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1.
J Neurosurg ; : 1-9, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33418529

RESUMO

OBJECTIVE: The sagittal stratum is divided into two layers. In classic descriptions, the stratum sagittale internum corresponds to optic radiations (RADs), whereas the stratum sagittale externum corresponds to fibers of the inferior longitudinal fasciculus. Although advanced for the time it was proposed, this schematic organization seems simplistic considering the recent progress on the understanding of cerebral connectivity and needs to be updated. Therefore, the authors sought to investigate the composition of the sagittal stratum and to detail the anatomical relationships among the macroscopic fasciculi. METHODS: The authors performed a layer-by-layer fiber dissection from the superolateral aspect to the ventricular cavity in 20 cadaveric human hemispheres. RESULTS: Diverse bundles of white matter were observed to contribute to the sagittal stratum and their spatial arrangement was highly consistent from one individual to another. This was the case of the middle longitudinal fasciculus, the inferior fronto-occipital fasciculus, the RADs, and other posterior thalamic radiations directed to nonvisual areas of the cerebral cortex. In addition, small contributions to the sagittal stratum came from the anterior commissure anteriorly and the inferior longitudinal fasciculus inferiorly. CONCLUSIONS: A general model of sagittal stratum organization in layers is possible, but the composition of the external layer is much more complex than is mentioned in classic descriptions. A small contribution of the inferior longitudinal fasciculus is the main difference between the present results and the classic descriptions in which this bundle was considered to entirely correspond to the stratum sagittale externum. This subject has important implications both for fundamental research and neurosurgery, as well as for the development of surgical approaches for the cerebral parenchyma and ventricular system.

2.
Clin Imaging ; 74: 15-18, 2021 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-33421698

RESUMO

OBJECTIVE: To compare the image quality of subtracted and nonsubtracted images obtained using volumetric interpolated breath-hold exam (VIBE) and free breathing T1 weighted Golden-angle Radial Sparse Parallel (GRASP). METHODS: We retrospectively evaluated 27 consecutive patients who underwent MRI for the evaluation of renal masses. Contrast enhanced VIBE and free breathing GRASP imaging were performed, and subtraction images generated. Two radiologists performed quantitative and qualitative evaluations of image quality of nonsubtracted and subtracted data sets. Statistical analysis was performed using the Wilcoxon signed-rank test, paired t-test and kappa statistics. RESULTS: VIBE images scored statistically higher for the following parameters in the coronal and axial plane: sharpness, streak artifact, image noise, and overall image quality for standard and subtracted images (all P values P < 0.001). GRASP images had significantly less subtraction artifact in the coronal (P = 0.042) plane with a similar trend in the axial plane (P = 0.079). Interreader Kappa values for qualitative images scores were fair to good (0.23-0.71). Quantitative subtracted GRASP images had significant less subtraction artifact compared to VIBE in the anterior-posterior (3.9 mm SD 2.6 mm versus 5.8 mm SD 3.6 mm, P = 0.010), and craniocaudal direction (4.4 mm SD 2.9 mm versus 7.0 mm SD 5.3 mm, P = 0.010); a trend was seen in the left-right direction (2.6 mm SD 1.4 mm versus 4.0 mm SD 3.9 mm, P = 0.084). CONCLUSION: VIBE images have significantly better image quality than free breathing GRASP images, however free breathing GRASP images have significantly less subtraction artifact.

