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排序方式: 共有128条查询结果,搜索用时 46 毫秒
61.
Antibody and clinical responses in volunteers to immunization with malaria peptide-diptheria toxoid conjugates.
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R Ramasamy D A Wijesundere K Nagendran M S Ramasamy 《Clinical and experimental immunology》1995,99(2):168-174
Twenty residue peptides from the 185-200-kD and 45-kD merozoite surface antigens of the malaria parasite Plasmodium falciparum were covalently linked to diphtheria toxoid as a carrier and used to immunize human volunteers with aluminium hydroxide as an adjuvant. Significant antibody levels were elicited by two boosting injections. The antibodies reacted with acetone-methanol fixed merozoite membranes in an immunofluorescence assay, but no inhibition of merozoite reinvasion could be detected in in vitro cultures containing the antibodies. Antibody levels against the immunizing peptides declined markedly within 77 days after the third injection. No hypersensitivity was observed against the peptides. However, the volunteers developed hypersensitivity against diphteria toxoid, and in particular a pronounced type III (Arthus) hypersensitivity after three injections with the toxoid. This effect might appear to limit the use of peptide-diphtheria toxoid conjugates for human immunization. Several biochemical, haematological and immunological tests done on the volunteers showed no other adverse effects from the immunizations. 相似文献
62.
63.
Deep vein thrombosis (DVT) after an unprotected total hip replacement (THR) is common and this review explores the balance between risks and benefits of thrombo-prophylaxis in protecting patients undergoing THR. A literature search for English publications was conducted on Medline & PubMed. Governance bodies and their guidelines were consulted. MESH terms included Deep Vein Thrombosis OR DVT AND Prophylaxis AND Hip AND/OR Surgery AND/OR Total Replacement OR Arthroplasty. THR results in significant risk of thrombo-embolic complications with studies showing that as many as one half of patients suffer from DVT post-operatively. Prophylactic treatments are used to reduce the incidence of DVT. However, there are also risks associated with the use of prophylaxis, including excessive bleeding and major cardio-vascular events. Further investigation is required to determine which patients should be given what prophylaxis and for how long post THR. 相似文献
64.
Camm CF Nagendran M Xiu PY Maruthappu M 《Interactive Cardiovascular and Thoracic Surgery》2011,13(4):410-414
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether performing cryoablative procedures during concomitant cardiac surgical procedures is effective for the treatment of atrial fibrillation (AF). Altogether 291 papers were found using the reported search, of which nine represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All studies showed that cryoablation during concomitant surgery had a significant effect on return to sinus rhythm (SR) conversion rate. One study showed that cryoablation was significantly more effective than mitral valve surgery alone at a 12-month follow-up (73.3% vs. 42.9%, respectively, P=0.013). The use of a concomitant cryoablative procedure has also been shown to be far superior to subsequent catheter based cryoablation in returning patients to SR at a 12-month follow-up (82% and 55.2%, respectively, P<0.001). Another study showed a significant return to AF over a three-year period (91.8% and 84.1% at discharge and three years, respectively). Return to SR was significantly decreased in those patients suffering from permanent rather than paroxysmal AF (47% vs. 85%, P<0.001). Paucity of level 1 evidence was a major limitation to this analysis. All nine papers were either small randomised controlled trials or retrospective studies with small sample sizes (57-521) and varied follow-up regimens. Six of nine studies suggested that cryoablation is most successful in patients suffering from paroxysmal rather than permanent AF. A lack of 24-h monitoring in seven of nine studies prevented effective elucidation of the rate of paroxysmal AF following cryoablation. Only one study suggested an increased complication rate from cryoablation, however, none suggested any negative impact on mortality or morbidity. We conclude that cryoablation during concomitant surgery is a safe and acceptable intervention for the treatment of AF with an SR conversion rate of between 60% and 82% at 12-months postsurgery. 相似文献
65.
Gill RS Al-Adra DP Nagendran J Campbell S Shi X Haase E Schiller D 《Journal of surgical oncology》2011,104(6):692-698
Gastric cancer with peritoneal carcinomatosis has an extremely poor prognosis, which may be improved with cytoreductive surgery (CRS) combined with heated intraperitoneal chemotherapy (HIPEC). We systematically reviewed the literature regarding the efficacy of CRS + HIPEC in these patients. Electronic databases were searched from 2000 to 2010. Following CRS + HIPEC, overall median survival was 7.9 months and improved to 15 months for patients with completeness of cytoreduction scores of 0/1, however with a 30‐day mortality rate of 4.8%. J. Surg. Oncol. 2011; 104:692–698. © 2011 Wiley Periodicals, Inc. 相似文献
66.
