Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 24
Filtrar
1.
Artigo em Inglês | MEDLINE | ID: mdl-37749851

RESUMO

BACKGROUND: Intraoperative hypotension is a risk factor for perioperative adverse outcomes and is highly prevalent in older patients. Frailty has been associated with hemodynamic instability but its impact on postinduction hypotension is unclear. Therefore, we assessed the association between frailty and postinduction hypotension in older patients. METHODS: We retrospectively evaluated electronic medical records of patients aged ≥65 years who were assessed for preoperative frailty and underwent noncardiac surgery under general anesthesia. Reported Edmonton Frail Scale (REFS) scores were used to stratify patients into a nonfrail (REFS scores 0-5), prefrail (6-7), and frail (8-18) groups. Postinduction hypotension was defined as a mean blood pressure below 65 mmHg or 20% from baseline occurring within the first 20 minutes after anesthesia induction and evaluated using multivariate logistic regression analysis. RESULTS: Independent factors related to postinduction hypotension in our sample (421 patients) were status of frail (REFS score ≥8) compared to nonfrail (odds ratio [OR], 2.73; 95% confidence interval [CI], 1.44-5.18; p = .002), lower baseline mean blood pressure in the operating room (OR, 0.98; 95% CI, 0.96-0.999; p = .034) and at the presurgical center (OR, 0.96; 95% CI, 0.94-0.99; p = .003), and orthopedic (compared to urologic) surgery (OR, 2.22; 95% CI, 1.14-4.30; p = .019). CONCLUSION: Preoperative frail status based on REFS scores is associated with postinduction hypotension. Frailty screening tool for older patients may enhance traditional risk calculators and improve patient selection for noncardiac surgery under general anesthesia.


Assuntos
Fragilidade , Hipotensão , Doenças Vasculares , Humanos , Idoso , Fragilidade/complicações , Fragilidade/epidemiologia , Fragilidade/diagnóstico , Estudos Retrospectivos , Hipotensão/complicações , Fatores de Risco , Complicações Pós-Operatórias/epidemiologia
2.
Pharmaceutics ; 15(2)2023 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-36839876

RESUMO

Complex regional pain syndrome (CRPS) is a condition associated with neuropathic pain that causes significant impairment of daily activities and functioning. Nuclear factor kappa B (NFκB) is thought to play an important role in the mechanism of CRPS. Recently, exosomes loaded with super-repressor inhibitory kappa B (Exo-srIκB, IκB; inhibitor of NFκB) have been shown to have potential anti-inflammatory effects in various inflammatory disease models. We investigated the therapeutic effect of Exo-srIκB on a rodent model with chronic post-ischemia pain (CPIP), a representative animal model of Type I CRPS. After intraperitoneal injection of a vehicle, Exo-srIκB, and pregabalin, the paw withdrawal threshold (PWT) was evaluated up to 48 h. Administration of Exo-srIκB increased PWT compared to the vehicle and pregabalin, and the relative densities of p-IκB and IκB showed significant changes compared to the vehicle 24 h after Exo-srIκB injection. The levels of several cytokines and chemokines were reduced by the administration of Exo-srIκB in mice with CPIP. In conclusion, our results showed more specifically the role of NFκB in the pathogenesis of CRPS and provided a theoretical background for novel treatment options for CRPS.

3.
Ther Clin Risk Manag ; 18: 249-258, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35330918

RESUMO

Purpose: Monitoring end-tidal carbon dioxide partial pressure (PETCO2) is a noninvasive, continuous method, but its accuracy is reduced by prolonged capnoperitoneum and the steep Trendelenburg position in robot-assisted radical prostatectomy (RARP). Transcutaneous carbon dioxide partial pressure (PTCCO2) monitoring, which is not affected by ventilator-perfusion mismatch, has been suggested as a suitable alternative. We compared the agreement of noninvasive measurements with the arterial carbon dioxide partial pressure (PaCO2) over a long period of capnoperitoneum, and investigated its sensitivity and predictive power for detecting hypercapnia. Patients and Methods: The patients who underwent RARP were enrolled in this study prospectively. Intraoperative measurements of PETCO2, PTCCO2, and PaCO2 were analyzed. The primary outcome was the agreement of noninvasive monitoring with PaCO2 during prolonged capnoperitoneum. Bias and precision between noninvasive measurements and PaCO2 were assessed using Bland-Altman analysis. The bias and mean absolute difference were compared using a two-tailed Wilcoxon signed-rank test for pairs. The secondary outcome was the sensitivity and predictive power for detecting hypercapnia. To assess this, the Yates corrected chi-square test and the area under the receiver operating characteristic curve were used. Results: The study analyzed 219 datasets from 46 patients. Compared with PETCO2, PTCCO2 had lower bias, greater precision, and better agreement with PaCO2 throughout the RARP. The mean absolute difference in PETCO2 and PaCO2 was larger than that of PTCCO2 and PaCO2, and continued to exceed the clinically acceptable range of 5 mmHg after 1 hour of capnoperitoneum. The sensitivity during capnoperitoneum and overall predictive power of PTCCO2 for detecting hypercapnia were significantly higher than those of PETCO2, suggesting a greater contribution to ventilator adjustment, to treat hypercapnia. Conclusion: PTCCO2 monitoring measured PaCO2 more accurately than PETCO2 monitoring during RARP requiring prolonged capnoperitoneum and a steep Trendelenburg position. PTCCO2 monitoring also provides more sensitive measurements for ventilator adjustment and detects hypercapnia more effectively than PETCO2 monitoring.

4.
Reg Anesth Pain Med ; 46(11): 965-970, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34535548

RESUMO

BACKGROUND AND OBJECTIVES: A single injection interscalene block (ISB) is a common regional analgesic technique in patients undergoing arthroscopic shoulder surgery. However, rebound pain after ISB resolution may reduce its overall benefit. Our primary aim was to assess whether perineural dexamethasone reduces the intensity and incidence of rebound pain in patients undergoing arthroscopic shoulder surgery under general anesthesia combined with a preoperative single injection ISB. METHODS: The patients were randomly assigned to receive single injection ISB using either 0.5% ropivacaine (control) or 0.5% ropivacaine containing 5 mg of dexamethasone. The primary outcomes were the pain score difference before and after ISB resolution, and the incidence of rebound pain. The secondary outcomes were the onset and duration of rebound pain, the presence of sleep disturbances due to postoperative pain, the first time when an analgesic was requested, and pain scores at various predefined time points. RESULTS: Pain increase following ISB resolution was lower in the dexamethasone group compared with the control group (4.5±2.4 and 6.9±2.2, respectively, p<0.001). The incidence of rebound pain was significantly lower in the dexamethasone group compared with the control group (37.1% and 82.9%, respectively, p<0.001). The controls experienced greater sleep disturbance during the postoperative period compared with those who received ISB with perineural dexamethasone. CONCLUSIONS: Perineural dexamethasone added to ISB using ropivacaine led to a much smoother resolution of ISB, reflected in a significantly smaller increase in pain after block resolution, a lower incidence of rebound pain and a lower sleep disturbance during the first postoperative week. TRIAL REGISTRATION NUMBER: Clinical Trial Registry of Korea (KCT0004418).


Assuntos
Bloqueio do Plexo Braquial , Ombro , Anestésicos Locais/efeitos adversos , Artroscopia/efeitos adversos , Bloqueio do Plexo Braquial/efeitos adversos , Dexametasona , Método Duplo-Cego , Humanos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/prevenção & controle , Ropivacaina
6.
Ther Clin Risk Manag ; 16: 1227-1234, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33363377

RESUMO

PURPOSE: In pediatric patients, the most common reason for delaying surgical intervention is an upper respiratory tract infection (URI). To date, there has been no consensus regarding the optimal timeframe for deferring surgery in children with URI. We conducted this study to evaluate whether a URI symptom-free period and other risk factors affect the incidence of perioperative respiratory adverse events (RAEs). PATIENTS AND METHODS: The study population included 267 pediatric patients (aged 0 to 13 years) with a recent URI episode who underwent surgery under general anesthesia. Following a retrospective review of medical records, several risk factors including a URI symptom-free period for intra- and postoperative RAEs were analyzed using univariate and multivariate logistic regression analyses. RESULTS: RAEs occurred in 23 of 267 patients (8.6%). Univariate analysis revealed that abnormal preoperative chest images (odds ratio [OR], 7.48; 95% confidence interval [CI], 2.46-22.68, p < 0.001) and emergency operations (OR, 2.84; 95% CI, 1.03-7.81, p = 0.04) were associated with RAEs. Four variables (abnormal preoperative chest images, emergency operations, age under 1 year and symptom-free period of 7-13 days) with a significance of <0.20 in the univariate logistic regression analysis were selected as candidate risk factors for the multivariate model. Among the four variables, abnormalities in preoperative chest images (OR, 7.60; 95% CI, 2.28-25.3, p = 0.001) and a symptom-free period of 7-13 days (OR, 0.13; 95% CI, 0.02-0.88, p = 0.04) were independently associated with RAEs in multivariate logistic regression analysis. CONCLUSION: For pediatric patients who require surgery and have a recent history of URI, procedures should be performed after a URI symptom-free period of at least 1-2 weeks. Confirming the absence of abnormalities in preoperative chest images can reduce the incidence of perioperative RAEs.

7.
J Korean Med Sci ; 35(39): e327, 2020 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-33045769

RESUMO

BACKGROUND: Protective mechanical ventilation using low tidal volume has been introduced to surgical patients to reduce the incidence of postoperative pulmonary complications. We investigated the effects of protective ventilation (PV) techniques on anesthesia-induced atelectasis identified via lung ultrasonography in patients undergoing abdominal surgery. METHODS: A total of 42 adult patients who were scheduled for open abdominal surgery with an expected duration > 2 hours were included in the study. Patients were randomized to receive either conventional ventilation (CV; tidal volume of 9-10 mL/kg predicted body weight [PBW] with no positive end-expiratory pressure [PEEP]) or PV (tidal volume of 6-8 mL/kg PBW and 5 cmH2O PEEP) via pressure-controlled ventilation with volume guaranteed. Lung ultrasonography was performed at four predefined time points to assess perioperative atelectasis by dividing each hemithorax into six quadrants based on a modified lung ultrasound (LUS) scoring system. RESULTS: The tidal volume delivered to patients was 9.65 ± 1.65 mL/kg PBW in the CV group and 6.31 ± 0.62 mL/kg PBW in the PV group. Ventilation using low tidal volume led to similar LUS scores in all lung areas and at all time points compared to ventilation using high tidal volume. There was no significant difference between the groups in the number of patients requiring recruitment maneuvers at the end of surgery. CONCLUSION: Ventilation with low tidal volume combined with 5 cmH2O PEEP did not cause further loss of aeration compared to ventilation with high tidal volume. Low tidal volume ventilation can be used in patients without lung injury based on lung assessment by bedside lung ultrasonography. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0003746.


Assuntos
Abdome/cirurgia , Pulmão/diagnóstico por imagem , Atelectasia Pulmonar/terapia , Respiração Artificial , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Respiração com Pressão Positiva , Estudos Prospectivos , Atelectasia Pulmonar/diagnóstico por imagem , Volume de Ventilação Pulmonar/fisiologia , Ultrassonografia
8.
Transplant Proc ; 52(1): 239-245, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31883766

RESUMO

BACKGROUND: Postoperative delirium after liver transplantation (LT) is associated with increased hospital length of stay and higher morbidity and mortality. Dexmedetomidine is a recommended and widely used sedative in critically ill patients with reports of potential for delirium prevention. METHODS: A randomized controlled clinical trial was performed to investigate whether perioperative low-dose dexmedetomidine infusion would decrease delirium after living-donor LT. Dexmedetomidine (0.1 mcg/kg/hour) was administered during anesthesia and through postoperative day 2 for patients in the dexmedetomidine group, whereas 0.9% saline was administered at the same rate for the same duration for patients in the control group. The incidence of delirium after LT was compared between the 2 groups. Delirium duration, mechanical ventilation duration, intensive care unit (ICU) and hospital length of stay, and in-hospital and 3-month mortality were also compared. RESULTS: There was no significant difference in delirium incidence in the dexmedetomidine group compared to the control group (9% vs 5.9%; P = .44). Duration of delirium and mechanical ventilation, ICU and hospital length of stay, and in-hospital and 3-month mortality were comparable between the 2 groups. CONCLUSIONS: Perioperative low-dose dexmedetomidine infusion did not reduce the incidence of delirium in living-donor LT.


Assuntos
Delírio/prevenção & controle , Dexmedetomidina/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Delírio/epidemiologia , Delírio/etiologia , Feminino , Humanos , Incidência , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia
9.
J Korean Med Sci ; 34(40): e260, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31625292

RESUMO

BACKGROUND: The impact of institutional case volume to graft failure rate after adult kidney transplantation is relatively unclear compared to other solid organ transplantations. METHODS: A retrospective cohort study of 13,872 adult kidney transplantations in Korea was performed. Institutions were divided into low- (< 24 cases/year), medium- (24-60 cases/year), and high- (> 60 cases/year) volume centers depending on the annual case volume. One-year graft failure rate was defined as the proportion of patients who required dialysis or re-transplantation at one year after transplantation. Postoperative in-hospital mortality and long-term graft survival were also measured. RESULTS: After adjustment, one year graft failure was higher in low-volume centers significantly (adjusted odds ratio [aOR], 1.50; 95% confidence interval [CI], 1.26-1.78; P < 0.001) and medium-volume centers (aOR, 1.87; 95% CI, 1.57-2.23; P < 0.001) compared to high-volume centers. Low-volume centers had significantly higher mortality (aOR, 1.75; 95% CI, 1.15-2.66; P = 0.01) than that of high-volume centers after adjustment. Long-term graft survival of up to 9 years was superior in high-volume centers compared to low- and medium-volume centers (P < 0.001). CONCLUSION: Higher-case volume centers were associated with lower one-year graft failure rate, lower in-hospital mortality, and higher long-term graft survival after kidney transplantation.


Assuntos
Rejeição de Enxerto/etiologia , Transplante de Rim/efeitos adversos , Adulto , Bases de Dados Factuais , Feminino , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/mortalidade , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Adulto Jovem
10.
Sci Rep ; 9(1): 13769, 2019 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-31551487

RESUMO

Bispectral index (BIS), a useful marker of anaesthetic depth, is calculated by a statistical multivariate model using nonlinear functions of electroencephalography-based subparameters. However, only a portion of the proprietary algorithm has been identified. We investigated the BIS algorithm using clinical big data and machine learning techniques. Retrospective data from 5,427 patients who underwent BIS monitoring during general anaesthesia were used, of which 80% and 20% were used as training datasets and test datasets, respectively. A histogram of data points was plotted to define five BIS ranges representing the depth of anaesthesia. Decision tree analysis was performed to determine the electroencephalography subparameters and their thresholds for classifying five BIS ranges. Random sample consensus regression analyses were performed using the subparameters to derive multiple linear regression models of BIS calculation in five BIS ranges. The performance of the decision tree and regression models was externally validated with positive predictive value and median absolute error, respectively. A four-level depth decision tree was built with four subparameters such as burst suppression ratio, power of electromyogram, 95% spectral edge frequency, and relative beta ratio. Positive predictive values were 100%, 80%, 80%, 85% and 89% in the order of increasing BIS in the five BIS ranges. The average of median absolute errors of regression models was 4.1 as BIS value. A data driven BIS calculation algorithm using multiple electroencephalography subparameters with different weights depending on BIS ranges has been proposed. The results may help the anaesthesiologists interpret the erroneous BIS values observed during clinical practice.

11.
Transplantation ; 103(9): 1877-1886, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30720690

RESUMO

BACKGROUND: Acute kidney injury (AKI) after living donor liver transplantation (LDLT) is associated with increased mortality. We sought to identify associations between intraoperative hemodynamic variables and postoperative AKI. METHODS: We retrospectively reviewed 734 cases of LDLT. Intraoperative hemodynamic variables of systemic and pulmonary arterial pressure, central venous pressure (CVP), and pulmonary artery catheter-derived parameters including mixed venous oxygen saturation (SvO2), right ventricular end-diastolic volume (RVEDV), stroke volume, systemic vascular resistance, right ventricular ejection fraction, and stroke work index were collected. Propensity score matching analysis was performed between patients with (n = 265) and without (n = 265) postoperative AKI. Hemodynamic variables were compared between patients with AKI, defined by Kidney Disease Improving Global Outcomes criteria, and those without AKI in the matched sample. RESULTS: The incidence of AKI was 36.1% (265/734). Baseline CVP, baseline RVEDV, and SvO2 at 5 minutes before reperfusion were significantly different between patients with and without AKI in the matched sample of 265 pairs. Multivariable logistic regression analysis revealed that baseline CVP, baseline RVEDV, and SvO2 at 5 minutes before reperfusion were independent predictors of AKI (CVP per 5 cm H2O increase: odds ratio [OR], 1.20; 95% confidence interval [CI], 1.09-1.32; SvO2: OR, 1.45; 95% CI, 1.27-1.71; RVEDV: OR, 1.48; 95% CI, 1.24-1.78). CONCLUSIONS: The elevated baseline CVP, elevated baseline RVEDV after anesthesia induction, and decreased SvO2 during anhepatic phase were associated with postoperative AKI. Prospective trials are required to evaluate whether the optimization of these variables may decrease the risk of AKI after LDLT.


Assuntos
Injúria Renal Aguda/etiologia , Hemodinâmica , Transplante de Fígado/efeitos adversos , Doadores Vivos , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/fisiopatologia , Pressão Arterial , Pressão Venosa Central , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Resistência Vascular , Função Ventricular Direita
12.
PLoS One ; 13(12): e0209078, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30550587

RESUMO

The widespread use of remifentanil during total intravenous anesthesia (TIVA) has raised concerns about the risk of postoperative remifentanil-associated pain. Although a recent meta-analysis suggests that remifentanil-associated pain is unlikely to occur in patients with TIVA because of the protective effect of co-administered propofol, the evidence is not conclusive. We retrospectively assessed 635 patients who received robotic thyroid surgery under TIVA to evaluate the risk of remifentanil-associated pain. Postoperative pain was evaluated using 11-point numeric rating scale (NRS). Time dependent Cox proportional hazards regression analysis was used to determine the risk factors of treatment-requiring pain (NRS > 4) during the first 48 postoperative hours. Postoperative pain rapidly decreased, and treatment-requiring pain remained in 12.8% (81 out of 635) of patients at 48 hours postoperatively. After adjusting for the time-dependent analgesic consumption, intraoperative use of remifentanil > 0.2 mcg/kg/min was a positive predictor of postoperative pain with a hazard ratio of 1.296 (95% C.I., 1.014-1.656, P = 0.039) during 48 hours after surgery. In conclusion, excessive use of remifentanil during TIVA was associated with increased risk of pain after robotic thyroid surgery. Prospective trials are required to confirm these results and determine whether decreasing remifentanil consumption below the threshold can reduce postoperative pain.


Assuntos
Anestesia Intravenosa/efeitos adversos , Dor Pós-Operatória/etiologia , Remifentanil/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Glândula Tireoide/cirurgia , Adulto , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco
13.
Korean J Intern Med ; 33(4): 696-704, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29117668

RESUMO

Background/Aims: The aim of this study was to investigate the mortality, bleeding control rate, and their associated predictors in patients treated with Sengstaken-Blakemore (SB) tube for uncontrolled variceal hemorrhage associated with hemodynamic instability or failure of endoscopic treatment. METHODS: The clinical data of 66 consecutive patients with uncontrolled variceal hemorrhage treated with SB tube at Gyeongsang National University Hospital from October 2010 to October 2015 were retrospectively analyzed. RESULTS: The overall success rate of initial hemostasis with SB tube was 75.8%, and the independent factors associated with hemostasis were non-intubated state before SB tube (odds ratio, 8.50; p = 0.007) and Child-Pugh score < 11 (odds ratio, 15.65; p = 0.022). Rebleeding rate after successful initial hemostasis with SB tube was 22.0%, and esophageal rupture occurred in 6.1%. Mortality within 30 days was 42.4%, and the related independent factors with mortality were failure of initial hemostasis with SB tube (hazard ratio, 6.24; p < 0.001) and endotracheal intubation before SB tube (hazard ratio, 2.81; p = 0.018). Conclusions: Since the era of endoscopic band ligation, SB tube might be a beneficial option as a temporary salvage treatment for uncontrolled variceal hemorrhage. However, rescue therapy had a high incidence of fatal complication and rebleeding.


Assuntos
Varizes Esofágicas e Gástricas , Hemorragia Gastrointestinal , Adulto , Varizes Esofágicas e Gástricas/terapia , Feminino , Hemorragia Gastrointestinal/terapia , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
Intervirology ; 60(3): 109-117, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29145204

RESUMO

OBJECTIVES: This study investigated the etiology of acute viral hepatitis and compared the clinical features of hepatitis E virus (HEV) infections with those of other acute viral hepatitis infections in Korea. METHODS: This study included 2,357 consecutive patients who were diagnosed with acute hepatitis, based on acute illness with jaundice or elevated alanine aminotransferase levels (>100 IU/L), between January 2007 and January 2016. Acute viral infections were observed in 23 (19.8%) patients with HEV, 49 (42.2%) patients with hepatitis A virus, 28 (24.1%) patients with hepatitis B virus, and 16 (13.8%) patients with hepatitis C virus. RESULTS: The incidence of acute HEV infection was higher among older patients (median age: 49 years) and male patients (69.6%), and was associated with the consumption of undercooked or uncooked meat (43.5%). Half of the acute HEV infections involved underlying liver disease, such as alcoholic liver disease, chronic hepatitis B, common bile duct stones, and autoimmune hepatitis. Two HEV-infected patients were diagnosed with Guillain-Barré syndrome, although no patients developed fulminant hepatitis. CONCLUSION: Our findings indicate that HEV infection in Korea is frequently transmitted through the consumption of raw meat and may cause acute or chronic liver disease.


Assuntos
Hepatite E/epidemiologia , Hepatite Viral Humana/virologia , Adulto , Antivirais/uso terapêutico , Feminino , Hepatite A/tratamento farmacológico , Hepatite A/etiologia , Hepatite A/virologia , Hepatite B Crônica/tratamento farmacológico , Hepatite B Crônica/etiologia , Hepatite B Crônica/virologia , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/etiologia , Hepatite C Crônica/virologia , Hepatite E/tratamento farmacológico , Hepatite E/etiologia , Hepatite Viral Humana/tratamento farmacológico , Hepatite Viral Humana/etiologia , Humanos , Masculino , Carne/virologia , Pessoa de Meia-Idade , Alimentos Crus/virologia , República da Coreia , Estudos Retrospectivos , Resultado do Tratamento
15.
Sci Rep ; 7(1): 13213, 2017 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-29038507

RESUMO

The neurobiological basis of social dysfunction and the high male prevalence in autism spectrum disorder (ASD) remain poorly understood. Although network alterations presumably underlie the development of autistic-like behaviors, a clear pattern of connectivity differences specific to ASD has not yet emerged. Because the heterogeneous nature of ASD hinders investigations in human subjects, we explored brain connectivity in an etiologically homogenous rat model of ASD induced by exposure to valproic acid (VPA) in utero. We performed partial correlation analysis of cross-sectional resting-state 18F-fluorodeoxyglucose positron emission tomography scans from VPA-exposed and control rats to estimate metabolic connectivity and conducted canonical correlation analysis of metabolic activity and behavior scores. VPA-treated rats exhibited impairments in social behaviors, and this difference was more pronounced in male than female rats. Similarly, current analyses revealed sex-specific changes in network connectivity and identified distinct alterations in the distributed metabolic activity patterns associated with autistic-like social deficits. Specifically, diminished activity in the salience network and enhanced activity in a cortico-cerebellar circuit correlated with the severity of social behavioral deficits. Such metabolic connectivity features may represent neurobiological substrates of autistic-like behavior, particularly in males, and may serve as a pathognomonic sign in the VPA rat model of ASD.


Assuntos
Transtorno do Espectro Autista/metabolismo , Encéfalo/metabolismo , Comportamento Social , Animais , Transtorno do Espectro Autista/fisiopatologia , Modelos Animais de Doenças , Feminino , Masculino , Tomografia por Emissão de Pósitrons , Ratos , Caracteres Sexuais
16.
J Phys Ther Sci ; 29(7): 1188-1191, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28744044

RESUMO

[Purpose] The purpose of this study was to investigate the effects of an occupation-centered activity program for dementia patients living in a local community, and examined the effects of the occupation-centered activity program on their cognitive functions, fall-related factors, and quality of life. [Subjects and Methods] Thirty subjects were divided into two groups: the experiment group (n=15) and the control group (n=15). The occupation-centered activity program was then applied to dementia patients for 60 minutes, 5 times/week for 12 weeks. To identify their cognitive functions before and after the intervention occupation-centered activity program, Mini-Mental State Examination-Korea (MMSE-K) and the Global Deterioration Scale (GDS) were used. To assess fall-related factors, Korean Falls Efficacy Scale for the Elderly (FES-K) was used and leg strength, agility, and balance of the participants was measured. To examine quality of life, the Korean version of Quality of Life-Alzheimer's Disease Scale (KQOL-AD) was used. [Results] The results of the intervention showed that although cognitive function improved in both the experimental and control groups, fall-related factors and the quality of life significantly improved only in the experimental group. [Conclusion] This indicates that the occupation-centered activity program had a positive effect on dementia patients' cognitive functions, fall-related factors, and quality of life.

17.
J Clin Anesth ; 36: 76-79, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28183579

RESUMO

STUDY OBJECTIVE: The purpose of this study was to determine the ideal insertion depth of the flexible laryngeal mask airway (FLMA) by elucidating the relationships between insertion depth and patient's age, body weight, height, and other parameters. We also evaluated an insertion technique that uses the change in intracuff pressure for proper positioning of the FLMA in cases where it is difficult to sense resistance during FLMA insertion. DESIGN: This study was a prospective observational study. SETTING: Participants were recruited from the Seoul National University Children's Hospital. PATIENTS: We enrolled 154 children aged ≤15 years with an American Society of Anesthesiologists physical status of I or II who were scheduled for ophthalmic surgery of <2 hours duration under general anesthesia. INTERVENTIONS: After induction of general anesthesia, FLMA insertion was guided by the change in intracuff pressure, measured using a manometer. The FLMA position was assessed using a fiberoptic bronchoscope. MEASUREMENTS: The FLMA insertion depth was measured at the end of each surgical procedure. A multiple linear regression model was then created using age, height, weight, nasal-tragus length, and sternal length. MAIN RESULTS: The FLMA was successfully inserted in the first attempt in 134 patients using continuous monitoring of intracuff pressure. Using multiple linear regression analysis and the Durbin-Watson test, we found that insertion depth was best predicted by height and weight (r2=0.777), and the resulting formula was as follows: insertion depth of FLMA (cm)=7.0+0.04×height (cm)+0.05 ×weight (kg). CONCLUSIONS: The FLMA insertion depth can be calculated using height and weight. Continuous monitoring of intracuff pressure during FLMA insertion is a useful alternative insertion method in cases where resistance is difficult to sense.


Assuntos
Máscaras Laríngeas , Adolescente , Anestesia Geral/métodos , Antropometria/métodos , Estatura , Peso Corporal , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Intubação Intratraqueal/métodos , Masculino , Manometria/métodos , Monitorização Intraoperatória/métodos , Pressão , Estudos Prospectivos
18.
J Phys Ther Sci ; 28(12): 3357-3360, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28174451

RESUMO

[Purpose] This study was designed to determine the effect of a respiration rehabilitation program on daily activities, satisfaction with leisure, and quality of sleep of patients with chronic obstructive pulmonary disease. [Subjects and Methods] The program was conducted three times a week for 12 weeks (a total of 36 times) with 20 patients aged between 50 and 70 years old. The Frenchay Activity Index was used to determine the instrumental activities of daily living before and after the intervention. The Korean scale of satisfaction with leisure was employed to determine the satisfaction with leisure, and the Korean version of the Pittsburgh Sleep Quality Index was used to measure the quality of sleep. [Results] The total score of all three instruments (instrumental activities of daily living (IADL), satisfaction with leisure, and quality of sleep) improved significantly after the intervention. [Conclusion] In conclusion, the scores of all three instruments (IADL, satisfaction with leisure, and quality of sleep) improved significantly after the intervention, indicating that the respiration rehabilitation program was effective at improving the overall quality of life for patients with chronic obstructive pulmonary disease.

19.
Paediatr Anaesth ; 25(11): 1120-6, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26248059

RESUMO

BACKGROUND: A needle or an angiocath has been generally used as a route for inserting a guide wire during central venous catheterization. We compared the needle with the angiocath for ultrasound-guided central venous catheterization in pediatric patients concerning accuracy and easiness. METHODS: One hundred and thirty-two patients aged between 1 day and 5 years were randomized into the needle and the angiocath groups. The study was separately carried out in two age groups: newborns vs infants and children. The primary outcome was time to successful insertion of the guide wire. Secondary outcomes including other time variables (time to 1st successful puncture of the vein, time between 1st successful puncture of the vein and successful insertion of the guide wire, total time to successful central venous catheterization), frequency variables (number of the puncture attempts, number of the guide wire insertion attempts), success rates (1st successful puncture rate, 1st successful guide wire insertion rate), and complications. RESULTS: There were no statistically significant differences in time and frequency variables, success rates, and complications between both the age groups. Time to 1st successful puncture of the vein (36.8 ± 31.7 vs 19.8 ± 27.1 s; 95% CI of mean difference 2.2-31.8; P = 0.03) and number of puncture attempts (1.6 ± 0.7 vs 1.3 ± 0.8; P = 0.02) were significantly greater in newborns with the needle, whereas with the angiocath, the number of puncture attempts was larger in newborns than in infants and children (1.7 ± 1.2 vs 1.2 ± 0.7; P = 0.02). CONCLUSION: The angiocath showed no superiority over the needle for ultrasound-guided central venous catheterization in pediatric patients. Regardless of the needle or the angiocath, puncture of the vein was more difficult in newborns than in infants and children.


Assuntos
Cateterismo Venoso Central/instrumentação , Ultrassonografia de Intervenção , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Veias Jugulares , Masculino , Agulhas , Reprodutibilidade dos Testes , Fatores de Tempo
20.
Korean J Gastroenterol ; 64(6): 364-9, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25530588

RESUMO

Esophageal carcinosarcoma is a rare malignant esophageal neoplasm consisting of both carcinomatous and sarcomatous elements, with an incidence of 0.5%. There have been only a few case reports of carcinosarcoma and squamous cell carcinoma coexisting in the esophagus. However, all of these are cases of synchronous or metachronous development of carcinosarcoma after chemoradiotherapy in patients of esophageal squamous cell carcinoma. A 53-year-old man underwent esophagogas-troduodenoscopy because of chest pain for several months. Endoscopic examination revealed a huge pedunculated esophageal polypoid mass. Endoscopic submucosal dissection (ESD) was performed and histopathologic examination confirmed spindle cell carcinoma (carcinosarcoma). He refused additional esophagectomy. After 21 months, third follow-up endoscopy showed poorly-demarcated flat, faint discolored lesions at different location from the previous ESD site and endoscopic biopsies confirmed squamous cell carcinoma. To the best of our knowledge, this is the first case of metachronous development of esophageal squamous cell carcinoma in a patient with esophageal carcinosarcoma.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Carcinossarcoma/diagnóstico , Neoplasias Esofágicas/diagnóstico , Antineoplásicos/uso terapêutico , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/patologia , Carcinossarcoma/tratamento farmacológico , Carcinossarcoma/patologia , Cisplatino/uso terapêutico , Quimioterapia Combinada , Endoscopia do Sistema Digestório , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/patologia , Fluoruracila/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Proteínas S100/metabolismo , Tomografia Computadorizada por Raios X , Proteína Supressora de Tumor p53/metabolismo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA