Background:This meta-analysis was performed to review the effects of the addition of modified ultrafiltration (MUF) and conventional ultrafiltration (CUF) to CUF alone on postoperative hemoglobin, surgical and ultrafiltration data, and postoperative clinical outcomes in pediatric patients undergoing cardiac surgery.Methods:A systematic search was performed to identify randomized controlled clinical trials that compared MUF and CUF combination with CUF alone in pediatric cardiac surgery undergoing cardiopulmonary bypass (CPB) in PubMed, Embase, Cochrane Library, and Web of Science without any language or date limitation in February 2020. For each included trial, the primary outcomes including post-CPB and postoperative hematocrit, surgical and ultrafiltration data, postoperative clinical outcomes including volume of chest tube drainage within 48 hours after surgery and perioperative blood requirement, ventilation support duration, and length of stay day in the intensive care unit (ICU) and hospital were collected and analyzed. The analysis was conducted using STATA version 12.0.Results:A total of 8 trials encompassing 405 patients were included in this analysis. Analysis indicated that MUF + CUF increased the post-CPB hematocrit (Standard mean difference, SMD = 1.85, 95% confidence interval, 95% CI 0.91–2.79). Meanwhile, ultrafiltration volume was higher in CUF+MUF infants than CUF-alone infants (SMD = 1.46, 95% CI 0.51–2.41, P = .003). The clinical outcomes, including postoperative hemodynamic changes, prime volume, blood requirement, chest tube drainage volume, mechanical ventilation duration, and ICU duration, were unclear because of the unstable sensitivity analyses.Conclusions:Beneficial effects of using MUF and CUF for pediatric cardiac surgery, including increase post-CPB hematocrit and ultrafiltration volume when compared with CUF alone. Meanwhile, MUF and CUF did not significantly influence the postoperative hospital stay duration, CPB, and aortic occlusion duration. 相似文献
Nanoparticles (NPs) play an important role in anticancer delivery systems. Surface modified NPs with hydrophilic polymers such as human serum albumin (HSA) have long half-life in the blood circulation system.
Methods
The method of modified nanoprecipitation was utilized for encapsulation of paclitaxel (PTX) in poly (lactic-co-glycolic acid) (PLGA). Para-maleimide benzoic hydrazide was conjugated to PLGA for the surface modifications of PLGA NPs, and then HSA was attached on the surface of prepared NPs by maleimide attachment to thiol groups (cysteines) of albumin. The application of HSA provides for the longer blood circulation of stealth NPs due to their escape from reticuloendothelial system (RES). Then the physicochemical properties of NPs like surface morphology, size, zeta potential, and in-vitro drug release were analyzed.
Results
The particle size of NPs ranged from 170 to 190 nm and increased about 20–30 nm after HSA conjugation. The zeta potential was about -6 mV and it decreased further after HSA conjugation. The HSA conjugation in prepared NPs was proved by Fourier transform infrared (FT-IR) spectroscopy, faster degradation of HSA in Differential scanning calorimetry (DSC) characterization, and other evidences such as the increasing in size and the decreasing in zeta potential. The PTX released in a biphasic mode for all colloidal suspensions. A sustained release profile for approximately 33 days was detected after a burst effect of the loaded drug. The in vitro cytotoxicity evaluation also indicated that the HSA NPs are more cytotoxic than plain NPs.
