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1.
Sergio Bracarda Camillo Porta Corrado Boni Armando Santoro Claudia Mucciarini Antonio Pazzola Enrico Cortesi Donatello Gasparro Roberto Labianca Francesco Di Costanzo Alfredo Falcone Michela Cinquini Claudia Caserta Chiara Paglino Verena De Angelis 《European urology》2013
Background
Sorafenib has proven efficacy in metastatic renal cell carcinoma (mRCC). Interferon (IFN) has antiangiogenic activity that is thought to be both dose- and administration-schedule dependent.Objective
To compare two different schedules of IFN combined with sorafenib.Design, setting, and participants
Single-stage, prospective, noncomparative, randomized, open-label, multicenter, phase 2 study on previously untreated patients with mRCC and Eastern Cooperative Oncology Group performance status 0–2.Intervention
Sorafenib 400 mg twice daily plus subcutaneous IFN, 9 million units (MU) three times a week (Arm A) or 3 MU five times a week (Arm B).Outcome measurements and statistical analysis
Primary end points were progression-free survival (PFS) for each arm and safety. Data were evaluated according to an intent-to-treat analysis.Results and limitations
A total of 101 patients were evaluated. Median PFS was 7.9 mo in Arm A and 8.6 mo in Arm B (p = 0.049) and the median duration of response was 8.5 and 19.2 mo, respectively (p = 0.0013). Nine partial responses were observed in Arm A, and three complete and 14 partial responses were observed in Arm B (17.6% vs 34.0%; p = 0.058); 24 and 21 patients (47% and 42%), respectively, achieved stable disease. The most common grade 3–4 toxicities were fatigue plus asthenia (28% vs 16%; p = 0.32) and hand-foot skin reactions (20% vs 18%).Conclusions
Sorafenib plus frequent low-dose IFN showed good efficacy and tolerability. Further investigations should be warranted to identify a possible positioning of this intriguing regimen (6% complete response rate) in the treatment scenario of mRCC. 相似文献2.
Umberto Capitanio Shahrokh F. Shariat Hendrik Isbarn Alon Weizer Mesut Remzi Marco Roscigno Eiji Kikuchi Jay D. Raman Christian Bolenz Karim Bensalah Theresa M. Koppie Wassim Kassouf Mario I. Fernández Philipp Ströbel Jeffrey Wheat Richard Zigeuner Cord Langner Matthias Waldert Mototsugu Oya Charles C. Guo Casey Ng Francesco Montorsi Christopher G. Wood Vitaly Margulis Pierre I. Karakiewicz 《European urology》2009
Background
Data regarding the oncologic efficacy of laparoscopic nephroureterectomy (LNU) compared to open nephroureterectomy (ONU) are scarce.Objective
We compared recurrence and cause-specific mortality rates of ONU and LNU.Design, setting, and participants
Thirteen centers from three continents contributed data on 1249 patients with nonmetastatic upper tract urothelial carcinoma (UTUC).Measurements
Univariable and multivariable survival models tested the effect of procedure type (ONU [n = 979] vs LNU [n = 270]) on cancer recurrence and cancer-specific mortality. Covariables consisted of institution, age, Eastern Cooperative Oncology Group (ECOG) performance status score, pT stage, pN stage, tumor grade, lymphovascular invasion, tumor location, concomitant carcinoma in situ, ureteral cuff management, previous urothelial bladder cancer, and previous endoscopic treatment.Results and limitations
Median follow-up for censored cases was 49 mo (mean: 62). Relative to ONU, LNU patients had more favorable pathologic stages (pT0/Ta/Tis: 38.1% vs 20.8%, p < 0.001) and less lymphovascular invasion (14.8% vs 21.3%, p = 0.02) and less frequently had tumors located in the ureter (64.5 vs 71.1%, p = 0.04). In univariable recurrence and cancer-specific mortality models, ONU was associated with higher cancer recurrence and mortality rates compared to LNU (hazard ratio [HR]: 2.1 [p < 0.001] and 2.0 [p = 0.008], respectively). After adjustment for all covariates, ONU and LNU had no residual effect on cancer recurrence and mortality (p = 0.1 for both).Conclusions
Short-term oncologic data on LNU are comparable to ONU. Since LNU was selectively performed in favorable-risk patients, we cannot state with certainty that ONU and LNU have the same oncologic efficacy in poor-risk patients. Long-term follow-up data and morbidity data are necessary before LNU can be considered as the standard of care in patients with muscle-invasive or high-grade UTUC. 相似文献3.
Jim C. Hu Chia-Hung Liu Eric G. Treat Alexander Ernest Jeffrey Veale Stacey Carter Kuo-How Huang Jeremy M. Blumberg Peter G. Schulam Hans A. Gritsch 《European urology》2014
Background
Pure laparoscopic donor nephrectomy (LDN) is a unique intervention because it carries known risks and complications, yet carries no direct benefit to the donor. Therefore, it is critical to continually examine and improve quality of care.Objective
To identify factors affecting LDN outcomes and complications.Design, setting, and participants
A retrospective analysis of prospectively collected data for 1204 consecutive LDNs performed from March 2000 through August 2012.Intervention
LDN performed at an academic training center.Outcome measurements and statistical analysis
Using multivariable regression, we assessed the effect of age, sex, body mass index (BMI), laterality, and vascular variation on operative time, estimated blood loss (EBL), complications, and length of stay.Results and limitations
The following variables were associated with longer operative time (data given as parameter estimate plus or minus the standard error): female sex (9.09 ± 2.43; p < 0.001), higher BMI (1.03 ± 0.32; p = 0.001), two (7.87 ± 2.70; p = 0.004) and three or more (22.45 ± 7.13; p = 0.002) versus one renal artery, and early renal arterial branching (5.67 ± 2.82; p = 0.045), while early renal arterial branching (7.81 ± 3.85; p = 0.043) was associated with higher EBL. Overall, 8.2% of LDNs experienced complications, and by modified Clavien classification, 74 (5.9%) were grade 1, 13 (1.1%) were grade 2a, 10 (0.8%) were grade 2b, and 2 (0.2%) were grade 2c. There were no grade 3 or 4 complications. Three or more renal arteries (odds ratio [OR]: 2.74; 95% CI, 1.05–7.16; p = 0.04) and late renal vein confluence (OR: 2.42; 95% CI, 1.50–3.91; p = 0.0003) were associated with more complications. Finally, we did not find an association of the independent variables with length of stay. A limitation is that warm ischemia time was not assessed.Conclusions
In our series, renal vascular variation prolonged operative time and was associated with more complications. While complicated donor anatomy is not a contraindication of LDN, surgical decision-making should take into consideration these results. 相似文献4.
Giuseppe Simone Rocco PapaliaSalvatore Guaglianone Mariaconsiglia FerrieroCostantino Leonardo Ester ForastiereMichele Gallucci 《European urology》2009
Background
Laparoscopic nephroureterectomy (LNU) is increasingly being used instead of open nephroureterectomy (ONU) for the treatment of urothelial carcinoma (UC) of the upper urinary tract (UUT), but the evidence of equal oncologic effectiveness is still lacking.Objective
To present perioperative and oncologic results from a prospective randomised study comparing ONU and LNU.Design, setting, and participants
Eighty patients with nonmetastatic UUT UC and without previous history of UC were enrolled. Of those, 40 patients (group A) randomly received ONU and 40 patients (group B) randomly received LNU.Interventions
ONU was performed through a flank incision with a lower quadrant incision to allow excision of a bladder cuff. Transperitoneal LNU was performed with a four-trocar technique, and bladder cuff was detached with a 10-mm LigaSure device.Measurements
Perioperative data were compared with the student t test. Bladder tumour–free survival (BTFS), metastasis-free survival (MFS), and cancer-specific survival (CSS) curves for both groups were compared with the log-rank test before and after stratifying patients for pT category and tumour grade.Results and limitations
Operative times were comparable, while mean blood loss and mean time to discharge were significantly lower in group B (both p values <0.001). At a median follow-up of 44 mo, BTFS, CSS, and MFS were not significantly different between the two groups (log rank test; BTFS: p = 0.86; CSS: p = 0.2; MFS: p = 0.124). When matched for pT3 and high-grade tumours, CSS and MFS were significantly different between the two groups in favour of ONU (p = 0.039 and p = 0.004, respectively, for pT3 tumours; p = 0.078 and p = 0.014, respectively, for high-grade tumours).The limitations of our study include the small sample size, the single-centre experience, the personal choice of laparoscopic technique, and not performing lymphadenectomies.Perioperative data and preliminary oncologic results were presented at 22nd Congress of the European Association of Urology, Berlin, Germany.Conclusions
In patients with organ-confined UUT UCs, LNU has the advantages of minimal invasiveness and oncologic outcomes comparable to those of ONU, while its effectiveness in patients with advanced stage diseases remains to be proven. 相似文献5.
Objective
To describe patients’ generic health status and health-related quality of life (HRQoL) 12-months following admission to a state-wide burns service.Methods
A total of 114 injured adults with >10% total body surface area burned (TBSA) or burns less than 10% TBSA to smaller anatomical areas such as the hands and feet participated in this study. Retrospective assessment of pre-burn injury status and prospective assessment of generic health and HRQoL were followed up at 3, 6 and 12-months after injury using the 36-item Short Form Health Survey (SF-36 v.2) and Burns Specific Health Scale-Brief (BSHS-B). The SF-36 v.2 was administered retrospectively during the initial hospital stay to assess pre-injury HRQoL. Changes in instruments scores were assessed using multilevel mixed effects regression models. Mean scores were compared over time and between severity groups as defined by <10%, 10–30% and >30% TBSA.Results
For the overall sample, the SF-36 v.2 physical component scale (PCS) score between 3 and 12-months post-burn injury were significantly lower than pre-injury scores (p < 0.01), with no significant change over time for the mental component scale (MCS) (p = 0.36). Significant %TBSA-burden by time interactions highlighted changes from pre-burn injury in overall PCS (p = 0.02), physical functioning (p < 0.001) and role-physical (p = 0.03), with subscales worse for the TBSA >30% group. With respect to the BSHS-B, significant improvement from 3 to 12-months post-burn injury was seen for the entire sample in simple abilities (p < 0.001), hand function (p = 0.001), work (p = 0.01), and treatment regime (p = 0.004) subscales. The TBSA >30% group showed a greater rate of improvement in simple abilities (p = 0.01) and hand function (p = 0.005) between 3 and 12 months post-burn injury.Conclusions
Whilst certain HRQoL measures improve over the 12-months, in most cases they do not reach pre-morbid levels. Patients face ongoing challenges regarding their physical and psychosocial recovery 12-months post-burn injury with respect to generic health and burn-specific health. These challenges vary at different time periods over the 12-month post-burn period, and may provide windows of opportunity in which to address ongoing issues. 相似文献6.
Omar M. Aboumarzouk Robert J. Stein Remi Eyraud Georges-Pascal Haber Piotr L. Chlosta Bhaskar K. Somani Jihad H. Kaouk 《European urology》2012
Context
Centres worldwide have been performing partial nephrectomies laparoscopically for greater than a decade. With the increasing use of robotics, many centres have reported their early experiences using it for nephron-sparing surgery.Objective
To review published literature comparing robotic partial nephrectomy (RPN) with laparoscopic partial nephrectomy (LPN).Evidence acquisition
An online systematic review of the literature according to Cochrane guidelines was conducted from 2000 to 2012 including studies comparing RPN and LPN. All studies comparing RPN with LPN were included. The outcome measures were the patient demographics, tumour size, operating time, warm ischaemic time, blood loss, transfusion rates, length of hospital stay, conversion rates, and complications. A meta-analysis of the results was conducted. For continuous data, a Mantel-Haenszel chi-square test was used; for dichotomous data, an inverse variance was used. Each was expressed as a risk ratio with a 95% confidence interval p < 0.05 considered significant.Evidence synthesis
A total of 717 patients were included, 313 patients in the robotic group and 404 patients in the laparoscopic group (seven studies). There was no significant difference between the two groups in any of the demographic parameters except for age (age: p = 0.006; sex: p = 0.54; laterality: p = 0.05; tumour size: p = 0.62, tumour location: p = 57; or confirmed malignant final pathology: p = 0.79). There was no difference between the two groups regarding operative times (p = 0.58), estimated blood loss (p = 0.76), or conversion rates (p = 0.84). The RPN group had significantly less warm ischaemic time than the LPN group (p = 0.0008). There was no difference regarding postoperative length of hospital stay (p = 0.37), complications (p = 0.86), or positive margins (p = 0.93).Conclusions
In early experience, RPN appears to be a feasible and safe alternative to its laparoscopic counterpart with decreased warm ischaemia times noted. 相似文献7.
Sarah. T. Smailes Rebecca.V. Martin Andrew. J. McVicar 《Burns : journal of the International Society for Burn Injuries》2009
Background
The extubation failure rate in our burn patients is 30%.Objective
To evaluate the influence of the 30 min spontaneous breathing trial on extubation outcome in burn patients.Methods
A prospective, observational study in a burn intensive care unit. All adult patients requiring mechanical ventilation for >24 h and meeting the inclusion criteria underwent a 30 min spontaneous breathing trial (SBT). Extubation was undertaken after a successful SBT.Results
Of 49 planned extubations, 9 failed (18%), much lower than the 30% extubation failure rate identified prior to the implementation of the SBT. The duration of ventilation was significantly shorter (p = 0.04) in the patients who passed a SBT and those who failed extubation were significantly older (p = 0.003). The logistic regression analysis identified that age independently predicted extubation outcome. Patients who failed extubation, after a successful SBT, had a significantly longer duration of ventilation (p = 0.0001) and ITU length of stay (p = 0.001).Conclusions
The incidence of extubation failure was much lower and the duration of ventilation significantly shorter in patients who were extubated after a successful SBT. These findings support the use of the SBT in burn patients. Age independently predicts extubation outcome in burn patients who have passed a SBT. 相似文献8.
Daniel E. Spratt Chi Zhang Zachary S. Zumsteg Xin Pei Zhigang Zhang Michael J. Zelefsky 《European urology》2013
Background
In vitro data and early clinical results suggest that metformin has desirable antineoplastic effects and has a theoretical benefit on castration-resistant prostate cancer (CRPC).Objective
To determine whether the use of metformin would be associated with improved clinical outcomes and a reduction in the development of CRPC.Design, setting, and participants
Data from 2901 consecutive patients (157 metformin, 162 diabetic non-metformin, and 2582 nondiabetic) with localized prostate cancer treated with external-beam radiation therapy from 1992 to 2008 were collected from a single institution in the United States.Intervention
Use of metformin in localized prostate cancer.Outcome measurements and statistical analysis
Univariate and multivariate regression models utilizing k-sample, Fine and Gray, Cox regression, log-rank, and Kaplan-Meier methods to assess prostate-specific antigen-recurrence-free survival (PSA-RFS), distant metastases-free survival (DMFS), prostate cancer–specific mortality (PCSM), overall survival (OS), and development of CRPC.Results and limitations
With a median follow-up of 8.7 yr, the 10-yr actuarial rates for metformin, diabetic non-metformin, and nondiabetic patients for PCSM were 2.7%, 21.9%, and 8.2% (log-rank p ≤ 0.001), respectively. Metformin use independently predicted (correcting for PSA, T stage, Gleason score, age, diabetic status, and androgen-deprivation therapy use) improvement in all outcomes compared with the diabetic non-metformin group; PSA-RFS (hazard ratio [HR]: 1.99 [1.24–3.18]; p = 0.004), DMFS (adjusted HR: 3.68 [1.78–7.62]; p < 0.001), and PCSM (HR: 5.15 [1.53–17.35]; p = 0.008). Metformin use was also independently associated with a decrease in the development of CRPC in patients experiencing biochemical failure compared with diabetic non-metformin patients (odds ratio: 14.81 [1.83–119.89]; p = 0.01). The retrospective study design was the primary limitation of the study.Conclusions
To our knowledge, our results are the first clinical data to indicate that metformin use may improve PSA-RFS, DMFS, PCSM, OS, and reduce the development of CRPC in prostate cancer patients. Further validation of metformin's potential benefits is warranted. 相似文献9.
Rana R. McKay Xun Lin Julia J. Perkins Daniel Y.C. Heng Ronit Simantov Toni K. Choueiri 《European urology》2014
Background
Bone metastases (BMs) are frequently present in patients with metastatic renal cell carcinoma (mRCC) and cause significant morbidity.Objective
The purpose of this analysis was to assess the impact of BMs and bisphosphonate therapy (BT) on outcomes in mRCC.Design, setting, and participants
We conducted a pooled analysis of patients with mRCC treated from 2003 to 2011 in phase 2 and 3 trials.Outcome measurements and statistical analysis
Statistical analyses were performed using Cox regression and the Kaplan-Meier method.Results and limitations
We identified 2749 patients treated with sunitinib (n = 1059), sorafenib (n = 355), axitinib (n = 359), temsirolimus (n = 208), temsirolimus plus interferon-α (IFN-α) (n = 208), or IFN-α (n = 560), with 28% (n = 781) having BMs. A total of 285 patients (10.4%) received BT. The presence of BMs in patients was associated with shorter overall survival (OS) when compared with patients without BMs (13.2 vs 20.2 mo, respectively; p < 0.0001) and shorter progression-free survival (PFS) (5.1 vs 6.7 mo, respectively; p < 0.0008). When stratified by risk groups, the presence of BMs was associated with shorter OS in all risk groups. The use of BT in patients with BMs was not associated with improved OS compared with patients who did not receive BT (13.3 vs 13.1 mo, respectively; p = 0.3801) or improved PFS (5.1 vs 4.9 mo, respectively; p = 0.1785). Bisphosphonate users with BMs did not have a decreased rate of skeletal-related events (SREs) compared with nonusers (8.6% vs 5.8%, respectively; p = 0.191). In addition, BT was associated with increased rates of hypocalcemia, renal insufficiency, and osteonecrosis of the jaw (p < 0.0001). Data were analyzed retrospectively.Conclusions
We confirm that the presence of BMs is associated with shorter survival in mRCC. BT did not affect survival or SRE prevention and was associated with increased toxicity.Patient summary
In this analysis, we demonstrate that bone metastases are associated with shorter survival in patients with metastatic renal cell carcinoma. In addition, we call into question the utility of bisphosphonate therapy in this population. 相似文献10.
