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1.
Nature ; 590(7847): 561-565, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33627814

RESUMO

The fundamental building blocks of the proton-quarks and gluons-have been known for decades. However, we still have an incomplete theoretical and experimental understanding of how these particles and their dynamics give rise to the quantum bound state of the proton and its physical properties, such as its spin1. The two up quarks and the single down quark that comprise the proton in the simplest picture account only for a few per cent of the proton mass, the bulk of which is in the form of quark kinetic and potential energy and gluon energy from the strong force2. An essential feature of this force, as described by quantum chromodynamics, is its ability to create matter-antimatter quark pairs inside the proton that exist only for a very short time. Their fleeting existence makes the antimatter quarks within protons difficult to study, but their existence is discernible in reactions in which a matter-antimatter quark pair annihilates. In this picture of quark-antiquark creation by the strong force, the probability distributions as a function of momentum for the presence of up and down antimatter quarks should be nearly identical, given that their masses are very similar and small compared to the mass of the proton3. Here we provide evidence from muon pair production measurements that these distributions are considerably different, with more abundant down antimatter quarks than up antimatter quarks over a wide range of momenta. These results are expected to revive interest in several proposed mechanisms for the origin of this antimatter asymmetry in the proton that had been disfavoured by previous results4, and point to future measurements that can distinguish between these mechanisms.

2.
Nat Mater ; 21(1): 54-61, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34608284

RESUMO

The properties of quantum materials are commonly tuned using experimental variables such as pressure, magnetic field and doping. Here we explore a different approach using irreversible, plastic deformation of single crystals. We show that compressive plastic deformation induces low-dimensional superconductivity well above the superconducting transition temperature (Tc) of undeformed SrTiO3, with evidence of possible superconducting correlations at temperatures two orders of magnitude above the bulk Tc. The enhanced superconductivity is correlated with the appearance of self-organized dislocation structures, as revealed by diffuse neutron and X-ray scattering. We also observe deformation-induced signatures of quantum-critical ferroelectric fluctuations and inhomogeneous ferroelectric order using Raman scattering. Our results suggest that strain surrounding the self-organized dislocation structures induces local ferroelectricity and quantum-critical dynamics that strongly influence Tc, consistent with a theory of superconductivity enhanced by soft polar fluctuations. Our results demonstrate the potential of plastic deformation and dislocation engineering for the manipulation of electronic properties of quantum materials.

3.
BJOG ; 130(7): 750-758, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37078279

RESUMO

OBJECTIVE: To evaluate the reasons for COVID-19 vaccine hesitancy during pregnancy. DESIGN: We used regular expressions to identify publicly available social media posts from pregnant people expressing at least one reason for their decision not to accept COVID-19 vaccine. SETTING: Two social media platforms - WhatToExpect and Twitter. SAMPLE: A total of 945 pregnant people in WhatToExpect (1017 posts) and 345 pregnant people in Twitter (435 tweets). METHODS: Two annotators manually coded posts according to the Scientific Advisory Group for Emergencies (SAGE) working group's 3Cs vaccine hesitancy model (confidence, complacency and convenience barriers). Within each 3Cs we created subthemes that emerged from the data. MAIN OUTCOME MEASURES: Subthemes were derived according to the people's posting own words. RESULTS: Safety concerns were most common and largely linked to the perceived speed at which the vaccine was created and the lack of data about its safety in pregnancy. This led to a preference to wait until after the baby was born or to take other precautions instead. Complacency surrounded a belief that they are young and healthy or already had COVID-19. Misinformation led to false safety and efficacy allegations, or even conspiracy theories, and fed into creating confidence and complacency barriers. Convenience barriers (such as availability) were uncommon. CONCLUSION: The information in this study can be used to highlight the questions, fears and hesitations pregnant people have about the COVID-19 vaccine. Highlighting these hesitations can help public health campaigns and improve communication between healthcare professionals and patients.


Assuntos
COVID-19 , Mídias Sociais , Feminino , Gravidez , Humanos , Vacinas contra COVID-19/uso terapêutico , COVID-19/prevenção & controle , Hesitação Vacinal , Vacinação
5.
Anaesthesia ; 78(9): 1139-1146, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37365701

RESUMO

It is essential that academic publishing complies with the highest standards in terms of ethics, research conduct and manuscript preparation. This protects the rights and welfare of research participants, ensures the integrity of study results and aids the communication and dissemination of novel findings into clinical practice. This position statement outlines the current policies and practices of the Editors of Anaesthesia and Anaesthesia Reports in relation to academic medical publishing.


Assuntos
Anestesia , Pesquisa Biomédica , Humanos , Editoração , Comunicação
6.
Anaesthesia ; 78(3): 320-329, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36477695

RESUMO

In the intravenous iron therapy to treat iron deficiency anaemia in patients undergoing major abdominal surgery (PREVENTT) trial, the use of intravenous iron did not reduce the need for blood transfusion or reduce patient complications or length of hospital stay. As part of the trial protocol, serum was collected at randomisation and on the day of surgery. These samples were analysed in a central laboratory for markers of iron deficiency. We performed a secondary analysis to explore the potential interactions between pre-operative markers of iron deficiency and intervention status on the trial outcome measures. Absolute iron deficiency was defined as ferritin <30 µg.l-1 ; functional iron deficiency as ferritin 30-100 µg.l-1 or transferrin saturation < 20%; and the remainder as non-iron deficient. Interactions were estimated using generalised linear models that included different subgroup indicators of baseline iron status. Co-primary endpoints were blood transfusion or death and number of blood transfusions, from randomisation to 30 days postoperatively. Secondary endpoints included peri-operative change in haemoglobin, postoperative complications and length of hospital stay. Most patients had iron deficiency (369/452 [82%]) at randomisation; one-third had absolute iron deficiency (144/452 [32%]) and half had functional iron deficiency (225/452 [50%]). The change in pre-operative haemoglobin with intravenous iron compared with placebo was greatest in patients with absolute iron deficiency, mean difference 8.9 g.l-1 , 95%CI 5.3-12.5; moderate in functional iron deficiency, mean difference 2.8 g.l-1 , 95%CI -0.1 to 5.7; and with little change seen in those patients who were non-iron deficient. Subgroup analyses did not suggest that intravenous iron compared with placebo reduced the likelihood of death or blood transfusion at 30 days differentially across subgroups according to baseline ferritin (p = 0.33 for interaction), transferrin saturation (p = 0.13) or in combination (p = 0.45), or for the number of blood transfusions (p = 0.06, 0.29, and 0.39, respectively). There was no beneficial effect of the use of intravenous iron compared with placebo, regardless of the metrics to diagnose iron deficiency, on postoperative complications or length of hospital stay.


Assuntos
Anemia Ferropriva , Deficiências de Ferro , Humanos , Anemia Ferropriva/tratamento farmacológico , Anemia Ferropriva/prevenção & controle , Anemia Ferropriva/complicações , Cuidados Pré-Operatórios/métodos , Hemoglobinas/análise , Complicações Pós-Operatórias/prevenção & controle , Ferritinas/uso terapêutico , Transferrinas
7.
Ann Oncol ; 33(7): 693-701, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35398288

RESUMO

BACKGROUND: Pancreatic cancer presents as advanced disease in >80% of patients; yet, appropriate ages to consider prevention and early detection strategies are poorly defined. We investigated age-specific associations and attributable risks of pancreatic cancer for established modifiable and non-modifiable risk factors. PATIENTS AND METHODS: We included 167 483 participants from two prospective US cohort studies with 1190 incident cases of pancreatic cancer during >30 years of follow-up; 5107 pancreatic cancer cases and 8845 control participants of European ancestry from a completed multicenter genome-wide association study (GWAS); and 248 893 pancreatic cancer cases documented in the US Surveillance, Epidemiology, and End Results (SEER) Program. Across different age categories, we investigated cigarette smoking, obesity, diabetes, height, and non-O blood group in the prospective cohorts; weighted polygenic risk score of 22 previously identified single nucleotide polymorphisms in the GWAS; and male sex and black race in the SEER Program. RESULTS: In the prospective cohorts, all five risk factors were more strongly associated with pancreatic cancer risk among younger participants, with associations attenuated among those aged >70 years. The hazard ratios comparing participants with three to five risk factors with those with no risk factors were 9.24 [95% confidence interval (CI) 4.11-20.77] among those aged ≤60 years, 3.00 (95% CI 1.85-4.86) among those aged 61-70 years, and 1.46 (95% CI 1.10-1.94) among those aged >70 years (Pheterogeneity = 3×10-5). These factors together were related to 65.6%, 49.7%, and 17.2% of incident pancreatic cancers in these age groups, respectively. In the GWAS and the SEER Program, the associations with the polygenic risk score, male sex, and black race were all stronger among younger individuals (Pheterogeneity ≤0.01). CONCLUSIONS: Established risk factors are more strongly associated with earlier-onset pancreatic cancer, emphasizing the importance of age at initiation for cancer prevention and control programs targeting this highly lethal malignancy.