Janek M. Senaratne Colleen M. Norris Erik Youngson Robert S. McClure Jayan Nagendran Craig R. Butler Steven R. Meyer Todd J. Anderson Sean van Diepen 《The Canadian journal of cardiology》2019,35(1):61-67
Background
Cardiac surgery waitlist recommendations, which were developed based on expert opinion, poorly predict preoperative mortality. Studies reporting risk factors for waitlist mortality have not evaluated the risks including nonadherence to waitlist benchmarks.Methods
In patients who underwent cardiac surgery or died on the waitlist between 2005 and 2015, we used a Fine and Gray competing risk model to identify independent predictors of waitlist mortality in 12,106 patients scheduled for urgent, semiurgent, or nonurgent surgery. The predictive variables were compared with Canadian Cardiovascular Society (CCS) waitlist recommendations using the Akaike information criterion.Results
A total of 101 (0.8%) patients died awaiting surgery. The median wait times and frequency waitlist deaths among emergent, urgent, semi-urgent, and nonurgent surgery were 0.6, 7.4, 69.0, 55.5 days (P < 0.001) and 6.3%, 0.8%, 0.3%, 0.6% (P < 0.001), respectively. Adherence to CCS waitlist recommendations was higher in patients who died on the waitlist (51.6% vs 70.8%, P = 0.001) and was not predictive of waitlist mortality (hazard ratio 1.48, 95% confidence interval 0.62-0.56). Independent predictors of waitlist mortality were age, aortic surgery, ejection fraction < 35%, urgent surgery, prior myocardial infarction, haemodynamic instability during cardiac catheterization, hypertension, and dyslipidemia. These variables were superior to current CCS guidelines (Akaike information criterion 1251 vs 1317, likelihood ratio test P < 0.001).Conclusions
CCS waitlist recommendations were poorly predictive of waitlist mortality and the majority of waitlist deaths occur within recommended benchmarks. We identified variables associated with waitlist mortality with improved clinical performance. Our findings suggest a need to re-evaluate cardiac surgical triage criteria using evidence-based data. 相似文献67.
Halder Jaydeep Khushwaha Deepak Rai A. B. Nagendran K. Singh B. 《Proceedings of the National Academy of Sciences, India. Section B.》2018,88(1):241-247
Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - Effects of Lecanicillium lecanii alone and in 1:1 combination with neem oil were evaluated against... 相似文献
68.
MacDonald DR Maruthappu M Nagendran M 《Interactive Cardiovascular and Thoracic Surgery》2012,15(1):122-127
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether performing microwave ablative procedures during concomitant cardiac surgical procedures is effective for the treatment of atrial fibrillation (AF). In total, 200 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Major exclusion criteria included studies exclusively using bipolar ablation, ambiguous or unspecified ablation technique, other energy modalities and studies with highly variable or undisclosed follow-up time. One study reported that 66% of patients were in sinus rhythm (SR) with follow-ups ranging from 1 to 14 months and suggested that the risk of AF recurrence was significantly increased with a larger left atrial diameter (OR = 1.21, P = 0.02) and an increased duration of preoperative AF (OR = 2.14, P = 0.03). A separate study found no significant difference in the success rate on the basis of the concomitant procedure (coronary artery bypass grafting or mitral valve surgery, P > 0.5). In the only randomized trial identified, microwave ablation delivered significantly inferior SR restoration rates to radiofrequency (RF) ablation at all time points from discharge to 24 months. There is a large degree of heterogeneity in the studies, with patients' characteristics, for example type of AF, and patient management postoperatively, for example administration of anti-arrhythmias, being inconsistent. Of the 12 studies, nine assessed SR at a mean of 6-12 months and found postoperative success rates between 62 and 87%. One study looked at the medium range follow-up of 24 months with SR restoration at 71%. Two studies looked at the long-term follow-up (5 and 5.37 years) with SR restoration at 39 and 61%, respectively. We conclude that microwave ablation, as an intervention for the treatment of AF during concomitant surgery, is not currently recommended on the limited available evidence. This is because the success rates in the longer term are less clear and the only randomized study to date has found inferior outcomes compared with RF-based ablation. 相似文献
69.
The coalition government's new NHS outcomes framework aims to refocus the NHS on improving outcomes for patients, avoiding the 'bureaucracy' and 'clinical distortions' of previous target-based approaches. The authors argue that its implementation will need a wider focus than on outcomes alone if the underlying goals of the NHS reforms--improving healthcare quality and outcomes in England--are to be achieved. 相似文献
70.
Sabin Bozso Vishnu Vasanthan Jessica GY Luc Katie Kinaschuk Darren Freed Jayan Nagendran 《Canadian respiratory journal》2015,22(1):47-51