 3 years after kidney transplantation based on initial immunosuppression regimen: a national study 下载免费PDF全文
Vikas R. Dharnidharka Mark A. Schnitzler Jiajing Chen Daniel C. Brennan David Axelrod Dorry L. Segev Kenneth B. Schechtman Jie Zheng Krista L. Lentine 《Transplant international》2016,29(11):1226-1236
We examined integrated national transplant registry, pharmacy fill, and medical claims data for Medicare‐insured kidney transplant recipients in 2000–2011 (n = 45 164) from the United States Renal Data System to assess the efficacy and safety endpoints associated with seven early (first 90 days) immunosuppression (ISx) regimens. Risks of clinical complications over 3 years according to IS regimens were assessed with multivariate regression analysis, including the adjustment for covariates and propensity for receipt of a nonreference ISx regimen. Compared with the reference ISx (thymoglobulin induction with tacrolimus, mycophenolate, and prednisone maintenance), sirolimus‐based ISx was associated with significantly higher three‐year risks of pneumonia (adjusted hazard ratio, aHR 1.45; P < 0.0001), sepsis (aHR 1.40; P < 0.0001), diabetes (aHR 1.21; P < 0.0001), acute rejection (AR; adjusted odds ratio, aOR 1.33; P < 0.0001), graft failure (aHR 1.78; P < 0.0001), and patient death (aHR 1.40; P < 0.0001), but reduced skin cancer risk (aHR 0.71; P < 0.001). Cyclosporine‐based IS was associated with increased risks of pneumonia (aHR 1.17; P < 0.001), sepsis (aHR 1.16; P < 0.001), AR (aOR 1.43; P < 0.001), and graft failure (aHR 1.39; P < 0.001), but less diabetes (aHR 0.83; P < 0.001). Steroid‐free ISx was associated with the reduced risk of pneumonia (aHR 0.89; P = 0.002), sepsis (aHR 0.80; P < 0.001), and diabetes (aHR 0.77; P < 0.001), but higher graft failure (aHR 1.35; P < 0.001). Impacts of ISx over time warrant further study to better guide ISx tailoring to balance the efficacy and morbidity. 相似文献
11.
Prelog M Schiefecker D Fille M Wurzner R Brunner A Zimmerhackl LB 《Pediatric nephrology (Berlin, Germany)》2008,23(4):597-602
The aim of this study was to characterize the pathogens and their antibiotic susceptibilities in defined groups of children
(total number 694) with urinary tract infection (UTI) regarding age, first UTI (FUTI) or recurrent UTI (RUTI), renal abnormalities
or vesico-ureteric reflux (VUR) in order to optimize empirical antibiotic therapy and prophylaxis. In patients aged between
1 month and 24 months with a first febrile UTI (FUTI; n = 205) the leading pathogen was Escherichia coli (E. coli) (83.4%). In comparison with patients with FUTI, those with RUTI (n = 24) had more Enterococcus and Enterobacter infections and higher resistance rates of E. coli against trimethoprim (TMP), trimethoprim/sulfamethoxazole (SXT) or ampicillin (AMP). Boys with ultrasound-detected renal
abnormalities (n = 71) showed 14.2% Pseudomonas and 59.1% E. coli infections versus girls (n = 48) (2.1% Pseudomonas and 93.7% E. coli). Of 390 patients who underwent voiding cysto-urethrography, 31.5% had VUR. Of them, 45.5% received antimicrobial prophylaxis
with SXT (n = 30) or cefazolin (n = 26). There was no difference between girls (n = 242) and boys (n = 148) regarding the frequency of VUR and pathogens. There were more TMP- and SXT-resistant E. coli cultures from patients with VUR (37.8%) than from those without VUR (25.8%). Treatment with TMP, SXT and AMP alone appeared
to be insufficient in many cases because of high resistance rates of E. coli and other uropathogens. 相似文献
12.
