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81.
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Martin B. Brodsky Jonathan E. Gellar Victor D. Dinglas Elizabeth Colantuoni Pedro A. Mendez-Tellez Carl Shanholtz Jeffrey B. Palmer Dale M. Needham 《Journal of critical care》2014
Purpose
The purpose of this study is to evaluate demographic and clinical factors associated with self-reported dysphagia after oral endotracheal intubation and mechanical ventilation in patients with acute lung injury (ALI).Materials and methods
This is a prospective cohort study of 132 ALI patients who had received mechanical ventilation via oral endotracheal tube.Results
The primary outcome was binary, whether clinically important symptoms of dysphagia at hospital discharge were reported by patients, using the Sydney Swallowing Questionnaire score 200 or more. Of 132 patients, 29% reported clinically important symptoms of dysphagia. Of 18 relevant demographic and clinical variables, only 2 were found to be independently associated with clinically important symptoms of dysphagia in a multivariable logistic regression model: upper gastrointestinal comorbidity (odds ratio, 2.82; 95% confidence interval, 1.09-7.26) and duration of oral endotracheal intubation (odds ratio, 1.79; [95% confidence interval, 1.15-2.79] per day for first 6 days, after which additional days of intubation were not associated with a further increase in the odds of dysphagia).Conclusions
In ALI survivors, patient-reported, postexubation dysphagia at hospital discharge was significantly associated with upper gastrointestinal comorbidity and a longer duration of oral endotracheal intubation during the first 6 days of intubation. 相似文献83.
B Ryczko L Brodsky J F Stanievich R Pordell 《International journal of pediatric otorhinolaryngology》1988,16(3):245-251
Spontaneous (congenital) cerebrospinal fluid (CSF) otorrhea is a rare occurrence with less than 100 cases being reported in the literature. In infants and children, it may present as otitis media with effusion. A 4-month-old infant, who was diagnosed with severe to profound sensorineural hearing impairment and spontaneous CSF otorrhea, initially presented with otitis media with effusion. The patient presentation, diagnostic dilemmas and pathophysiology of this rare but interesting problem are discussed. 相似文献
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Mark D Stewart Diana Merino Vega Rebecca C Arend Jonathan F Baden Olena Barbash Nike Beaubier Grace Collins Tim French Negar Ghahramani Patsy Hinson Petar Jelinic Matthew J Marton Kimberly McGregor Jerod Parsons Lakshman Ramamurthy Mark Sausen Ethan S Sokol Albrecht Stenzinger Hillary Stires Kirsten M Timms Diana Turco Iris Wang J Andrew Williams Elaine Wong-Ho Jeff Allen 《The oncologist》2022,27(3):167
BackgroundHomologous recombination deficiency (HRD) is a phenotype that is characterized by the inability of a cell to effectively repair DNA double-strand breaks using the homologous recombination repair (HRR) pathway. Loss-of-function genes involved in this pathway can sensitize tumors to poly(adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibitors and platinum-based chemotherapy, which target the destruction of cancer cells by working in concert with HRD through synthetic lethality. However, to identify patients with these tumors, it is vital to understand how to best measure homologous repair (HR) status and to characterize the level of alignment in these measurements across different diagnostic platforms. A key current challenge is that there is no standardized method to define, measure, and report HR status using diagnostics in the clinical setting.MethodsFriends of Cancer Research convened a consortium of project partners from key healthcare sectors to address concerns about the lack of consistency in the way HRD is defined and methods for measuring HR status.ResultsThis publication provides findings from the group’s discussions that identified opportunities to align the definition of HRD and the parameters that contribute to the determination of HR status. The consortium proposed recommendations and best practices to benefit the broader cancer community.ConclusionOverall, this publication provides additional perspectives for scientist, physician, laboratory, and patient communities to contextualize the definition of HRD and various platforms that are used to measure HRD in tumors. 相似文献
86.
Courtney S. Streur Ethan A. Smith Jonathan R. Dillman Kate H. Kraft 《Canadian Urological Association journal》2022,16(1):E15
IntroductionAcoustic radiation force imaging (ARFI) is a recently developed form of ultrasound imaging that allows in vivo measurement of tissue stiffness. This technology could be useful at predicting bladder compliance in children. We hypothesize that tissue stiffness, as measured by ARFI, correlates with abnormal bladder compliance and capacity in patients with bladder dysfunction.MethodsPatients who presented for cystometrography (CMG) underwent ARFI of the bladder wall. Nine bladder wall shear wave speed (SWS) measurements were acquired using point and 2D ultrasound shear wave elastography. The mean for each ARFI technique was correlated to bladder compliance, calculated using Wahl’s dimensionless number. ARFI parameters also were correlated with bladder capacity.ResultsA total of 25 patients were enrolled. Mean age at time of enrollment was 4.2±3.9 years (range two months to 15 years). There was no significant correlation between bladder compliance and point shear wave speed measurements (r=−0.22, p=0.31) or 2D shear wave speed measurements (r=−0.35, p=0.1). A total of 19 patients had bladder capacity below expected bladder capacity (EBC). There was no significant correlation between bladder capacity and point shear wave speed measurements (r =−0.08, p=0.7) or 2D shear wave speed measurements (r=−0.36, p=0.09).ConclusionsOur results did not demonstrate a significant correlation between bladder wall ARFI shear wave measurements and bladder compliance or bladder capacity. Further studies are warranted to determine whether ARFI may be used to predict abnormal urodynamic parameters in children. 相似文献
87.
Jesse Ory Sirpi Nackeeran Udi Blankstein Joshua T. White Ethan Grober Sheldon H. Marks Ranjith Ramasamy 《Canadian Urological Association journal》2022,16(3):E132
IntroductionVasectomy reversal (VR) represents an excellent option for paternity in men who desire to expand their family following vasectomy. Traditional VR via vasovasostomy has a success rate upwards of 90%1,2 but when sperm or sperm parts are not present in vasal fluid, epididymovasostomy (EV) must be performed instead. Our objective was to determine which factors influence success after bilateral EV.MethodsA prospectively maintained database with data from the U.S. and Canada was used to identify men who underwent bilateral EV at time of VR. Success was defined as motile sperm in any postoperative semen analyses. Multivariable logistic regression was used to identify predictors of success.ResultsA total of 200 men had at least one postoperative semen analysis, and 171 men were included in the analysis. Average age was 44.7 years, with average followup of seven months. Median time elapsed between vasectomy and EV was 15 years (interquartile range [IQR] 10–18). Overall success rate was 50%. Despite the study being adequately powered, factors such as years since vasectomy (odds ratio [OR] 1.01, confidence interval [CI] 0.95–1.06), age (OR 0.96, CI 0.91–1.01), intraoperative presence of motile sperm (OR 0.81, CI 0.41–1.62), and epidydimal fluid characteristics did not predict success.ConclusionsBilateral EV at time of VR is successful in 50% of cases in a multi-institutional, North American cohort. Microsurgeons can be reassured that neither time elapsed nor epididymal fluid characteristics negatively impact success rates as long as sperm or sperm parts are present. Surgeons performing VR should be comfortable and prepared to perform EV if indicated. 相似文献
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Uganda suffered four Ebola and five Marburg virus outbreaks from 2000 to 2012 with significant health worker mortality. This paper describes findings from 41 interviews with health workers from three outbreaks. Interviewees frequently encountered stigma from their communities, sometimes accompanied by mistrust and violence. These difficulties were defined as ‘challenges of society.’ Health workers also suffered emotional trauma, depressive symptoms, and fear classified as ‘challenges of psyche.’ As the incidence of such outbreaks will likely increase due to ecological and economic trends, health workers require greater access to personal protective equipment (PPE) and knowledge of viral containment. Such improvements would create an optimal psychosocial climate for managing infectious patients ultimately decreasing the severity of future outbreaks. 相似文献