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Andrea R. Marcadis Richard Teo Wenqi Ouyang Josefina C. Farrá John I. Lew 《Surgery》2018,163(3):633-637
Background
The effect of altered parathyroid hormone metabolism in renal insufficiency on intraoperative parathyroid hormone monitoring during parathyroidectomy is not well known. This study evaluates operative outcomes in patients undergoing parathyroidectomy guided by intraoperative parathyroid hormone monitoring for primary hyperparathyroidism with mild and moderate renal insufficiency.Methods
A retrospective review of prospectively collected data in 604 patients with sporadic primary hyperparathyroidism undergoing parathyroidectomy guided by intraoperative parathyroid hormone monitoring was performed. Patients were stratified by stage of chronic kidney disease (CKD); those with overt secondary hyperparathyroidism (CKD stages IV and V) were excluded. Rates of bilateral neck exploration, multiglandular disease, and long-term operative outcomes, including success, failure, and recurrence were compared.Results
Of the 604 patients, 38% (230/604) had normal renal function or stage I CKD, 44% (268/604) had stage II CKD, and 18% (106/604) had stage III CKD. Overall, there were no differences in the rates of bilateral neck exploration or multiglandular disease or in rates of operative success, failure, or recurrence in patients with normal renal function and stages I to III CKD.Conclusion
Parathyroidectomy guided by intraoperative parathyroid hormone monitoring is performed with high operative success uniformly in primary hyperparathyroidism patients with mild and moderate renal insufficiency with outcomes similar to those with normal renal function. 相似文献113.
Introduction
After significant improvement of the family consent rate to organ donation (OD) in recent years, owing to an increase in cultural activities and social awareness, a plateau has been reached. This study was performed to detect the causes for this plateau.Methods
We reviewed exact causes of family refusal after providing a list of failed potential donors from July 2015 to December 2016. The expert coordinators responsible for handling the failed cases chose the cause of refusal from the previously prepared list. The list was rechecked by contacting the nondonating families by phone. The results were compared with those obtained from a similar group of families in 2009.Results
In an 18-month period of OD practice, 353 potential brain dead organ donors were referred to our organ procurement unit. The mean age of the cases was 42.6, and 62% were male. The main causes of brain death were cerebrovascular accident and trauma (41.2% and 32.6%, respectively). The family consent rate was 84.4%, and 55 families rejected the request for OD. The leading cause for family refusal was religious beliefs, mainly from Sunni families (43.6% vs 8.6% in 2009). Brain death denial reduced significantly from 44.4% in 2009 to 12.7% in 2015 and 2016 (P < .001 for both causes). Opposite donor wishes, unstable family mood, the belief in body integrity, and expectation of a miracle were the other causes of no reportable changes.Conclusions
After massive social activities in the media designed to enhance social awareness regarding brain death and OD, people currently do not doubt the irreversibility of death, as in the past. However, the noticeable increase in the consent rate has made the religious cause of family refusal prominent. Therefore, this cause seems to be the next barrier to fight against, requiring a careful approach to religious leaders and societies. 相似文献114.
Andrea K. Viecelli Allison Tong Emma O’Lone Angela Ju Camilla S. Hanson Benedicte Sautenet Jonathan C. Craig Braden Manns Martin Howell Eric Chemla Lai-Seong Hooi David W. Johnson Timmy Lee Charmaine E. Lok Kevan R. Polkinghorne Robert R. Quinn Tushar Vachharajani Raymond Vanholder David Ennis 《American journal of kidney diseases》2018,71(5):690-700
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Tam N. Pham Joshua N. Wong Tonya Terken Nicole S. Gibran Gretchen J. Carrougher Aaron Bunnell 《Burns : journal of the International Society for Burn Injuries》2018,44(8):2080-2086
Introduction
The advent of consoles that deliver both interactive games and therapy may augment rehabilitation options in burn patients. The Jintronix software combines therapy-specific software and interactive gaming as a form of coaching and records patient performance on the Kinect® platform. Our objective was to determine the feasibility of a set of Jintronix games and therapy modules in hospitalized adult burn patients.Methods
We conducted a prospective single center feasibility study from August through October 2016. The study enrolled subjects to conduct 1 supervised session with 6 Jintronix modules targeting their burned areas of the body, with an acceptability survey and a safety analysis. We also performed qualitative analysis to detect major themes from free-text responses.Results
We enrolled 20 participants. Eleven (55%) completed all the modules; reasons for incompletion included baseline shoulder abduction pain and poor balance. Participants responded that the activity was comfortable (90%), safe (100%), easy to understand (95%), and improved strength/range of motion (100%). Mean module completion time was 43 ± 10 min. Mean pain score was 3.8 ± 2.8 (out of 10) and localized to burned areas. The wall climbing module had 4 episodes of temporary imbalance. Eight (40%) participants recorded fatigue at completion and noted “sweating” or “feeling stretched”. Qualitative analysis highlighted that the activity was “fun/cool” and a “good challenge”. Negative themes included “inaccurate depth” sensing and “too lengthy” on a specific module.Conclusions
A Jintronix-based therapy demonstrated good acceptability and safety in hospitalized burn patients. Feedback from this study led to software modifications implemented by the Jintronix company. This feasibility study has informed the design of a prospective randomized controlled trial to determine whether a virtual-environment home rehabilitation strategy improves functional outcomes after burn injury. 相似文献119.
Gina L. Griffith Barbara Wirostko Hee-Kyoung Lee Lauren E. Cornell Jennifer S. McDaniel David O. Zamora Anthony J. Johnson 《Burns : journal of the International Society for Burn Injuries》2018,44(5):1179-1186
Purpose
The study objective was to test the utilization of a crosslinked, thiolated hyaluronic acid (CMHA-S) film for treating corneal chemical burns.Methods
Burns 5.5 mm in diameter were created on 10 anesthetized, male New Zealand white rabbits by placing a 1N NaOH soaked circular filter paper onto the cornea for 30 s. Wounds were immediately rinsed with balanced salt solution (BSS). CMHA-S films were placed in the left inferior fornix of five injured and five uninjured animals. Five animals received no treatment. At 0 h, 48 h, 96 h, and on day 14 post chemical burn creation, eyes were evaluated by white light imaging, fluorescein staining, and optical coherence tomography (OCT). Corneal histology was performed using H&E and Masson's Trichrome stains.Results
Image analysis indicated biocompatible CMHA-S treatment resulted in significant decreases in the areas of corneal opacity at 48 h, 96 h, and on day 14 postoperatively. A significant increase in re-epithelialization was seen 14 days post injury. CMHA-S treated corneas showed significantly less edema than untreated burns. No pathological differences were observed in corneal histological samples as a result of CMHA-S treatment.Conclusions
CMHA-S films facilitate re-epithelialization and decrease the area of corneal opacity in our corneal alkali burn rabbit model. 相似文献120.
Hanaa Dakour Aridi Isibor Arhuidese Melissa Scudder Thomas Reifsnyder Mahmoud B. Malas 《Journal of vascular surgery》2018,67(5):1606-1612.e4