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1.
Nat Commun ; 12(1): 4194, 2021 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-34234144

RESUMO

Photomorphogenesis, light-mediated development, is an essential feature of all terrestrial plants. While chloroplast development and brassinosteroid (BR) signaling are known players in photomorphogenesis, proteins that regulate both pathways have yet to be identified. Here we report that DE-ETIOLATION IN THE DARK AND YELLOWING IN THE LIGHT (DAY), a membrane protein containing DnaJ-like domain, plays a dual-role in photomorphogenesis by stabilizing the BR receptor, BRI1, as well as a key enzyme in chlorophyll biosynthesis, POR. DAY localizes to both the endomembrane and chloroplasts via its first transmembrane domain and chloroplast transit peptide, respectively, and interacts with BRI1 and POR in their respective subcellular compartments. Using genetic analysis, we show that DAY acts independently on BR signaling and chlorophyll biogenesis. Collectively, this work uncovers DAY as a factor that simultaneously regulates BR signaling and chloroplast development, revealing a key regulator of photomorphogenesis that acts across cell compartments.


Assuntos
Proteínas de Arabidopsis/metabolismo , Proteínas de Choque Térmico HSP40/metabolismo , Proteínas de Membrana/metabolismo , Morfogênese/fisiologia , Proteínas Quinases/metabolismo , Arabidopsis/genética , Arabidopsis/crescimento & desenvolvimento , Arabidopsis/metabolismo , Proteínas de Arabidopsis/genética , Brassinosteroides/metabolismo , Clorofila/biossíntese , Cloroplastos/metabolismo , Estiolamento/fisiologia , Regulação da Expressão Gênica de Plantas/fisiologia , Técnicas de Silenciamento de Genes , Proteínas de Choque Térmico HSP40/genética , Proteínas de Choque Térmico HSP40/isolamento & purificação , Luz , Proteínas de Membrana/genética , Proteínas de Membrana/isolamento & purificação , Proteínas Associadas aos Microtúbulos/genética , Proteínas Associadas aos Microtúbulos/metabolismo , Morfogênese/efeitos da radiação , Mutação , Plantas Geneticamente Modificadas , Proteínas Quinases/genética , RNA-Seq , Proteínas Recombinantes/genética , Proteínas Recombinantes/isolamento & purificação , Proteínas Recombinantes/metabolismo , Plântula/crescimento & desenvolvimento , Transdução de Sinais/fisiologia
2.
Curr Opin Plant Biol ; 62: 102044, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33979769

RESUMO

The detection of molecular signals derived from other organisms is central to the evolutionary success of plants in the colonization of Earth. The sensory coding of these signals is critical for marshaling local and systemic immune responses that keep most invading organisms at bay. Plants detect immune signals inside and outside their cells using receptors. Here, we focus on receptors that function at the cell surface. We present recent work that expands our understanding of the repertoire of immune signals sensed by this family of receptors.


Assuntos
Plantas , Receptores de Reconhecimento de Padrão , Imunidade Vegetal/genética , Plantas/genética
3.
Cell Host Microbe ; 29(4): 620-634.e9, 2021 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-33713601

RESUMO

Immune systems respond to "non-self" molecules termed microbe-associated molecular patterns (MAMPs). Microbial genes encoding MAMPs have adaptive functions and are thus evolutionarily conserved. In the presence of a host, these genes are maladaptive and drive antagonistic pleiotropy (AP) because they promote microbe elimination by activating immune responses. The role AP plays in balancing the functionality of MAMP-coding genes against their immunogenicity is unknown. To address this, we focused on an epitope of flagellin that triggers antibacterial immunity in plants. Flagellin is conserved because it enables motility. Here, we decode the immunogenic and motility profiles of this flagellin epitope and determine the spectrum of amino acid mutations that drives AP. We discover two synthetic mutational tracks that undermine the detection activities of a plant flagellin receptor. These tracks generate epitopes with either antagonist or weaker agonist activities. Finally, we find signatures of these tracks layered atop each other in natural Pseudomonads.


Assuntos
Proteínas de Arabidopsis , Arabidopsis , Arabidopsis/imunologia , Epitopos/genética , Flagelina/genética , Imunidade , Doenças das Plantas
4.
J Korean Med Sci ; 36(12): e80, 2021 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-33783145

RESUMO

BACKGROUND: Spinal cord injury (SCI) is a serious clinical condition that impacts a patient's physical, psychological, and socio-economic status. The aim of this pilot study was to evaluate the effects of training with a newly developed powered wearable exoskeleton (Hyundai Medical Exoskeleton [H-MEX]) on functional mobility, physiological health, and quality of life in non-ambulatory SCI patients. METHODS: Participants received 60 minutes of walking training with a powered exoskeleton 3 times per week for 10 weeks (total 30 sessions). The 6-minute walking test (6MWT) and timed-up-and-go test (TUGT) were performed to assess ambulatory function. The physiological outcomes of interest after exoskeleton-assisted walking training were spasticity, pulmonary function, bone mineral density, colon transit time, and serum inflammatory markers. Effects of walking training on subjective outcomes were estimated by the Korean version of the Falls Efficacy Scale-International and the 36-Item Short-Form Health Survey version 2. RESULTS: Ten participants finished 30 sessions of training and could ambulate independently. No severe adverse events were reported during the study. After training, the mean distance walked in the 6MWT (49.13 m) was significantly enhanced compared with baseline (20.65 m). The results of the TUGT also indicated a statistically significant improvement in the times required to stand up, walk 3 m and sit down. Although not statistically significant, clinically meaningful changes in some secondary physiological outcomes and/or quality of life were reported in some participants. CONCLUSION: In conclusion, this study demonstrated that the newly developed wearable exoskeleton, H-MEX is safe and feasible for non-ambulatory SCI patients, and may have potential to improve quality of life of patients by assisting bipedal ambulation. These results suggest that the H-MEX can be considered a beneficial device for chronic non-ambulatory SCI patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04055610.

5.
Cell Host Microbe ; 29(4): 635-649.e9, 2021 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-33713602

RESUMO

Immune systems restrict microbial pathogens by identifying "non-self" molecules called microbe-associated molecular patterns (MAMPs). It is unclear how immune responses are tuned to or by MAMP diversity present in commensal microbiota. We systematically studied the variability of commensal peptide derivatives of flagellin (flg22), a MAMP detected by plants. We define substantial functional diversity. Most flg22 peptides evade recognition, while others contribute to evasion by manipulating immunity through antagonism and signal modulation. We establish a paradigm of signal integration, wherein the sequential signaling outputs of the flagellin receptor are separable and allow for reprogramming by commensal-derived flg22 epitope variants. Plant-associated communities are enriched for immune evading flg22 epitopes, but upon physiological stress that represses the immune system, immune-activating flg22 epitopes become enriched. The existence of immune-manipulating epitopes suggests that they evolved to either communicate or utilize the immune system for host colonization and thus can influence commensal microbiota community composition.


Assuntos
Epitopos/imunologia , Flagelina/imunologia , Interações entre Hospedeiro e Microrganismos/imunologia , Imunidade Vegetal , Bactérias/genética , Imunidade , Microbiota , Peptídeos , Ralstonia , Simbiose
6.
Knee Surg Sports Traumatol Arthrosc ; 29(3): 998-1005, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33095332

RESUMO

PURPOSE: Osteoarthritis (OA) in the glenohumeral joint is a concomitant lesion with rotator cuff tear that commonly occurs in older patients. The authors aimed to evaluate the effect of associated OA on the treatment outcome of rotator cuff repair. METHODS: A total of three hundred and forty-eight patients who underwent full-thickness arthroscopic rotator cuff repair were retrospectively reviewed, and the data were prospectively collected. The severity of OA was evaluated using the Samilson and Prieto method preoperatively and the Outerbridge classification intraoperatively. The patients were divided into the small-to-medium group and large-to-massive group according to rotator cuff tear size and were evaluated for presence or absence of OA. The postoperative clinical outcomes were assessed using the visual analog scale for pain, simple shoulder test (SST), University of California-Los Angeles, Constant, and American Shoulder and Elbow Surgeons (ASES) scoring systems at baseline and at final follow-up. RESULTS: Forty-five patients were diagnosed with glenohumeral OA (12.9%). Overall, no significant differences were observed in demographic and baseline data between the two groups according to the presence or absence of OA. The clinical symptoms of both groups significantly improved at the final follow-up. At the final follow-up, no significant differences were found in the VAS for pain, SST, UCLA, Constant, and ASES scores between the two groups. In the large-to-massive tear group, patients with OA had significantly inferior clinical results compared with those without OA. CONCLUSION: The clinical outcome scores improved after rotator cuff repair regardless of the presence of concomitant OA. However, glenohumeral OA should be considered as a potential negative prognostic factor in patients with large-to-massive rotator cuff tears. LEVEL OF EVIDENCE: III.


Assuntos
Artroscopia , Osteoartrite/complicações , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/cirurgia , Articulação do Ombro/cirurgia , Idoso , Artroscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Manguito Rotador/cirurgia , Ruptura/complicações , Ruptura/cirurgia , Resultado do Tratamento , Escala Visual Analógica
7.
Medicine (Baltimore) ; 99(28): e20935, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664091

RESUMO

During ganglion impar block, the needle may approach the presacral space and the sacrum may be penetrated during caudal anesthesia. Because the rectum is in front of the sacrococcyx and is thus at risk for puncture, it is important to determine the distance between the sacrococcyx and rectum, as well as the thickness of the sacrococcyx.Computed tomography was used to measure the distance between the rectum and sacrococcyx, as well as the thickness of the sacrococcyx. The distances between the coccyx and rectum, sacrococcygeal joint and rectum, sacral level 5 ('sacrum 5') and rectum, and 'sacrum 4 to 5 junction' and rectum were measured. The results were compared based on the presence or absence of stools in the rectum. The thickness of the sacrococcyx was measured at the sacrum 4 to 5 junction and sacrococcygeal joint.In total, 1264 patients were included in this study. All distances were less than 1 mm in both males and females, with the exception of the distance between the coccyx and rectum in males. In both males and females, there was no significant difference in distance between the sacrococcyx and rectum according to the presence or absence of feces in the rectum, but there was a difference in the distance between sacrum 5 and the rectum in males (P = .048). Several male and female patients showed thicknesses of less than 5 mm at the sacrococcygeal joint.Some patients have a distance of less than 1 mm between the sacrum and rectum. Practitioners should exercise caution when applying a needle to the presacral space. If the sacrum is accidentally penetrated during caudal block, rectum puncture cannot be ruled out. Excretion of feces does not influence the distance between the sacrococcyx and rectum in females.


Assuntos
Anestesia Caudal/instrumentação , Cóccix/anatomia & histologia , Agulhas , Reto/anatomia & histologia , Reto/lesões , Sacro/anatomia & histologia , Ferimentos Penetrantes/etiologia , Ferimentos Penetrantes/prevenção & controle , Adulto , Idoso , Pesos e Medidas Corporais , Cóccix/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Sacro/diagnóstico por imagem , Tomografia Computadorizada por Raios X
8.
J Clin Med ; 9(6)2020 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-32466515

RESUMO

The impact of body mass index (BMI) on postoperative nausea and vomiting (PONV) is controversial, and few studies have focused on their relationship. We investigated the effects of BMI on PONV, taking into account other PONV risk factors. We analyzed adults over the age of 18 years who received general anesthesia between 2015 and 2019, using propensity score matching. Before propensity score matching, odds ratios (ORs) for PONV were lower for overweight (OR, 0.91; 95% confidence interval (CI), 0.87-0.96; p < 0.0001) or obese patients (OR, 0.77; 95% CI, 0.71-0.84; p < 0.0001) than for normal-BMI patients. After matching, the ORs for PONV of overweight (OR, 0.89; 95% CI, 0.80-0.98; p = 0.016) and obese patients (OR, 0.71; 95% CI, 0.63-0.79; p < 0.0001) were low. However, the ORs of underweight patients did not differ from those of normal-BMI patients, irrespective of matching. Therefore, the incidence of PONV may be lower among adults with a higher­than­normal BMI.

9.
J Clin Med ; 9(3)2020 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-32197451

RESUMO

Postoperative nausea and vomiting (PONV) are common complications after anesthesia, but no study has considered the effects of a proton pump inhibitor (PPI) and gastroesophageal reflux disease (GERD) on PONV at the same time. Thus, we investigated the effects of a PPI and GERD on PONV. Patients aged ≥18 years who underwent general anesthesia between 2010 and 2019 were enrolled. In total, 202,439 patients were included and 21,361 In a multivariate analysis, the OR for PONV was higher in subjects with GERD (OR, 1.157; 95% CI, 1.032-1.298; p = 0.012). The OR was lower for subjects with taking a PPI (OR, 0.890; 95% CI, 0.832-0.953; p < 0.0001). In patients without GERD, the incidence of PONV was lower when lansoprazole (OR, 0.801; 95% CI, 0.718-0.894; p < 0.0001), pantoprazole (OR, 0.856; 95% CI, 0.748-0.980; p = 0.025) and ilaprazole (OR, 0.391; 95% CI, 0.158-0.966; p = 0.042) were taken. However, in GERD patients, all PPIs did not show reducing the incidence of PONV. Taken together, the results show that a lansoprazole, pantoprazole, and ilaprazole reduced PONV in patients without GERD, and PPI could not reduce PONV in patients with GERD.

