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41.
High immunogenicity of red blood cell antigens restricted to the population of African descent in a cohort of sickle cell disease patients
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42.
Fernando G. Zampieri Theodore J. Iwashyna Elizabeth M. Viglianti Leandro U. Taniguchi William N. Viana Roberto Costa Thiago D. Corrêa Carlos Eduardo N. Moreira Marcelo O. Maia Giulliana M. Moralez Thiago Lisboa Marcus A. Ferez Carlos Eduardo F. Freitas Clayton B. de Carvalho Bruno F. Mazza Mariza F. A. Lima Grazielle V. Ramos Aline R. Silva Fernando A. Bozza Jorge. I. F. Salluh Marcio Soares for the ORCHESTRA Study Investigators 《Intensive care medicine》2018,44(9):1512-1520
Purpose
Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients’ physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients.Methods
Retrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI). The primary outcome was in-hospital mortality. Secondary outcomes were discharge home without need for nursing care, ICU and hospital length of stay (LOS), and utilization of ICU organ support and transfusion. We used mixed logistic regression and competing risk models accounting for relevant confounders in outcome analyses.Results
The analysis consisted of 129,680 eligible patients. There were 40,779 (31.4%) non-frail (MFI?=?0), 64,407 (49.7%) pre-frail (MFI?=?1–2) and 24,494 (18.9%) frail (MFI?≥?3) patients. After adjusted analysis, frailty was associated with higher in-hospital mortality (OR 2.42, 95% CI 1.89–3.08), particularly in patients admitted with lower SOFA scores. Frail patients were less likely to be discharged home (OR 0.36, 95% CI 0.54–0.79) and had higher hospital and ICU LOS than non-frail patients. Use of all forms of organ support (mechanical ventilation, non-invasive ventilation, vasopressors, dialysis and transfusions) were more common in frail patients and increased as MFI increased.Conclusions
Frailty, as assessed by MFI, was associated with several patient-centered endpoints including not only survival, but also ICU LOS and organ support.43.
44.
Anna Lam MD Thomas Küffer MSc Lukas Hunziker MD Nikolas Nozica MD Babken Asatryan MD PhD Florian Franzeck MD Antonio Madaffari MD Andreas Haeberlin MD PhD Aline Mühl MSc Helge Servatius MD Jens Seiler MD Fabian Noti MD Samuel H. Baldinger MD Hildegard Tanner MD Stephan Windecker MD Tobias Reichlin MD Laurent Roten MD 《Journal of cardiovascular electrophysiology》2021,32(6):1610-1619
45.
Rahili A Karimdjee BS Hastier P Myx A Juwid A Benchimol D Bourgeon A 《Gastroentérologie clinique et biologique》2005,29(5):604-606
Spontaneous rupture of the spleen is a rare complication of chronic calcifying pancreatitis. Anemia and hemorrhagic shock may not occur, making diagnosis more difficult. Favourable response to conservative treatment does not prevent the need for splenectomy, as calcifiying chronic pancreatitis may progress locally. We report three cases of spontaneous rupture of the spleen. In two cases, splenic rupture revealed calcifying chronic pancreatitis and both patients underwent urgent splenectomy. In the third case, the patient was known to have calcifying chronic pancreatitis, and splenectomy was performed because of unsuccessful conservative treatment. We discuss the role of distal pancreatectomy during splenectomy to reduce the rate of postoperative complications and additional surgery. We also discuss the role of arterial embolisation and laparoscopy in the management of this rare condition. 相似文献
46.
Medical marijuana laws and adolescent marijuana use in the United States: a systematic review and meta‐analysis
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Aaron L. Sarvet Melanie M. Wall David S. Fink Emily Greene Aline Le Anne E. Boustead Rosalie Liccardo Pacula Katherine M. Keyes Magdalena Cerdá Sandro Galea Deborah S. Hasin 《Addiction (Abingdon, England)》2018,113(6):1003-1016
Aims
To conduct a systematic review and meta‐analysis of studies in order to estimate the effect of US medical marijuana laws (MMLs) on past‐month marijuana use prevalence among adolescents.Methods
A total of 2999 papers from 17 literature sources were screened systematically. Eleven studies, developed from four ongoing large national surveys, were meta‐analyzed. Estimates of MML effects on any past‐month marijuana use prevalence from included studies were obtained from comparisons of pre–post MML changes in MML states to changes in non‐MML states over comparable time‐periods. These estimates were standardized and entered into a meta‐analysis model with fixed‐effects for each study. Heterogeneity among the study estimates by national data survey was tested with an omnibus F‐test. Estimates of effects on additional marijuana outcomes, of MML provisions (e.g. dispensaries) and among demographic subgroups were abstracted and summarized. Key methodological and modeling characteristics were also described. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed.Results
None of the 11 studies found significant estimates of pre–post MML changes compared with contemporaneous changes in non‐MML states for marijuana use prevalence among adolescents. The meta‐analysis yielded a non‐significant pooled estimate (standardized mean difference) of ?0.003 (95% confidence interval = ?0.012, +0.007). Four studies compared MML with non‐MML states on pre‐MML differences and all found higher rates of past‐month marijuana use in MML states pre‐MML passage. Additional tests of specific MML provisions, of MML effects on additional marijuana outcomes and among subgroups generally yielded non‐significant results, although limited heterogeneity may warrant further study.Conclusions
Synthesis of the current evidence does not support the hypothesis that US medical marijuana laws (MMLs) until 2014 have led to increases in adolescent marijuana use prevalence. Limited heterogeneity exists among estimates of effects of MMLs on other patterns of marijuana use, of effects within particular population subgroups and of effects of specific MML provisions.47.
48.
Giovanni Battistella Julien Niederhauser Eleonora Fornari Loyse Hippolyte Aline Gronchi Perrin Gaetan Lesca Francesca Forzano Patric Hagmann Francois J.G. Vingerhoets Bogdan Draganski Philippe Maeder Sébastien Jacquemont 《Neurobiology of aging》2013
Fragile X-associated tremor/ataxia syndrome (FXTAS), a late-onset movement disorder affecting FMR1 premutation carriers, is associated with cerebral and cerebellar lesions. The aim of this study was to test whether computational anatomy can detect similar patterns in asymptomatic FMR1 premutation carriers (mean age 46.7 years) with qualitatively normal -appearing grey and white matter on brain MRI. We used a multimodal imaging protocol to characterize brain anatomy by automated assessment of gray matter volume and white matter properties. Structural changes in the hippocampus and in the cerebellar motor network with decreased gray matter volume in lobule VI and white matter alterations of the corresponding afferent projections through the middle cerebellar peduncles are demonstrated. Diffuse subcortical white matter changes in both hemispheres, without corresponding gray matter alterations, are only identified through age × group interactions. We interpret the hippocampal fimbria and cerebellar changes as early alterations with a possible neurodevelopmental origin. In contrast, progression of the diffuse cerebral hemispheric white matter changes suggests a neurodegenerative process, leading to late-onset lesions, which may mark the imminent onset of FXTAS. 相似文献
49.
Mechanisms relating Type D personality to poor health are largely unknown, with autonomic nervous system function being a candidate. This study examined the physiologic response to cold stress. Undergraduates (N = 101, 84% female) underwent a cold pressor test. An electrocardiogram, impedance cardiogram, and blood pressure were recorded. Type D personality was assessed by self‐report questionnaire. Type D was associated with increased systolic and diastolic blood pressure reactivity. Exploratory analyses showed Type D men to respond with increased respiratory sinus arrhythmia (i.e., higher parasympathetic activity), and decreased pre‐ejection period (i.e., larger sympathetic activity), while Type D women showed a reciprocal response pattern. In conclusion, Type D personality was associated with an exaggerated hemodynamic response to cold stress, which may contribute to an increased risk of hypertension in Type D individuals. 相似文献
50.
Human plasmacytoid dendritic cells (PDC) are blood dendritic cell antigen 2 (BDCA2) and blood dendritic cell antigen 4 (BDCA4) positive leukocytes that do not express common lineage markers. They have been described as proinflammatory innate immune cells and are the major source of αIFN in the human body. PDC-derived secretion of type I IFNs upon triggering of nucleic acid-sensing toll-like receptors (TLR) primes immune cells to rapidly respond to microbial stimuli and promotes a Th1 response. Here, we report that human PDC express CD36 and CD61 (β3 integrin), both involved in uptake of apoptotic cells and in induction of tolerance. Freshly isolated PDC and PDC within human blood leukocytes constitutively express IL-10. Thus, PDC may possess a so far neglected role in propagation of immune tolerance. 相似文献