Background
Technical errors (TE) that occur during surgery for treating fractures are considered as being preventable by good preoperative planning and surgeon education. This prospective study evaluated a new instructional method for improving surgical outcomes that involved assessing surgeons’ own recent performances.Methods
Postoperative radiographs from two groups of patients were assessed during consecutive 4-month periods. 350 operations were included in the Early Group and 411 operations in the Late Group. All the TE that occurred during the first period were reviewed and discussed among the residents and the consultant surgeons who had performed those operations. The same procedure was followed 4 months later. The TE were classified as minor, moderate and major.Results
The two groups included the same 41 surgeons. The most common TE were: insufficient reduction, varus and valgus malalignment and prominent hardware. The total number of errors dropped significantly, from 52 (14.7%) during the first period to 26 (6.3%) during the second period (p = 0.0003). The TE score severity dropped from 81 to 38, respectively (p = 0.0001). The most affected regions were, the humerus (p < 000.1), midshaft femur (p = 0.007), proximal femur (p = 0.004) and radius (p = 0.008). Most of the gains were made in the moderate category (p = 0.0001). The consultants performed statistically better than the residents in the first period (12% vs. 20%, p = 0.036), but almost similar to the residents in the second period (5.3% vs. 9%, p = 0.164). A TE index was calculated by dividing the accumulated sum by the number of operations and it dropped in both groups from 0.2 and 0.3 to 0.09 and 0.09, respectively.Conclusion
Intraoperative TE can be significantly reduced by periodic performance evaluations in a seminar setting during which groups of surgeons can review the TE that they and their colleagues had made during recent orthopaedic surgical procedures.Level of Evidence: Level II. 相似文献11.
Kathelijne M. Groeneveld Falco Hietbrink Timothy C. Hardcastle Brian L. Warren Leo Koenderman Luke P.H. Leenen 《Injury》2014
Introduction
Trauma is one of the major causes of morbidity and mortality. Thoracic injuries are associated with inflammatory complications such as ARDS. The pathogenesis of this complication after pulmonary injury is incompletely understood, but neutrophils are thought to play a pivotal role. The aim of this project was to gain more insight in the role of thoracic injuries in the pathophysiological processes that link systemic neutrophil activation with inflammatory complications after trauma.Methods
In this prospective cohort study fifty-five patients with isolated penetrating thoracic injury were included at a level one Trauma Unit. Blood samples were analysed for neutrophil phenotype with the use of flowcytometry within 3 h of trauma and repeated six and 24 h after injury. The presence of inflammatory complications (e.g. ARDS or sepsis/septic shock) was assessed during admission, and this was related to the neutrophil phenotpe.Results
The clinical follow-up of fifty-three patients was uneventful. Only two patients developed an inflammatory complication. Within 3 h after trauma, neutrophils showed a decreased expression of FcγRII (p = 0.007) and FcγRIII (p = 0.001) compared to healthy individuals. After 6 h, expression of active FcγRII (p = 0.017), C5aR (p = 0.004) and CAECAM8 (p = 0.043) increased, whereas L-selectin (p = 0.002) decreased. After 24 h also CXCR-2 (CD182) expression increased compared to healthy individuals (p = 0.001).Conclusions
Penetrating thoracic trauma leads to a distinct primed activation status of circulating neutrophils within hours. In addition to activation of cells, both young and reverse migrated neutrophils are released into the circulation. This degree of systemic inflammation does not exceed a threshold of inflammation that is needed for the development of inflammatory complications like ARDS. 相似文献12.
Roberto Eljaiek Marc-Jacques Dubois 《Burns : journal of the International Society for Burn Injuries》2013
Objective
Hypoalbuminemia is a common finding in burned patients, but its association with increased morbidity and mortality has not been well established. We assessed whether hypoalbuminemia in the first 24 h of admission is associated with organ dysfunction in patients with severe burns.Methods
For a two year period (2008–2009), we reviewed the records of burn adult patients with a total body surface area 20% admitted in our unit within the first 24 h of injury. A multiple linear regression analysis was conducted to assess hypoalbuminemia as an independent predictor of organ dysfunction.Results
56 subjects were analyzed. Multiple linear regression analysis showed that hypoalbuminemia in the first 24 h of admission was an independent predictor of organ dysfunction. Serum albumin concentration ≤30 g/L was associated with a two-fold increase in organ dysfunction [SOFA scores at day 0 (p = 0.005), day 1 (p = 0.005) and first week mean values (p = 0.004)], but not with mortality (p = 0.061).Conclusion
Hypoalbuminemia is associated with organ dysfunction in burned patients. Unlike unmodifiable predictors such as age, burn surface and inhalation burn, correction of hypoalbuminemia might represent a goal for a future trial in burn patients. 相似文献13.
Background
Intravesical injection of botulinum toxin type A (BoNTA) provides effective treatment for detrusor overactivity and overactive bladder (OAB). However, the high rates of treatment-related adverse events (AEs) prevent its more widespread use.Objective
To investigate the risk factors of increasing AEs after BoNTA injection for idiopathic detrusor overactivity (IDO).Design, setting, and participants
This study included a total of 217 patients receiving their first intravesical BoNTA injection for refractory IDO in a tertiary university hospital from 2004 to 2009.Measurements
AE incidence was analyzed according to gender, age, comorbidities, prostate condition in men, OAB subtype, BoNTA dose, injection site, and baseline urodynamic parameters. Successful outcome was determined based on patient perception of improvement of bladder condition at 3 mo.Results and limitations
Successful outcomes were reported by 144 (66.3%) patients. By multivariable analysis, male gender (p = 0.013) and baseline postvoid residual (PVR) ≥100 ml (p = 0.003) were independent predictors of acute urinary retention (AUR). Baseline PVR ≥100 ml (p = 0.007) and receiving >100 U BoNTA (p = 0.029) were predictors of straining to void. The incidence of large PVR after treatment was associated with comorbidity (p = 0.011). Urinary tract infection occurred more frequently in women (p = 0.003) and in men with retaining prostate (p = 0.008). No AUR developed after bladder base/trigonal injection. Nevertheless, the occurrence of AUR or large PVR did not affect therapeutic outcome. This study is limited by nonconsecutive enrollment of patients.Conclusions
Male gender, baseline PVR ≥100 ml, comorbidity, and BoNTA dose >100 U are risk factors for increasing incidence of AEs after intravesical BoNTA injection for IDO. 相似文献14.
Eveline H. Shue Samuel C. Schecter Wenhui Gong Mozziyar Etemadi Michael Johengen Corey Iqbal S. Christopher Derderian Peter Oishi Jeffrey R. Fineman Doug Miniati 《Journal of pediatric surgery》2014
Purpose
Pulmonary hypertension (pHTN), a main determinant of survival in congenital diaphragmatic hernia (CDH), results from in utero vascular remodeling. Phosphodiesterase type 5 (PDE5) inhibitors have never been used antenatally to treat pHTN. The purpose of this study is to determine if antenatal PDE5 inhibitors can prevent pHTN in the fetal lamb model of CDH.Methods
CDH was created in pregnant ewes. Postoperatively, pregnant ewes received oral placebo or tadalafil, a PDE5 inhibitor, until delivery. Near term gestation, lambs underwent resuscitations, and lung tissue was snap frozen for protein analysis.Results
Mean cGMP levels were 0.53 ± 0.11 in placebo-treated fetal lambs and 1.73 ± 0.21 in tadalafil-treated fetal lambs (p = 0.002). Normalized expression of eNOS was 82% ± 12% in Normal-Placebo, 61% ± 5% in CDH-Placebo, 116% ± 6% in Normal-Tadalafil, and 86% ± 8% in CDH-Tadalafil lambs. Normalized expression of β-sGC was 105% ± 15% in Normal-Placebo, 82% ± 3% in CDH-Placebo, 158% ± 16% in Normal-Tadalafil, and 86% ± 8% in CDH-Tadalafil lambs. Endothelial NOS and β-sGC were significantly decreased in CDH (p = 0.0007 and 0.01 for eNOS and β-sGC, respectively), and tadalafil significantly increased eNOS expression (p = 0.0002).Conclusions
PDE5 inhibitors can cross the placental barrier. β-sGC and eNOS are downregulated in fetal lambs with CDH. Antenatal PDE5 inhibitors normalize eNOS and may prevent in utero vascular remodeling in CDH. 相似文献15.