10.
Cell Host Microbe ; 27(3): 308-310, 2020 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-32164838

RESUMO

The organizational principles of the root immune system are largely uncharacterized. In the February 6, 2020 issue of Cell, Zhou et al. showed roots are built entirely by immunocompetent cells that require distinct instructions to unlock cell-autonomous immune programs. A root cell's developmental identity combined with its spatial distribution fine-tunes immune signal sensitivity, enabling sector-specific immune responses.


Assuntos
Imunidade Celular
11.
Medicine (Baltimore) ; 98(46): e17957, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725655

RESUMO

BACKGROUND: Although surgical field visualization is important in functional endoscopic sinus surgery (FESS), the complications associated with controlled hypotension for surgery should be considered. Intraoperative hypotension is associated with postoperative stroke, leading to subsequent hypoxia with potential neurologic injury. We investigated the effect of propofol and desflurane anesthesia on S-100ß and glial fibrillary acidic protein (GFAP) levels which are early biomarkers for cerebral ischemic change during controlled hypotension for FESS. METHODS: For controlled hypotension during FESS, anesthesia was maintained with propofol/remifentanil in propofol group (n = 30) and with desflurane/remifentanil in desflurane group (n = 30). For S-100ß and GFAP assay, blood samples were taken at base, 20 and 60 minutes after achieving the target range of mean arterial pressure, and at 60 minutes after surgery. RESULTS: The base levels of S-100ß were 98.04 ±â€Š78.57 and 112.61 ±â€Š66.38 pg/mL in the propofol and desflurane groups, respectively. The base levels of GFAP were 0.997 ±â€Š0.486 and 0.898 ±â€Š0.472 ng/mL in the propofol and desflurane groups, respectively. The S-100ß and GFAP levels were significantly increased in the study period compared to the base levels in both groups (P ≤ .001). There was no significant difference at each time point between the 2 groups. CONCLUSION: On comparing the effects of propofol and desflurane anesthesia for controlled hypotension on the levels of S-100ß and GFAP, we noted that there was no significant difference in S-100ß and GFAP levels between the 2 study groups. CLINICAL TRIAL REGISTRATION: Available at: http://cris.nih.go.kr, KCT0002698.


Assuntos
Proteína Glial Fibrilar Ácida/sangue , Hipotensão Controlada/métodos , Propofol/uso terapêutico , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Sinusite/cirurgia , Adulto , Anestésicos Intravenosos , Pressão Arterial/efeitos dos fármacos , Dióxido de Carbono/sangue , Doença Crônica , Desflurano/administração & dosagem , Desflurano/efeitos adversos , Desflurano/uso terapêutico , Endoscopia , Feminino , Proteína Glial Fibrilar Ácida/biossíntese , Humanos , Hipotensão Controlada/efeitos adversos , Masculino , Pessoa de Meia-Idade , Propofol/administração & dosagem , Propofol/efeitos adversos , Estudos Prospectivos , Remifentanil/administração & dosagem , Subunidade beta da Proteína Ligante de Cálcio S100/biossíntese , Fatores de Tempo
12.
Open Med (Wars) ; 14: 431-436, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31198857

RESUMO

Background: We evaluated the endotracheal tube cuff pressure (Pcuff) changes during pneumoperitoneum for laparoscopic cholecystectomy and the correlations between body mass index (BMI), pneumoperitoneum time, and Pcuff changes. Methods: Total 60 patients undergoing laparoscopic cholecystectomy were allocated to either a study group (BMI ≥ 25 kg/m2) or a control group (BMI < 25 kg/m2). The endotracheal intubation was performed with a high-volume low-pressure cuffed oral endotracheal tube. A manometer was connected to the pilot balloon using a 3-way stopcock and the cuff was inflated. The change in Pcuff was defined as the difference between the pressure just before intra-abdominal CO2 insufflation and the pressure before CO2 desufflation. Results: Pcuff increased to 5.3 ± 3.6 cmH2O in the study group and 5.7 ± 5.4 cmH2O in the control group. There was no significant difference between two groups. While BMI was not correlated with change in Pcuff (r = 0.022, p = 0.867), there was a significant correlation between change in Pcuff and the duration of pneumoperitoneum (r = 0.309, p = 0.016). Conclusion: The change in Pcuff was not affected by BMI and was significantly correlated with pneumoperitoneum time. We recommend regular measurement and adjustment of Pcuff during laparoscopic surgery.

13.
J Exp Bot ; 70(10): 2741-2757, 2019 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-30825377

RESUMO

Chaperonin containing T-complex polypeptide-1 (CCT) is an evolutionarily conserved chaperonin multi-subunit complex that mediates protein folding in eukaryotes. It is essential for cell growth and survival in yeast and mammals, with diverse substrate proteins. However, only a few studies on plant CCT have been reported to date, due to the essentiality of CCT subunit genes and the large size of the complex. Here, we have investigated the structure and function of the Arabidopsis CCT complex in detail. The plant CCT consisted of eight subunits that assemble to form a high-molecular-mass protein complex, shown by diverse methods. CCT-deficient cells exhibited depletion of cortical microtubules, accompanied by a reduction in cellular α- and ß-tubulin levels due to protein degradation. Cycloheximide-chase assays suggested that CCT is involved in the folding of tubulins in plants. Furthermore, CCT interacted with PPX1, the catalytic subunit of protein phosphatase 4, and may participate in the folding of PPX1 as its substrate. CCT also interacted with Tap46, a regulatory subunit of PP2A family phosphatases, but Tap46 appeared to function in PPX1 stabilization, rather than as a CCT substrate. Collectively, our findings reveal the essential functions of CCT chaperonin in plants and its conserved and novel substrates.


Assuntos
Proteínas de Arabidopsis/genética , Arabidopsis/genética , Proteínas Repressoras/genética , Arabidopsis/metabolismo , Proteínas de Arabidopsis/metabolismo , Microtúbulos/metabolismo , Proteínas Repressoras/metabolismo , Tubulina (Proteína)
14.
J Inequal Appl ; 2018(1): 165, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30137893

RESUMO

This paper considers subsistence consumption of an economic agent both before and after retirement in analyzing the optimal consumption, portfolio, and retirement problem. We allow the relative risk aversion of the economic agent to make a one-off jump at retirement. With a Cobb-Douglas utility function, we obtain explicit expressions for the optimal policies. Numerical results show that, whereas post-retirement subsistence consumption tends to delay retirement, pre-retirement subsistence consumption and the magnitude of jump in relative risk aversion may stimulate early retirement. Also, the consumption drop at retirement deepens as post-retirement subsistence consumption increases, but it weakens as pre-retirement subsistence consumption increases.

15.
J Audiol Otol ; 22(2): 105-109, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29301392

RESUMO

Stem cell transplantation represents a promising therapy for several degenerating and necrotic diseases. In several animal studies, we could find hearing restoration after inoculation of the mesenchymal stem cells' as well as mesenchymal stem cells' differentiation of hair cells and spiral ganglion. But until now, no clinical study has been reported directly for the human being. In this pilot studies, we applied mesenchymal stem cells to human beings trans-venously. Although we verified the safety of the autologous bone marrow stem cell transplantation in sensorineural hearing loss patients but we could not achieve significant improvement in hearing.

16.
Laryngoscope ; 128(3): 732-744, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29068049

RESUMO

OBJECTIVES: We performed a systemic review and meta-analysis regarding the postoperative pain, perioperative, and postoperative morbidity of powered intracapsular tonsillectomy and adenoidectomy (PITA) using a microdebrider as a method of tonsillectomy. DATA SOURCES: Five databases (PubMed, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials) in their entirety through March 2017. REVIEW METHODS: We included studies in which there was a comparison between groups of patients who underwent PITA (PITA group) and those who had extracapsular tonsillectomy (control group). Articles assessing effects of PITA in the pediatric patient were systemically and independently reviewed by two researchers. The outcomes of interest were intraoperative morbidity (operative time and bleeding), postoperative morbidity (postoperative pain, recovery time, tonsil regrowth, and postoperative bleeding rate), and improvement of sleep breath disorder (apnea-hypopnea index [AHI] and symptomatic scores). RESULTS: PITA did not significantly increase operative time or intraoperative blood loss. With PITA, there was significantly decreased postoperative pain, amount of analgesia, time to resumption of normal diet and activity, and incidence of postoperative admissions (due to dehydration or postoperative bleeding control) compared to those of the control group. In contrast, the incidence of postoperative tonsil regrowth was statistically higher in the PITA group than in the control group. The PITA improved AHI and obstructive sleep apnea 18-item questionnaire scores significantly, which were similar with the control group. CONCLUSIONS: With regard to intraoperative morbidity and postoperative morbidity, PITA is a safe procedure. However, there are high levels of heterogeneity with regard to several measured parameters. Therefore, further large, well-designed trials are required to substantiate our findings. Laryngoscope, 128:732-744, 2018.


Assuntos
Tonsila Palatina/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Tonsilectomia/métodos , Criança , