Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 34
Filtrar
1.
Perioper Med (Lond) ; 13(1): 57, 2024 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-38879506

RESUMO

BACKGROUND: Intraoperative hypotension is a common side effect of general anesthesia. Here we examined whether the Hypotension Prediction Index (HPI), a novel warning system, reduces the severity and duration of intraoperative hypotension during general anesthesia. METHODS: This randomized controlled trial was conducted in a tertiary referral hospital. We enrolled patients undergoing general anesthesia with invasive arterial monitoring. Patients were randomized 1:1 either to receive hemodynamic management with HPI guidance (intervention) or standard of care (control) treatment. Intraoperative hypotension treatment was initiated at HPI > 85 (intervention) or mean arterial pressure (MAP) < 65 mmHg (control). The primary outcome was hypotension severity, defined as a time-weighted average (TWA) MAP < 65 mmHg. Secondary outcomes were TWA MAP < 60 and < 55 mmHg. RESULTS: Of the 60 patients who completed the study, 30 were in the intervention group and 30 in the control group. The patients' median age was 62 years, and 48 of them were male. The median duration of surgery was 490 min. The median MAP before surgery presented no significant difference between the two groups. The intervention group showed significantly lower median TWA MAP < 65 mmHg than the control group (0.02 [0.003, 0.08] vs. 0.37 [0.20, 0.58], P < 0.001). Findings were similar for TWA MAP < 60 mmHg and < 55 mmHg. The median MAP during surgery was significantly higher in the intervention group than that in the control group (87.54 mmHg vs. 77.92 mmHg, P < 0.001). CONCLUSIONS: HPI guidance appears to be effective in preventing intraoperative hypotension during general anesthesia. Further investigation is needed to assess the impact of HPI on patient outcomes. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04966364); 202105065RINA; Date of registration: July 19, 2021; The recruitment date of the first patient: July 22, 2021.

2.
PLoS One ; 18(2): e0282214, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36827351

RESUMO

The aim of systematic review and meta-analysis was to investigate whether APOE4 was associated with postoperative neurologic dysfunction occurrence in short- or medium-term among surgical patients and to study the potential genetic association among these two entities. We searched electronic databases for reserch studies to evaluate the association of APOE4 with postoperative delirium (POD) or short- and medium term postoperative cognitive dysfunction (POCD). Twenty-two trials (16 prospective and six retrospective) with 6734 patients were included. APOE4 alleles was shown significantly associated with POCD within 1 week (odds ratio, OR, 1.89, 95% confidence interval, CI, 1.36 to 2.6278, p < 0.01) in the random-effects model. A significant association was also noted between APOE4 and POCD in medium-term, 1-3 months, after surgery (OR: 1.67, 95% CI: 1.003-2.839, p = 0.049). However, APOE4 was not significantly associated with POCD 1 year after surgery (OR: 0.98, 95% CI: 0.57-1.70, p = 0.9449) and POD (OR: 1.28, 95% CI: 0.85-1.91, p = 0.23). In conclusion, APOE4 alleles was genetically associated with short- and medium-term postoperative neurological dysfunction and future screening or preventive strategies derived is highly potential to improve outcomes.


Assuntos
Disfunção Cognitiva , Delírio , Complicações Cognitivas Pós-Operatórias , Humanos , Complicações Cognitivas Pós-Operatórias/diagnóstico , Apolipoproteína E4/genética , Delírio/diagnóstico , Estudos Retrospectivos , Alelos , Estudos Prospectivos , Disfunção Cognitiva/genética , Complicações Pós-Operatórias/prevenção & controle
4.
Gerontol Geriatr Med ; 8: 23337214221093891, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35958034

RESUMO

Aim: This systematic review aims to evaluate changes in Chinese older adults' psychosocial wellbeing after receiving horticultural therapy, and examine existing evidence regarding horticultural therapy's effectiveness in a Chinese setting. Method: Intervention studies measuring relevant outcomes amongst older adults and conducted in China were identified from ASSIA, CIHAHL Plus, PsycINFO, EMBASE, MEDLINE, SCOPUS, Web of Science Core Collection and CNKI. Cochrane risk of bias assessment tools were used to appraise study quality. Result: 16 studies were selected, among which four were published in English and 12 in Chinese. Findings suggested that after receiving horticultural therapy, older adults' psychosocial wellbeing is generally improved, but causal relationships between improvements and horticulture therapy were less clear. Conclusion: Features of horticultural therapy conducted in China is with its cultural and social uniqueness. Existing evidence supports the post-intervention benefits on completion of horticultural therapies, but the limitations in programme design, sample representativeness and methodological robustness limited the quality of the evidence.

