RESUMO
ABSTRACT: The aim of this study was to determine which of 4 laryngoscopes, including A-LRYNGO, a newly developed channel-type video-laryngoscope with an embedded artificial intelligence-based glottis guidance system, is appropriate for tracheal intubation training in novice medical students wearing personal protective equipment (PPE).Thirty healthy senior medical school student volunteers were recruited. The participants underwent 2 tests with 4 laryngoscopes: Macintosh, McGrath, Pentax Airway-Scope and A-LRYNGO. The first test was conducted just after a lecture without any hands-on workshop. The second test was conducted after a one-on-one hands-on workshop. In each test, we measured the time required for tracheal intubation, intubation success rate, etc, and asked all participants to complete a short questionnaire.The time to completely insert the endotracheal tube with the Macintosh laryngoscope did not change significantly (Pâ=â.177), but the remaining outcomes significantly improved after the hands-on workshop (all Pâ<â.05). Despite being novice practitioners with no intubation experience and wearing PPE, the, 2 channel-type video-laryngoscopes were associated with good intubation-related performance before the hands-on workshop (all Pâ<â.001). A-LRYNGO's artificial intelligence-based glottis guidance system showed 93.1% accuracy, but 20.7% of trials were guided by the vocal folds.To prepare to manage the airway of critically ill patients during the coronavirus disease 2019 pandemic, a channel-type video-laryngoscope is appropriate for tracheal intubation training for novice practitioners wearing PPE.
Assuntos
COVID-19/prevenção & controle , Intubação Intratraqueal/instrumentação , Laringoscópios , Laringoscopia/instrumentação , Equipamento de Proteção Individual/efeitos adversos , Adulto , Inteligência Artificial , Desenho de Equipamento , Feminino , Glote , Humanos , Masculino , Manequins , SARS-CoV-2 , Estudantes de MedicinaRESUMO
BACKGROUND: Clinical decision-making of invasive high-intensity care for critically ill stage IV cancer patients in the emergency department (ED) is challenging. A reliable and clinically available prognostic score for advanced cancer patients with septic shock presented at ED is essential to improve the quality of intensive care unit care. This study aimed to develop a new prognostic score for advanced solid cancer patients with septic shock available early in the ED and to compare the performance to the previous severity scores. METHODS: This multi-center, prospective cohort study included consecutive adult septic shock patients with stage IV solid cancer. A new scoring system for 28-day mortality was developed and validated using the data of development (January 2016 to December 2017; n = 469) and validation sets (January 2018 to June 2019; n = 428). The developed score's performance was compared to that of the previous severity scores. RESULTS: New scoring system for 28-day mortality was based on six variables (score range, 0-8): vital signs at ED presentation (respiratory rate, body temperature, and altered mentation), lung cancer type, and two laboratory values (lactate and albumin) in septic shock (VitaL CLASS). The C-statistic of the VitaL CLASS score was 0.808 in the development set and 0.736 in the validation set, that is superior to that of the Sequential Organ Failure Assessment score (0.656, p = 0.01) and similar to that of the Acute Physiology and Chronic Health Evaluation II score (0.682, p = 0.08). This score could identify 41% of patients with a low-risk group (observed 28-day mortality, 10.3%) and 7% of patients with a high-risk group (observed 28-day mortality, 73.3%). CONCLUSIONS: The VitaL CLASS score could be used for both risk stratification and as part of a shared clinical decision-making strategy for stage IV solid cancer patients with septic shock admitting at ED within several hours.
Assuntos
Neoplasias/complicações , Choque Séptico/etiologia , Idoso , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de Risco , Choque Séptico/mortalidadeRESUMO
The objective of this study was to evaluate the prognostic value of C-reactive protein (CRP), procalcitonin (PCT), and their combination for mortality in patients with septic shock. This multicenter, prospective, observational study was conducted between November 2015 and December 2017. A total of 1,772 septic shock patients were included, and the overall 28-day mortality was 20.7%. Although both CRP and PCT were elevated in the non-survivor group, only CRP had statistical significance (11.9 mg/dL vs. 14.7 mg/dL, p = 0.003, 6.4 ng/mL vs. 8.2 ng/mL, p = 0.508). Multivariate analysis showed that CRP and PCT were not independent prognostic markers. In the subgroup analysis of the CRP and PCT combination matrix using their optimal cut-off values (CRP 14.0 mg/dL, PCT 17.0 ng/dL), both CRP and PCT elevated showed significantly higher mortality (Odds ratio 1.552 [95% Confidence intervals 1.184-2.035]) than both CRP and PCT not elevated (p = 0.001) and only PCT elevated (p = 0.007). However, both CRP and PCT elevated was also not an independent predictor in multivariate analysis. Initial levels of CRP and PCT alone and their combinations in septic shock patients had a limitation to predict 28-day mortality. Future research is needed to determine new biomarkers for early prognostication in patients with septic shock.