Francesco Santini Francesco Onorati Mariassunta Telesca Fabio Patelli Giorgio Berton Gianluigi Franchi Giuseppe Faggian Alessandro Mazzucco 《European journal of cardio-thoracic surgery》2011,40(4):794-803
Objective: Acute lung injury still accounts for postoperative mortality after cardiopulmonary bypass (CPB). The safety and the efficacy of pulsatile pulmonary perfusion (PPP) during CPB were analyzed. Preliminary results of the first PPP trial in human beings are reported. Methods: Thirty low-risk coronary artery bypass grafting (CABG) patients were prospectively randomized to receive PPP with oxygenated blood during CPB and aortic cross-clamping (15 patients, PPP-group) or to conventional CPB (15 patients, control group). Alveolo–arterial oxygen gradient (A-aDO2) was set as the primary end point and collected preoperatively, at intensive care unit (ICU) arrival (T1), 3 h postoperatively (T2), and post extubation (T3). Secondary end points were collected at the same time points and consisted of respiratory indices (partial pressure of arterial oxygen/fraction of inspired O2 (PaO2/FiO2), lung compliance, mixed-venous partial pressure of oxygen (pO2)) and hemodynamic pulmonary parameters (indexed pulmonary vascular resistances (PVRI), pulmonary arterial pressure (PAP), pulmonary capillary wedge pressure (PCWP), and cardiac index (CI)). Bronchoalveolar lavage (BAL) fluid was collected preoperatively, at ICU arrival (T1-BAL) and after 4 h. Results: There were no PPP-related complications. Patients undergoing PPP showed a better preserved A-aDO2 (group-p = 0.001) throughout the study period (group × time-p = 0.0001). PaO2/FiO2 and lung compliance were better preserved by PPP (group-p and group × time-p ≤ 0.05 for all). Pulmonary hemodynamic status was positively influenced by PPP, as shown by the higher CI (group-p = 0.0001, group × time-p = 0.0001), and the lower PVRI, PAP, and PCWP (group-p ≤ 0.001, group × time-p = 0.0001 for all). Postoperative BAL specimens demonstrated a lower absolute count of white blood cells (group-p = 0.0001), a higher percentage of monocytes/macrophages (group-p = 0.027), and a lower percentage of neutrophils (group-p = 0.015) after PPP. Conclusions: Oxygenated blood PPP proved safe and significantly ameliorated pulmonary hemodynamic parameters and respiratory indices in low-risk CABG. 相似文献
13.
Roland Seiler Andreas Rickenbacher Sidney Shaw Simon Haefliger Bruno M. Balsiger 《Journal of gastrointestinal surgery》2008,12(6):1087-1093
Gut motility is modulated by adrenergic mechanisms. The aim of our study was to examine mechanisms of selective adrenergic
receptors in rat jejunum. Spontaneous contractile activity of longitudinal muscle strips from rat jejunum was measured in
5-ml tissue chambers. Dose–responses (six doses, 10−7–3 × 10−5M) to norepinephrine (NE, nonspecific), phenylephrine (PH, α1), clonidine (C, α2), prenalterol (PR, β1), ritodrine (RI, β2), and ZD7714 (ZD, β3) were evaluated with and without tetrodotoxin (TTX, nerve blocker). NE(3 × 10−5M) inhibited 74 ± 5% (mean ± SEM) of spontaneous activity. This was the maximum effect. The same dose of RI(β2), PH(α1), or ZD(β3) resulted in an inhibition of only 56 ± 5, 43 ± 4, 33 ± 6, respectively. The calculated concentration to induce 50% inhibition
(EC50) of ZD(β3) was similar to NE, whereas higher concentrations of PH(α1) or RI(β2) were required. C(α2) and PR(β1) had no effect. TTX changed exclusively the EC50 of RI from 4.4 ± 0.2 to 2.7 ± 0.8% (p < 0.04). Contractility was inhibited by NE (nonspecific). PH(α1), RI(β2), and ZD(β3) mimic the effect of NE. TTX reduced the inhibition by RI. Our results suggest that muscular α1, β2, and β3 receptor mechanisms mediate adrenergic inhibition of contractility in rat jejunum. β2 mechanisms seem to involve also neural pathways.
Part of this work was presented as a poster at the annual meeting of the Society for Surgery of the Alimentary Tract, Orlando,
FL, May 17–22, 2003, and published as an abstract in Gastroenterology 2003, 124(4):M1342. 相似文献
14.
