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211.
Anders Morten Grejs Jakob Gjedsted Kristian Thygesen Jens Flensted Lassen Bodil Steen Rasmussen Anni Nørgaard Jeppesen Christophe Henri Valdemar Duez Eldar Søreide Hans Kirkegaard 《The American journal of medicine》2017,130(1):37-46
Aim
The aim of this study is to evaluate the extent of myocardial injury by cardiac biomarkers during prolonged targeted temperature management of 24 hours vs 48 hours after out-of-hospital cardiac arrest.Methods
This randomized Scandinavian multicenter study compares the extent of myocardial injury quantified by area under the curve (AUC) of cardiac biomarkers during prolonged targeted temperature management at 33°C ± 1°C of 24 hours and 48 hours, respectively. Through a period of 2.5 years, 161 comatose out-of-hospital cardiac arrest patients were randomized to targeted temperature management for 24 hours (n = 77) or 48 hours (n = 84). The AUC was calculated using both high-sensitivity cardiac troponin T (hs-cTnTAUC) and creatine kinase-myocardial band (CK-MBAUC) that were based upon measurements of these biomarkers every 6 hours upon admission until 96 hours after reaching target temperature.Results
The median hs-cTnTAUC of 33,827 ng/L/h (interquartile range [IQR] 11,366-117,690) of targeted temperature management at 24 hours did not differ significantly from that of 28,973 ng/L/h (IQR 10,656-163,655) at 48 hours. In contrast, the median CK-MBAUC of 1829 μg/L/h (IQR 800-6799) during targeted temperature management at 24 hours was significantly lower than that of 2428 μg/L/h (IQR 1163-10,906) within targeted temperature management at 48 hours, P <.05.Conclusion
This study of comatose out-of-hospital cardiac arrest survivors showed no difference between the extents of myocardial injury estimated by hs-cTnTAUC of prolonged targeted temperature management of 48 hours vs 24 hours, although the CK-MBAUC was significantly higher during 48 hours vs 24 hours. Hence, it seems unlikely that the duration of targeted temperature management has a beneficial effect on the extent of myocardial injury after out-of-hospital cardiac arrest, and may even have a worsening effect. 相似文献212.
213.
Christophe Henri Valdemar Duez Mads Qvist Ebbesen Krisztina Benedek Martin Fabricius Mary Doreen Atkins Sandor Beniczky Troels W. Kjaer Hans Kirkegaard Birger Johnsen 《Clinical neurophysiology》2018,129(4):724-730
Objective
To assess inter-rater agreement on EEG-reactivity (EEG-R) in comatose patients and compare it with a quantitative method (QEEG-R).Methods
Six 30-s stimulation epochs (noxious, visual and auditory) were performed during EEG on 19 neurosurgical and 11 cardiac arrest patients. Six experts analysed EEGs for reactivity using their habitual methods. QEEG-R was defined as present if ≥2/6 epochs were reactive (stimulation/rest power ratio exceeding noise level). Three-months patient outcome was assessed by the Cerebral Performance Category Score (CPC) dichotomized in good (1–2) or poor (3–5).Results
Agreement among experts on overall EEG-R varied from 53% to 83% (κ: 0.05–0.64) and reached 100% (κ: 1) between two QEEG-R calculators. For the experts, absence of EEG-R yielded sensitivities for poor outcome between 40–85% and specificities between 20–90%, for QEEG-R sensitivity was 40% (CI: 23–68%) and specificity 100% (CI: 69–100%).Conclusions
There is a large inter-rater variation among experts on EEG-R assessment in comatose patients. QEEG-R is a promising objective prognostic parameter with low inter-rater variation and a high specificity for prediction of poor outcome.Significance
Clinicians should be cautious when using the traditional, qualitative method, in particular in end-of-life decisions. Implementation of the quantitative method in clinical practice may improve reliability of reactivity assessments. 相似文献214.
Etiology-specific outcomes of intracytoplasmic sperm injection in azoospermic patients 总被引:2,自引:0,他引:2
Pasqualotto FF Rossi LM Guilherme P Ortiz V Iaconelli A Borges E 《Fertility and sterility》2005,83(3):606-611
OBJECTIVE: To assess fertilization, pregnancy, and miscarriage rates after intracytoplasmic sperm injection (ICSI) with epididymal or testicular spermatozoa from different types of azoospermia. DESIGN: Retrospective study. SETTING: Academic medical center and private fertility center. PATIENT(S): Two hundred twelve patients underwent 257 ICSI cycles. INTERVENTION(S): Cycles of ICSI were divided into four groups according to the etiology of azoospermia: A (nonobstruction), B (postvasectomy), C (congenital obstruction), and D (obstruction due to infection). Testicular sperm aspiration and percutaneous epididymal sperm aspiration were the sperm retrieval methods used for ICSI. MAIN OUTCOME MEASURE(S): Fertilization, pregnancy, and miscarriage rates. RESULT(S): Normal fertilization rates were higher in groups C (67.7%) and B (64.1%) compared with groups A (47.3%) and D (58.9%). Although lower pregnancy rates were seen in group A, no statistical differences were detected among groups. However, the miscarriage rate was higher in group A (45.6%) compared with groups B (25.25%), C (24%), and D (22.58%). CONCLUSION(S): Although no differences were detected in the pregnancy rates across groups, fertilization and implantation rates were higher in patients with congenital obstruction of the seminal path. The pregnancy rate was higher and the miscarriage rate lower when epididymal sperm was used compared with testicular sperm. 相似文献
215.
216.
Passerotti CC Bonfim A Martins JR Dall'Oglio MF Sampaio LO Mendes A Ortiz V Srougi M Dietrich CP Nader HB 《European urology》2006,49(1):71-75
OBJECTIVE: The purpose of this report is to evaluate the value of urinary hyaluronan (HA) as a maker of residual transitional cell carcinoma (TCC). PATIENTS AND METHODS: Urine samples were collected from 83 patients hospitalized for transurethral resection (TUR). Patient ages ranged from 36 to 86 years. Samples were taken both before and after surgery. HA analysis was performed using an "ELISA-like" fluorometric assay. RESULTS: Patients were divided into two groups: a control group whose previous diagnosis was negative for tumors (n=22) and another with positive diagnosis for tumors (n=61) which was further sub-divided into with and without residual tumor. After the second procedure 47 individuals did not display residual tumor, whereas 14 (23%) did. The average HA in the control group was 8.3 microg/L pre- and 7.1 post-operatively, hence, no change occurred (p=0.471). In the group with TCC patients, the HA dropped from 885.5 microg/L to 215.3 microg/L with residual tumors and from 234.3 microg/L to 11.2 microg/L for those without residual tumor. Using a cut-off value of 20 microg/L, the sensitivity to detect residual tumor is 92.9% and specificity is 83%. CONCLUSION: HA in addition to being one of the best markers for the initial evaluation of bladder carcinoma can be used to determine the presence of a residual tumor. This is associated with poor prognosis. 相似文献
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