Assuntos
Proteína C-Reativa/metabolismo , Pró-Calcitonina/sangue , Sepse/sangue , Choque Séptico/sangue , Biomarcadores/sangue , Peptídeo Relacionado com Gene de Calcitonina/sangue , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Prognóstico , Sistema de Registros , Sepse/mortalidade , Sepse/patologia , Choque Séptico/mortalidade , Choque Séptico/patologiaRESUMO
BACKGROUND: Leukosan SkinLink (LS), which combines non-woven textile strips and tissue adhesive, offers the advantage of atraumatic treatment while effectively shortening the procedure time. We hypothesized that wound closure would be faster with LS than with surgical suture (SS) and the wound infection and dehiscence would be similar. METHODS: A prospective, open label, single-center, randomized controlled trial was performed. Between November 2014 and April 2016, 49 patients with traumatic lacerations who presented to the emergency department were eligible for study inclusion. RESULTS: The mean wound closure time was significantly lower in the LS group than in the SS group (1.48â±â0.2 seconds vs 8.8â±â3.6 minutes, Pâ<â.001). After adjusting the wound closure time according to the lacerations length, the time remained significantly lower in the LS group than in the SS group (1.0â±â0.8 seconds vs 5.03â±â2.5minutes, Pâ<â.001). During follow-up for 14 days, no significant differences in dehiscence and wound infection were observed between the 2 groups. CONCLUSION: Wound closure was approximately 4minutes faster with LS and there were no differences in wound infection and dehiscence rates. Thus, the LS could be used as a timesaving suture technique for acute traumatic lacerations in emergency department (ED). TRIAL REGISTRATION: ClinicalTrials.gov NCT02333877.
Assuntos
Cicatriz/prevenção & controle , Embucrilato/uso terapêutico , Lacerações/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Técnicas de Sutura , Procedimentos Cirúrgicos sem Sutura , Técnicas de Fechamento de Ferimentos , Adulto , Idoso , Humanos , Lacerações/etiologia , Pessoa de Meia-Idade , Técnicas de Sutura/efeitos adversos , Técnicas de Sutura/instrumentação , Procedimentos Cirúrgicos sem Sutura/instrumentação , Procedimentos Cirúrgicos sem Sutura/métodos , Adesivos Teciduais/uso terapêutico , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/efeitos adversos , Técnicas de Fechamento de Ferimentos/instrumentação , Cicatrização/efeitos dos fármacosRESUMO
OBJECTIVES: Early airway management is very important for severely ill patients. This study aimed to investigate the efficacy of face to face intubation in four different types of laryngoscopes (Macintosh laryngoscope, Pentax airway scope (AWS), Glidescope video laryngoscope (GVL), and C-MAC video laryngoscope (C-MAC)). METHOD: Ninety-five nurses and emergency medical technicians were trained to use the AWS, C-MAC, GVL and Macintosh laryngoscope with standard airway trainer manikin and face to face intubation. We compared VCET (vocal cord exposure time), tube pass time, 1st ventilation time, VCET to tube pass time, tube pass time to 1st ventilation time, and POGO (percentage of glottis opening) score. In addition, we compared success rate according to the number of attempts and complications. RESULT: VCET was similar among all laryngoscopes and POGO score was higher in AWS. AWS and Macintosh blade were faster than GVL and C-MAC in total intubation time. Face to face intubation success rate was lower in GVL than other laryngoscopes. CONCLUSION: AWS and Macintosh were favorable laryngoscopes in face to face intubation. GVL had disadvantage performing face to face intubation.
Assuntos
Intubação Intratraqueal/métodos , Laringoscópios , Laringoscopia/métodos , Prega Vocal/fisiopatologia , Adulto , Competência Clínica , Feminino , Pessoal de Saúde , Humanos , Masculino , Manequins , Pessoa de Meia-IdadeAssuntos
Síndrome Coronariana Aguda/diagnóstico , Fumar Maconha/efeitos adversos , Ponte Miocárdica , Piperazinas/efeitos adversos , Sulfonamidas/efeitos adversos , Vasodilatadores/efeitos adversos , Síndrome Coronariana Aguda/induzido quimicamente , Síndrome Coronariana Aguda/diagnóstico por imagem , Adulto , Angiografia Coronária , Diagnóstico Diferencial , Eletrocardiografia , Humanos , Masculino , Purinas/efeitos adversos , Citrato de SildenafilaRESUMO
Noncompaction of the ventricular myocardium (NCM) is a disorder of unknown aetiology characterised by numerous, prominent ventricular trabeculations and deep intertrabecular recesses. Polycystic kidney disease (PKD) is characterised by the formation of multiple cysts in the kidneys and liver and, less frequently, in the pancreas. Cardiovascular abnormalities in PKD involve hypertension, mitral valve prolapse, intracranial aneurysms and pulmonary abnormalities include primary ciliary dyskinesia and bronchiectasis. Several case reports have described the possible association between PKD and NCM. However, NCM, PKD and bronchiectasis have not previously been correlated. This is the first case of NCM coupled with PKD and bronchiectasis.
Assuntos
Bronquiectasia , Cardiomegalia , Doenças Renais Policísticas , Bronquiectasia/etiologia , Bronquiectasia/patologia , Bronquiectasia/fisiopatologia , Cardiomegalia/etiologia , Cardiomegalia/patologia , Cardiomegalia/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Doenças Renais Policísticas/complicações , Doenças Renais Policísticas/patologia , Doenças Renais Policísticas/fisiopatologiaRESUMO
BACKGROUND: To explore the possible association between EBV, microsatellite instability (MSI), and alterations of hMLH1 protein, 282 tumors from 141 patients with multiple synchronous gastric carcinomas (MSGC) were studied. METHODS: In situ hybridization for EBV-encoded small RNA and hMLH1 immunohistochemistry were performed in tissue microarrays. In 19 MSGC cases with altered hMLH1 expression, methylation analyses by MethyLight and MSI tests were performed. RESULTS: Loss of hMLH1 was found in 19 of 141 MSGC patients (13.5%) and 26 of 282 MSGC tumors (9.2%). hMLH1 loss was associated with differentiated histology (P = 0.03). Out of the 38 tumors from 19 hMLH1-negative MSGCs, 12 tumors from six cases (31.6%) showed concurrent methylation of hMLH1 and MSI-high in both multiple tumors. EBV was found in 31 of 141 MSGC patients (21.9%) and 49 of 282 MSGC tumors (17.4%) and was significantly associated with undifferentiated histology and a location within the upper third of the stomach (P < 0.002). EBV was not observed in any of the tumors that had a loss of hMLH1 expression. CONCLUSIONS: Considering that EBV-associated GCs show global CpG island methylation, our findings suggest that EBV infection allows the gastric mucosa to escape from aberrant methylation of hMLH1 and induces a malignant pathway independent of MSI.
Assuntos
Proteínas Adaptadoras de Transdução de Sinal/fisiologia , Reparo de Erro de Pareamento de DNA , Infecções por Vírus Epstein-Barr/complicações , Neoplasias Primárias Múltiplas/etiologia , Proteínas Nucleares/fisiologia , Neoplasias Gástricas/etiologia , Proteínas Adaptadoras de Transdução de Sinal/genética , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteína 1 Homóloga a MutL , Neoplasias Primárias Múltiplas/genética , Neoplasias Primárias Múltiplas/virologia , Proteínas Nucleares/genética , Regiões Promotoras Genéticas , Neoplasias Gástricas/genética , Neoplasias Gástricas/virologiaAssuntos
Neoplasias Esofágicas/genética , Tumores do Estroma Gastrointestinal/genética , Deleção de Genes , Proteínas Proto-Oncogênicas c-kit/genética , Idoso , Antineoplásicos/uso terapêutico , Benzamidas , Biomarcadores Tumorais/metabolismo , Terapia Combinada , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/terapia , Éxons/genética , Feminino , Tumores do Estroma Gastrointestinal/patologia , Tumores do Estroma Gastrointestinal/terapia , Homozigoto , Humanos , Mesilato de Imatinib , Recidiva Local de Neoplasia , Piperazinas/uso terapêutico , Pirimidinas/uso terapêuticoRESUMO
A 77-year-old man visited our hospital complaining of aggravated exertional chest pain. He was diagnosed with syndrome X 7 years ago and underwent medical treatment in a regional hospital. Coronary angiography and echocardiography did not show any significant abnormalities. On the seventh in-hospital day, cardiogenic shock developed and echocardiography showed a dilated left ventricular (LV) cavity and severe LV systolic dysfunction. We thus inserted an intra-aortic balloon pump for hemodynamic support and were forced to maintain it because of weaning failure several times. Finally, heart transplantation was the decided necessary procedure. After successful heart transplantation, the biopsy specimen revealed a wild-type transthyretin deposition indicating senile systemic amyloidosis in the intramuscular coronary vessels and interstitium. Cardiac biopsy at the 4-year follow-up showed no recurrence of amyloid deposition.
