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1.
Marie Warrer Petersen Tine Sylvest Meyhoff Marie Helleberg Maj-Brit Nørregaard Kjær Anders Granholm Carl Johan Steensen Hjortsø Thomas Steen Jensen Morten Hylander Møller Peter Buhl Hjortrup Mik Wetterslev Gitte Kingo Vesterlund Lene Russell Vibeke Lind Jørgensen Klaus Tjelle Thomas Benfield Charlotte Suppli Ulrik Anne Sofie Andreasen Thomas Mohr Morten H. Bestle Lone Musaeus Poulsen Mette Friberg Hitz Thomas Hildebrandt Lene Surland Knudsen Anders Møller Christoffer Grant Sølling Anne Craveiro Brøchner Bodil Steen Rasmussen Henrik Nielsen Steffen Christensen Thomas Strøm Maria Cronhjort Rebecka Rubenson Wahlin Stephan Jakob Luca Cioccari Balasubramanian Venkatesh Naomi Hammond Vivekanand Jha Sheila Nainan Myatra Christian Gluud Theis Lange Anders Perner 《Acta anaesthesiologica Scandinavica》2020,64(9):1365-1375
Introduction
Severe acute respiratory syndrome coronavirus-2 has caused a pandemic of coronavirus disease (COVID-19) with many patients developing hypoxic respiratory failure. Corticosteroids reduce the time on mechanical ventilation, length of stay in the intensive care unit and potentially also mortality in similar patient populations. However, corticosteroids have undesirable effects, including longer time to viral clearance. Clinical equipoise on the use of corticosteroids for COVID-19 exists.Methods
The COVID STEROID trial is an international, randomised, stratified, blinded clinical trial. We will allocate 1000 adult patients with COVID-19 receiving ≥10 L/min of oxygen or on mechanical ventilation to intravenous hydrocortisone 200 mg daily vs placebo (0.9% saline) for 7 days. The primary outcome is days alive without life support (ie mechanical ventilation, circulatory support, and renal replacement therapy) at day 28. Secondary outcomes are serious adverse reactions at day 14; days alive without life support at day 90; days alive and out of hospital at day 90; all-cause mortality at day 28, day 90, and 1 year; and health-related quality of life at 1 year. We will conduct the statistical analyses according to this protocol, including interim analyses for every 250 patients followed for 28 days. The primary outcome will be compared using the Kryger Jensen and Lange test in the intention to treat population and reported as differences in means and medians with 95% confidence intervals.Discussion
The COVID STEROID trial will provide important evidence to guide the use of corticosteroids in COVID-19 and severe hypoxia.2.
Oral Everolimus for Treatment of a Giant Left Ventricular Rhabdomyoma in a Neonate—Rapid Tumor Regression Documented by Real Time 3D Echocardiography 下载免费PDF全文
Robert Wagner M.D. Ph.D. Frank Thomas Riede M.D. Hiroshi Seki M.D. Frauke Hornemann M.D. Steffen Syrbe M.D. Ingo Daehnert M.D. Ph.D. Michael Weidenbach M.D. Ph.D. 《Echocardiography (Mount Kisco, N.Y.)》2015,32(12):1876-1879
The presented case reports on successful treatment with everolimus in a neonate with left ventricular giant rhabdomyoma. The authors used a different dosage regime compared to literature and documented rapid tumor regression by 3D echocardiography. 相似文献
3.
R. H. Wiesner B. J. Steffen K. M. David A. H. Chu R. D. Gordon J. R. Lake 《American journal of transplantation》2006,6(7):1609-1616
Mycophenolate mofetil (MMF) used in a triple-drug regimen has been shown to decrease acute rejection rates, compared to a double-drug regimen. The impact of MMF on late acute rejection (LAR) episodes has not been well described. To investigate the risk of LAR (rejection > or = 6 months post-transplantation) data from the Scientific Registry of Transplant Recipients (SRTR) were used. We studied adult primary liver transplant recipients transplanted between June 1, 1995, and April 30, 2004, with hepatitis C virus (HCV) (n = 3356), hepatitis B virus (HBV) (n = 550) or a nonviral (n = 5740) primary cause of liver disease who were recorded as receiving continuous 3-(MMF + Tacro + steroids) versus 2-drug (Tacro + steroids) therapy for at least 6 months immediately post transplantation. Kaplan-Meier analysis showed significantly lower LAR rates 4 years post-transplant in 3- versus 2-drug HCV, HBV and nonviral disease patients. Multivariate regression confirmed 3- versus 2-drug therapy to be associated with a decreased risk of LAR. Late graft survival was significantly lower at 4 years post-transplant for patients with LAR 6-12 months post-transplantation versus patients with early rejection (78.0% vs. 87.0%, p < 0.001) and no rejection (88.1%, p < 0.001). Three-drug versus 2-drug therapy for a minimum of 6 months may offer a better treatment strategy to avoid the consequences and expense of LAR episodes. 相似文献
4.
Priv.-Doz. Dr. Rüdiger Dissmann Joachim Schröder MD PhD Prof. Dr. med. Heinz Völler Prof. Dr. med. Steffen Behrens 《Clinical research in cardiology》2006,95(4):241-243
Summary During pacemaker implantation in a patient with permanent atrial fibrillation, it remained impossible to advance a passive
fixation lead with fins through the right atrium. However, a lead with a retractable screw easily passed the right atrium
and was positioned in the right ventricle. Transesophageal echocardiography revealed an extensive net–like perforated Eustachian
valve within the right atrium that had caused entrapment of the anchor fins during lead implantation. Remnants of embryonal
structures within the right atrium should be considered a rare possible barrier during pacemaker implantation. 相似文献
5.
Christian Waydhas Dieter Nast-Kolb Steffen Ruchholtz 《European journal of trauma and emergency surgery》2007,33(2):170-175
Abstract
Objective: To define the diagnostic accuracy of clinical examination in patients with impaired consciousness or endotracheal intubation
to detect pelvic ring fractures and to identify those with severe bleeding.
Methods: Included in this prospective data collection with retrolective data analysis were a consecutive series of blunt trauma victims
with either a Glasgow Coma Scale ≤ 13 or tracheal intubation. Clinical examination comprised testing for stability of the
iliac wings.
Results: From 784 subjects (injury severity score 23.3 ± 17.4) 93 patients (11.9%) were found to have a pelvic ring fracture. Clinical
instability of the pelvic ring was found in 42 patients. There was only one false positive. Fifty-two fractures could not
be identified by clinical examination, including nine fractures (17%) that required surgical fracture stabilization (sensitivity
of clinical examination 44.1%). Seventeen fractures (18.3%) were associated with a blood loss larger than 20% of circulating
blood volume. Sixteen of those were identified by clinical instability of the pelvic ring (sensitivity 94.1%, specificity
97.0%, positive predictive value 38.1%, negative predictive value 99.9%).
Conclusions: Clinical examination for stability of the pelvis in this selected group of patients missed a significant number of pelvic
ring fractures including fractures that require surgical stabilization. The finding of a clinically unstable identifies most
of the patients with the pelvic ring fracture being a major source of bleeding. A stable pelvis makes pelvic ring fracture
as being the source of bleeding quite unlikely. 相似文献
6.
Quantification of Basal and Stimulated ROS Levels as Predictors of Islet Potency and Function 总被引:2,自引:0,他引:2
B. Armann M. S. Hanson E. Hatch A. Steffen L. A. Fernandez 《American journal of transplantation》2007,7(1):38-47
We have developed a luminol-based assay using intact islets, which allows for quantification of reactive oxygen species (ROS). In addition, an index capable of characterizing metabolic and mitochondrial integrity prior to transplantation was created based on the capacity of islets to respond to high glucose and rotenone (mitochondrial respiratory chain complex I inhibitor) by production of ROS. To validate this assay, lipid peroxidation and antioxidative defense capacity were evaluated by detection of malondialdehyde (MDA) levels and glutathione peroxidase activity (GPx), respectively. Also, flow cytometric analyses of ROS (dihydroethidine), apoptosis (Annexin V, active caspases), necrosis (Topro3), and mitochondrial membrane potential (JC-1) were done in parallel to correlate with changes in luminol-measured ROS. ATP/ADP ratios were quantified by HPLC and the predictive value of ROS measurement on islet functional potency was correlated with capacity to reverse diabetes in a streptozotocin-induced diabetic NOD.scid mouse model as well as in human transplant recipients. Our data demonstrate that levels of ROS in islets correlate with the percentage of apoptotic cells and their functional potency in vivo. The ROS indices following glucose and rotenone exposure are indicative of metabolic potency and mitochondrial integrity and can be used as surrogate markers to evaluate the quality of islets prior to transplantation. 相似文献
7.
Frank G. Holz Caren Bellmann Heimo Steffen Bernhard Nölle Jens Huober Hermann Krastel Evangelos Alexandridis 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1997,94(5):337-342
Fragestellung: Die Karzinomassoziierte Retinopathie (CAR) stellt ein seltenes paraneoplastisches Syndrom dar, das bislang
am h?ufigsten bei kleinzelligen Bronchialkarzinomen beschrieben wurde. Wir berichten über 3 Patientinnen mit CAR in Gegenwart
eines Mammakarzinoms bzw. eines Karzinoids der Cervix uteri.
Patienten und Methode: Es wurden biomikroskopische, perimetrische, angiographische und elektrophysiologische Befunde erhoben.
Au?erdem erfolgte eine Testung der Immunreaktivit?t der Seren an humaner Retina.
Ergebnisse: Die Befunde umfa?ten ringf?rmige Gesichtsfelddefekte mit statokinetischer Dissoziation und eine pathologische
St?bchen- und Zapfenantwort im ERG. Bei 1 Patientin wurde immunhistochemisch eine Reaktion im Bereich der Photorezeptorinnensegmente,
der ?u?eren K?rnerschicht sowie der ?u?eren plexiformen Schicht bei fehlendem Nachweis von Antik?rpern gegen Recoverin gefunden.
Diskussion: Neben dem kleinzelligen Bronchialkarzinom k?nnen auch andere Prim?rtumoren mit einer CAR vergesellschaftet sein.
Der Nachweis von retinalen Autoantik?rpern unterstützt die Annahme einer tumorinduzierten Immunantwort aufgrund der Expression
identischer Epitope durch die Tumorzellen. Dabei kommen offensichtlich verschiedene retinale Proteine als Autoantigene in
Betracht.
相似文献
8.
Liver transplantation in HBsAg positive patients 总被引:1,自引:0,他引:1
G Blumhardt P Neuhaus W O Bechstein R Steffen U Hopf B M?ller R Raakow H Keck 《Transplantation proceedings》1990,22(4):1517-1518
9.
In CDH ultrasound control of reduction in the unstable period of the first 3 months has to be performed by an inguinal access, as the splint can not be removed for the reason of high risks of redislocation. Controls are possible whenever required, according to anglo-american techniques. Thus treatment within the first year of life may be controlled by ultrasound imaging alone. Criteria for detection of posterior and cranial redislocation as well as for the anterior positioning of the femoral head are given. 相似文献
10.
G. Dewasmes B. Bothorel A. Hoeft V. Candas 《European journal of applied physiology》1993,66(6):542-546
Summary Thermoregulatory sweating [total body (m
sw,b), chest (m
sw,c) and thigh (m
sw,t) sweating], body temperatures [oesophageal (T
oes) and mean skin temperature (T
sk)] and heart rate were investigated in five sleep-deprived subjects (kept awake for 27 h) while exercising on a cycle (45 min at approximately 50% maximal oxygen consumption) in moderate heat (T
air andT
wall at 35° C. Them
sw,c andm
sw,t were measured under local thermal clamp (T
sk,1), set at 35.5° C. After sleep deprivation, neither the levels of body temperatures (T
oes,T
sk) nor the levels ofm
sw, b,m
sw, c orm
sw, t differed from control at rest or during exercise steady state. During the transient phase of exercise (whenT
sk andT
sk,1 were unvarying), them
sw, c andm
sw, t changes were positively correlated with those ofT
oes. The slopes of them
sw, c versusT
oes, orm
sw, t versusT
oes relationships remained unchanged between control and sleep-loss experiments. Thus the slopes of the local sweating versusT
oes, relationships (m
sw, c andm
sw, t sweating data pooled which reached 1.05 (SEM 0.14) mg·cm–2·min–1°C–1 and 1.14 (SEM 0.18) mg·cm–2·min–1·°C–1 before and after sleep deprivation) respectively did not differ. However, in our experiment, sleep deprivation significantly increased theT
oes threshold for the onset of bothm
sw, c andm
sw, t (+0.3° C,P<0.001). From our investigations it would seem that the delayed core temperature for sweating onset in sleep-deprived humans, while exercising moderately in the heat, is likely to have been due to alterations occurring at the central level. 相似文献