3.
Spinal Cord Ser Cases ; 7(1): 4, 2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468993

RESUMO

INTRODUCTION: Spinal cord injury (SCI) often leads to impairment of the respiratory system. In fact, respiratory insufficiency is a significant cause of mortality and morbidity following SCI, related to the extent and level of the neurologic injury and its effects on the respiratory muscles (reduction in respiratory muscle strength and fatigue due to a reduction in inspiratory capacity, atelectasis and ineffective coughing). Less commonly recalled is the fact that autonomic dysreflexia (AD) is the result of parasympathetic imbalance. However, AD results from a massive, unrestrained outpouring of norepinephrine from the peripheral sympathetic ganglia. More accurately, the vagal (parasympathetic) response to this sympathetic discharge may have been responsible for the respiratory changes reported. This is not described in medical literature, although breathing difficulty is named as a common symptom and sign. The objective of this report is to describe a clinical case for the first time, that of T4 AIS (American spinal injury association impairment scale) A in which AD leads to acute respiratory insufficiency. CASE REPORT: A patient with prior history of spinal cord injury, T4 AIS A, was admitted to the Inpatient Unit to improve her respiratory function and autonomy and to discontinue the ventilation maintained after an episode of pneumonia. The patient developed AD during the rehabilitation programme, namely during hamstring stretching exercises. Besides persistent hypertension, cutaneous rash, hyperhidrosis and light-headedness, the patient was diagnosed with acute respiratory insufficiency, with desaturation and hypercapnia. The patient fully recovered, in terms of the signs and symptoms of AD, with the cessation of noxious stimulation and oxygen administration. DISCUSSION: To date, the association between AD and acute respiratory insufficiency has not been described in spinal cord injury or rehabilitation literature. This case draws attention for the first time to the possibility that respiratory insufficiency is one of the signs associated with episodes of AD and highlights the need to look at this possibility.

4.
Asian J Psychiatr ; 54: 102436, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33271716

RESUMO

OBJECTIVES: Among all known risk factors of preterm birth, psychosocial factors form an intricate collection, which includes a multidimensional spectrum of interrelated mediating mechanisms. The understanding of these interconnected mechanisms is vital for designing targeted interventions to reduce preterm births. The objective of this systematic review was to investigate potential psychosocial maternal factors and their interactions to cause preterm birth. METHODS: PubMed, CINAHL, Scopus, Medline, and Cochrane Database of Systematic Reviews were searched for U.S.-based English language studies published between 1989 and 2019. Titles, abstracts, and full-texts were screened to determine eligibility for inclusion. Data were extracted from eligible studies using a customized data collection form. The National Institutes of Health assessment tool was utilized for quality assessment. RESULTS: Among the 76 full texts that were reviewed, 9 records met the eligibility criteria, and were included in the final review. The included publications addressed psychosocial factors including racial disparity, lifetime racism, neighborhood disadvantage, lack of partner support, childhood maltreatment and life-course variations, including homelessness and marital status. Antenatal stress was identified as a common mechanism through which psychosocial mediators may act to cause preterm birth. CONCLUSIONS: This review highlights the need for controlling potential risk factors of maternal stress by improving prenatal care, providing proper housing, and establishing conducive social environments for pregnant women. The review also suggests the importance of maternal psychological counselling and extensive maternal health monitoring among minority groups during the pregnancy period.

5.
Top Magn Reson Imaging ; 29(6): 347-354, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33264274

RESUMO

The rapid evolution of MR scanners and pulse sequence design brings an ever-expanding arsenal of diagnostic tools to radiology departments. However, this increasing abundance of diagnostic tools accentuates the challenge of using new technology efficiently and wisely-that is, to employ what may help diagnosis and/or management, but discards what has a poor likelihood of aiding patient care. This article aims to highlight practical points regarding MR pulse sequences for the evaluation of common emergencies in body imaging through case examples.

6.
Environ Monit Assess ; 193(1): 3, 2020 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-33300102

RESUMO

We investigated the fluvial geochemistry of two catchments at different stages in the forest recovery process which have been a focus of an Environmental Services Payment (ESP) program in Brazil. The Posses (PS) and Salto de Cima (SC) catchments (1200 ha and 1500 ha, respectively) are situated in the municipality of Extrema, Minas Gerais state. Their streams flow into the Jaguari River that supplies part of the water demand of the São Paulo metropolitan area. Samples were collected for chemical analysis and physical-chemical field measures every 2 weeks from January to December 2017. An important pollution point source was discovered in the PS stream related to bovine urine and feces, as well another unidentified source that can be related to a small food processing industry and/or a small fish farm. At the SC stream, on the other hand, there was clear evidence of domestic sewage input. This preliminary study confirmed a limited improvement of the stream water quality in response to recovery of the forest vegetation. Therefore, we recommend that in addition to enhanced monitoring to help distinguish biogeochemical sources and the benefits of land conservation practices, the ESP program should consider controlling point source pollution to accomplish its purpose.

7.
Rev. Fund. Educ. Méd. (Ed. impr.) ; 23(6): 331-333, dic. 2020. tab
Artigo em Espanhol | IBECS-Express | IBECS | ID: ibc-ET2-7908

RESUMO

INTRODUCCIÓN: El abandono escolar representa desde hace años uno de los grandes problemas a los que se enfrenta la educación en México, principalmente a nivel superior y en licenciaturas de alta exigencia académica como es el caso de medicina. SUJETOS Y MÉTODOS: Se realizó un análisis cuantitativo de tres promociones de la licenciatura de médico cirujano de la Universidad Nacional Autónoma de México con el fin de comparar el abandono escolar según sexo y promoción. RESULTADOS: Se observó que el primer año de la licenciatura de médico cirujano es donde se presenta un mayor porcentaje de abandono escolar (77%), con un predominio de población femenina y abandono definitivo. CONCLUSIÓN: Se estudió el comportamiento estudiantil de la licenciatura de Médico Cirujano para replantear métodos y estrategias institucionales en términos de abandono escolar


INTRODUCTION: For years, school dropout has represented one of the greatest problems that education in Mexico faces, mainly at the higher level and in highly demanding academic degrees such as Medicine. SUBJECTS AND METHODS: We carried out a quantitative analysis of three generations enrolled in Medicine Bachelor of the UNAM's School of Medicine in order to compare school dropouts by sex and generation. RESULTS: It was observed that the Medicine Bachelor's first year is where the highest percentage of school dropouts (77%) occurs, with a predominance of female population and definitive dropout. CONCLUSION: Medicine Bachelor's student behavior was studied to rethink institutional methods and strategies focused on scholar dropout

8.
Mol Oncol ; 2020 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-33107189

RESUMO

Several platforms for noninvasive EGFR testing are currently used in the clinical setting with sensitivities ranging from 30% to 100%. Prospective studies evaluating agreement and sources for discordant results remain lacking. Herein, seven methodologies including two next-generation sequencing (NGS)-based methods, three high-sensitivity PCR-based platforms, and two FDA-approved methods were compared using 72 plasma samples, from EGFR-mutant non-small-cell lung cancer (NSCLC) patients progressing on a first-line tyrosine kinase inhibitor (TKI). NGS platforms as well as high-sensitivity PCR-based methodologies showed excellent agreement for EGFR-sensitizing mutations (K = 0.80-0.89) and substantial agreement for T790M testing (K = 0.77 and 0.68, respectively). Mutant allele frequencies (MAFs) obtained by different quantitative methods showed an excellent reproducibility (intraclass correlation coefficients 0.86-0.98). Among other technical factors, discordant calls mostly occurred at mutant allele frequencies (MAFs) ≤ 0.5%. Agreement significantly improved when discarding samples with MAF ≤ 0.5%. EGFR mutations were detected at significantly lower MAFs in patients with brain metastases, suggesting that these patients risk for a false-positive result. Our results support the use of liquid biopsies for noninvasive EGFR testing and highlight the need to systematically report MAFs.

9.
J Geriatr Oncol ; 2020 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-33109485

RESUMO

BACKGROUND: Inconsistent doses and schemes are commonly used in older patients receiving cancer chemotherapy. We performed this study in patients with cancer and age ≥ 70 years to determine the frequency of undertreatment and overtreatment as well as factors influencing the decision to modify chemotherapy doses. PATIENTS AND METHODS: Patients aged ≥70 years starting new chemotherapy regimens were prospectively included in a multicentre study. The schedule and drug doses were determined by the treating oncologist. Pre-chemotherapy assessment included sociodemographics, treatment details and geriatric assessment (GA) variables. Association between these factors and undertreatment (use of less intensive cancer treatment [LICT] in a fit patient) or overtreatment (use of standard cancer treatment in an unfit older patient) were examined by multivariate logistic regression. RESULTS: Three- hundred ninety-seven patients were included, 43% of whom received LICT. If not adjusted for GA, toxicity did not differ between those receiving LICT (38%) or standard doses of chemotherapy (37%). If the dose of chemotherapy was analyzed according to the results of GA 61 (15%) patients had been undertreated and 133 (34%) had been overtreated. Undertreatment was related with increasing age and decreased renal function. Factors related with overtreatment were younger age, curative intention of treatment, prescription of G-CSF as primary prophylaxis and adequate cognitive status. Overtreated patients had more grade 3-4 toxicity than those receiving treatment adapted to fragility (42% vs 31%; p < 0.05). CONCLUSIONS: The use of chemotherapy without considering GA leads to overtreatment more commonly than undertreatment in older patients with cancer. Oncologists should take into account the results of GA to stratify patients and to avoid under or overtreatment.

10.
Cancer Biol Med ; 17(2): 444-457, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32587780

RESUMO

Objective: Long-term survivors (LS) of non-small cell lung cancer (NSCLC) without driver alterations, displaying an overall survival (OS) of more than 3 years, comprise around 10% of cases in several series treated with chemotherapy. There are classical prognosis factors for these cases [stage, Eastern Cooperative Oncology Group (ECOG), etc.], but more data are required in the literature. In this multi-center study, we focused on LS of advanced NSCLC with OS above 36 months to perform a clinical-pathological and molecular characterization. Methods: In the first step, we conducted a clinical-pathological characterization of the patients. Afterwards, we carried out a genetic analysis by comparing LS to a sample of short-term survivors (SS) (with an OS less than 9 months). We initially used whole-genome RNA-seq to identify differentiating profiles of LS and SS, and later confirmed these with reverse transcription-polymerase chain reaction (RT-PCR) for the rest of the samples. Results: A total of 94 patients were included, who were mainly men, former smokers, having adenocarcinoma (AC)-type NSCLC with an ECOG of 0-1. We obtained an initial differential transcriptome expression, displaying 5 over- and 33 under-expressed genes involved in different pathways: namely, the secretin receptor, surfactant protein, trefoil factor 1 (TFF1), serpin, Ca-channels, and Toll-like receptor (TLRs) families. Finally, RT-PCR analysis of 40 (20 LS/20 SS) samples confirmed that four genes (surfactant proteins and SFTP) were significantly down-regulated in SS compared to LS by using an analysis of covariance (ANCOVA) model: SFTPA1 (P = 0.023), SFTPA2 (P = 0.027), SFTPB (P = 0.02), and SFTPC (P = 0.047). Conclusions: We present a sequential genetic analysis of a sample of NSCLC LS with no driver alterations, obtaining a differential RNA-seq/RT-PCR profile showing an abnormal expression of SF genes.

11.
Rev. colomb. cancerol ; 24(2): 88-91, abr.-jun. 2020. graf
Artigo em Espanhol | LILACS | ID: biblio-1144325

RESUMO

Resumen El carcinoma de célula pequeña (CPCP) o microcítico de pulmón es un subtipo de cáncer de pulmón que típicamente se ha asociado al tabaquismo y que se caracteriza por su agresividad y mal pronóstico a corto plazo. Como entidad, puede metastatizar en cualquier órgano, siendo las metástasis pancreáticas raras y la mayoría de las veces asintomáticas. Por ello, la presencia de una pancreatitis neoplásica, como en el caso presentado, es excepcional, y aún más cuando presenta refractariedad al tratamiento médico convencional y responde al tratamiento citotóxico sistémico. Por todo ello, se expone esta experiencia clínica y se debate la presencia de esta rara entidad y su manejo.


