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51.
P.S. Myles O. Boney M. Botti A.M. Cyna T.J. Gan M.P. Jensen H. Kehlet A. Kurz G.S. De Oliveira P. Peyton D.I. Sessler M.R. Tramèr C.L. Wu Paul Myles Michael Grocott Bruce Biccard Jane Blazeby Duminda Wijeysundera 《British journal of anaesthesia》2018,120(4):705-711
Background
Maximising patient comfort during and after surgery is a primary concern of anaesthetists and other perioperative clinicians, but objective measures of what constitutes patient comfort in the perioperative period remain poorly defined. The Standardised Endpoints in Perioperative Medicine initiative was established to derive a set of standardised endpoints for use in perioperative clinical trials.Methods
We undertook a systematic review to identify measures of patient comfort used in the anaesthetic, surgical, and other perioperative literature. A multi-round Delphi consensus process that included up to 89 clinician researchers was then used to refine a recommended list of outcome measures.Results
We identified 122 studies in a literature search, which were the basis for a preliminary list of 24 outcome measures and their definitions. The response rates for Delphi Rounds 1, 2, and 3 were 100% (n=22), 90% (n=79), and 100% (n=13), respectively. A final list of six defined endpoints was identified: pain intensity (at rest and during movement) at 24 h postoperatively, nausea and vomiting (0–6 h, 6–24 h, and overall), one of two quality-of-recovery (QoR) scales (QoR score or QoR-15), time to gastrointestinal recovery, time to mobilisation, and sleep quality.Conclusions
As standardised outcomes will support benchmarking and pooling (meta-analysis) of trials, one or more of these recommended endpoints should be considered for inclusion in clinical trials assessing patient comfort and pain after surgery. 相似文献52.
Peyton DH 《Current topics in medicinal chemistry》2012,12(5):400-407
This short review tells the story of how Reversed Chloroquine drugs (RCQs) were developed. These are hybrid molecules, made by combining the quinoline nucleus from chloroquine (CQ) with moieties which are designed to inhibit efflux via known transporters in the membrane of the digestive vacuole of the malaria parasite. The resulting RCQ drugs can have potencies exceeding that of CQ, while at the same time having physical chemical characteristics that may make them favorable as partner drugs in combination therapies. The need for such novel antimalarial drugs will continue for the foreseeable future. 相似文献
53.
54.
Martin D. Zielinski Thomas D. Atwell Peyton W. Davis Michael L. Kendrick Florencia G. Que 《Journal of gastrointestinal surgery》2009,13(1):19-25
Background Polypoid lesions of the gallbladder (PLG) have been a common finding on ultrasound examinations of the abdomen and are more
prevalent since our use of equipment incorporating pulse shaping increased bandwidth, and enhanced phase use for image reconstruction
began in 1996. Our study correlates the pre-operative ultrasonographic findings of these lesions to the surgically resected
specimen with specific regard to identifying neoplastic polyps.
Methods A retrospective review was performed of 130 patients who had a pre-operative ultrasound of the gallbladder and subsequently
underwent cholecystectomy between August 1996 and July 2007 at the Mayo Clinic Rochester.
Results Seventy-nine pseudopolyps (cholesterol polyps, inflammatory polyps, and adenomyomas) and 15 neoplastic polyps were identified
on histopathologic analysis. However, 36 patients (27%) did not have a PLG upon histopathologic analysis. Thirty-one polyps
had suspicious ultrasonographic characteristics for neoplastic changes. Twenty-nine were ≥10 mm, 12 had vascularity, and one
demonstrated invasion. Of these, there were 23 pseudopolyps and six true polyps with neoplastic changes on final pathology
(four dysplastic adenomas and two adenocarcinomas). Three asymptomatic polyps ≤10 mm (4%) in maximum diameter based on pre-operative
ultrasound imaging (US) had neoplastic changes at pathology (two dysplastic adenomas and one adenocarcinoma). Several statistically
significant risk factors were identified that increased the likelihood for malignancy in a PLG: history of primary sclerosing
cholangitis (PSC), local invasion, vascularity, and ≥6 mm maximum diameter based on pre-operative US. Of PLGs ≤10 mm, 7.4%
were neoplastic. Twenty-five patients were followed up with at least two serial ultrasound examinations. Of these, seven demonstrated
polyp growth. None of these specimens demonstrated neoplastic changes. The positive predictive value (PPV) and negative predictive
value (NPV) for ultrasound diagnosing neoplastic changes based on current criteria was 28.5% and 93.1%, respectively, with
a false negative rate of 5.0%. Expanding the criteria to include cholecystectomy for PLGs ≥ 6 mm changes the positive predictive
value and negative predictive value to 18.5% and 100%, respectively, with a false negative rate of 0%.
Conclusion Histopathologic analysis of polypoid lesions of the gallbladder continues to be the gold standard to identify malignancy.
Ultrasound has been used extensively in the pre-operative management of these lesions, but modern ultrasound techniques are
unable to differentiate between benign and malignant PLGs with any certainty. We recommend that strong consideration be given
to surgical resection of PLGs ≥ 6 mm based on pre-operative US due to the significant risk of neoplasm. Additionally, PLGs
in all patients with PSC, any patient in whom diligent long-term follow-up cannot be completed, and lesions that demonstrate
growth, vascularity, invasion, or are symptomatic require cholecystectomy.