Assuntos
Estudo de Associação Genômica Ampla , Neoplasias Pancreáticas , Humanos , Masculino , Neoplasias Pancreáticas/etiologia , Neoplasias Pancreáticas/genética , Estudos Prospectivos , Fatores de Risco , Neoplasias Pancreáticas
8.
Anaesthesia ; 76(8): 1077-1081, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33440026

RESUMO

Case reports have fulfilled an important role in the development of anaesthesia and continue to be highly relevant to modern practice. Despite this, they are sometimes criticised for being insufficiently rigorous to meaningfully inform clinical practice or research design. Reporting checklists are a useful tool to improve rigour in research and, although case report checklists have previously been developed, no existing checklist focuses on the peri-operative setting. In order to address the need for a case reports checklist that better accommodates peri-operative care, we used an established tool as the basis for developing the 12-item Anaesthesia Case Report checklist. This was refined using an iterative approach through feedback from journal editors with experience of handling case reports, patient and public involvement, and trialling its use on Anaesthesia Reports submissions. The Anaesthesia Case Report checklist differs from existing checklists by aligning with peri-operative practice; it places less emphasis on making diagnoses and focuses on the way in which clinical challenges, for example, related to the patient's comorbidities or operative interventions, are addressed. Adopting a standardised approach to the content of case reports presents clear benefits to authors, editors and peer reviewers through streamlining the processes involved in writing and publication. The Anaesthesia Case Report checklist provides a pragmatic framework for comprehensive and transparent reporting. We hope it will facilitate the authorship of high-quality case reports with the potential to further improve the quality and safety of peri-operative care.


Assuntos
Anestesia/métodos , Lista de Checagem/métodos , Assistência Perioperatória/métodos , Editoração/normas , Relatório de Pesquisa/normas , Humanos
9.
Anaesthesia ; 76(1): 19-26, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32406071

RESUMO

Over 30,000 adult cardiac operations are carried out in the UK annually. A small number of these patients need to return to theatre in the first few days after the initial surgery, but the exact proportion is unknown. The majority of these resternotomies are for bleeding or cardiac tamponade. The Association of Cardiothoracic Anaesthesia and Critical Care carried out a 1-year national audit of resternotomy in 2018. Twenty-three of the 35 centres that were eligible participated. The overall resternotomy rate (95%CI) within the period of admission for the initial operation in these centres was 3.6% (3.37-3.85). The rate varied between centres from 0.69% to 7.6%. Of the 849 patients who required resternotomy, 127 subsequently died, giving a mortality rate (95%CI) of 15.0% (12.7-17.5). In patients who underwent resternotomy, the median (IQR [range]) length of stay on ICU was 5 (2-10 [0-335]) days, and time to tracheal extubation was 20 (12-48 [0-2880]) hours. A total of 89.3% of patients who underwent resternotomy were transfused red cells, with a median (IQR [range]) of 4 (2-7 [1-1144]) units of red blood cells. The rate (95%CI) of needing renal replacement therapy was 23.4% (20.6-26.5). This UK-wide audit has demonstrated that resternotomy after cardiac surgery is associated with prolonged intensive care stay, high rates of blood transfusion, renal replacement therapy and very high mortality. Further research into this area is required to try to improve patient care and outcomes in patients who require resternotomy in the first 24 h after cardiac surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Reoperação/mortalidade , Reoperação/estatística & dados numéricos , Esternotomia/mortalidade , Esternotomia/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Extubação , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Cuidados Críticos/estatística & dados numéricos , Transfusão de Eritrócitos/mortalidade , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Humanos , Incidência , Tempo de Internação , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/cirurgia , Terapia de Substituição Renal/mortalidade , Terapia de Substituição Renal/estatística & dados numéricos , Reino Unido/epidemiologia
10.
Anaesthesia ; 76 Suppl 4: 84-95, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33682105

