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31.
Background
Since a study in orthopedic hip fracture patients demonstrated that a liberal hemoglobin (Hb) threshold does not improve patient morbidity and mortality relative to a restrictive Hb threshold, the standard of care in total joint arthroplasty (TJA) should be examined to understand the variability of red blood cell (RBC) transfusion following TJA.Questions/purposes
The study aimed to answer the following questions: (1) What is the blood utilization rate after primary TJA for individual surgeons within a large hospital network? (2) What is the comparison of hospital charges, length of stay (LOS), and discharge locations among TJA patients who were and were not transfused?Methods
A retrospective study was conducted on 3,750 primary total knee arthroplasties (TKAs) and 2,070 primary total hip arthroplasties (THAs), and data was retrospectively collected over a 15-month period on the number of RBCs transfused per patient, along with demographic and cost details. The number of patients who received at least 1 RBC unit and the number of RBCs transfused per patient was calculated and stratified by surgeon.Results
In the postoperative period, 19.3% TKA patients and 38.5% THA patients received a RBC transfusion. Transfusion rates following TJA varied widely between surgeons (TKA 4.8–63.8%, THA 4.3–86.8%). Transfused TKA patients received an average of 1.65 ± 0.03 RBCs, and THA patients received an average of 1.97 ± 0.14 RBCs. LOS and hospital charges for blood transfusion patients were higher than nontransfused patients.Conclusion
Blood utilization after primary TJA varies greatly among surgeons, suggesting that resources may be misallocated. These findings highlight the need to standardize RBC transfusion practice following TJA.Electronic supplementary material
The online version of this article (doi:10.1007/s11420-013-9327-y) contains supplementary material, which is available to authorized users. 相似文献32.
De Tommasi A Occhiogrosso M De Tommasi C Cimmino A Sanguedolce F Vailati G 《Neurosurgical review》2005,28(2):104-114
It is well known that radiation can induce meningiomas. These tumors usually arise in patients with a history of low-dose radiation to the scalp for treatment of tinea capitis or high-dose radiation for a previous brain tumor. Radiation-associated meningiomas (RAMs) morphologically resemble their spontaneously arising counterparts. However, RAMs frequently present a more malignant phenotype and, as such, are diagnosed as atypical or aggressive meningiomas and occur predominantly in younger patients. This paper describes six cases of radiation-associated intracranial meningiomas in patients previously treated with low-dose radiation to the scalp for tinea capitis. 相似文献
33.
34.
Jimenez C Mathieu J Peinnequin A Carter R Alonso A Melin B 《Aviation, space, and environmental medicine》2008,79(6):570-576
INTRODUCTION: As exercise while wearing protective clothing exacerbates body heat storage compared to exercise in the heat, and as exercise alters immune responses, it appeared worthwhile to examine immune and stress responses while wearing protective clothing during moderate exercise. METHODS: Eight subjects completed two bouts of exercise at 45% Vo2(max) in a thermoneutral environment: once while wearing shorts only (Control trial, CON) and again while wearing protective clothing (PRO). Venous blood samples were taken to analyze TNF-alpha mRNA by RT-PCR in LPS stimulated blood, plasma catecholamines, and cortisol. Blood cell count was analyzed by flow cytometry. Rectal temperature (T(re)) was monitored continuously. RESULTS: Exercise with PRO resulted in significantly greater increases in T(re) (39.2 +/- 0.2 degrees C in PRO vs. 38.0 +/- 0.1 degrees C in CON) and plasma epinephrine and norepinephrine (+70% and 150%, respectively). Plasma cortisol increased only at the end of PRO exercise (+33%). Leukocyte and lymphocyte cell count was 14% and 18% higher, respectively, but there were no significant changes in T cytotoxic and NK cell counts compared to the CON trial. Only T helper lymphocyte count was lower (-29%). During both exercise trials, T helper lymphocytes were significantly decreased at the end of exercise and recovery. With or without protective clothing, exercise was associated with an inhibition of TNF- alpha expression in stimulated monocytes (approximately -50% at min 20 and 40, and approximately -30% at min 60). DISCUSSION: Protective clothing wearing induces significant thermal challenge during exercise. The inhibition of TNF-alpha appears to be mediated primarily by exercise and not the added thermal load associated with protective clothing. 相似文献
35.
SUMMARY: Neurotrophic factors are a family of polypeptides required for survival of discrete neuronal populations. In the normal state such factors are mostly synthesised by target tissues and are used for the viability of the nerve-cell bodies. After nerve injury, neurotrophic factors (NFs) are synthesised by non-neuronal (Schwann cells and fibroblasts) in the nerve trunk, and act to support the outgrowth of axons. NFs can be classified into three major groups: (1) neurotrophins; (2) neurokines; and (3) the transforming growth factor beta (TGF)-beta superfamily. 相似文献
36.
Cogliati AA Vellutini R Nardini A Urovi S Hamdan M Landoni G Guelfi P 《Journal of cardiothoracic and vascular anesthesia》2007,21(6):847-850
OBJECTIVE: The purpose of this study was to evaluate the renoprotective effects of fenoldopam in patients at high risk of postoperative acute kidney injury undergoing elective cardiac surgery requiring cardiopulmonary bypass. DESIGN: A double-blind randomized clinical trial. Setting: Hospital. Participants: One hundred ninety-three patients. Interventions: Patients undergoing cardiac surgery were randomly assigned to receive a continuous infusion of fenoldopam, 0.1 microg/kg/min (95 patients), or placebo (98 patients) for 24 hours. Patients were included if at least 1 of the following risk factors was present: preoperative serum creatinine > or =1.5 mg/dL, age >70 years, diabetes mellitus, or prior cardiac surgery. Serum creatinine and urinary output were measured at baseline (T1), 24 hours (T2), and 48 hours after surgery (T3). Acute kidney injury was defined as a postoperative serum creatinine level of > or =2 mg/dL with an increase in serum creatinine level of 0.7 mg/dL or greater from preoperative to maximum postoperative values. MEASUREMENTS AND MAIN RESULTS: Acute kidney injury developed in 12 of 95 (12.6%) patients receiving fenoldopam and in 27 of 98 (27.6%) patients receiving placebo (p = 0.02), whereas renal replacement therapy was started in 0 of 95 and 8 of 98 (8.2%) patients, respectively (p = 0.004). Serum creatinine was similar at baseline (1.8 +/- 0.4 mg/dL v 1.9 +/- 0.3 mg/dL) in the fenoldopam and placebo groups but differed significantly (p < 0.001 and p < 0.001) 24 hours (1.6 +/- 0.2 mg/dL v 2.5 +/- 0.6 mg/dL) and 48 hours (1.5 +/- 0.3 mg/dL v 2.8 +/- 0.4 mg/dL) after the operation. CONCLUSIONS: A 24-hour infusion of 0.1 mug/kg/min of fenoldopam prevented acute kidney injury in a high-risk population undergoing cardiac surgery. 相似文献
37.
Daniel Muñoz-Velez Fernando Garcia-Montes Antonia Costa-Bauza Felix Grases 《Urological research》2010,38(1):35-39
Most studies on epidemiology, composition, and recurrence of renal calculi include both spontaneously passed calculi and those
retrieved after surgical manipulation or shock wave lithotripsy. The present study exclusively focused on epidemiology, composition,
and recurrence of spontaneously expelled stones in patients from North and East Mallorca (Spain) which represents a geographically
specific non-urban region of a developed country. The study involved 136 patients who spontaneously passed 205 renal calculi.
All calculi were classified and sub-classified according to composition after macroscopic and microscopic examination. We
also analyzed prevalence, gender, age, and stone recurrence rate over a period of 3 years. The peak incidence of spontaneously
stone passage is within the fourth to sixth decade. Overall male to female ratio was 3/1. Calcium oxalate was the most prevalent
composition (64.8%) followed by uric acid (25.3%), mixed stones (5.3%) and calcium phosphate calculi (4.3%). Uric acid stones
were the most recurrent (50%) followed by calcium oxalate monohydrate papillary calculi (26.4%), calcium oxalate monohydrate
un-attached calculi (19.2%), calcium oxalate dihydrate calculi (18.3%), calcium phosphate calculi (14%), and mixed calculi
(12.5%). In conclusion, spontaneously passed stones in Mallorcan population have similar epidemiology, composition, and recurrence
rate from that found in other developed countries. Calcium oxalate stones are largely the most spontaneously passed type of
calculi and uric acid stones are the most frequently recurred. These findings are also found to be similar to those reported
in previous studies examining both spontaneously and non-spontaneously passed stones. 相似文献
38.
