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1.
J Intensive Care ; 10(1): 12, 2022 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-35256012

RESUMO

BACKGROUND: Even an ultraprotective ventilation strategy in severe acute respiratory distress syndrome (ARDS) patients treated with extracorporeal membrane oxygenation (ECMO) might induce ventilator-induced lung injury and apneic ventilation with the sole application of positive end-expiratory pressure may, therefore, be an alternative ventilation strategy. We, therefore, compared the effects of ultraprotective ventilation with apneic ventilation on oxygenation, oxygen delivery, respiratory system mechanics, hemodynamics, strain, air distribution and recruitment of the lung parenchyma in ARDS patients with ECMO. METHODS: In a prospective, monocentric physiological study, 24 patients with severe ARDS managed with ECMO were ventilated using ultraprotective ventilation (tidal volume 3 ml/kg of predicted body weight) with a fraction of inspired oxygen (FiO2) of 21%, 50% and 90%. Patients were then treated with apneic ventilation with analogous FiO2. The primary endpoint was the effect of the ventilation strategy on oxygenation and oxygen delivery. The secondary endpoints were mechanical power, stress, regional air distribution, lung recruitment and the resulting strain, evaluated by chest computed tomography, associated with the application of PEEP (apneic ventilation) and/or low VT (ultraprotective ventilation). RESULTS: Protective ventilation, compared to apneic ventilation, improved oxygenation (arterial partial pressure of oxygen, p < 0.001 with FiO2 of 50% and 90%) and reduced cardiac output. Both ventilation strategies preserved oxygen delivery independent of the FiO2. Protective ventilation increased driving pressure, stress, strain, mechanical power, as well as induced additional recruitment in the non-dependent lung compared to apneic ventilation. CONCLUSIONS: In patients with severe ARDS managed with ECMO, ultraprotective ventilation compared to apneic ventilation improved oxygenation, but increased stress, strain, and mechanical power. Apneic ventilation might be considered as one of the options in the initial phase of ECMO treatment in severe ARDS patients to facilitate lung rest and prevent ventilator-induced lung injury. TRIAL REGISTRATION: German Clinical Trials Register (DRKS00013967). Registered 02/09/2018. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013967 .

2.
Arch Toxicol ; 95(4): 1349-1365, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33523262

RESUMO

A major challenge in current cancer therapy is still the treatment of metastatic melanomas of the skin. BH3 mimetics represent a novel group of substances inducing apoptosis. In this study, we investigated the cytotoxic effect of (±) gossypol (GP), a natural compound from cotton seed, on A375 melanoma cells and the underlying biochemical mechanisms. To prevent undesired side effects due to toxicity on normal (healthy) cells, concentrations only toxic for tumor cells have been elaborated. Viability assays were performed to determine the cytotoxicity of GP in A375 melanoma and normal (healthy) cells. For the majority of experiments, a concentration of 2.5 µM GP was used resulting in a ROS-independent but caspase-dependent cell death of A375 melanoma cells. At this level, GP was non-toxic for normal human epidermal melanocytes. GP has a very short half-life, however, it was demonstrated that only the "parent" compound and not decomposition products are responsible for the cytotoxic effect in A375 melanoma cells. GP significantly decreased mitochondrial membrane potential accompanied by a Drp1-dependent loss of mitochondrial integrity (fragmentation) in tumor cells. Taken together, GP induced a ROS-independent intrinsic apoptosis leading to the conclusion that within a specific concentration range, GP may work as effective anticancer drug without harmful side effects.


Assuntos
Antineoplásicos Fitogênicos/farmacologia , Gossipol/farmacologia , Melanoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Antineoplásicos Fitogênicos/toxicidade , Apoptose/efeitos dos fármacos , Morte Celular/efeitos dos fármacos , Linhagem Celular Tumoral , Gossipol/toxicidade , Humanos , Melanoma/patologia , Potencial da Membrana Mitocondrial/efeitos dos fármacos , Mitocôndrias/efeitos dos fármacos , Espécies Reativas de Oxigênio/metabolismo , Neoplasias Cutâneas/patologia
3.
Comput Inform Nurs ; 34(7): 297-302, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27270628

RESUMO

Concerns have been raised about the effects of current medication administration processes on the safety of many of the aspects of medication administration. Keeping electronic medication administration records could decrease many of these problems. Unfortunately, there has not been much research on this topic, especially in nursing homes. A prospective case-control survey was consequently performed at two nursing homes; the electronic record system was introduced in one, whereas the other continued to use paper records. The personnel were asked to fill in a questionnaire of their perceptions of stress and risk of medication errors at baseline (n = 66) and 20 weeks after the intervention group had started recording medication administration electronically (n = 59). There were statistically significant decreases in the perceived risk of omitting a medication, of medication errors occurring because of communication problems, and of medication errors occurring because of inaccurate medication administration records in the intervention group (all P < .01 vs the control group). The perceived overall daily stress levels were also reduced in the intervention group (P < .05). These results indicate that the utilization of electronic medication administration records will reduce many of the concerns regarding the medication administration process.


Assuntos
Registros Eletrônicos de Saúde , Sistemas de Registro de Ordens Médicas , Erros de Medicação/estatística & dados numéricos , Assistentes de Enfermagem/psicologia , Estresse Psicológico/psicologia , Humanos , Erros de Medicação/prevenção & controle , Casas de Saúde , Estudos Prospectivos
4.
Gynecol Oncol ; 127(3): 462-6, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22943880

RESUMO

OBJECTIVE: To evaluate the sensitivity of sentinel node (SN) ultrastaging and to define parameters that may reduce the overall false-negative rate in women with early-stage cervical cancer. METHODS: We analyzed data from a large retrospective multicenter cohort group with FIGO stages IA-IIB cervical cancer in whom at least one SN was identified and systematic pelvic lymphadenectomy was uniformly performed. All who were SN negative by initial evaluation were subjected to ultrastaging. RESULTS: In all, 645 patients were evaluable. SN were detected bilaterally in 72% of cases and unilaterally in 28%. Patients with optimal bilateral SN detection were significantly more likely to have any metastasis detected (33.3% vs. 19.2%; P<0.001) as well as micrometastasis detected in their SN (39.6% vs. 11.4%). SN ultrastaging resulted in a low overall false-negative rate of 2.8% (whole group) and an even lower false-negative rate of 1.3% for patients with optimal bilateral mapping. Patients with false-negative SN after ultrastaging had a higher prevalence of LVSI and more frequent unilateral SN detection. Sensitivity of SN ultrastaging was 91% (95% CI: 86%-95%) for the whole group and 97% (95% CI: 91%-99%) in the subgroup with bilateral SN detection. CONCLUSION: These data confirm previous observations that optimal bilateral SN detection substantially decreases the false negative rate of SN ultrastaging and increases detection of micrometastasis. In patients with bilateral SN detection, the sensitivity of SN ultrastaging is not reduced in more advanced stages of the disease. SN mapping and ultrastaging should become standard practice in the surgical management of early-stage cervical cancer.


Assuntos
Metástase Linfática/diagnóstico , Micrometástase de Neoplasia/diagnóstico , Biópsia de Linfonodo Sentinela , Neoplasias do Colo do Útero/patologia , Idoso , Estudos de Coortes , Reações Falso-Negativas , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Neoplasias do Colo do Útero/diagnóstico
5.
PLoS One ; 7(5): e36820, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22606293

RESUMO

While the effects of cannabis use on retrospective memory have been extensively examined, only a limited number of studies have focused on the links between cannabis use and prospective memory. We conducted two studies to examine the links between cannabis use and both time-based and event-based prospective memory as well as potential mechanisms underlying these links. For the first study, 805 students completed an online survey designed to assess cannabis consumption, problems with cannabis use indicative of a disorder, and frequency of experiencing prospective memory failures. The results showed small to moderate sized correlations between cannabis consumption, problems with cannabis use, and prospective memory. However, a series of mediation analyses revealed that correlations between problems with cannabis use and prospective memory were driven by self-reported problems with retrospective memory. For the second study, 48 non-users (who had never used cannabis), 48 experimenters (who had used cannabis five or fewer times in their lives), and 48 chronic users (who had used cannabis at least three times a week for one year) were administered three objective prospective memory tests and three self-report measures of prospective memory. The results revealed no objective deficits in prospective memory associated with chronic cannabis use. In contrast, chronic cannabis users reported experiencing more internally-cued prospective memory failures. Subsequent analyses revealed that this effect was driven by self-reported problems with retrospective memory as well as by use of alcohol and other drugs. Although our samples were not fully characterized with respect to variables such as neurological disorders and family history of substance use disorders, leaving open the possibility that these variables may play a role in the detected relationships, the present findings indicate that cannabis use has a modest effect on self-reported problems with prospective memory, with a primary problem with retrospective memory appearing to underlie this relationship.


Assuntos
Fumar Maconha/efeitos adversos , Fumar Maconha/psicologia , Memória Episódica , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Abuso de Maconha/psicologia , Inquéritos e Questionários , Adulto Jovem
6.
Arch Biochem Biophys ; 496(2): 93-100, 2010 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-20153715

RESUMO

Selected biological effects of 1,4-naphthoquinone, menadione (2-methyl-1,4-naphthoquinone) and structurally related quinones from natural sources--the 5-hydroxy-naphthoquinones juglone, plumbagin and the 2-hydroxy-naphthoquinones lawsone and lapachol--were studied in human keratinocytes (HaCaT). 1,4-naphthoquinone and menadione as well as juglone and plumbagin were highly cytotoxic, strongly induced reactive oxygen species (ROS) formation and depleted cellular glutathione. Moreover, they induced oxidative DNA base damage and accumulation of DNA strand breaks, as demonstrated in an alkaline DNA unwinding assay. Neither lawsone nor lapachol (up to 100 microM) were active in any of these assays. Cytotoxic and oxidative action was paralleled by stimulation of stress signaling: all tested quinones except lawsone and lapachol strongly induced phosphorylation of the epidermal growth factor receptor (EGFR) and the related ErbB2 receptor tyrosine kinase. EGFR activation by plumbagin, juglone and menadione was attenuated by a superoxide dismutase mimetic, indicating that ROS-related mechanisms contribute to EGFR activation by these naphthoquinones.


Assuntos
Queratinócitos/metabolismo , Naftoquinonas/administração & dosagem , Estresse Oxidativo/fisiologia , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais/fisiologia , Linhagem Celular , Relação Dose-Resposta a Droga , Humanos , Queratinócitos/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Transdução de Sinais/efeitos dos fármacos
8.
Clin Neuropsychol ; 18(2): 208-28, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15587669

RESUMO

The primary objective of the present investigation was to characterize the neuropsychological test performance of a large sample of clinic-referred individuals diagnosed as Cognitively-Impaired-Not-Demented (CIND). Participants classified as Not-Cognitively-Impaired (NCI; n = 68) differed from CIND individuals (n = 205) on a number of demographic, clinical, and neuropsychological measures. A backward stepwise logistic regression analysis revealed that measures of learning and memory, visuoconstruction abilities, and cognitive flexibility provided the best discrimination between NCI and CIND participants. Clinical comparison data for CIND participants were generated for various demographically defined groups. The amount of inter-test scatter (highest minus lowest sample-based z-score) and the overall number of cognitive impairments (impairment being defined as performance equal to or greater than 1 standard deviation below the sample mean) in CIND individuals are reported. The results support the impression that CIND is a cognitively heterogeneous condition.


Assuntos
Transtornos Cognitivos/fisiopatologia , Cognição/fisiologia , Memória/fisiologia , Testes Neuropsicológicos/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Aprendizagem por Associação , Distribuição de Qui-Quadrado , Demografia , Escolaridade , Feminino , Humanos , Inteligência/fisiologia , Testes de Inteligência , Idioma , Modelos Logísticos , Masculino , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-Idade , Comportamento Verbal/fisiologia
9.
J Am Podiatr Med Assoc ; 92(9): 507-11, 2002 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-12381800

RESUMO

Fibrosarcoma is an uncommon, malignant soft-tissue tumor that is rarely found as a primary neoplasm in the foot. A case report is presented that demonstrates a large, locally invasive fibrosarcoma of the plantar aspect of the foot with initial symptoms consistent with plantar fasciitis. Below-the-knee amputation was performed as curative treatment.


Assuntos
Fasciíte Plantar/diagnóstico , Fibrossarcoma/diagnóstico , Doenças do Pé/diagnóstico , Neoplasias de Tecidos Moles/diagnóstico , Idoso , Humanos , Masculino
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