Conclusions
HSA decoration of PLGA NPs may be a suitable method for longer blood circulation of NPs. 相似文献
Videofluoroscopic modified barium swallow (VMBS) examinations may provide clinically relevant information regarding deglutition in children with cerebral palsy and dysphagia. A retrospective review of clinical evaluations and VMBS studies on 90 consecutive children with cerebral palsy and dysphagia was completed. Most children were referred because of concerns regarding airway protection during oral feedings. Most children had multiple disabilities and 93% were nonambulatory. The majority of children were totally dependent for oral feedings (80%). Oral and pharyngeal phase abnormalities were present in almost all patients. Abnormalities of deglutition were observed only while swallowing specific food textures in the majority of patients. Aspiration of specific food textures was significantly more common than aspiration of all food textures (p<0.0001). Finally, aspiration was silent in 97% of the patients. VMBS studies can provide clinicians with valuable information regarding the most appropriate food textures and rates of oral feeding for children with cerebral palsy and dysphagia. 相似文献
Acute ischemic stroke is the leading cause of disability and among the leading causes of mortality worldwide. Intravenous tissue plasminogen activator has been a cornerstone for treatment of acute ischemic stroke for more than 20 years; however, its use is limited due to a narrow therapeutic window, several contraindications, and low efficacy to recanalize the artery in large vessel occlusion. Recently, the addition of endovascular mechanical thrombectomy of large artery occlusion has revolutionized the stroke treatment for most disabling strokes. The paper reviews updates to the thrombolytic treatment as well as catheter-based treatment, and results from recent trials in the selection of patients in an extended time window using perfusion imaging. 相似文献
Introduction: The first gene therapy medicines are licensed and National Institute for Health and Care Excellence approved for use in the NHS. UK Hospital pharmacy departments will need to work with multidisciplinary colleagues to ensure that there are facilities available to handle this new group of medicines.
Areas Covered: UK licensed and National Institute for Health and Care Excellence gene therapy medicinal products (GTMP) and requirements for handling. Review of pharmacy facilities and implementation of advanced therapy medicinal products (ATMP) in the UK.
Expert Opinion: Most hospital pharmacy departments do not have aseptic facilities for the reconstitution of gene therapy medicines, or have the appropriate freezers in place. Staff do not have the understanding or training of these products unless they are experienced in using them in clinical trials. Chief Pharmacists will need to ensure that governance process are in place as they will ultimately be responsible for the implementation and safe handling of these product. Therefore, work needs to continue to highlight the importance of pharmacy departments and their role in the implementation of this new group of medicines. As more GTMPs are licensed and become standard medicines being handled in pharmacy departments, there will be more hospital pharmacy departments ready to handle them. Initially it will just be the centers of excellence, ATMP centers, and research centers with the expertise and facilities. In the long-term, other hospitals will plan and build the facilities they require. 相似文献
The role of cerebral venous thrombosis (CVT) recanalization on neurologic outcome is still debated.
We studied a large cohort of 508 CVT patients with 419 patient years of radiological follow‐up.
Recanalization rate is high during the first months after CVT and neurologic outcome is favorable.
High recanalization grade of CVT independently predicts good neurological outcome.
Summary
Background
Studies with limited sample size and with discordant results described the recanalization time‐course of cerebral venous thrombosis (CVT). The neurological outcome after a first episode of CVT is good, but the role of recanalization on neurological dependence is still debated.
Objectives
The aim of the study is to assess the recanalization rate after cerebral venous thrombosis (CVT) and its prognostic role in long‐term neurological outcome.
Patients/Methods
In a retrospective observational multicenter cohort study, patients with an acute first episode of CVT with at least one available imaging test during follow‐up were enrolled. Patency status of the vessels was categorized as complete, partial or not recanalized. Neurological outcome was defined using the modified Rankin scale (mRS) as good (mRS = 0–1) or poor (mRS = 2–6).
Results
Five‐hundred and eight patients (median [IQR] age, 39 [28.5–49] years; 26% male) were included. Complete or partial recanalization was not differently represented in patients undergoing scans at different periods of time (from 28‐day to 3 month‐period up to a 1–3 year‐period). mRS at the time of follow‐up imaging was available in 483 patients; 92.8% of them had a mRS of 0‐1. CVT recanalization (odds ratio [OR], 2.56; 95% confidence interval [CI], 1.59–4.13) was positively associated, whereas cancer (OR, 0.29; 95% CI, 0.09–0.88), and personal history of venous thromboembolism (VTE) (OR, 0.36; 95% CI, 0.14–0.92) were negatively associated as independent predictors of favorable (mRS = 0–1) outcome at follow‐up.
Conclusions
Most patients with a first CVT had complete or partial recanalization at follow‐up. Recanalization was independently associated with a favorable neurological outcome. 相似文献