E. Leighton Durham Hee Jung Jeong Tyler M. Moore Randolph M. Dupont Carlos Cardenas-Iniguez Zaixu Cui Farrah E. Stone Marc G. Berman Benjamin B. Lahey Antonia N. Kaczkurkin 《Neuropsychopharmacology》2021,46(7):1333
Childhood is an important time for the manifestation of psychopathology. Psychopathology is characterized by considerable comorbidity which is mirrored in the underlying neural correlates of psychopathology. Both common and dissociable variations in brain volume have been found across multiple mental disorders in adult and youth samples. However, the majority of these studies used samples with broad age ranges which may obscure developmental differences. The current study examines associations between regional gray matter volumes (GMV) and psychopathology in a large sample of children with a narrowly defined age range. We used data from 9607 children 9–10 years of age collected as part of the Adolescent Brain Cognitive DevelopmentSM Study (ABCD Study®). A bifactor model identified a general psychopathology factor that reflects common variance across disorders and specific factors representing internalizing symptoms, ADHD symptoms, and conduct problems. Brain volume was acquired using 3T MRI. After correction for multiple testing, structural equation modeling revealed nearly global inverse associations between regional GMVs and general psychopathology and conduct problems, with associations also found for ADHD symptoms (pfdr-values ≤ 0.048). Age, sex, and race were included as covariates. Sensitivity analyses including total GMV or intracranial volume (ICV) as covariates support this global association, as a large majority of region-specific results became nonsignificant. Sensitivity analyses including income, parental education, and medication use as additional covariates demonstrate largely convergent results. These findings suggest that globally smaller GMVs are a nonspecific risk factor for general psychopathology, and possibly for conduct problems and ADHD as well.Subject terms: Human behaviour, Risk factors, Neuroscience 相似文献
39.
Laura Pérez-Egido María Antonia García-Casillas Isabel Simal María Fanjul Agustin Cañizo Julio A. Cerdá Beatriz Fernandez Manuel de la Torre Javier Ordoñez Juan Carlos de Agustin 《Journal of pediatric surgery》2019,54(4):693-695
Introduction
New digital thoracic drainage systems allow an objective measurement of air leakage. They have proven their usefulness in the postoperative thoracic surgery in adults, but there is little experience with its use in the pediatric population. The objective of our study is to analyze their safety and effectiveness in the postoperative period of the pediatric patients.Method
A prospective consecutive observational study was done. All patients submitted to pulmonary resection between 2011 and 2017 and in whom digital thoracic drainage system was used (Thopaz Chest Drain System, Medela, Switzerland) were prospectively enrolled in this study. We analyzed variables: duration of chest tube (CT), days of hospitalization and radiographs in the immediate postoperative period related to the presence of CT. This group was compared with a historical cohort of patients (from 2011 to 2015) with a pulmonary resection in whom the traditional thoracic drainage was used. For the statistical analysis, the Mann–Whitney U-Test was used for independent samples.Result
Twenty-six patients were included, Digital drainage system was used in13 patients and traditional drainage was used in 13 patients. The median age was 18?months (12?days-14?years). The mean number of days with the chest tube was 1.69?±?0.6 in digital drainage group versus 5.38?±?4?days in traditional drainage group (p?<?0.05) The mean number of postoperative radiographs was 2.8?±?1.1 in digital drainage group versus 6.23?±?5.2 radiographs in traditional drainage group (p?<?0.05). The average hospital stay in digital drainage group was 5.69?±?2.7?days versus 7?±?4.7?days in the traditional drainage group (p?>?0.05). No complications related to the use of digital drainage group were registered.Conclusion
The digital thoracic drainage systems provide an objective measurement of air leakage, allowing early chest tube removal and decreasing the number of radiographs performed postoperatively. Its use in the pediatric population appears to be safe and potentially beneficial.Level of evidence
II. 相似文献40.
Hepatitis B virus and hepatitis C virus infections in children 总被引:3,自引:0,他引:3
PURPOSE OF REVIEW: To analyse the most relevant recent information on efficacy, duration and coverage of anti-hepatitis B virus vaccination; correlates of mother-to-child hepatitis C virus transmission; the natural history and outcomes of hepatitis B and C virus infections in children; the efficacy and safety of specific therapies. RECENT FINDINGS: Insufficient hepatitis B virus vaccine coverage and incomplete or delayed vaccine cycles need improvement in many countries. Hepatitis B virus mutants may explain some fulminant hepatitis in perinatally infected infants and vaccine failures. No interventions to prevent vertical hepatitis C virus transmission have been identified. Spontaneous clearance of hepatitis B is lower in children than in adults, while the rates appear to be similar for hepatitis C. The disease progression is slower for both infections in childhood. Several studies support the efficacy and safety of interferons and lamivudine in chronic hepatitis B or of interferons and ribavirin in chronic hepatitis C in children, but the optimal therapy remains unclear. SUMMARY: There are doubts as to the long-term persistence of anti-hepatitis B immunization in low-endemicity areas. Routine hepatitis C virus testing in pregnancy is not recommended as there are no available prophylactic measures. Although hepatitis B and C virus infections are usually asymptomatic or with mild manifestations in childhood, concerns around their long-term clinical impact suggest the need for early treatment. Children should preferably be treated in the context of targeted trials for a better understanding of the efficacy and tolerance of drugs currently used in adults. 相似文献