Nadia J. Brown Roy M. Kimble Sylvia Rodger Robert S. Ware Brett C. McWhinney Jacobus P.J. Ungerer Leila Cuttle 《Burns : journal of the International Society for Burn Injuries》2014
Background
Burns and their associated wound care procedures evoke significant stress and anxiety, particularly for children. Little is known about the body's physiological stress reactions throughout the stages of re-epithelialization following an acute burn injury. Previously, serum and urinary cortisol have been used to measure stress in burn patients, however these measures are not suitable for a pediatric burn outpatient setting.Aim
To assess the sensitivity of salivary cortisol and sAA in detecting stress during acute burn wound care procedures and to investigate the body's physiological stress reactions throughout burn re-epithelialization.Methods
Seventy-seven participants aged four to thirteen years who presented with an acute burn injury to the burn center at the Royal Children's Hospital, Brisbane, Australia, were recruited between August 2011 and August 2012.Results
Both biomarkers were responsive to the stress of burn wound care procedures. sAA levels were on average 50.2 U/ml higher (p < 0.001) at 10 min post-dressing removal compared to baseline levels. Salivary cortisol levels showed a blunted effect with average levels at ten minutes post dressing removal decreasing by 0.54 nmol/L (p < 0.001) compared to baseline levels. sAA levels were associated with pain (p = 0.021), no medication (p = 0.047) and Child Trauma Screening Questionnaire scores at three months post re-epithelialization (p = 0.008). Similarly, salivary cortisol was associated with no medication (p < 0.001), pain scores (p = 0.045) and total body surface area of the burn (p = 0.010).Conclusion
Factors which support the use of sAA over salivary cortisol to assess stress during morning acute burn wound care procedures include; sensitivity, morning clinic times relative to cortisol's diurnal peaks, and relative cost. 相似文献16.
Beatriz C. Nunes João Batista dos Santos GarciaRioko Kimiko Sakata 《Brazilian Journal of Anesthesiology》2014
Background and objectives
The medications used according to the recommendation of the World Health Organization do not promote pain relief in a number of patients with cancer pain. The aim of this study was to evaluate the use of morphine as first medication for the treatment of moderate cancer pain in patients with advanced and/or metastatic disease, as an option to the recommendations of the World Health Organization analgesic ladder.Method
Sixty patients without opioid therapy, with ≥18 years of age, were randomized into two groups. G1 patients received medication according to the analgesic ladder and started treatment with non‐opioids in the first, weak opioids in the second, and strong opioids in the third step; G2 patients received morphine as first analgesic medication. The efficacy and tolerability of initial use of morphine were evaluated every two weeks for three months.Results
The groups were similar with respect to demographic data. There was no significant difference between the groups regarding pain intensity, quality of life, physical capacity, satisfaction with treatment, need for complementation and dose of morphine. In G1 there was a higher incidence of nausea (p = 0.0088), drowsiness (p = 0.0005), constipation (p = 0.0071) and dizziness (p = 0.0376) in the second visit and drowsiness (p = 0.05) in the third.Conclusions
The use of morphine as first medication for pain treatment did not promote better analgesic effect than the ladder recommended by World Health Organization, with higher incidence of adverse effects. 相似文献17.
Yoo Seok Park Young Hwan Choi Hye Sun Lee Duk Ju Moon Seon Gyu Kim Jong Ho Lee Jin Kyung Cho Cheon Jae Yoon 《Burns : journal of the International Society for Burn Injuries》2013
Objective
We aimed to analyze whether laser Doppler imaging (LDI) can lead to earlier decision-making regarding the need for surgery in adults with indeterminate burns.Methods
In a retrospective cohort study, we developed a prediction model for surgery in adults with indeterminate burns. Patient data (n = 101) from January 2007 to December 2009 were used for model development, and those (n = 40) from January 2010 to October 2010 for external validation.Results
Between non-surgical and surgical groups, there were significant differences for mean age (p = 0.009), % total body surface area burn (p = 0.016), site of burn wound (p = 0.033), and mean perfusion units (PU) (p < 0.001). Multiple logistic regression showed that only the mean PU differed significantly between the groups. The area under the curve (AUC) of the equation derived from multiple logistic regression was 0.938, which did not differ from that of the mean PU alone (0.931; p = 0.453). Using a cut-off point of 154.7PU, the sensitivity of LDI was 78.3% and the specificity was 92.7%. This cut-off point also yielded a sensitivity of 77.8% and specificity of 95.5% in the external validation dataset.Conclusion
LDI can help make a decision for surgery in the early stages of care for adults with indeterminate burns. 相似文献18.