5.
Front Psychiatry ; 13: 899847, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35693976

RESUMO

Introduction: Modified electroconvulsive therapy (MECT) is a viable therapeutic option for patients with mood disorders and schizophrenia. We found that there is a relationship between MECT and leukocytosis. To the best of our knowledge, this is the first case of this problem. There are no relevant guidelines recommending the risk of leukocytosis caused by MECT, nor the method to reduce the risk. We hope to share this case to provide a reference for the prevention and treatment of similar patients with leukocytosis during or after MECT and remind psychiatrists to pay attention to this risk of leukocytosis before making the decision of MECT while knowing how to deal with it. Case presentation: We describe a case of a 24-year-old woman diagnosed with Paranoid personality disorder (PPD) whose symptoms began at 19 years old. Her main clinical manifestations are feeling targeted, cheated, tracked, misunderstood, and repeating action. Since antipsychotic treatment was ineffective, we considered MECT. After MECT, the patient's body temperature increased, and leukocytosis was found. After excluding infection and other possibilities, we added 1,000 ml physiological saline to the patient through the vein. The white blood cell (WBC) count returned to normal in a short time. Conclusion: Before MECT, it is necessary to screen blood cytology. During and after MECT, we should be alert to leukocytosis that may be related to MECT and deal with it correctly in time.

6.
Surg Endosc ; 36(9): 6516-6521, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35041053

RESUMO

BACKGROUND: Remifentanil is a rapid onset and rapid recovery opioid. The combination of remifentanil and propofol for deep sedation decreases the incidents of movement, cough, and hiccup. We evaluated the efficacy and safety of remifentanil during endoscopic ultrasound-guided tissue acquisition. METHODS: We retrospectively reviewed patients in whom endoscopic ultrasound-guided tissue acquisition was performed for solid mass lesions of the upper gastrointestinal tract and adjacent organs. All patients were premedicated with midazolam (2 mg), and target-controlled infusion of propofol, opioid, and Bispectral Index (BIS) monitoring were administered as necessary to maintain moderate-to-deep sedation. The opioids used were a bolus of alfentanil or remifentanil infusion. The discharge time, consumption of propofol and opioid, adverse events, diagnostic accuracy, and sensitivity and specificity for malignancy, were compared. RESULTS: Tissue acquisition was achieved in 123 patients (alfentanil group, n = 64; remifentanil group, n = 59). The discharge time of the remifentanil group (16.5 ± 3.2 min) was significantly shorter than that of the alfentanil group (19.0 ± 4.9 min, P = 0.001). The consumption of propofol, adverse events, diagnostic accuracy, sensitivity, and specificity for malignancy in the alfentanil group were not significantly different from those in the remifentanil group. CONCLUSIONS: Use of alfentanil or remifentanil for target-controlled infusion of propofol-BIS monitoring can provide good sedative and diagnostic quality for endoscopic ultrasound-guided tissue acquisition. However, remifentanil resulted in faster recovery than alfentanil.


Assuntos
Alfentanil , Propofol , Alfentanil/efeitos adversos , Analgésicos Opioides , Anestésicos Intravenosos , Humanos , Piperidinas/efeitos adversos , Propofol/efeitos adversos , Remifentanil , Estudos Retrospectivos , Ultrassonografia de Intervenção
7.
J Formos Med Assoc ; 119(1 Pt 3): 449-454, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31506213

RESUMO

BACKGROUND: Double-lumen endotracheal tubes and bronchial blockers are the two lung separation devices most commonly used for lung resection. The preference and outcomes of choosing different lung separation devices have not been discussed in the literature. METHODS: This study was conducted using the data of 2 million patients randomly chosen from the National Health Insurance Research Database between 2011 and 2016. We selected patients who underwent lung resection surgery and surveyed their demographic data and trends of double-lumen endotracheal tube and bronchial blocker use. To determine the influence of endotracheal tubes on clinical outcomes, we computed multiple linear regressions of the number of deaths within 30 days after surgery, intensive care unit stay, hospital stay, and medical cost. RESULTS: The use of bronchial blockers in Taiwan has steadily increased from 6.13% to 11.33% from 2011 to 2016. Anaesthesiologists working in regions with higher thoracic surgery volumes preferred bronchial blockers over double-lumen endotracheal tubes. Bronchial blockers were the preferred choice in women, elderly individuals, patients with more comorbidities, and those undergoing video-assisted thoracoscopic surgeries. After adjustment for sex, age, Charlson Comorbidity Index, and video-assisted thoracoscopic surgeries, we found that patients in whom bronchial blockers were applied had shorter hospital stays. CONCLUSION: The use of bronchial blockers is increasing as the experience of anaesthesiologists increases. Although double-lumen endotracheal tubes remain the principal choice for lung separation in Taiwan, clinical outcomes of the bronchial blocker group were not inferior to those of the double-lumen endotracheal tube group.


Assuntos
Broncoscopia/métodos , Intubação Intratraqueal/instrumentação , Pulmão/cirurgia , Ventilação Monopulmonar/métodos , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Idoso , Broncoscopia/efeitos adversos , Estudos de Coortes , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Ventilação Monopulmonar/efeitos adversos , Atelectasia Pulmonar/prevenção & controle , Inquéritos e Questionários , Taiwan , Cirurgia Torácica Vídeoassistida/mortalidade , Fatores de Tempo
8.
J Gastroenterol Hepatol ; 35(7): 1189-1195, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31802534

RESUMO

BACKGROUND AND AIM: Target-controlled infusion (TCI) uses averaged pharmacokinetic datasets derived from population samples to automatically control the infusion rate. Bispectral index (BIS) technology non-invasively measures levels of consciousness during surgical procedures. We compared the efficacy and safety of propofol TCI with or without BIS monitoring for sedation during advanced gastrointestinal endoscopy. METHODS: This prospective study enrolled 200 patients who were premedicated with midazolam 2 mg and alfentanil 0.4 mg before undergoing advanced gastrointestinal endoscopy. The initial target blood concentration of propofol was set at 1.0 µg/mL, and adjustments of 0.2 µg/mL were made as necessary to maintain moderate-to-deep sedation. Patients were randomized to either the BIS-blind group and evaluated for depth of anesthesia by monitoring scores of 1-2 on the Modified Observer's Assessment of Alertness/Sedation scale (n = 100) or to the BIS-open group and monitored by BIS scores of 60-80 (n = 100). The primary outcome was the total amount of propofol required to maintain anesthesia. Secondary outcomes were sedation-induced adverse events, recovery, and quality of sedation (endoscopist and patient satisfaction). RESULTS: The mean propofol infusion rate was significantly higher in patients not monitored by BIS scores than in those who were (5.44 ± 2.12 vs 4.76 ± 1.84 mg/kg/h; P = 0.016). Levels of satisfaction were higher for endoscopists who used BIS monitoring than in those who did not. CONCLUSIONS: Mean infusion rates were higher in propofol TCI without BIS monitoring compared with propofol TCI with BIS during advanced gastrointestinal endoscopy. Endoscopists expressed satisfaction with BIS monitoring.


Assuntos
Sedação Consciente/métodos , Monitores de Consciência , Sedação Profunda/métodos , Endoscopia Gastrointestinal/métodos , Monitorização Intraoperatória/métodos , Propofol/administração & dosagem , Idoso , Sedação Consciente/efeitos adversos , Conjuntos de Dados como Assunto , Sedação Profunda/efeitos adversos , Feminino , Humanos , Infusões Intravenosas/métodos , Masculino , Pessoa de Meia-Idade , Propofol/efeitos adversos , Estudos Prospectivos , Segurança , Resultado do Tratamento
9.
Sci Rep ; 9(1): 16032, 2019 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690742

RESUMO

Pain is a major primary health care problem. Emerging studies show that inhibition of spinal microglial activation reduces pain. However, the precise mechanisms by which microglial activation contributes to nociceptive synaptic transmission remain unclear. In this study, we measured spontaneous synaptic activity of miniature excitatory postsynaptic currents (mEPSCs) in rat spinal cord superficial dorsal horn (SDH, laminae I and II) neurons. Lipopolysaccharide (LPS) and adenosine triphosphate (ATP) increased the frequency, but not amplitude, of mEPSCs in SDH neurons. Microglial inhibitors minocycline and paeonol, as well as an astrocyte inhibitor, a P2Y1 receptor (P2Y1R) antagonist, and a metabotropic glutamate receptor 5 (mGluR5) antagonist, all prevented LPS-induced enhancement of mEPSC frequency. In mouse behavioral testing, minocycline and paeonol effectively reduced acetic acid-induced writhing and LPS-induced hyperalgesia. These results indicate that LPS-activated microglia release ATP, which stimulates astrocyte P2Y1Rs to release glutamate, triggering presynaptic mGluR5 receptors and increasing presynaptic glutamate release, leading to an increase in mEPSC frequency and enhancement of nociceptive transmission in SDH neurons. We propose that these effects can serve as a new electrophysiological model for evaluating pain. Moreover, we predict that pharmacologic agents capable of inhibiting the LPS-induced enhancement of mEPSC frequency in SDH neurons will have analgesic effects.


Assuntos
Potenciais Pós-Sinápticos Excitadores/efeitos dos fármacos , Hiperalgesia , Lipopolissacarídeos/toxicidade , Modelos Neurológicos , Dor , Células do Corno Posterior/metabolismo , Trifosfato de Adenosina/farmacologia , Animais , Hiperalgesia/induzido quimicamente , Hiperalgesia/metabolismo , Hiperalgesia/patologia , Hiperalgesia/fisiopatologia , Masculino , Camundongos , Dor/induzido quimicamente , Dor/metabolismo , Dor/patologia , Dor/fisiopatologia , Células do Corno Posterior/patologia , Ratos , Ratos Sprague-Dawley
10.
Aging (Albany NY) ; 11(16): 6358-6370, 2019 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-31437127

RESUMO

GP IIb/IIIa receptor activation plays an important role in thrombosis. The mechanism of early activation of GP IIb/IIIa receptors in diabetic conditions remains unknown. The purpose of this study was to investigate the release of Endothelial microparticle (EMP)-associated protein disulfide isomerase (PDI) after endothelial cell injury induced in diabetes and the changes in platelet activation. We produced an animal model of type 2 diabetes mellitus using ApoE-/- mice. Normal ApoE-/- and diabetic mice were allocated to four groups (n = 15): normal diet, normal diet plus rutin, diabetic, and diabetes plus rutin. The EMP-PDI content and GP IIb/IIIa expression of mice platelets were determined. In addition, EMPs obtained from the four groups were pretreated with the PDI inhibitor rutin; then, their effects on the platelets of normal C57 mice were characterized. Compared with the normal diet group, the diabetic group had significantly increased plasma EMP-PDI content and accelerated platelet activation by increased GP IIb/IIIa expression. In conclusion, EMP-PDI promotes early platelet activation through glycoprotein (GP) IIb/IIIa receptors present on platelet surface in the diabetic state. However, this process could be partially suppressed by the administration of rutin.


Assuntos
Diabetes Mellitus Tipo 2/metabolismo , Células Endoteliais/metabolismo , Ativação Plaquetária/efeitos dos fármacos , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/metabolismo , Isomerases de Dissulfetos de Proteínas/metabolismo , Animais , Regulação da Expressão Gênica/efeitos dos fármacos , Regulação da Expressão Gênica/fisiologia , Masculino , Camundongos , Camundongos Knockout para ApoE , Rutina/farmacologia
11.
Int J Med Sci ; 15(9): 953-960, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30008609

RESUMO

Pruritus, or itch, is a frequent complaint amongst patients with cholestatic hepatobiliary disease and is difficult to manage, with many patients refractory to currently available antipruritic treatments. In this study, we examined whether manual acupuncture (MA) at particular acupoints represses deoxycholic acid (DCA)-induced scratching behavior and microglial activation and compared these effects with those induced by another pruritogen, 5'-guanidinonaltrindole (GNTI, a kappa opioid receptor antagonist). MA at Hegu (LI4) and Quchi (LI11) acupoints significantly attenuated DCA- and GNTI-induced scratching, whereas no such effects were observed at the bilateral Zusanli acupoints (ST36). Interestingly, GNTI-induced scratching was reduced similarly by both MA and electroacupuncture (EA) at the LI4 and LI11 acupoints. MA at non-acupoints did not affect scratching behavior. Intraperitoneal injection of minocycline (a microglial inhibitor) reduced GNTI- and DCA-induced scratching behavior. In Western blot analysis, subcutaneous DCA injection to the back of the neck increased spinal cord expression of ionized calcium-binding adapter molecule 1 (Iba1) and tumor necrosis factor-alpha (TNF-α) as compared with saline injection, while MA at LI4 and LI11 reduced these DCA-induced changes. Immunofluorescence confocal microcopy revealed that DCA-induced Iba1-positive cells with thicker processes emanated from the enlarged cell bodies, while this effect was attenuated by pretreatment with MA. It is concluded that microglia and TNF-α play important roles in the itching sensation and MA reduces DCA-induced scratching behavior by alleviating spinal microglial activation. MA may be an effective treatment for cholestatic pruritus.


Assuntos
Terapia por Acupuntura , Ácidos e Sais Biliares/efeitos adversos , Microglia/metabolismo , Prurido/terapia , Fator de Necrose Tumoral alfa/fisiologia , Animais , Humanos , Masculino , Camundongos , Camundongos Endogâmicos ICR , Prurido/etiologia
12.
Anesth Analg ; 126(3): 1013-1018, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29200073

RESUMO

BACKGROUND: In residency programs, it is well known that autonomic regulation is influenced by night duty due to workload stress and sleep deprivation. A less investigated question is the impact on the autonomic nervous system of residents before or when anticipating a night duty shift. In this study, heart rate variability (HRV) was evaluated as a measure of autonomic nervous system regulation. METHODS: Eight residents in the Department of Anesthesiology were recruited, and 5 minutes of electrocardiography were recorded under 3 different conditions: (1) the morning of a regular work day (baseline); (2) the morning before a night duty shift (anticipating the night duty); and (3) the morning after a night duty shift. HRV parameters in the time and frequency domains were calculated. Repeated measures analysis of variance was performed to compare the HRV parameters among the 3 conditions. RESULTS: There was a significant decrease of parasympathetic-related HRV measurements (high-frequency power and root mean square of the standard deviation of R-R intervals) in the morning before night duty compared with the regular work day. The mean difference of high-frequency power between the 2 groups was 80.2 ms (95% confidence interval, 14.5-146) and that of root mean square of the standard deviation of R-R intervals was 26 milliseconds (95% confidence interval, 7.2-44.8), with P = .016 and .007, respectively. These results suggest that the decrease of parasympathetic activity is associated with stress related to the condition of anticipating the night duty work. On the other hand, the HRV parameters in the morning after duty were not different from the regular workday. CONCLUSIONS: The stress of anticipating the night duty work may affect regulation of the autonomic nervous system, mainly manifested as a decrease in parasympathetic activity. The effect of this change on the health of medical personnel deserves our concern.


Assuntos
Anestesiologistas/psicologia , Antecipação Psicológica/fisiologia , Frequência Cardíaca/fisiologia , Internato e Residência , Sistema Nervoso Parassimpático/fisiologia , Jornada de Trabalho em Turnos/psicologia , Adulto , Anestesiologia/educação , Anestesiologia/métodos , Ritmo Circadiano/fisiologia , Eletrocardiografia/métodos , Feminino , Humanos , Internato e Residência/métodos , Masculino , Sistema Nervoso Parassimpático/fisiopatologia , Privação do Sono/diagnóstico , Privação do Sono/fisiopatologia , Privação do Sono/psicologia
13.
Mitochondrial DNA B Resour ; 3(2): 715-716, 2018 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-33474294

RESUMO

In this study, the complete mitochondrial genome of human lung fluke, Paragonimus kellicotti, was recovered through Illumina sequencing data. This complete mitochondrial genome of P. kellicotti is 13,927 bp in length and has a base composition of A (16.6%), T (41.8%), C (13.%), and G (28.4%), demonstrating an obvious bias of high AT content (58.4%). The mitochondrial genome contains a typically conserved structure, encoding 12 protein-coding genes (PCGs), 22 transfer RNA genes (tRNA), 2 ribosomal RNA genes (12S rRNA and 16S rRNA), and a control region (D-loop region). All PCGs were located on the H-strand. ND4 gene and ND4L gene were overlapped by 39 bp. The nucleotide sequence of 12 PCGs of P. heterotremus and other 10 parasite species were used for phylogenetic analysis. The result indicated P. heterotremus a relative close relationship with species P. westermani (AF219379.2).

14.
Oncotarget ; 8(38): 63715-63723, 2017 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-28969023

RESUMO

INTRODUCTION: Malignant primary brain tumors are one of the most aggressive cancers. Pretreatment serum nonneuronal biomarkers closely associated with postoperative outcomes are of high clinical relevance. The present study aimed to identify potential pretreatment serum biomarkers that may influence oncological outcomes in patients with primary brain tumors. METHODS: A total of 74 patients undergoing supratentorial primary brain tumor resection were enrolled. Before tumor resection, serum neuronal biomarkers, namely neuron-specific enolase (NSE), S100ß, and glial fibrillary acidic protein (GFAP), and serum nonneuronal biomarkers, namely neutrophil gelatinase-associated lipocalin (NGAL), lactate dehydrogenase (LDH), and lactate, were measured and associated postoperative oncological outcomes, including brain tumor grading, progression-free survival (PFS), and overall survival (OS), were compared. RESULTS: Patients with high-grade brain tumors had significantly higher pretreatment serum lactate levels (p = 0.011). By contrast, other biomarkers were comparable between patients with high-grade and low-grade brain tumors. Receiver operating characteristic curve analysis of serum lactate levels yielded an area under the curve of 0.71 for differentiating between high-grade and low-grade brain tumors. Kaplan-Meier survival analysis revealed patients with high serum lactate levels (≧2.0 mmol/L) had shorter PFS and OS (p = 0.021 and p = 0.093, respectively). In a multiple regression model, only elevated serum lactate levels were associated with poor PFS and OS (p = 0.021 and p = 0.048, respectively). CONCLUSIONS: An elevated pretreatment serum lactate level is a prognostic biomarker of high-grade primary brain tumors and is significantly associated with poor PFS in patients with supratentorial brain tumors undergoing tumor resection. By contrast, other serum biomarkers are not significantly associated with oncological outcomes.

15.
Support Care Cancer ; 25(7): 2049-2054, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28181014

RESUMO

PURPOSE: Identifying risk factors for premature totally implantable venous access device (TIVAD) catheter removal is crucial; however, because of the diversity of study methodologies, there is no consensus on such factors. The objective of the present study was to identify such risk factors by applying a cohort design study with a long-term follow-up period. METHODS: For this cohort study, we selected cancer patients who had newly implanted TIVADs between July 2008 and December 2008. The follow-up period lasted until September 2012. Univariate analysis was performed for age, gender, cancer type, TIVAD brand, puncture site, sidedness of puncture, and catheter tip position. The hazard ratio (HR) of potential risk factors was calculated using the Cox proportional hazards regression model, and Kaplan-Meier curves were applied for catheter survival analysis. RESULTS: Our study consisted of 240 people, with 5 people lost to follow-up. The cumulative premature catheter removal rate of all TIVADs was 9.8%, with the most common reason for premature removal being port-associated blood stream infection (PABSI), which proved to be highest in patients with hematology cancer (27.8%) and upper gastrointestinal cancer (19.4%). Suboptimal tip position (HR 5.13, 95% confidence interval 1.73-15.21) was also a risk factor for premature removal, and it was correlated with symptomatic TIVAD occlusion (p = 0.0004). CONCLUSIONS: PABSI was the most common reason for premature catheter removal, with a varied incidence rate between different cancer types. Suboptimal tip position was also a risk factor. Confirming the final tip position after implantation is crucial. Infection control is important for TIVAD care, especially in high-risk cancer patients.


Assuntos
Cateterismo Venoso Central/estatística & dados numéricos , Cateteres de Demora/estatística & dados numéricos , Próteses e Implantes/estatística & dados numéricos , Estudos de Coortes , Feminino , Humanos , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade
16.
Chin Med J (Engl) ; 127(12): 2275-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24931241

RESUMO

BACKGROUND: Coronary heart disease (CHD) is the most common type of heart disease and cause of heart attacks. This study investigated the epidemiological characteristics of CHD and its risk factors in Jiaozhou, Shandong province, to ultimately find a way of reducing the prevalence of cardiovascular disease, and to provide a theoretical basis for establishing a cardiovascular disease management path under the regional medical collaborative mechanism. METHODS: A questionnaire survey was performed including 1 952 people aged 35 years or older who were questioned by means of stratified, cluster, proportional sampling to investigate the prevalence of CHD and its risk factors. The data were inputted into SPSS11.0 statistical software for processing and analysis. We advised the local medical institutions to establish health files for the residents with CHD and risk factors. They were followed up regularly. Their risk factors and life-style were monitored, and advice was given as to proper medications. Green channels were established, and the patients were transmitted in a timely manner to superior hospitals for better treatment if the necessary treatments were not available in the local hospitals. The control of risk factors was observed after the follow-up for half a year. RESULTS: In Jiaozhou, the rates of coronary artery disease, hypertension, diabetes, hyperlipidemia and overweight were 8.15%, 28.54%, 11.43%, 35.46%, and 18.70% respectively. The rates of hypertension, diabetes, hyperlipidemia and overweight were higher than the data published in "The report of Chinese cardiovascular disease 2012"; which are 24%, 9.7%, 18.6%, and 9.7%, respectively. The control of risk factors improved significantly after the guidance of the residents lifestyle and medication for six months. CONCLUSIONS: The high prevalence of coronary artery disease in Jiaozhou is closely related to age, gender, diet structure, family history of cardiovascular disease, hypertension, diabetes, hyperlipidemia, overweight, and unhealthy lifestyle. Under the regional medical coordination mechanism, the collaborative management of cardiovascular disease can provide new management concepts for the areas short of medical resources, so as to reduce the prevalence of cardiovascular disease.


Assuntos
Doença das Coronárias/epidemiologia , Adulto , Idoso , China/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco
17.
Taiwan J Obstet Gynecol ; 53(1): 8-11, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24767638

RESUMO

OBJECTIVES: Patient-controlled epidural analgesia (PCEA) and continuous epidural infusion (CEI) are popular and effective methods for pain relief during labor; however, there are concerns about increasing rates of cesarean section (C/S) and instrumental delivery. This prospective study investigated the effect of PCEA and CEI with different formulas on labor and the mode of delivery in nulliparous women. MATERIALS AND METHODS: A total of 480 nulliparous women were randomized into four groups, with 120 in each. Group A received a loading dose of 10 mL of 1 mg/mL ropivacaine with 2 µg/mL fentanyl, then an intermittent bolus of 5 mL with a background infusion of 5 mL/hour by PCEA. Group B received the same PCEA formula as Group A with 0.8 mg/mL bupivacaine. Group C received the same formula as Group A by CEI with 1 mg/mL ropivacaine at a rate of 10 mL/hour. Group D received the same formula as Group C with 0.8 mg/mL bupivacaine. The rates of C/S and instrumental delivery and the incidence of side effects were recorded. RESULTS: The rates of C/S were significantly different between Groups A and C, Groups A and D, and Groups B and D. The rates of instrumental delivery for normal spontaneous delivery were significantly different between Groups A and B, A and D, B and C, and C and D. CONCLUSION: The C/S rate was higher in Groups C and D; however, the instrumental delivery rate was lower in Groups A and C. We conclude that PCEA with 1 mg/mL ropivacaine might provide the greatest benefit for labor analgesia.