Francesco Onorati Giuseppe Santarpino Gelsomina Tangredi Giorgio Palmieri Antonino S. Rubino Daniela Foti Elio Gulletta Attilio Renzulli 《European journal of cardio-thoracic surgery》2009,35(6):1012-1019
Objective: Intra-aortic balloon pump (IABP)-induced pulsatile perfusion has demonstrated that it can preserve organ function during cardiopulmonary bypass (CPB). We evaluated the role of IABP pulsatile perfusion on endothelial response. Methods: Forty consecutive isolated CABG undergoing preoperative IABP were randomized to receive IABP pulsatile CPB during aortic cross-clamping (group A, 20 patients) or standard linear CPB (group B, 20 patients) during cross-clamp time. Hemodynamic results were analyzed by Swan-Ganz catheter [mean arterial pressure (MAP), cardiac index (CI), indexed systemic vascular resistances (ISVR), indexed pulmonary vascular resistances (IPVR), wedge pressure (PCWP)]. Inflammatory/endothelial response was analyzed by pro-inflammatory (IL-2, IL-6, IL-8), anti-inflammatory cytokines (IL-10), and endothelial markers [vascular endothelial growth factor (VEGF) and monocyte chemotactic protein-1 (MCP-1)]. All measurements were recorded preoperatively (T0), before aortic declamping (T1), at the end of surgery (T2), 12 h (T3) and 24 h (T4) postoperatively. ANOVA for repeated measures was used to evaluate the differences of means. Results: Hemodynamic response was comparable except for higher MAP (p = 0.01 at T1) and lower ISVR (p = 0.001 at T1, p = 0.003 at T2) in group A. No differences were found in perioperative leakage of IL-2, IL-6, and IL-8 between the two groups (within-group p = 0.0001 either in group A and group B; between-groups p = NS at 2-ANOVA). Group A showed significantly lower VEGF (between-groups p = 0.001 at 2-ANOVA, p = 0.001 at T1, T2) and MCP-1 (between-groups p = 0.001 at 2-ANOVA, p = 0.001 at T1, T2) with higher IL-10 secretion (between-groups p = 0.001 at 2-ANOVA, p = 0.01 at T1, T2, T3). Conclusions: IABP-induced pulsatile perfusion allows lower endothelial activation during CPB and higher anti-inflammatory cytokines secretion. 相似文献
15.
U. Lehmann G. Regel B. Ellendorf E. Rickels M. Lorenz H. Becker H. Tscherne 《Der Unfallchirurg》1997,100(9):705-710
Summary
A total of 208 multiple trauma patients with head injury (HI) were investigated who had been treated in the period from 1990
to 1995. The average age was 35.2 ± 17.7 years; the injury severity according to ISS was 30.2 ± 8.6 points; 20.5 % died as
a result of the HI; the mortality of all patients was 26.5 %. The Glasgow Coma Scale (GCS) was determined at an average of
22 min after trauma (8.0 ± 4.3 points) at the scene of accident. The patients were classified according to GCS into minor
HI (group 1: 14–15 points), moderate HI (group 2: 9–13 points) and severe HI (group 3: 3–8 points). Patient outcome was assessed
by the Glasgow Outcome Scale (GOS) and was classified as good (GOS 4 and 5) and poor (GOS 1, 2 and 3) outcome. At the latest,
2 h after trauma, a CT scan of the head (CCT) was done. The HI groups are compared regarding frequency of types of injury.
In all HI groups the fractures of the bony face occurred at the same frequency (36.0–38.9 %). The frequency of calotte fractures
(Kal-Fx) increased from group 1 (8.0 %) to 2 (19.2 %) and 3 (25.6 %); fractures of the skull base significantly differed between
group 1 (16.0 %), 2 (7.8 %) and 3 (33.4 %). Epidural hemorrhage (EDB) appeared only in group 2 (7.8 %) and 3 (6.7); subdural
hemorrhage was found in group 1 (2.7 %), 2 (7.8 %) and 3 (10.0 %). Subarachnoid hemorrhage (SAB) was significantly more frequently
seen, dependent on HI severity, in group 3 (26.7 %) compared to group 2 (11.7 %) and 1 (8.0 %). Intracerebral contusion (ICK)
significantly increased from group 1 (12.0 %) to 2 (27.3) and 3 (45.6 %). Brain swelling (BS) also significantly increased
from group 1 (8.0 %) to 2 (19.5 %) and 3 (49.0 %) and lesions of ventricles (VL) from group 1 (2.7 %) to 2 (11.7 %) and 3
(20.0 %). Midline shift (13.4 %) and signs of herniation (4.5 %) only occurred in group 3. The analysis of correlation/regression
and receiver operating characteristics was able to predict 79 % of patients' outcome accurately using GCS (r 0.54; P < 0.0001) alone, using CCT (r 0.65; P < 0.0001) 87 % were correctly predicted with significant variables Cal-Fx, EDB, SAB and BS. CCT with GCS (r 0.74; P < 0.0001) were able to predict 88 % accurately with significant variables Cal-Fx, EDB, BS and GCS. The combination of CCT
with GCS, age and ISS (r 0.78; P < 0.0001) was able to predict only 87 % correctly, although the r value was the highest; significant variables were Kal-Fx, EDB, BS, VL, GCS, age and ISS.