Objective
Our study aimed to determine whether the displacement and morphology of a fragment in femur fracture with Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association/32-B/32-C (AO/OTA/32-B/32-C) classification affect the outcomes following closed reduction and internal fixation with an interlocking nail.Design
This was a retrospective study.Setting
The study was conducted at a Level III trauma centre.Patients
A total of 50 consecutive patients presenting femoral shaft fracture with AO/OTA-type 32-B/32-C were included in the present study.Interventions
Patients were divided into two groups according to the displacement of the fragments. In the large displacement group, patients were further subgrouped according to whether a reversed morphology of the fragment was present.Outcomes measurement
The radiographic union score of femur (RUSF), the mean union time and the re-operation rate were assessed.Results
The union rate of small- and large-gap groups at 12 months postoperatively was 75.9% and 21.1%, respectively (p = 0.000). The mean union time of those union cases in these two groups was 7.8 and 13.0 months, respectively (p = 0.000). The union rate of the non-reversed and reversed groups at 12 months postoperatively was 30% and 11.1%, respectively (p = 0.179). The mean RUSF at 12 months in the non-reversed and reversed groups was 8.8 and 8.3, respectively (p = 0.590). However, we found that patients presenting a reversed fragment had an increased risk of more than one re-operation (p = 0.030).Conclusions
A fragmentary displacement of >1 cm in AO/OTA-type 32-B/32-C femoral shaft fracture after nailing affected bone healing. Among the large-gap group patients, an unreduced reverse fragment presented a negative prognostic factor for re-operation.Level of evidence
Prognostic level III. 相似文献19.
Stephen B. Williams Mehrdad Alemozaffar Yin Lei Nathanael Hevelone Stuart R. Lipsitz Blakely A. Plaster Jim C. Hu 《European urology》2010
Background
Transperitoneal robot-assisted laparoscopic prostatectomy (RALP) urethrovesical anastomosis is a critical step. Although the prevalence of urine leaks ranges from 4.5% to 7.5% at high-volume RALP centers, urine leaks prolong catheterization and may lead to ileus, peritonitis, and require intervention. Barbed polyglyconate sutures maintain running suture line tension and may be advantageous in RALP anastomosis for reducing this complication.Objective
To compare barbed polyglyconate and polyglactin 910 (Vicryl, Ethicon, Somerville, NJ, USA) running sutures for RALP anastomosis.Design, setting, and participants
This was a prospective, randomized, controlled, single-surgeon study comparing RALP anastomosis using either barbed polyglyconate (n = 45) or polyglactin 910 (n = 36) sutures.Surgical procedure
RALP anastomosis using either barbed polyglyconate or polyglactin 910 sutures was studied.Measurements
Operative time, cost differential, perioperative complications, and cystogram contrast extravasation by anastomosis suture type were measured.Results and limitations
Although baseline characteristics and overall operative times were similar, barbed polyglyconate sutures were associated with shorter mean anastomosis times of 9.7 min versus 9.8 min (p = 0.014). In addition, anastomosis with barbed polyglyconate rather than polyglactin 910 sutures was associated with more frequent cystogram extravasation 8 d postoperatively (20.0% vs 2.8%; p = 0.019), longer mean catheterization times (11.1 d vs 8.3 d; p = 0.048), and greater suture costs per case ($51.52 vs $8.44; p < 0.001). After 8 of 29 (27.6%) barbed polyglyconate anastomosis sites demonstrated postoperative day 8 cystogram extravasation, we modified our technique to avoid overtightening, reducing cystogram extravasation to 1 (6.3%) of 16 subsequent barbed polyglyconate anastomosis sites. Potential limitations include small sample size and the single-surgeon study design.Conclusions
Compared to traditional sutures, barbed polyglyconate is more costly and requires technical modification to avoid overtightening, delayed healing, and longer catheterization time following RALP. 相似文献20.