Assuntos
Neoplasias Cardíacas/patologia , Veia Ilíaca/patologia , Leiomioma/patologia , Leiomiomatose/patologia , Neoplasias Uterinas/patologia , Neoplasias Vasculares/patologia , Veia Cava Inferior/patologia , Procedimentos Cirúrgicos Cardíacos , Feminino , Átrios do Coração/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Histerectomia , Veia Ilíaca/cirurgia , Leiomioma/cirurgia , Leiomiomatose/cirurgia , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Uterinas/cirurgia , Neoplasias Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares , Veia Cava Inferior/cirurgiaRESUMO
Pathological diagnosis of gastrointestinal stromal tumors (GISTs) is based on histological findings and immunohistochemical demonstration of the KIT protein. KIT-negative GISTs account for â¼5% of cases and cause diagnostic difficulties. In the era of imatinib therapy, a correct diagnosis of GISTs is important for therapeutic reasons regardless of KIT expression. Recently, DOG1 has been introduced as an important diagnostic marker with high sensitivity and specificity. In this study, immunohistochemical staining for DOG1 and protein kinase C-θ (PKC-θ) in whole tissue sections, and mutation analyses for KIT and PDGFRA were performed in 26 KIT-negative GISTs. Tissue microarrays of 112 KIT-positive GISTs were used as controls. Overall, 25 KIT-negative GISTs were located in the stomach, and 1 in the rectum. The histological subtype was spindle in 12, epithelioid in 11, and mixed in 3 cases. The expression of DOG1 and PKC-θ was positive in 24 (92%) and in 25 cases (96%), respectively. All 26 KIT-negative GISTs expressed either DOG1 or PKC-θ, and 23 cases (89%) were positive for both makers. PKC-θ was positive in two cases (8%), which lacked both KIT and DOG1 expressions. Mutation analysis showed PDGFRA exon 18 mutation in 15 cases (58%) and KIT exon 11 mutation in 1 case (4%), whereas the remaining 10 cases (39%) were wild type for both KIT and PDGFRA. The expression of DOG1 and PKC-θ showed no significant difference in KIT-negative and KIT-positive GISTs (P=1.000 and P=0.167, respectively). Our findings suggest that both DOG1 and PKC-θ can be used in the diagnosis of KIT-negative GISTs and they show positive staining even in KIT-negative tumors, which are wild type for KIT and PDGFRA on mutation analysis.
Assuntos
Tumores do Estroma Gastrointestinal/diagnóstico , Proteínas de Membrana/metabolismo , Proteínas de Neoplasias/metabolismo , Proteína Quinase C/metabolismo , Neoplasias Gástricas/diagnóstico , Adulto , Idoso , Anoctamina-1 , Biomarcadores Tumorais/metabolismo , Canais de Cloreto , Análise Mutacional de DNA , Feminino , Tumores do Estroma Gastrointestinal/genética , Tumores do Estroma Gastrointestinal/metabolismo , Humanos , Imuno-Histoquímica , Isoenzimas/genética , Isoenzimas/metabolismo , Masculino , Pessoa de Meia-Idade , Mutação , Proteína Quinase C/genética , Proteína Quinase C-theta , Proteínas Proto-Oncogênicas c-kit/genética , Proteínas Proto-Oncogênicas c-kit/metabolismo , Neoplasias Gástricas/genética , Neoplasias Gástricas/metabolismo , Análise Serial de Tecidos , Adulto JovemRESUMO
OBJECTIVES: Limited data are available regarding the impact of pressure or volume overload on the clinical or echocardiographic parameters and the levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with chronic severe aortic valve diseases. We aimed to investigate and compare the relationships between these parameters in such patients. METHODS: One hundred twenty-four consecutive patients who underwent aortic valve replacement for chronic severe aortic valve diseases were enrolled. Plasma NT- proBNP was measured and echocardiographic parameters were recorded before surgery, before discharge and 12 months after surgery. RESULTS: NT-proBNP levels were significantly higher in patients with aortic regurgitation (AR) (n = 63) than in those with aortic stenosis (n = 61) (1,836.0 ± 376.1 vs. 508.4 ± 74.5 pg/ml, p = 0.001). There was a significant relationship between NT-proBNP levels and left ventricular mass index (LVMI) in AR (r = 0.436, p = 0.002) and a weaker, but significant, relationship between NT-proBNP levels and LVMI in aortic stenosis patients (r = 0.290, p = 0.046). In the AR group, preoperative NT-proBNP levels positively correlated with LVMI regression during the 12 months after surgery (r = 0.488, p = 0.001). CONCLUSION: NT-proBNP levels may reflect LVMI changes that are caused by volume overload rather than pressure overload in chronic aortic valve diseases. Higher preoperative NT-proBNP levels may predict left ventricular reverse remodeling early after surgery for chronic severe AR.
Assuntos
Insuficiência da Valva Aórtica/metabolismo , Estenose da Valva Aórtica/metabolismo , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/metabolismo , Disfunção Ventricular Esquerda/metabolismo , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/cirurgia , Distribuição de Qui-Quadrado , Comorbidade , Ecocardiografia , Feminino , Seguimentos , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estatísticas não Paramétricas , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/cirurgiaRESUMO
AIMS: Heat shock proteins (HSP) are up-regulated under conditions of increased stress, including cancer. Recently, HSP90 has been shown to be crucial to the expression and activation of the KIT oncoprotein. The aim was to explore the role of HSP90 expression as a prognostic marker and therapeutic target in gastrointestinal stromal tumours (GISTs) and other mesenchymal tumours. METHODS AND RESULTS: The expression of HSP90 was evaluated by immunohistochemistry in 92 GISTs, 47 mesenteric fibromatoses, six schwannomas, leiomyomas, melanomas, malignant peripheral nerve sheath tumours and leiomyosarcomas. Western blotting was performed in 22 selected cases. HSP90 overexpression was found in 33.7% of GISTs and was correlated with non-gastric location, mixed histological subtype, high mitotic index, high risk grades, and specific mutation genotypes. In mesenchymal tumours, HSP90 overexpression was found in 66.7% of malignant peripheral nerve sheath tumours, 83.3% of leiomyosarcomas, and 100% of melanomas. HSP90 expression by Western blotting correlated with the results of immunohistochemistry. The Cox proportional hazards model showed that HSP90 expression is an independent predictor of recurrence in GISTs (P = 0.003). CONCLUSIONS: Overexpression of HSP90 is predictive of adverse behaviour in GISTs and may provide a therapeutic solution to the challenge of imatinib-resistant GISTs and other mesenchymal sarcomas.
Assuntos
Tumores do Estroma Gastrointestinal/metabolismo , Proteínas de Choque Térmico HSP90/metabolismo , Idoso , Feminino , Tumores do Estroma Gastrointestinal/genética , Tumores do Estroma Gastrointestinal/patologia , Humanos , Imuno-Histoquímica , Masculino , Melanoma/genética , Melanoma/patologia , Pessoa de Meia-Idade , Neoplasias de Tecido Muscular/genética , Neoplasias de Tecido Muscular/patologia , Neoplasias de Bainha Neural/genética , Neoplasias de Bainha Neural/patologia , Prognóstico , Modelos de Riscos Proporcionais , Proteínas Proto-Oncogênicas c-kit/genéticaRESUMO
AIMS: Wilms' tumour-1 (WT-1) encodes a transcription factor originally identified as a tumour suppressor gene, whose mutations are responsible for tumorigenesis of Wilms' tumour. The overexpression of WT-1 has been demonstrated in variable tumours. In this study, WT-1 immunoreactivity was explored in 97 gastrointestinal stromal tumours (GISTs). METHODS: The expression of WT-1 was compared with other immunohistochemical markers of GIST and the association with clinicopathological features was also evaluated. For comparison, six melanomas and 71 soft tissue tumours were used. RESULTS: All 97 GISTs were positive for WT-1 and the staining intensity was strong in 59 (60.8%), moderate in 28 (28.9%) and weak in 10 cases (10.3%). Cytoplasmic staining with moderate to strong intensity was more frequent in GISTs positive for platelet-derived growth factor receptor-alpha (PDGFRA) (p = 0.04). However, WT-1 immunoreactivity was not related to the clinicopathological variables, including tumour location, histological subtype, risk of progression and recurrence status. Leiomyosarcomas, schwannomas, malignant peripheral nerve sheath tumours (MPNSTs) and melanomas showed cytoplasmic staining, whereas leiomyomas and mesenteric fibromatoses were totally negative for WT-1. CONCLUSIONS: Although the biological roles of WT-1 in GIST are still unknown, our findings might provide a rationale for immunotherapy targeting WT-1 and a therapeutic solution to the challenge of imatinib-resistant GISTs.