Assuntos
Amidas/uso terapêutico , Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Analgesia Controlada pelo Paciente/métodos , Fentanila/uso terapêutico , Dor do Parto/tratamento farmacológico , Adulto , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Cesárea/métodos , Feminino , Humanos , Paridade , Gravidez , Estudos Prospectivos , Ropivacaina , Resultado do Tratamento
18.
J Anesth ; 28(2): 202-5, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24277110

RESUMO

BACKGROUND: We hypothesized that body shape metrics influence the anatomy of spinal canal and intraabdominal pressure in three dimensions. We explored the effects of abdominal circumference, trunk length, and their combination on the level of spinal anesthesia in the term parturient in this study. METHODS: Thirty term parturients, ASA class I-II, from 20 to 41 years of age, scheduled for cesarean section were enrolled in this observational study. Abdominal circumference (AC) and trunk length (TL) were recorded preoperatively. Spinal anesthesia was performed with 10 mg 0.5% hyperbaric bupivacaine at the L4-L5 intervertebral space in all parturients. Correlation between maximal sensory spinal anesthesia level and physical parameters was analyzed with Spearman rank correlation coefficients. The calculated r value was compared with r = 0 with p < 0.05 as the significant level. The prediction power of these physical parameters for spinal level was evaluated by prediction probability. RESULTS: The parameter TL/AC2 was statistically correlated with maximal sensory level (Spearman correlation coefficient, -0.45 with p < 0.02). The prediction probability of TL/AC2 for the dermatomal level was P K = 0.685. If the dermatomal levels were lumped as higher (above T2) and lower (below T3) levels, the prediction probability of TL/AC2 was as high as P K = 0.856. CONCLUSIONS: TL/AC2, which simulated the ratio of the long axis and transection area of the abdomen, was correlated with maximal spinal level, and parturients with low TL/AC2 values tended to have higher dermatomal levels during spinal anesthesia.


Assuntos
Anestesia Obstétrica/métodos , Raquianestesia/métodos , Anestésicos Locais/uso terapêutico , Bupivacaína/uso terapêutico , Adulto , Cesárea/métodos , Feminino , Humanos , Gravidez , Estatísticas não Paramétricas , Adulto Jovem
20.
Taiwan J Obstet Gynecol ; 50(4): 441-6, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22212315

RESUMO

OBJECTIVE: Conventional, intermittent, epidural morphine is widely applied as a post-Cesarean delivery analgesia. We compared the analgesic efficacy, motor weakness, and side effects of administering a patient-controlled epidural analgesia (PCEA) of pure ropivacaine versus the intermittent administration of epidural morphine after Cesarean delivery. MATERIALS AND METHODS: This randomized, double-blind study included 120 full-term parturients who underwent elective Cesarean delivery and received either PCEA with pure ropivacaine or an intermittent bolus epidural of 2 mg/10 mL morphine in normal saline twice per day. The efficacy of pain relief, post-Cesarean side effects, motor blockades, time to first ambulation, and global satisfaction scores were evaluated. RESULTS: Pain scores were recorded at the four evaluation times (2, 12, 24, and 48 hours post-Cesarean delivery), and the time to first ambulation did not statistically differ between the two groups. Patients in the ropivacaine group experienced more motor weakness at 2 and 12 hours, fewer side effects, and higher global satisfaction scores than those in the morphine group (p < 0.05). CONCLUSION: The analgesic efficacy after cesarean delivery was almost equivalent between two groups. PCEA with pure ropivacaine induced significant motor blockade during the first 12 hours, but without delaying the time to first ambulation. Patients in the ropivacaine group reported higher patient satisfaction scores due to the significant reduction of annoying side effects, such as pruritus, nausea, vomiting, and urinary retention.


Assuntos
Amidas/uso terapêutico , Analgesia Controlada pelo Paciente , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Cesárea , Morfina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Adulto , Amidas/efeitos adversos , Analgésicos Opioides/efeitos adversos , Anestésicos Locais/efeitos adversos , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Injeções Epidurais , Morfina/efeitos adversos , Medição da Dor , Satisfação do Paciente , Gravidez , Estudos Prospectivos , Recuperação de Função Fisiológica , Ropivacaina , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA