RESUMO
Medication errors can have severe consequences and threaten patient safety. The patient safety-related benefits of automated dispensing cabinets (ADCs) have been reported by several previous studies, including a reduction in medication errors in intensive care units (ICUs) and emergency departments. However, the benefits of ADCs need to be assessed, given the different healthcare practice models. This study aimed to compare the rates of medication errors, including prescription, dispensing, and administrative, before and after using ADCs in intensive care units. The prescription, dispensing, and administrative error data before and after the adoption of ADCs were retrospectively collected from the medication error report system. The severity of medication errors was classified according to the National Coordinating Council for Medication Error Reporting and Prevention guidelines. The study outcome was the rate of medication errors. After the adoption of ADCs in the intensive care units, the rates of prescription and dispensing errors reduced from 3.03 to 1.75 per 100,000 prescriptions and 3.87 to 0 per 100,000 dispensations, respectively. The administrative error rate decreased from 0.046 to 0.026%. The ADCs decreased National Coordinating Council for Medication Error Reporting and Prevention category B and D errors by 75% and category C errors by 43%. To improve medication safety, multidisciplinary collaboration and strategies, such as the use of automated dispensing cabinets, education, and training programs from a systems perspective, are warranted.
Assuntos
Erros de Medicação , Sistemas de Medicação no Hospital , Humanos , Estudos Retrospectivos , Erros de Medicação/prevenção & controle , Unidades de Terapia Intensiva , Cuidados CríticosRESUMO
In this novel study, we isolated 28 compounds from the leaves of Aquilaria sinensis (Lour.) Gilg based on a bioassay-guided procedure and also discovered the possible matrix metalloprotease 2 (MMP-2) and 9 (MMP-9) modulatory effect of pheophorbide A (PA). To evaluate the regulatory activity on MMP-2 and MMP-9, the HT-1080 human fibrosarcoma cells were treated with various concentrations of extracted materials and isolated compounds. PA was extracted by methanol from the leaves of A. sinensis and separated from the fraction of the partitioned ethyl acetate layer. PA is believed to be an active component for MMP expression since it exhibited significant stimulation on MMP-2 and proMMP-9 activity. When treating with 50 µM of PA, the expression of MMP-2 and MMP-9 were increased 1.9-fold and 2.3-fold, respectively. PA also exhibited no cytotoxicity against HT-1080 cells when the cell viability was monitored. Furthermore, no significant MMP activity was observed when five PA analogues were evaluated. This study is the first to demonstrate that C-17 of PA is the deciding factor in determining the bioactivity of the compound. The MMP-2 and proMMP-9 modulatory activity of PA indicate its potential applications for reducing scar formation and comparative medical purposes.
Assuntos
Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Metaloproteinase 2 da Matriz/genética , Metaloproteinase 9 da Matriz/genética , Compostos Fitoquímicos/farmacologia , Extratos Vegetais/farmacologia , Folhas de Planta/química , Thymelaeaceae/química , Linhagem Celular Tumoral , Humanos , Estrutura Molecular , Compostos Fitoquímicos/química , Extratos Vegetais/químicaRESUMO
Brain functions express rhythmic fluctuations accompanied by sleep and wakefulness each day, but how sleep regulates brain rhythms remains unclear. Following the dose-dependent local sleep concept, two succeeding questions emerge: (1) is the sleep regulation a network-specific process; and (2) is the awakening state dependent on the previous sleep stages? To answer the questions, we conducted simultaneous EEG and fMRI recordings over 22 healthy male participants, along pre-sleep, nocturnal sleep and awakening. Using paired comparisons between awakening and pre-sleep conditions, three scenarios of the regional specificity were demonstrated on awakening: (1) the default-mode and hippocampal networks maintained similar connectivity and spectral power; (2) the sensorimotor network presented reduced connectivity and spectral power; and (3) the thalamus demonstrated substantially enhanced connectivity to the neo-cortex with decreased spectral power. With regard to the stage effect, the deep sleep group had significant changes in both functional connectivity and spectral power on awakening, whereas the indices of light sleep group remained relatively quiescent after sleep. The phenomena implied that slow-wave sleep could be key to rebooting the BOLD fluctuations after sleep. In conclusion, the regional specificity and the stage effect were verified in support of the local awakening concept, indicating that sleep regulation leads to the reorganization of brain networks upon awakening.