Presented at SSAT at the DDW 相似文献
55.
Tsethlikai M Peyton V O'Brien M 《American Indian and Alaska native mental health research (Online)》2007,14(1):63-84
Currently, the majority of American Indian families live in urban areas. A number of statistics demonstrate that urban American Indian families deal with a variety of stressors such as poverty and isolation. However, very little is known about how these families perceive their lives. This report provides an exploratory study examining the status of 20 urban American Indian mother/child dyads. Mothers were asked about the role of American Indian culture in their lives, their views of life in general, and their attributions for their child's mild misbehavior. Two measures of child aggression were collected as well. The links between maternal perceptions and child aggression were complex, indicating the need for more studies of urban American Indian families. 相似文献
56.
57.
Hocker JR Lerner MR Mitchell SL Lightfoot SA Lander TJ Quillet AA Hanas RJ Peyton MD Postier RG Brackett DJ Hanas JS 《Cancer investigation》2011,29(2):173-179
This study evaluated the usefulness of electrospray mass spectrometry to distinguish sera of early-stage pancreatic cancer patients from disease-free individuals. Sera peak data were generated from 33 pancreatic cancer patients and 30 disease-free individuals. A "leave one out" cross-validation procedure discriminated stage I/II pancreatic cancer versus disease-free sera with a p value <.001 and a receiver-operator characteristic curve area value of 0.85. Predictive values for cancer stage I/II test efficiency, specificity, and sensitivity were 78%, 77%, and 79%, respectively. These studies indicate that electrospray mass spectrometry is useful for distinguishing sera of early-stage pancreatic cancer patients from disease-free individuals. 相似文献
58.
Clifford P. Weisel Susan D. Richardson Benoit Nemery Gabriella Aggazzotti Eugenio Baraldi Ernest R. Blatchley III Benjamin C. Blount Kai-H?kon Carlsen Peyton A. Eggleston Fritz H. Frimmel Michael Goodman Gilbert Gordon Sergey A. Grinshpun Dirk Heederik Manolis Kogevinas Judy S. LaKind Mark J. Nieuwenhuijsen Fontaine C. Piper Syed A. Sattar 《Environmental health perspectives》2009,117(4):500-507
Objectives
Recent studies have explored the potential for swimming pool disinfection by-products (DBPs), which are respiratory irritants, to cause asthma in young children. Here we describe the state of the science on methods for understanding children’s exposure to DBPs and biologics at swimming pools and associations with new-onset childhood asthma and recommend a research agenda to improve our understanding of this issue.Data sources
A workshop was held in Leuven, Belgium, 21–23 August 2007, to evaluate the literature and to develop a research agenda to better understand children’s exposures in the swimming pool environment and their potential associations with new-onset asthma. Participants, including clinicians, epidemiologists, exposure scientists, pool operations experts, and chemists, reviewed the literature, prepared background summaries, and held extensive discussions on the relevant published studies, knowledge of asthma characterization and exposures at swimming pools, and epidemiologic study designs.Synthesis
Childhood swimming and new-onset childhood asthma have clear implications for public health. If attendance at indoor pools increases risk of childhood asthma, then concerns are warranted and action is necessary. If there is no such relationship, these concerns could unnecessarily deter children from indoor swimming and/or compromise water disinfection.Conclusions
Current evidence of an association between childhood swimming and new-onset asthma is suggestive but not conclusive. Important data gaps need to be filled, particularly in exposure assessment and characterization of asthma in the very young. Participants recommended that additional evaluations using a multidisciplinary approach are needed to determine whether a clear association exists. 相似文献59.
Aston JE Apel WA Lee BD Peyton BM 《Environmental toxicology and chemistry / SETAC》2009,28(2):279-286
Acidithiobacillus caldus is a thermophilic acidophile found in commercial biomining, acid mine drainage systems, and natural environments. Previous work has characterized A. caldus as a chemolithotrophic autotroph capable of utilizing reduced sulfur compounds under aerobic conditions. Organic acids are especially toxic to chemolithotrophs in low-pH environments, where they diffuse more readily into the cell and deprotonate within the cytoplasm. In the present study, the toxic effects of oxaloacetate, pyruvate, 2-ketoglutarate, acetate, malate, succinate, and fumarate on A. caldus strain BC13 were examined under batch conditions. All tested organic acids exhibited some inhibitory effect. Oxaloacetate was observed to inhibit growth completely at a concentration of 250 microM, whereas other organic acids were completely inhibitory at concentrations of between 1,000 and 5,000 microM. In these experiments, the measured concentrations of organic acids decreased with time, indicating uptake or assimilation by the cells. Phospholipid fatty acid analyses indicated an effect of organic acids on the cellular envelope. Notable differences included an increase in cyclic fatty acids in the presence of organic acids, indicating possible instability of the cellular envelope. This was supported by field emission scanning-electron micrographs showing blebbing and sluffing in cells grown in the presence of organic acids. 相似文献
60.