RESUMO
BACKGROUND: Fluid overload (FO) after resuscitation is frequent and contributes to adverse outcomes among postinjury open abdomen (OA) patients. Bioelectrical impedance analysis (BIA) is a promising tool for monitoring fluid status and FO. Therefore, we sought to investigate the efficacy of BIA-directed fluid resuscitation among OA patients. METHODS: A pragmatic, prospective, randomized, observer-blind, single-center trial was performed for all trauma patients requiring OA between January 2013 and December 2017 to a national referral center. A total of 140 postinjury OA patients were randomly assigned in a 1:1 ratio to receive either a BIA-directed fluid resuscitation (BIA) protocol that included fluid administration with monitoring of hemodynamic parameters and different degrees of interventions to achieve a negative fluid balance targeting the hydration level (HL) measured by BIA or a traditional fluid resuscitation (TRD) in which clinicians determined the fluid resuscitation regimen according to traditional parameters during 30 days of ICU management. The primary outcome was the 30-day primary fascial closure (PFC) rate. The secondary outcomes included the time to PFC, postoperative 7-day cumulative fluid balance (CFB) and adverse events within 30 days after OA. The Kaplan-Meier method and the log-rank test were utilized for PFC after OA. A generalized linear regression model for the time to PFC and CFB was built. RESULTS: A total of 134 patients completed the trial (BIA, n = 66; TRD, n = 68). The BIA patients were significantly more likely to achieve PFC than the TRD patients (83.33% vs. 55.88%, P < 0.001). In the BIA group, the time to PFC occurred earlier than that of the TRD group by an average of 3.66 days (P < 0.001). Additionally, the BIA group showed a lower postoperative 7-day CFB by an average of 6632.80 ml (P < 0.001) and fewer complications. CONCLUSION: Among postinjury OA patients in the ICU, the use of BIA-guided fluid resuscitation resulted in a higher PFC rate and fewer severe complications than the traditional fluid resuscitation strategy.
Assuntos
Impedância Elétrica/uso terapêutico , Fáscia/efeitos dos fármacos , Hidratação/instrumentação , Técnicas de Abdome Aberto/instrumentação , Adulto , Análise de Variância , Fáscia/fisiopatologia , Feminino , Hidratação/métodos , Hidratação/normas , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas de Abdome Aberto/métodos , Técnicas de Abdome Aberto/normas , Estudos Prospectivos , Equilíbrio Hidroeletrolítico/fisiologia , Ferimentos e Lesões/terapiaRESUMO
BACKGROUND: Acute mesenteric venous thrombosis (AMVT) can cause a poor prognosis. Prompt transcatheter thrombolysis (TT) can achieve early mesenteric revascularization. However, irreversible intestinal ischemia still occurs and the mechanism is still unclear. AIM: To evaluate the clinical outcomes of and to identify predictive factors for irreversible intestinal ischemia requiring surgical resection in AMVT patients treated by TT. METHODS: The records of consecutive patients with AMVT treated by TT from January 2010 to October 2017 were retrospectively analyzed. We compared patients who required resection of irreversible intestinal ischemia to patients who did not require. RESULTS: Among 58 patients, prompt TT was carried out 28.5 h after admission. A total of 42 (72.4%) patients underwent arteriovenous combined thrombolysis, and 16 (27.6%) underwent arterial thrombolysis alone. The overall 30-d mortality rate was 8.6%. Irreversible intestinal ischemia was indicated in 32 (55.2%) patients, who had a higher 30-d mortality and a longer in-hospital stay than patients without resection. The significant independent predictors of irreversible intestinal ischemia were Acute Physiology and Chronic Health Evaluation (APACHE) II score (odds ratio = 2.368, 95% confidence interval: 1.047-5.357, P = 0.038) and leukocytosis (odds ratio = 2.058, 95% confidence interval: 1.085-3.903, P = 0.027). Using the receiver operating characteristic curve, the cutoff values of the APACHE II score and leukocytosis for predicting the onset of irreversible intestinal ischemia were calculated to be 8.5 and 12 × 109/L, respectively. CONCLUSION: Prompt TT could achieve a favorable outcome in AMVT patients. High APACHE II score and leukocytosis can significantly predict the occurrence of irreversible intestinal ischemia. Therefore, close monitoring of these factors may help with the early identification of patients with irreversible intestinal ischemia, in whom ultimately surgical resection is required, before the initiation of TT.
Assuntos
Isquemia Mesentérica , Doença Aguda , Humanos , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/cirurgia , Curva ROC , Estudos Retrospectivos , Procedimentos Cirúrgicos VascularesRESUMO
AIM: To determine the optimal initial treatment modality for acute superior mesenteric vein thrombosis (ASMVT) in patients with circumscribed peritonitis. METHODS: A retrospective review was made of the Vascular Surgery Department's medical records to identify adult patients (≥ 18 years old) presenting with circumscribed peritonitis and diagnosed with ASMVT by imaging or endoscopic examination. Patients were selected from the time period between October 2009 and October 2012 to assess the overall performance of a new first-line treatment policy implemented in May 2011 for patients with circumscribed peritonitis, which recommends transcatheter thrombolysis with local anticoagulation and endovascular mechanical thrombectomy. Of the 25 patients selected for study inclusion, 12 had undergone emergency surgical exploration (group 1) and 13 had undergone the initial catheter-directed thrombolysis (group 2). Data extracted from each patient's records for statistical analyses included method of diagnosis, symptoms, etiology and risk factors, thrombus location, initial management, morbidity, mortality, duration and total cost of hospitalization (in Renminbi, RMB), secondary operation, total length of bowel resection, duration of and findings in follow-up, and death/survival. RESULTS: The two treatment groups showed similar rates of morbidity, 30-d mortality, and 1-year survival, as well as similar demographic characteristics, etiology or risk factors, computed tomography characteristics, symptoms, findings of blood testing at admission, complications, secondary operations, and follow-up outcomes. In contrast, the patients who received the initial non-operative treatment of transcatheter thrombolysis had significantly shorter durations of admission to symptom elimination (group 1: 18.25 ± 7.69 d vs group 2: 7.23 ± 2.42 d) and hospital stay (43.00 ± 13.77 d vs 20.46 ± 6.59 d), and early enteral or oral nutrition restoration (20.50 ± 5.13 d vs 8.92 ± 1.89 d), as well as significantly less total length of bowel resection (170.83 ± 61.27 cm vs 29.23 ± 50.24 cm) and lower total cost (200020.4 ± 91505.62 RMB vs 72785.6 ± 21828.16 RMB) (P < 0.05 for all). Statistical analyses suggested that initial transcatheter thrombolysis is correlated with quicker resolution of the thrombus, earlier improvement of symptoms, stimulation of collateral vessel development, reversal of intestinal ischemia, receipt of localizing bowel resection to prevent short bowel syndrome, shorter hospitalization, and lower overall cost of treatment. CONCLUSION: For ASMVT patients with circumscribed peritonitis, early diagnosis is key to survival, and non-operative transcatheter thrombolysis is feasible and effective as an initial treatment.
Assuntos
Cateterismo Periférico , Fibrinolíticos/administração & dosagem , Veias Mesentéricas/efeitos dos fármacos , Terapia Trombolítica , Trombose Venosa/tratamento farmacológico , Dor Abdominal/tratamento farmacológico , Dor Abdominal/etiologia , Doença Aguda , Adulto , Angiografia Digital , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/economia , Cateterismo Periférico/mortalidade , Análise Custo-Benefício , Custos de Medicamentos , Feminino , Fibrinolíticos/efeitos adversos , Fibrinolíticos/economia , Custos Hospitalares , Humanos , Tempo de Internação , Angiografia por Ressonância Magnética , Masculino , Veias Mesentéricas/diagnóstico por imagem , Pessoa de Meia-Idade , Peritonite/tratamento farmacológico , Peritonite/etiologia , Flebografia/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/economia , Terapia Trombolítica/mortalidade , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/diagnóstico , Trombose Venosa/economia , Trombose Venosa/mortalidadeRESUMO
Heliconema hainanensis sp. nov. collected from Uroconger lepturus (Richardson) (Anguilliformes: Congridae), Muraenesox cinereus (Forsskål) and Congresox talabonoides (Bleeker) (Anguilliformes: Muraenesocidae) in the South China Sea was described using light and scanning electron microscopy. The new species differs from its congeners by the following morphology: pseudolabia, the number and arrangement of caudal papillae (4 pairs of pedunculate precloacal papillae arranged in 2 groups of 2 and 2 pairs and 6 pairs of pedunculate postcloacal papillae arranged in 4 groups of 1, 2, 1 and 2 pairs), the length of spicules [left spicule 0.51-0.69 mm, right spicule 0.20-0.27 mm, spicule (right:left) ratio 1:2.20-2.69] and the morphology of the female tail tip. In addition, specimens of the new species collected from the three different hosts and specimens of an unidentified species of Heliconema collected from U. lepturus were characterised using molecular methods by sequencing the internal transcribed spacer (ITS) of ribosomal DNA. Analyses and comparison of the ITS sequence of H. hainanensis sp. nov. with Heliconema sp. support the validity of the new species based on morphological observations. An identification key to the species of Heliconema is also provided.
Assuntos
Enguias/parasitologia , Spirurina , Animais , China , Feminino , Masculino , Microscopia Eletrônica de Varredura , Oceano Pacífico , Spirurina/anatomia & histologia , Spirurina/classificação , Spirurina/ultraestruturaRESUMO
Heliconema hainanensis sp. nov. collected from Uroconger lepturus (Richardson) (Anguilliformes: Congridae), Muraenesox cinereus (Forsskål) and Congresox talabonoides (Bleeker) (Anguilliformes: Muraenesocidae) in the South China Sea was described using light and scanning electron microscopy. The new species differs from its congeners by the following morphology: pseudolabia, the number and arrangement of caudal papillae (4 pairs of pedunculate precloacal papillae arranged in 2 groups of 2 and 2 pairs and 6 pairs of pedunculate postcloacal papillae arranged in 4 groups of 1, 2, 1 and 2 pairs), the length of spicules [left spicule 0.51-0.69 mm, right spicule 0.20-0.27 mm, spicule (right:left) ratio 1:2.20-2.69] and the morphology of the female tail tip. In addition, specimens of the new species collected from the three different hosts and specimens of an unidentified species of Heliconema collected from U. lepturus were characterised using molecular methods by sequencing the internal transcribed spacer (ITS) of ribosomal DNA. Analyses and comparison of the ITS sequence of H. hainanensis sp. nov. with Heliconema sp. support the validity of the new species based on morphological observations. An identification key to the species of Heliconema is also provided.
Assuntos
Animais , Feminino , Masculino , Enguias/parasitologia , Spirurina , China , Microscopia Eletrônica de Varredura , Oceano Pacífico , Spirurina/anatomia & histologia , Spirurina/classificação , Spirurina/ultraestruturaRESUMO
BACKGROUND AND AIMS: Phospholipase C epsilon 1 (PLCε1) may regulate cell growth, differentiation, apoptosis and angiogenesis and play an important role in carcinogenesis and the progression of several cancers. This study was designed to validate the association of the PLCε1 rs2274223 single nucleotide polymorphism (SNP) with esophageal squamous cell carcinoma (ESCC) as identified by genome-wide association studies (GWAS) and further assess whether the rs11599672 SNP could affect an individual's susceptibility to ESCC. METHODS: These two SNPs were genotyped by polymerase chain reaction ligase detection reaction (PCR-LDR) in 527 ESCC patients and 527 controls. RESULTS: Compared with the rs2274223 SNP AA genotype, other genotypes or combined genotypes all enhanced the risk of ESCC. Further analyses showed that AG/GG genotype carriers with a family history of upper gastrointestinal cancers (UGIC) had an increased risk of ESCC than those AA genotype carriers without UGIC family history (OR = 2.10, 95% CI = 1.46-3.10). Overall, rs11599672 SNP had no influence on ESCC susceptibility. However, UGIC family history elevated the risk of ESCC for subjects with the TT genotype (OR = 1.59, 95% CI = 1.13-2.24). CONCLUSIONS: These results highlighted the role of a genetic factor in ESCC and suggested that the PLCε1 rs2274223 SNP might be an effective genetic marker to assess the risk of ESCC in individuals with a UGIC family history from a region of high incidence in northern China.
Assuntos
Carcinoma de Células Escamosas/genética , Neoplasias Esofágicas/genética , Neoplasias Gastrointestinais/genética , Predisposição Genética para Doença , Fosfoinositídeo Fosfolipase C/genética , Polimorfismo de Nucleotídeo Único/genética , Idoso , Carcinoma de Células Escamosas/epidemiologia , Estudos de Casos e Controles , China/epidemiologia , Neoplasias Esofágicas/epidemiologia , Carcinoma de Células Escamosas do Esôfago , Feminino , Neoplasias Gastrointestinais/epidemiologia , Genótipo , Humanos , Incidência , Masculino , Pessoa de Meia-IdadeRESUMO
The little known ascaridoid nematode Raphidascaris (Ichthyascaris) lophii (Wu, 1949) is redescribed and illustrated based on newly collected specimens from the five different marine fishes: Lophius litulon (Jordan) (Lophiiformes: Lophiidae), Lophiomus setigerus (Vahl) (Lophiiformes: Lophiidae), Antennarius hispidus (Bloch et Schneider) (Lophiiformes: Antennaridae), Zeus faber Linnaeus (Zeiformes: Zeidae) and Ostichthys japonicus (Cuvier) (Beryciformes: Holocentridae) from the East and South China Sea. This species differs from all congeners in the subgenus Ichthyascaris by the length of the ventricular appendix (0.52-0.98 mm long), the number and arrangement of caudal papillae (26-32 pairs of precloacal, 3-4 pairs of paracloacal and 8-11 pairs of postcloacal) and the length of the spicules (0.49-0.88 mm long, representing 3.08-4.70% of body length). In addition, nematodes collected from these five different fishes have been characterized using molecular methods by sequencing and analysing the internal transcribed spacer (ITS) of ribosomal DNA. No variation in size and nucleotide polymorphisms is detected within the target sequence among all samples analysed. These data contribute to facilitate an accurate diagnosis of this poorly known nematode. An identification key to the species of the subgenus Ichthyascaris is also provided.
Assuntos
Infecções por Ascaridida/veterinária , Ascaridídios/classificação , Ascaridídios/ultraestrutura , Doenças dos Peixes/parasitologia , Animais , Infecções por Ascaridida/epidemiologia , Infecções por Ascaridida/parasitologia , China/epidemiologia , Doenças dos Peixes/epidemiologia , Peixes , Oceanos e MaresRESUMO
A new anisakid nematode, Raphidascaris (Ichthyascaris) longispicula sp. nov., is described from the intestine and stomach of the marine fish Uroconger lepturus (Richardson) (Anguilliformes: Congridae) from the South China Sea (Guangdong and Hainan Province, respectively). The new species differs from all congeners in the subgenus Ichthyascaris by the short ventricular appendix (0.36-0.49 mm long), the number and arrangement of caudal papillae (25-28 pairs of preanal, 1-2 pairs of paranal, and 6-8 pairs of postanal), and the very long spicules (1.13-1.32 mm long, representing 9.34-10.3% of body length). The sequences of the internal transcribed spacer of ribosomal DNA of R. (I.) longispicula sp. nov. are analyzed and compared with the closely related nematode sequences. Molecular analyses seem to support the validity of this new nematode species based on morphological observation.