相似文献
16.
The association of body fat mass (FM) with bone mineral mass (BMC) and bone mineral density (BMD) has been attributed to a
mechanical load exerted on the skeleton by FM and by the effect of different hormones. The aim of the present study was to
determine whether there is a relationship between ghrelin, adiponectin, and leptin with BMC and BMD in healthy postmenopausal
women (n = 88; age, 68.9 ± 6.8 years; body mass index, 27.4 ± 3.6 kg/m2). Body composition, BMC, and BMD were derived by dualenergy X-ray absorptiometry. Waist-to-hip (WHR) and waist-to-thigh (WTR)
ratios were also obtained. Ghrelin was associated with total BMC (β = −0.945; P = 0.0001), total BMD (β = −0.959; P = 0.0001), lumbar spine BMD (β = −0.945; P = 0.0001), and femoral neck BMD (β = −0.957; P = 0.0001), and remained associated (P < 0.041) in different analyses that controlled for measured body composition and hormonal and insulin resistance values.
However, the associations between ghrelin and measured bone mineral values were no longer significant (P > 0.149) when adjusted for body fat distribution values (WHR, WTR). Adiponectin was significantly related to total BMC (β
= −0.931; P = 0.0001), total BMD (β = −0.940; P = 0.0001), lumbar spine BMD (β = −0.937; P = 0.0001), and femoral neck BMD (β = −0.940; P = 0.0001) values, and these relationships remained significant (P < 0.019) after adjusting for measured body fat, hormonal, and insulin resistance values but not when adjusted for fat-free
mass (FFM; P > 0.106). In addition, significant associations of leptin with total BMC (β = 0.912; P = 0.0001), total BMD (β = 0.907; P = 0.0001), lumbar spine BMD (β = 0.899; P = 0.0001), and femoral neck BMD (β = 0.906; P = 0.0001) were found. These associations remained significant (P < 0.010) in different analyses that controlled for hormonal and insulin resistance values, but the associations between leptin
and bone mineral values were no longer significant (P > 0.145) when adjusted for specific body composition values (WHR, WTR, FM, and FFM). In conclusion, it appears that the influence
of plasma ghrelin, adiponectin, and leptin levels on BMC and BMD values is mediated or confounded by the specific body composition
parameters in healthy postmenopausal women. 相似文献
17.
Intra-aortic balloon pump-induced pulsatile flow reduces coagulative and fibrinolytic response to cardiopulmonary bypass 总被引:1,自引:0,他引:1
Onorati F Esposito A Comi MC Impiombato B Cristodoro L Mastroroberto P Renzulli A 《Artificial organs》2008,32(6):433-441
Abstract: The aim of this study is to evaluate if a simple intra-aortic balloon pump (IABP)-induced pulsatile perfusion reduces activation of coagulative system during cardiopulmonary bypass (CPB). Ninety-six patients undergoing preoperative IABP were randomized to nonpulsatile CPB with IABP discontinued during cardioplegic arrest (Group A) or IABP-induced pulsatile CPB (Group B). White blood cells (WBC), hematocrit (Ht), platelets (PLTs), International Normalized Ratio (INR), fibrinogen, activated partial thromboplastin time (aPTT), antithrombin III (AT-III) activity, and D-dimer were measured at the end of surgery (ES) and postoperatively. Chest drainage, need for reexploration, and transfusions were compared. Group B showed lower chest drainage (1st day P = 0.038; 2nd day P = 0.044), transfusions ( P = 0.031), WBC ( P < 0.05 at all time points), and INR ( P < 0.05 at all time points), together with a higher Ht ( P < 0.05 at ES, 12 h), platelets ( P < 0.04 at all time points), fibrinogen ( P < 0.05 at ES, 12 h, 24 h), and aPTT ( P < 0.05 at all time points). AT-III activity lowered in Group A ( P = 0.001 at ES, 12 h, 24 h), together with higher D-dimer levels ( P < 0.05 at all time points). IABP-induced pulsatile perfusion ameliorates coagulative system activation following CPB. 相似文献
18.
Lorna Dunning Aditya R Gandhi Martina Penazzato Djra I Soeteman Paul Revill Simone Frank Andrew Phillips Caitlin Dugdale Elaine Abrams Milton C Weinstein MarieLouise Newell Intira J Collins Meg Doherty Lara Vojnov Patricia Fassinou Ekouvi Landon Myer Angela Mushavi Kenneth A Freedberg Andrea L Ciaranello 《Journal of the International AIDS Society》2021,24(1)
IntroductionUptake of early infant HIV diagnosis (EID) varies widely across sub‐Saharan African settings. We evaluated the potential clinical impact and cost‐effectiveness of universal maternal HIV screening at infant immunization visits, with referral to EID and maternal antiretroviral therapy (ART) initiation.MethodsUsing the CEPAC‐Pediatric model, we compared two strategies for infants born in 2017 in Côte d’Ivoire (CI), South Africa (SA), and Zimbabwe: (1) existing EID programmes offering six‐week nucleic acid testing (NAT) for infants with known HIV exposure (EID), and (2) EID plus universal maternal HIV screening at six‐week infant immunization visits, leading to referral for infant NAT and maternal ART initiation (screen‐and‐test). Model inputs included published Ivoirian/South African/Zimbabwean data: maternal HIV prevalence (4.8/30.8/16.1%), current uptake of EID (40/95/65%) and six‐week immunization attendance (99/74/94%). Referral rates for infant NAT and maternal ART initiation after screen‐and‐test were 80%. Costs included NAT ($24/infant), maternal screening ($10/mother–infant pair), ART ($5 to 31/month) and HIV care ($15 to 190/month). Model outcomes included mother‐to‐child transmission of HIV (MTCT) among HIV‐exposed infants, and life expectancy (LE) and mean lifetime per‐person costs for children with HIV (CWH) and all children born in 2017. We calculated incremental cost‐effectiveness ratios (ICERs) using discounted (3%/year) lifetime costs and LE for all children. We considered two cost‐effectiveness thresholds in each country: (1) the per‐capita GDP ($1720/6380/2150) per year‐of‐life saved (YLS), and (2) the CEPAC‐generated ICER of offering 2 versus 1 lifetime ART regimens (e.g. offering second‐line ART; $520/500/580/YLS).ResultsWith EID, projected six‐week MTCT was 9.3% (CI), 4.2% (SA) and 5.2% (Zimbabwe). Screen‐and‐test decreased total MTCT by 0.2% to 0.5%, improved LE by 2.0 to 3.5 years for CWH and 0.03 to 0.07 years for all children, and increased discounted costs by $17 to 22/child (all children). The ICER of screen‐and‐test compared to EID was $1340/YLS (CI), $650/YLS (SA) and $670/YLS (Zimbabwe), below the per‐capita GDP but above the ICER of 2 versus 1 lifetime ART regimens in all countries.ConclusionsUniversal maternal HIV screening at immunization visits with referral to EID and maternal ART initiation may reduce MTCT, improve paediatric LE, and be of comparable value to current HIV‐related interventions in high maternal HIV prevalence settings like SA and Zimbabwe. 相似文献
19.
This study examined the relationship between oxidation–reduction potential (ORP) in frozen-thawed semen and the post-thaw sperm parameters. Levels of ORP were measured in 25 samples from men presenting for routine infertility work-up and were expressed as millivolt (mV)/106 sperm/ml. Frozen-thawed samples were examined for post-thaw total motility (TM%), progressive motility (PM%), total sperm count (TSC) and ORP. The cryo-survival rate (CSR) was calculated as post-thaw TM/pre-freeze TM × 100. Data are provided as median and interquartile range (25th and 75th percentiles). The post-thaw TM% (10.0% [4.00%, 15.1%]), PM% (5.88% [2.97%, 9.33%]) and TSC (12.5 [10.0, 17.5] × 106 sperm) were significantly lower than the pre-freeze TM% (45.9% [32.9%, 59.1%], PM% (31.5% [24.4%, 40.0%] and TSC (120 [90, 250] ×106 sperm) (p < .001). Post-thaw ORP (2.62 [2.52, 3.13] mV/106 sperm/ml) was significantly higher than pre-freeze ORP (0.73 [0.54, 1.21] mV/106 sperm/ml; p < .001). The CSR was 21.7% (11.3%, 31.9%). The post-thaw seminal ORP was negatively correlated with post-thaw TM% (r = −.5; p = .02), PM% (r = −.41; p = .03), TSC (r = −.60; p = .03) and CSR (r = −.52; p = .01). Increased levels of ORP are significantly correlated with poor post-thaw sperm quality and CSR. 相似文献
20.
Anna Bogaczewicz Tomasz Sobow Jan Kowalski Jakub Z?bek Anna Wo?niacka Jaroslaw Bogaczewicz 《Reumatologia》2015,53(3):131-138