Assuntos
Encéfalo/fisiologia , Eletroencefalografia , Imageamento por Ressonância Magnética , Sono/fisiologia , Vigília/fisiologia , Mapeamento Encefálico , Humanos , Masculino , Rede Nervosa/fisiologiaRESUMO
BACKGROUND: Adipokines, including adipocyte fatty acid-binding protein (A-FABP), have been demonstrated to be involved in the pathogenesis of atherosclerosis. In the present study, we investigated the association of circulating A-FABP level with severity of myocardial perfusion abnormalities analyzed by Tl-201 dipyridamole single-photon emission computed tomography. METHODS: A total of 170 patients with coronary artery disease (CAD) from cardiovascular clinics were enrolled in the study. Serum A-FABP levels, echocardiography, and stress myocardial perfusion imaging results were analyzed. RESULTS: Compared with the patients with mild CAD (summed stress score [SSS] ≤ 8), those with moderate to severe CAD (SSS > 8) had significantly higher A-FABP concentrations. However, the difference was attenuated in the subgroup of patients with heart failure. In the correlation analyses, A-FABP level was correlated with age, body mass index, waist circumference, levels of creatinine, fasting glucose, high-sensitivity C-reactive protein, N-terminal pro-brain natriuretic peptide, adiponectin, and several echocardiographic parameters, including left ventricular ejection fraction. Multivariate logistic regression analysis demonstrated that the A-FABP level was not only associated with higher SSS (odds ratio, 1.30; 95% confidence interval [CI], 1.01-1.69; P = 0.048), but also an independent risk factor for heart failure (odds ratio 2.71, 95% CI, 1.23-5.94; P = 0.013). CONCLUSIONS: Serum A-FABP levels not only were associated with myocardial perfusion abnormalities and left ventricular function, but also predicted the presence of heart failure in our patients with CAD.
Assuntos
Doença da Artéria Coronariana/sangue , Proteínas de Ligação a Ácido Graxo/sangue , Insuficiência Cardíaca/sangue , Disfunção Ventricular Esquerda/sangue , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia sob Estresse , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Imagem de Perfusão do Miocárdio , Índice de Gravidade de Doença , Volume Sistólico , Tomografia Computadorizada de Emissão de Fóton Único , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular EsquerdaRESUMO
ABSTRACT: A 13-year-old boy was suspected with pericarditis after a second booster dose of bivalent mRNA COVID-19 vaccine. After specific preparation for cardiac inflammation with carbohydrate-free, high-fat diet, the 18 F-FDG PET/CT successfully demonstrated simultaneous presentation of vaccination-related axillary lymphadenopathy and pericarditis without the interference of physiological myocardial uptake.
Assuntos
Vacinas contra COVID-19 , COVID-19 , Pericardite , Adolescente , Humanos , Masculino , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Fluordesoxiglucose F18 , Pericardite/diagnóstico por imagem , Pericardite/etiologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , RNA Mensageiro , VacinaçãoRESUMO
PURPOSE: To illustrate the beneficial effect of zolpidem on the neuropsychiatric and motor symptoms in a patient with Parkinson disease (PD) after bilateral subthalamic nucleus deep brain stimulation. CASE REPORT: The 61-year-old housewife was diagnosed to have PD for 12 years with initial presentation of clumsiness and rest tremor of right limbs. She was referred to our hospital in March 2009 due to shortening of drug beneficial period since 3 years ago and on-phase dyskinesia in recent 2 years. Bilateral STN DBS was conducted on 18 June, 2009. Fluctuating spells of mental confusion were developed on the next day after surgery. Electric stimuli via DBS electrodes were delivered with parameters of 2 volts, 60 µs, 130 Hz on bilateral STN 32 days after DBS. The incoherent behaviors and motor fluctuation remained to occur. The beneficial effect of zolpidem on her neuropsychiatric and motor symptoms was detected incidentally in early July 2009. She could chat normally with her caregiver and walk with assistance after taking zolpidem. The beneficial period may last for 2 hours. Zolpidem was then given in dosage of 10 mg three times per day. The neuropsychiatric inventory was scored 56 during zolpidem 'off' and 30 during zolpidem 'on'. To understand the intriguing feature, we conducted FDG-PET during 'off' and 'on' zolpidem conditions. The results revealed that the metabolism was decreased in the right frontal, parietal cortex and caudate nucleus during zolpidem 'off'. These cool spots can be partially restored by zolpidem. CONCLUSION: Zolpidem ameliorated the neuropsychiatric and parkinsonian motor symptom in the PD patient. Since GABAA benzodiazepine receptors are widely distributed throughout the central nervous system, zolpidem probably acts via modulating structures lying within the cortico-subcortical loop or by direct effect on these cortical regions.
Assuntos
Confusão/tratamento farmacológico , Confusão/etiologia , Estimulação Encefálica Profunda/efeitos adversos , Hipnóticos e Sedativos/uso terapêutico , Atividade Motora/efeitos dos fármacos , Piridinas/uso terapêutico , Confusão/diagnóstico por imagem , Feminino , Fluordesoxiglucose F18 , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Doença de Parkinson/terapia , Tomografia por Emissão de Pósitrons , Escalas de Graduação Psiquiátrica , Subtálamo/fisiologia , ZolpidemRESUMO
ABSTRACT: Spontaneous regression of testicular mixed germ cell tumor is rare and is also called burned-out testicular tumor. We herein present the case of a 20-year-old man who was initially diagnosed with metastatic embryonal carcinoma. 18 F-FDG PET/CT demonstrated apparent metastases in the lymph node regions and both lungs. A covert right testicular lesion was noted according to the features on the CT component of PET/CT, which was subsequently confirmed as burned-out testicular mixed germ cell tumor.
Assuntos
Neoplasias Embrionárias de Células Germinativas , Neoplasias Testiculares , Adulto , Fluordesoxiglucose F18 , Humanos , Masculino , Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Compostos Radiofarmacêuticos , Neoplasias Testiculares/diagnóstico por imagem , Neoplasias Testiculares/patologia , Adulto JovemRESUMO
ABSTRACT: 18F-fluciclovine, a radiolabeled amino acid analog, has been approved by US Food and Drug Administration for detecting lesions of biochemical recurrence of prostate adenocarcinoma with PET/CT. However, it is not specific for prostate cancer and has been found to be present in variety of malignant and benign etiologies. We herein present an interesting case of the incidental finding of increasing uptake of 18F-fluciclovine related to intramuscular injection of antiandrogen.
Assuntos
Ciclobutanos , Neoplasias da Próstata , Idoso , Antagonistas de Androgênios , Transporte Biológico , Ácidos Carboxílicos , Feminino , Humanos , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologiaRESUMO
Malignant mesotheliomas may be classified into epithelioid (60%), sarcomatoid (20%), or mixed (20%) type microscopically. Malignant deciduoid mesothelioma, a rare phenotype of epithelioid mesothelioma, arises more commonly from the peritoneum of young women, but is also from the pleura of elderly people. In the current report, the authors describe an unusual case of peritoneal malignant epithelioid mesothelioma with rare deciduoid phenotype demonstrated with Ga SPECT/CT.
Assuntos
Radioisótopos de Gálio , Neoplasias Pulmonares/diagnóstico por imagem , Mesotelioma/diagnóstico por imagem , Neoplasias Peritoneais/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Feminino , Humanos , Neoplasias Pulmonares/patologia , Mesotelioma/patologia , Mesotelioma Maligno , Pessoa de Meia-Idade , Neoplasias Peritoneais/patologiaRESUMO
Tc-TRODAT-1, as a tropane-derived compound with highly selective binding to the dopamine transporter, has been extensively used as an in vivo biomarker to evaluate parkinsonism. There have been few reports indicating various etiologies about extrastriatal findings on the Tc-TRODAT-1 SPECT. We herein present an interesting case about the incidental discovery of brain lymphoma with increasing uptake of Tc-TRODAT-1.
Assuntos
Encéfalo/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Compostos de Organotecnécio , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos , Transporte Biológico , Encéfalo/metabolismo , Feminino , Humanos , Achados Incidentais , Linfoma/metabolismo , Pessoa de Meia-Idade , Compostos de Organotecnécio/metabolismo , Tropanos/metabolismoRESUMO
Hepatocellular carcinoma (HCC) is a disease usually diagnosed in its advanced-stage, and is frequently not amenable to curative surgical treatment. Also, HCC is resistant to chemotherapy and less vulnerable to radiation therapy compared to normal hepatic parenchyma. Both of these facts render the efficacy of adjuvant and palliative treatments problematic. Selective internal radiation therapy (SIRT) with 90Y-bearing microspheres is characterized by preferentially delivering substantially high doses of radiation to a liver tumor dose simultaneously limiting the damage to its non-tumorous cells, providing an opportunity for effective local tumor control and even tumor regression therapy. The current article reviews the specific characters, dosimetry, possible applications, and special considerations toward the pre-existing radiation therapy of 90Y microsphere SIRT in treating HCC.
RESUMO
Testicular metastases, despite their proximity, from prostate adenocarcinoma are rare and usually found along with bone or other visceral metastases. We herein present a case with recurrent disease of prostate adenocarcinoma as solitary testicular metastasis detected by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT).
Assuntos
Carcinoma/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias Testiculares/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Carcinoma/patologia , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Neoplasias da Próstata/patologia , Compostos Radiofarmacêuticos , Neoplasias Testiculares/secundárioRESUMO
Urachal remnant anomalies are rare, and vesicourachal diverticulum is the most uncommon subtype of these anomalies. We present such a rare case of vesicourachal diverticulum that is incidentally discovered during the staging surveillance of a known esophageal cancer with F-FDG PET/CT. The physiological urinary excretion of radiopharmaceutical in the vesicourachal diverticulum mimics intra-abdominal malignancy, which resolves spontaneously in the follow-up FDG PET/CT.
Assuntos
Neoplasias Abdominais/diagnóstico por imagem , Divertículo/diagnóstico por imagem , Fluordesoxiglucose F18/urina , Compostos Radiofarmacêuticos/urina , Úraco/anormalidades , Sistema Urinário/diagnóstico por imagem , Diagnóstico Diferencial , Neoplasias Esofágicas/diagnóstico por imagem , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Sistema Urinário/anormalidadesRESUMO
BACKGROUND: The current study aimed to evaluate whether therapy-related changes occurred in brain metabolism at an earlier stage during the course of anticancer therapy. METHODS: We recruited 14 non-diabetic male patients with newly diagnosed pharyngeal squamous cell carcinoma. We analyzed the patients' serial brain FDG PET/CT scans by SPM8 to establish whether any therapy-related changes had occurred in brain FDG metabolism, either during or after the course of therapy. RESULTS: Decreased metabolism was noted during the anticancer therapy, displaying a symmetric pattern involving bilateral basal ganglia and bilateral occipital lobes. The decrease in FDG metabolism in these regions persisted after the anticancer therapy had terminated. However, relative recovery of the metabolism was noted in the bilateral occipital lobes, whereas further deterioration was noted in bilateral basal ganglia. CONCLUSIONS: The current study revealed that unappreciable changes in brain metabolism can occur during the early course of anticancer therapy, and persist even after therapy has terminated. Although the exact mechanism remains unclear, these changes may be related to the systemic effects of chemotherapy or radiotherapy as well as subclinical cancer-related depressive or adjustment mood disorder.
Assuntos
Encéfalo/metabolismo , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/metabolismo , Fluordesoxiglucose F18/farmacocinética , Neoplasias Faríngeas/tratamento farmacológico , Neoplasias Faríngeas/metabolismo , Adulto , Idoso , Antineoplásicos/uso terapêutico , Encéfalo/efeitos dos fármacos , Carcinoma de Células Escamosas/diagnóstico por imagem , Simulação por Computador , Diagnóstico Precoce , Humanos , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Taxa de Depuração Metabólica/efeitos dos fármacos , Pessoa de Meia-Idade , Modelos Biológicos , Especificidade de Órgãos , Neoplasias Faríngeas/diagnóstico por imagem , Cintilografia , Compostos Radiofarmacêuticos/farmacocinética , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Distribuição Tecidual/efeitos dos fármacosRESUMO
A 54-year-old woman had a primary breast sarcoma with rapid enlargement in 3 months. The mass became so huge that it was more than 20 cm in diameter and occupied the entire right breast on presentation. Extraosseous uptake was present in this mass and demonstrated a unique picture, mimicking the posture of a racing driver who holds a helmet under the armpit, on the bone scan.
Assuntos
Osso e Ossos/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Tomografia Computadorizada por Raios X , Carga Tumoral , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Dopamine transporter (DAT) radiopharmaceuticals are capable of binding to the DAT with high selectivity, especially in the corpora striata, and have been widely used to evaluate parkinsonian disorder. However, only a few reports have mentioned about the extrastriatal pathologic DAT uptake. Herein we present an interesting case about the incidental discovery of pituitary macroadenoma with intense uptake of 99mTc-TRODAT-1.
Assuntos
Adenoma/diagnóstico por imagem , Corpo Estriado/diagnóstico por imagem , Transtornos Parkinsonianos/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico por imagem , Adenoma/complicações , Adenoma/patologia , Idoso , Corpo Estriado/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Compostos de Organotecnécio , Transtornos Parkinsonianos/complicações , Transtornos Parkinsonianos/patologia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/patologia , Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão de Fóton Único , TropanosRESUMO
We presented a patient with abnormal focal accumulation of 67Ga in the left upper abdomen. After drinking water, we successfully identified the abnormal radioactivity that was from the stomach. Subsequent endoscopic examination did not reveal gastric pathological condition. Gastric accumulation of 67Ga may relate to pathological conditions or physiological uptake, confounding interpretation of 67Ga scintigraphy. Simple water ingestion method can rapidly identify gastric 67Ga uptake, and the shape of distended stomach can also help to differentiate pathological conditions from physiological uptake, which is especially helpful for a busy nuclear medicine department and for places where the SPECT/CT systems are not available.
Assuntos
Estômago/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X , Endoscopia do Sistema Digestório , Estudos de Viabilidade , Radioisótopos de Gálio , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A 25-year-old woman had carcinosarcoma of uterine cervix after definitive treatment. One year later, local recurrent disease was found in the right posterior pelvis on FDG PET/CT. FDG PET/CT also disclosed an incidental intramural hypermetabolic lesion in the rectum, which seemed separate from the right pelvic lesion on contrast-enhanced CT. The rectal lesion was confirmed as metastatic carcinosarcoma from uterine cervix after endoscopic biopsy.