Abstract Small-cell lung carcinoma is a subtype of neoplasm that has been typically associated with smoking; it is characterized by its aggressiveness and poor prognosis in the short term. As an entity, it can metastasize in any organ, but pancreatic metastases are rare and most of the time asymptomatic. Therefore, the presence of neoplastic pancreatitis as in our case is exceptional; even more when it presents refractoriness to conventional medical treatment, responding instead to systemic cytotoxic treatment. Therefore, we expose our clinical experience and discuss the presence of this rare entity and its management.


Assuntos
Humanos , Pancreatite , Terapêutica , Carcinoma de Pequenas Células do Pulmão , Neoplasias Pulmonares , Tabagismo , Carcinoma , Agressão , Metástase Neoplásica
12.
Oncologist ; 2020 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-32329131

RESUMO

BACKGROUND: Standard oncology tools are inadequate to distinguish which older patients are at higher risk of developing chemotherapy-related complications. MATERIALS AND METHODS: Patients over 70 years of age starting new chemotherapy regimens were prospectively included in a multicenter study. A prechemotherapy assessment that included sociodemographics, tumor/treatment variables, and geriatric assessment variables was performed. Association between these factors and the development of grade 3-5 toxicity was examined by using logistic regression. RESULTS: A total of 551 patients were accrued. Chemotherapy doses (odds ratio [OR] 1.834; 95% confidence interval [CI] 1.237-2.719) and creatinine clearance (OR 0.989; 95% CI 0.981-0.997) were the only factors independently associated with toxicity. Only 19% of patients who received reduced doses of chemotherapy and had a creatinine clearance ≥40 mL/minute had grade 3-4 toxicity, compared with 38% of those who received standard doses or had a creatinine clearance <40 mL/minute (p < .0001). However, no satisfactory multivariate model was obtained using different selection approaches. CONCLUSION: Chemotherapy doses and renal function were identified as the major risk factors for developing severe toxicity in the older patient. These factors should be considered when planning to initiate a new chemotherapy regimen and should also lead to a closer follow-up in these patients. IMPLICATIONS FOR PRACTICE: Older patients are more vulnerable to chemotherapy toxicity. However, standard tools are inadequate to identify who is at higher risk of developing chemotherapy-related complications. Chemotherapy doses (standard vs. reduced) and renal function were identified as the major risk factors for developing severe toxicity in the elderly. These factors should be considered when planning to initiate a new chemotherapy regimen and should also lead to a closer follow-up.

13.
Cancers (Basel) ; 12(4)2020 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-32224864

RESUMO

Despite often leading to platinum resistance, platinum-based chemotherapy continues to be the standard treatment for many epithelial tumors. In this study we analyzed and validated the cytogenetic alterations that arise after treatment in four lung and ovarian paired cisplatin-sensitive/resistant cell lines by 1-million microarray-based comparative genomic hybridization (array-CGH) and qRT-PCR methodologies. RNA-sequencing, functional transfection assays, and gene-pathway activity analysis were used to identify genes with a potential role in the development of this malignancy. The results were further explored in 55 lung and ovarian primary tumors and control samples, and in two extensive in silico databases. Long-term cell exposure to platinum induces the frequent deletion of ITF2 gene. Its expression re-sensitized tumor cells to platinum and recovered the levels of Wnt/ß-catenin transcriptional activity. ITF2 expression was also frequently downregulated in epithelial tumors, predicting a worse overall survival. We also identified an inverse correlation between ITF2 and HOXD9 expression, revealing that Non-small cell lung cancer (NSCLC) patients with lower expression of HOXD9 had a better overall survival rate. We defined the implication of ITF2 as a molecular mechanism behind the development of cisplatin resistance probably through the activation of the Wnt-signaling pathway. This data highlights the possible role of ITF2 and HOXD9 as novel therapeutic targets for platinum resistant tumors.

14.
Enferm. glob ; 19(58): 1-10, abr. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-195549

RESUMO

OBJETIVOS: Conocer la prevalencia de la adicción a la comida de acuerdo a la edad, sexo e índice de masa corporal, y determinar la asociación entre la adicción a la comida y el estado nutricional en adolescentes del norte de México. MÉTODO: Estudio descriptivo correlacional de corte transversal, realizado durante agosto y septiembre de 2018. La población se conformó por 630 adolescentes estudiantes de 15 a 17 años de edad, de una preparatoria pública en Nuevo León, México, a los que se les realizaron mediciones antropométricas y se empleó el cuestionario Yale Food Addiction Scale. RESULTADOS: Una muestra de 245 adolescentes, predominando el sexo femenino (53,1%), con una edad media de 15,83 años, la media de índice de masa corporal fue de 23,18 kg/mt2 (S = 3,74) en hombres y 24,57 kg/mt2 (S = 4,00) en mujeres. El 87,8% de los adolescentes presentó positivo el criterio "deseo frustrado de parar el consumo", el 36,3% la tolerancia, y el 34,3% el consumo a pesar de las consecuencias. El 20,7% de los adolescentes con sobrepeso presentan adicción a la comida. CONCLUSIONES: La mayoría de los adolescentes presentan peso normal, las mujeres presentaron un índice de masa corporal mayor que el de los hombres, menos de la mitad de los participantes presenta adicción a la comida predominando los criterios positivos en mujeres, adolescentes en condición de sobrepeso, obesidad y de mayor edad. No se encontró asociación entre adicción a la comida y estado nutricional


OBJECTIVE: To know the prevalence of food addiction according to age, sex, and body mass index and to determine the association between food addiction and nutritional status in adolescents from northern México. METHOD: Cross-sectional study with a descriptive and correlational design, carried out during August and September 2018; the study population was comprised by 630 adolescents, students, ranging from 15 to 17 years of age, from a public high school in Nuevo Leon, Mexico. Anthropometric measurements were taken and the Yale Food Addiction Scale questionnaire was used. RESULTS: A sample of 245 adolescents predominantly female (53.1%), with a mean age of 15.83 years; mean body mass index was 23.18 kg/mt2 (S = 3.74) in males and 24.57 kg/mt2 (S = 4.00) in females; 87.8% of adolescents showed positive to the frustrated desire to stop consumption criterion, 36.3% tolerance, and 34.3% consumption despite the consequences; 20.7% of overweight adolescents showed food addiction. CONCLUSIONS: The majority of adolescents showed normal weight, while women showed a body mass index (BMI) higher than men; less than half of the participants had food addiction; positive criteria prevailed in women, and adolescents with overweight and obesity, and older. No association was found between food addiction and nutritional status


Assuntos
Humanos , Masculino , Feminino , Adolescente , Avaliação Nutricional , Estado Nutricional , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Pesos e Medidas Corporais/estatística & dados numéricos , Dependência de Alimentos/psicologia , México/epidemiologia , Epidemiologia Nutricional , Comportamento do Adolescente/psicologia , Antropometria/métodos , Comportamento Aditivo/psicologia , Estudos Transversais
15.
J Bone Joint Surg Am ; 102(10): 880-888, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32118652

RESUMO

BACKGROUND: Myocardial injury after noncardiac surgery (MINS) is common and of prognostic importance. Little is known about MINS in orthopaedic surgery. The diagnostic criterion for MINS was a level of ≥0.03 ng/mL on a non-high-sensitivity troponin T (TnT) assay due to myocardial ischemia. METHODS: We undertook an international, prospective study of 15,103 patients ≥45 years of age who had inpatient noncardiac surgery; 3,092 underwent orthopaedic surgery. Non-high-sensitivity TnT assays were performed on postoperative days 0, 1, 2, and 3. Among orthopaedic patients, we determined (1) the prognostic relevance of the MINS diagnostic criteria, (2) the 30-day mortality rate for those with and without MINS, and (3) the probable proportion of MINS cases that would go undetected without troponin monitoring because of a lack of an ischemic symptom. RESULTS: Three hundred and sixty-seven orthopaedic patients (11.9%) had MINS. MINS was associated independently with 30-day mortality including among those who had had orthopaedic surgery. Orthopaedic patients without and with MINS had a 30-day mortality rate of 1.0% and 9.8%, respectively (odds ratio [OR], 11.28; 95% confidence interval [CI], 6.72 to 18.92). The 30-day mortality rate was increased for patients with MINS who had an ischemic feature (i.e., symptoms, or evidence of ischemia on electrocardiography or imaging) (OR, 18.25; 95% CI, 10.06 to 33.10) and for those who did not have an ischemic feature (OR, 7.35; 95% CI, 3.37 to 16.01). The proportion of orthopaedic patients with MINS who were asymptomatic and in whom the myocardial injury would have probably gone undetected without TnT monitoring was 81.3% (95% CI, 76.3% to 85.4%). CONCLUSIONS: One in 8 orthopaedic patients in our study had MINS, and MINS was associated with a higher mortality rate regardless of symptoms. Troponin levels should be measured after surgery in at-risk patients because most MINS cases (>80%) are asymptomatic and would go undetected without routine measurements. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

17.
J Gerontol A Biol Sci Med Sci ; 75(8): 1457-1464, 2020 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-31603987

RESUMO

The NLRP3 inflammasome has emerged as an important regulator of metabolic disorders and age-related diseases in NLRP3-deficient mice. In this article, we determine whether, in old mice C57BL6J, the NLRP3 inflammasome inhibitor MCC950 is able to attenuate age-related metabolic syndrome to providing health benefits. We report that MCC950 attenuates metabolic and hepatic dysfunction in aged mice. In addition, MCC950 inhibited the Pi3K/AKT/mTOR pathway, enhanced autophagy, and activated peroxisome proliferator-activated receptor-α in vivo and in vitro. The data suggest that MCC950 mediates the protective effects by the mammalian target of rapamycin inhibition, thus activating autophagy and peroxisome proliferator-activated receptor-α. In conclusion, pharmacological inhibition of NLRP3 in aged mice has a significant impact on health. Thus, NLRP3 may be a therapeutic target of human age-related metabolic syndrome.

18.
Eur Heart J ; 41(5): 645-651, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31237939

RESUMO

AIMS: To determine the 1-year risk of stroke and other adverse outcomes in patients with a new diagnosis of perioperative atrial fibrillation (POAF) after non-cardiac surgery. METHODS AND RESULTS: The PeriOperative ISchemic Evaluation (POISE)-1 trial evaluated the effects of metoprolol vs. placebo in 8351 patients, and POISE-2 compared the effect of aspirin vs. placebo, and clonidine vs. placebo in 10 010 patients. These trials included patients with, or at risk of, cardiovascular disease who were undergoing non-cardiac surgery. For the purpose of this study, we combined the POISE datasets, excluding 244 patients who were in atrial fibrillation (AF) at the time of randomization. Perioperative atrial fibrillation was defined as new AF that occurred within 30 days after surgery. Our primary outcome was the incidence of stroke at 1 year of follow-up; secondary outcomes were mortality and myocardial infarction (MI). We compared outcomes among patients with and without POAF using multivariable adjusted Cox proportional hazards models. Among 18 117 patients (mean age 69 years, 57.4% male), 404 had POAF (2.2%). The stroke incidence 1 year after surgery was 5.58 vs. 1.54 per 100 patient-years in patients with and without POAF, adjusted hazard ratio (aHR) 3.43, 95% confidence interval (CI) 2.00-5.90; P < 0.001. Patients with POAF also had an increased risk of death (incidence 31.37 vs. 9.34; aHR 2.51, 95% CI 2.01-3.14; P < 0.001) and MI (incidence 26.20 vs. 8.23; aHR 5.10, 95% CI 3.91-6.64; P < 0.001). CONCLUSION: Patients with POAF have a significantly increased risk of stroke, MI, and death at 1 year. Intervention studies are needed to evaluate risk reduction strategies in this high-risk population.