RESUMO

Iron deficiency and anaemia are global health problems and major causes of morbidity in women. Current definitions of anaemia in women are historic and have been challenged by recent data from observational studies. Menstrual loss, abnormal uterine bleeding and pregnancy put women at risk of developing iron deficiency which can result in severe fatigue, reduced exercise capacity and poor work performance. Iron deficiency and anaemia during pregnancy are associated with adverse maternal and fetal outcomes, including neurocognitive deficits in children born to iron-deficient mothers. Both iron deficiency and anaemia are common in women undergoing surgery but their association with poor outcomes remains uncertain. The enduring burden of iron deficiency and anaemia in women suggests that current strategies for recognition, prevention and treatment are limited in their utility. Improvements in our understanding of iron homeostasis and the development of new iron preparations, which are better absorbed with fewer side-effects, may improve therapeutic effectiveness of oral iron. Intravenous iron is efficacious for correcting anaemia rapidly but high-quality data on patient-centred outcomes and cost-effectiveness are currently lacking. Many recommendations for the treatment of iron deficiency and anaemia in national guidelines are not supported by high-quality evidence. There is a need for robust epidemiological data and well-designed clinical trials. The latter will require collaborative working between researchers and patients to design studies in ways that incorporate patients' perspectives on the research process and target outcomes that matter to them.


Assuntos
Anemia Ferropriva/patologia , Anemia/patologia , Administração Oral , Anemia/tratamento farmacológico , Anemia/terapia , Anemia Ferropriva/tratamento farmacológico , Anemia Ferropriva/terapia , Transfusão de Eritrócitos , Feminino , Hepcidinas/metabolismo , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , Humanos , Ferro/administração & dosagem , Ferro/metabolismo , Saúde da Mulher
11.
Anaesthesia ; 76(9): 1212-1223, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34013531

RESUMO

This guideline updates and replaces the 5th edition of the Standards of Monitoring published in 2015. The aim of this document is to provide guidance on the minimum standards for monitoring of any patient undergoing anaesthesia or sedation under the care of an anaesthetist. The recommendations are primarily aimed at anaesthetists practising in the UK and Ireland, but it is recognised that these guidelines may also be of use in other areas of the world. Minimum standards for monitoring patients during anaesthesia and in the recovery phase are included. There is also guidance on monitoring patients undergoing sedation and during transfer. There are new sections specifically discussing capnography, sedation and regional anaesthesia. In addition, the indications for processed electroencephalogram and neuromuscular monitoring have been updated.


Assuntos
Anestesiologia/normas , Monitorização Fisiológica/normas , Anestesistas , Humanos , Irlanda , Sociedades Médicas , Reino Unido
12.
Anaesthesia ; 76(7): 892-901, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33285008

RESUMO

There is equipoise regarding the use of prothrombin complex concentrate vs. fresh frozen plasma in bleeding patients undergoing cardiac surgery. We performed a pilot randomised controlled trial to determine the recruitment rate for a large trial, comparing the impact of prothrombin complex concentrate vs. fresh frozen plasma on haemostasis (1 h and 24 h post-intervention), and assessing safety. Adult patients who developed bleeding within 24 h of cardiac surgery that required coagulation factor replacement were randomly allocated to receive prothrombin complex concentrate (15 IU.kg-1 based on factor IX) or fresh frozen plasma (15 ml.kg-1 ). If bleeding continued after the first administration of prothrombin complex concentrate or fresh frozen plasma administration, standard care was administered. From February 2019 to October 2019, 180 patients were screened, of which 134 (74.4% (95%CI 67-81%)) consented, 59 bled excessively and 50 were randomly allocated; 25 in each arm, recruitment rate 35% (95%CI 27-44%). There were 23 trial protocol deviations, 137 adverse events (75 prothrombin complex concentrate vs. 62 fresh frozen plasma) and 18 serious adverse events (5 prothrombin complex concentrate vs. 13 fresh frozen plasma). There was no increase in thromboembolic events with prothrombin complex concentrate. No patient withdrew from the study, four were lost to follow-up and two died. At 1 h after administration of the intervention there was a significant increase in fibrinogen, Factor V, Factor XII, Factor XIII, α2 -antiplasmin and antithrombin levels in the fresh frozen plasma arm, while Factor II and Factor X were significantly higher in the prothrombin complex concentrate group. At 24 h, there were no significant differences in clotting factor levels. We conclude that recruitment to a larger study is feasible. Haemostatic tests have provided useful insight into the haemostatic changes following prothrombin complex concentrate or fresh frozen plasma administration. A definitive trial is needed to ascertain the benefits and safety for each.


Assuntos
Fatores de Coagulação Sanguínea/uso terapêutico , Procedimentos Cirúrgicos Cardíacos , Plasma , Hemorragia Pós-Operatória/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Resultado do Tratamento
13.
Public Health ; 190: 93-98, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33385640

RESUMO

OBJECTIVES: The objective of the study is the identification of racial differences in characteristics and comorbidities in patients hospitalized for COVID-19 and the impact on outcomes. STUDY DESIGN: The study design is a retrospective observational study. METHODS: Data for all patients admitted to seven community hospitals in Michigan, United States, with polymerase chain reaction confirmed diagnosis of COVID-19 from March 10 to April 15, 2020 were analyzed. The primary outcomes of racial disparity in inpatient mortality and intubation were analyzed using descriptive statistics and multivariate regression models. RESULTS: The study included 336 Black and 408 White patients. Black patients were younger (62.9 ± 15.0 years vs 71.8 ± 16.4, P < .001), had a higher mean body mass index (32.4 ± 8.6 kg/m2 vs 28.8 ± 7.5, P < .001), had higher prevalence of diabetes (136/336 vs 130/408, P = .02), and presented later (6.6 ± 5.3 days after symptom onset vs. 5.4 ± 5.4, P = .006) compared with White patients. Younger Black patients had a higher prevalence of obesity (age <65 years, 69.9%) than older Black patients (age >65 years, 39.2%) and younger White patients (age < 65, 55.1%). Intubation did not reach statistical significance for racial difference (Black patients 61/335 vs. 54/406, P = .08). Mortality was not higher in Black patients (65/335 vs. 142/406 in White patients, odds ratio 0.61, 95% confidence interval: 0.37 to 0.99, 2-sided P = .05) in multivariate analysis, accounting for other risk factors associated with mortality. CONCLUSIONS: Higher prevalence of obesity and diabetes in young Black populations may be the critical factor driving disproportionate COVID-19 hospitalizations in Black populations. Hospitalized Black patients do not have worse outcomes compared with White patients.


Assuntos
COVID-19/etnologia , COVID-19/terapia , Diabetes Mellitus/epidemiologia , Hospitalização/estatística & dados numéricos , Obesidade/epidemiologia , Grupos Raciais/estatística & dados numéricos , SARS-CoV-2 , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , Índice de Massa Corporal , COVID-19/mortalidade , COVID-19/virologia , Comorbidade , Feminino , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hospitais Comunitários , Humanos , Unidades de Terapia Intensiva , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Pandemias , Prevalência , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Grupos Raciais/etnologia , Estudos Retrospectivos , Fatores de Risco , População Branca/estatística & dados numéricos
14.
Encephale ; 47(2): 157-170, 2021 Apr.
Artigo em Francês | MEDLINE | ID: mdl-33051084

RESUMO

INTRODUCTION: The early identification and access to health care of toddlers with autism spectrum disorder (ASD) - or at risk of developing it - is a crucial public health issue, as care and intervention may be more effective in younger children in order to improve their development and prognosis. However, there are still disparities in identification and health care access for children with ASD despite better screening methods. Given that misdiagnosis and delayed diagnosis are often due to the cultural gap between clinician and patient in some psychiatric disorders such as depression or schizophrenia, we examined this question concerning ASD and wondered to what extent ethno-cultural or migratory status might have an impact on the age at which a child is diagnosed. The only published review looking for independent factors influencing age of diagnosis concludes that the factors that have been proved to play a role are: socioeconomic status; symptom severity; level of parental concern, and family interactions with the health and education systems prior to diagnosis. The impact of ethno-cultural or migratory status is less clear. And yet, all these factors may be interconnected: migrants have on average a lower socioeconomic status, minorities don't have the same access to health care, and cultural background can have an influence on what is expected of a child's development and health. In order to try and clarify this issue and to analyze the way in which the international literature approaches the subject, we carried out a systematic review. METHOD: Six databases were interrogated: Pubmed, Embase, Psychinfo, WebOfScience, Cochrane and Cinahl using the key words "ASD", "pervasive developmental disorder", "diagnosis", "age", "migrant", "ethnicity", "cross cultural". We narrowed neither the period of time not selected the articles by their method, as our objective was to collect the entirety of the articles written on the subject. We completed this review by including the pertinent references made in the articles. RESULTS: Twenty articles were included, all epidemiological and observational, about children diagnosed in specialized centers. Published between 2002 and 2019, they cover a 20-year research period, between 1992 and 2016. The methods are disparate: the diagnosis criteria used are from DSM IV, IV TR and ICD; data originate from medical records, phone or internet surveys, and Medicaid healthcare claims. Comparison of the age at diagnosis is the principal objective for only thirteen studies; statistical data analyses vary, especially concerning adjustments. Seventy-five percent of the articles originate from North America where the compared populations are defined by ethnic and racial categories that are not used in some other countries, notably in Europe. Only five explore the link between migratory status and age at diagnosis. The research results concerning the impact of ethnicity are contradictory, while those concerning migratory status seem to indicate that migrant children are likely to be diagnosed later. But the articles and their methods being too heterogeneous, it was difficult to make a meta-analysis and impossible to reach a scientific conclusion. CONCLUSION: Nevertheless, this review highlights the existence of a lot of confounding factors and raises many issues. It shows that the United States produces most of the studies whose conclusions cannot be generalized because of the particular history and organization of this country. In Europe, where belonging to minority groups is thought to be through migratory status, studies are rare. There is an urgent need for new research in order to clarify the connection between migratory status and socioeconomic factors, to precisely define the independent variables influencing diagnosis -such as access to healthcare- and finally to explore the possibility of different symptomatic expressions depending on cultural backgrounds. This review falls within studies currently carried out by the psychiatric service at Avicenne hospital in Bobigny, France about ASD in a transcultural context.


Assuntos
Transtorno do Espectro Autista , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Cultura , Família , Humanos , Fatores Socioeconômicos , Inquéritos e Questionários , Estados Unidos
15.
Br J Surg ; 107(2): e26-e38, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31903592

RESUMO

BACKGROUND: Reducing operative blood loss improves patient outcomes and reduces healthcare costs. The aim of this article was to review current surgical, anaesthetic and haemostatic intraoperative blood conservation strategies. METHODS: This narrative review was based on a literature search of relevant databases up to 31 July 2019 for publications relevant to reducing blood loss in the surgical patient. RESULTS: Interventions can begin early in the preoperative phase through identification of patients at high risk of bleeding. Directly acting anticoagulants can be stopped 48 h before most surgery in the presence of normal renal function. Aspirin can be continued for most procedures. Intraoperative cell salvage is recommended when anticipated blood loss is greater than 500 ml and this can be continued after surgery in certain situations. Tranexamic acid is safe, cheap and effective, and routine administration is recommended when anticipated blood loss is high. However, the optimal dose, timing and route of administration remain unclear. The use of topical agents, tourniquet and drains remains at the discretion of the surgeon. Anaesthetic techniques include correct patient positioning, avoidance of hypothermia and regional anaesthesia. Permissive hypotension may be beneficial in selected patients. Promising haemostatic strategies include use of pharmacological agents such as desmopressin, prothrombin complex concentrate and fibrinogen concentrate, and use of viscoelastic haemostatic assays. CONCLUSION: Reducing perioperative blood loss requires a multimodal and multidisciplinary approach. Although high-quality evidence exists in certain areas, the overall evidence base for reducing intraoperative blood loss remains limited.


ANTECEDENTES: La reducción de la pérdida hemática operatoria mejora los resultados y reduce los costes sanitarios. El objetivo de este artículo es revisar las estrategias actuales intraoperatorias quirúrgicas, anestésicas y hemostáticas de ahorro de sangre. MÉTODOS: Revisión descriptiva basada en publicaciones destacadas que analizaban la forma de reducir la pérdida de sangre en el paciente quirúrgico, seleccionadas a partir de una búsqueda bibliográfica en bases de datos relevantes hasta el 31 de julio de 2019. RESULTADOS: Las intervenciones se pueden iniciar precozmente en el período preoperatorio a través de la identificación de pacientes con elevado riesgo de hemorragia. Se pueden suspender los anticoagulantes de acción directa 48 horas antes de la mayoría de las operaciones quirúrgicas si la función renal es normal. Se puede continuar la administración de aspirina en la mayoría de las intervenciones. En el período intraoperatorio, se recomienda el uso de rescate celular cuando la pérdida de sangre prevista es superior a 500 ml y este método se puede continuar después de la operación en determinadas situaciones. La administración de ácido tranexámico es segura, barata y eficaz y se recomienda de forma rutinaria cuando la pérdida hemática prevista es alta. Sin embargo, la dosis óptima, el momento y la vía de administración no están bien establecidos. El uso de agentes tópicos, torniquetes y drenajes queda a discreción del cirujano. Las técnicas anestésicas incluyen la correcta posición del paciente, así como evitar la hipotermia y la anestesia regional. La hipotensión controlada puede ser beneficiosa en casos seleccionados. Las estrategias hemostáticas innovadoras incluyen agentes farmacológicos como la desmopresina, los concentrados del complejo de protrombina y concentrados de fibrinógeno, y el uso de hemostáticos viscoelásticos, pero se requiere disponer de evidencia sobre su beneficio. CONCLUSIÓN: La reducción de la pérdida hemática perioperatoria requiere un enfoque multimodal y multidisciplinario. Aunque existe evidencia de alta calidad en ciertas áreas, la evidencia general para reducir la pérdida hemática intraoperatoria sigue siendo limitada.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Procedimentos Médicos e Cirúrgicos sem Sangue , Técnicas Hemostáticas , Humanos , Período Intraoperatório , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos
16.
Br J Surg ; 107(12): 1558-1561, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32996596

RESUMO

CAVIAR is a multicentre prospective stepped observational study encompassing 160 patients undergoing vascular intervention. The aim was to identify whether it was feasible to establish a preoperative anaemia pathway and, if so, the efficacy of intravenous iron for treatment of preoperative anaemia. Large barriers prevented implementation of an intravenous iron pathway, with only ten patients receiving intravenous iron and a small increase in haemoglobin level (mean 5·7 (95 per cent c.i. 4·5 to 6·9) g/l). Preoperative anaemia was associated with a longer hospital stay and greater transfusion requirement. Anaemia common and dedicated pathway difficult to instigate.


Assuntos
Anemia/complicações , Assistência Perioperatória/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Anemia/terapia , Transfusão de Sangue/estatística & dados numéricos , Procedimentos Clínicos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Prospectivos
17.
Mol Cell Biochem ; 464(1-2): 93-109, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31728802

RESUMO

This study investigated the impact of experimental pulmonary arterial hypertension (PAH) progression by evaluating morphometric and functional parameters, oxidative stress, autonomic nervous system (ANS) activation, and inflammation in the right (RV) and left (LV) ventricles. Male rats were first divided into two groups: monocrotaline (MCT) and control. The MCT group received a single MCT injection (60 mg/kg, intraperitoneal), while control received saline. The MCT and control groups were further divided into four cohorts based on how long they were observed: 1, 2, 3, and 4 weeks. Animals were submitted to echocardiographic and hemodynamic analysis. RV and LV were used for morphometric, biochemical, and histological measurements. Autonomic modulation was evaluated by cardiac spectral analysis, considering two components: low frequency (LF) and high frequency (HF). Lung and liver weight was used for morphometric analysis. MCT induced 100% mortality at 4 weeks. In the RV, disease progression led to mild inflammation and enhanced reactive oxygen species (ROS) in week 1, followed by moderate inflammation, ROS production, and hypertrophy in week 2. By week 3, there was moderate inflammation, oxidative stress, and ANS imbalance, with development of right heart dysfunction. LV biochemical changes and inflammation were observed at week 3. The initial changes appeared to be related to inflammation and ROS, and the later ones to inflammation, oxidative stress, and ANS imbalance in MCT animals. This study reinforces the severity of the disease in the RV, the late effects in the LV, and the role of ANS imbalance in the development of heart dysfunction.


Assuntos
Sistema Nervoso Autônomo , Hipertensão Pulmonar , Estresse Oxidativo , Remodelação Ventricular , Animais , Sistema Nervoso Autônomo/metabolismo , Sistema Nervoso Autônomo/patologia , Sistema Nervoso Autônomo/fisiopatologia , Modelos Animais de Doenças , Hipertensão Pulmonar/metabolismo , Hipertensão Pulmonar/patologia , Hipertensão Pulmonar/fisiopatologia , Inflamação/metabolismo , Inflamação/patologia , Inflamação/fisiopatologia , Masculino , Ratos , Ratos Wistar
18.
Int J Legal Med ; 134(3): 921-927, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31960151

RESUMO

Blood at crime scenes is one of the most significant traces of evidence in investigation proceedings. Cleaning up these traces with household cleaning products, often containing bleaching agents, inhibits or complicates the detection of DNA. In this study, human blood was applied onto different floor coverings (carpet, laminate, parquet, PVC, tile) and subsequently cleaned with water and bleaching agents (hydrogen peroxide, sodium hypochlorite, DanKlorix®, Vanish Oxi Action®) at different times. Samples have been collected afterwards from the floors. The samples underwent a quantitative and qualitative DNA analysis. Cleaning smooth surfaces with water is usually sufficed to prohibit retrieving a DNA profile in most of the cases. Cleaning carpets was more difficult due to their absorbent surface whereas the use of bleaching agents caused an additional reduction of verifiable DNA concentrations. Retrieving partial or complete profiles after the use of bleaching agents was only possible when cleaning with low concentrations of 3% hydrogen peroxide.