19.
Artigo em Inglês | MEDLINE | ID: mdl-33396848

RESUMO

Neonatal abstinence syndrome (NAS) is a postnatal withdrawal syndrome among neonates born to mothers with drug dependence disorders. NAS poses a significant public health challenge nationally, with a six-fold increase in incidence (1.2 to 6.7 per 1000 hospital births/year) from 2000-2016. Besides national data, it is critical to quantify NAS at the state-level to identify target areas for prevention. The objectives of this study were to ascertain statewide burden, including county and regional distribution of NAS in Nevada during 2016-2018, and to investigate potential factors associated with NAS. This study utilized hospital administrative data, and a total of 100,845 inpatient pediatric discharges were examined to identify NAS cases. Statistical analyses included estimation of crude incidence rates per 1000 hospital births and multilevel logistic regression modeling. NAS incidence in Nevada decreased slightly from 8.6 to 7.7 per 1000 hospital births between 2016 and 2018, but the overall incidence of 8 was substantially higher than earlier estimates (4.8/1000 hospital births) reported for 2013. Incidence was disproportionately higher among white newborns (12, 95% CI 11.0,13.0) and Medicaid enrollees (13.2, 95% CI 11.0,15.0). Southern Nevada had the highest incidence rate of 8.2 per 1000 hospital births. Nearly 75% of NAS cases were residents of Clark County. Incidence rates of NAS parallel the growing opioid prescription rates in Nevada and highlight the need for adopting opioid control prescribing practices to combat this drug epidemic. These findings might help in designing and evaluating state- and system-level interventions introduced to combat the opioid epidemic.


Assuntos
Síndrome de Aspiração de Mecônio , Síndrome de Abstinência Neonatal , Complicações na Gravidez , Analgésicos Opioides/efeitos adversos , Feminino , Humanos , Incidência , Recém-Nascido , Masculino , Síndrome de Abstinência Neonatal/epidemiologia , Nevada/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Fatores de Risco , Estados Unidos
20.
Trials ; 20(1): 622, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694684

RESUMO

BACKGROUND: Use of minimally invasive surgical techniques for lung resection surgery (LRS), such as video-assisted thoracoscopy (VATS), has increased in recent years. However, there is little information about the best anesthetic technique in this context. This surgical approach is associated with a lower intensity of postoperative pain, and its use has been proposed in programs for enhanced recovery after surgery (ERAS). This study compares the severity of postoperative complications in patients undergoing LRS who have received lidocaine intraoperatively either intravenously or via paravertebral administration versus saline. METHODS/DESIGN: We will conduct a single-center randomized controlled trial involving 153 patients undergoing LRS through a thoracoscopic approach. The patients will be randomly assigned to one of the following study groups: intravenous lidocaine with more paravertebral thoracic (PVT) saline, PVT lidocaine with more intravenous saline, or intravenous remifentanil with more PVT saline. The primary outcome will be the comparison of the postoperative course through Clavien-Dindo classification. Furthermore, we will compare the perioperative pulmonary and systemic inflammatory response by monitoring biomarkers in the bronchoalveolar lavage fluid and blood, as well as postoperative analgesic consumption between the three groups of patients. We will use an ANOVA to compare quantitative variables and a chi-squared test to compare qualitative variables. DISCUSSION: The development of less invasive surgical techniques means that anesthesiologists must adapt their perioperative management protocols and look for anesthetic techniques that provide good analgesic quality and allow rapid rehabilitation of the patient, as proposed in the ERAS protocols. The administration of a continuous infusion of intravenous lidocaine has proven to be useful and safe for the management of other types of surgery, as demonstrated in colorectal cancer. We want to know whether the continuous administration of lidocaine by a paravertebral route can be substituted with the intravenous administration of this local anesthetic in a safe and effective way while avoiding the risks inherent in the use of regional anesthetic techniques. In this way, this technique could be used in a safe and effective way in ERAS programs for pulmonary resection. TRIAL REGISTRATION: EudraCT, 2016-004271-52; ClinicalTrials.gov, NCT03905837 . Protocol number IGGFGG-2016 version 4.0, 27th April 2017.


Assuntos
Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Pneumonectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Método Duplo-Cego , Recuperação Pós-Cirúrgica Melhorada , Humanos , Infusões Intravenosas , Assistência Perioperatória , Toracoscopia
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