Assuntos
Clareadores/química , Manchas de Sangue , DNA/análise , Pisos e Cobertura de Pisos , Desnaturação de Ácido Nucleico , Ciências Forenses/métodos , Humanos
19.
Fish Shellfish Immunol ; 101: 234-243, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32240748

RESUMO

Establishing new animal models for the study of inflammation is very important in the process of discovering new drugs, since the inflammatory event is the basis of many pathological processes. Whereas rodent models have been the primary focus of inflammation research, we defend the zebrafish (Danio rerio) test as a feasible alternative for preclinical studies. Moreover, despite all the technological development already achieved by humanity, nature can still be considered a relevant source of new medicines. In this context, the aim of this work was to evaluate the anti-inflammatory effect of a substance isolated from the medicinal plant Annona crassilfora Mart, the peltatoside, in an inflammatory model of zebrafish. It was determined: (i) total leukocyte count in the coelomate exudate; (ii) N-acetyl-ß-d-glucuronidase (NAG); (iii) myeloperoxidase (MPO); (iv) and the histology of liver, intestine and mesentery. Peltotoside (25, 50 and 100 µg) and dexamethasone (25 µg) were administered intracelomatically (i.c.) 30 min before carrageenan (i.c.). Pretreatment with peltatoside at three doses significantly inhibited leukocyte recruitment in the coelomic cavity, and inhibited NAG and MPO activity against the action of Cg, in a similar manner as dexamethasone. However, some microlesions in the evaluated organs were detected. The dose of 25 µg showed an anti-inflammatory effect with lower undesirable effects in the tissues. Our results suggest that the zebrafish test was satisfactory in performing our analyzes and that the peltotoside has a modulatory action in reducing leukocyte migration.


Assuntos
Annona/química , Anti-Inflamatórios/farmacologia , Modelos Animais de Doenças , Glicosídeos/farmacologia , Inflamação/tratamento farmacológico , Extratos Vegetais/farmacologia , Quercetina/análogos & derivados , Peixe-Zebra , Animais , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/química , Glicosídeos/administração & dosagem , Glicosídeos/química , Extratos Vegetais/administração & dosagem , Extratos Vegetais/química , Folhas de Planta/química , Plantas Medicinais/química , Quercetina/administração & dosagem , Quercetina/química , Quercetina/farmacologia
20.
Anaesthesia ; 75(2): 247-253, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31472021

RESUMO

Pilot and feasibility studies are preliminary investigations undertaken before a larger study. We hypothesised that only a small proportion of pilot or feasibility studies published in anaesthesia journals were correctly labelled as such. We searched for papers published between 2007 and 2017 in six anaesthesia journals using the text words 'pilot' OR 'feasibility' and included 266 original articles with 26,682 human participants. Only 34 (12.8%) were correctly labelled as a pilot or feasibility study. They were more likely to: have more median (IQR [range]) participants, 73 (40-130 [4-2716]) vs. 27 (15-60 [2-3305], p < 0.001; report feasibility outcomes, 82.4% vs. 4.3%, p < 0.001; and report an intention to convert, 100% vs. 39.7%, p < 0.001. They were less likely to test the efficacy of the primary outcome, 50% vs. 72.8%, p = 0.009; and report firm clinical conclusions 41.2% vs. 67.7%, p = 0.004. Of the studies published more than 5 years ago, correctly labelled pilot or feasibility studies were more likely to precede a published conversion study, 53.8% vs. 16%, p = 0.004. There was no difference between the number of citations 18 (9-44 [2-216]) vs. 20 (7-47 [0-251]), p = 0.865. These results have important consequences for patients, trialists, researchers and funders. We argue that correctly labelled pilot studies enhance the quality of scientific research by encouraging methodological rigour, ensuring scientific validity and reducing research waste. Authors, reviewers, editors and publishers should ensure they adhere to the contents of the 2016 CONSORT extension for pilot and feasibility studies.


Assuntos
Anestesiologia/estatística & dados numéricos , Bibliometria , Publicações Periódicas como Assunto , Pesquisa/estatística & dados numéricos , Humanos , Projetos Piloto
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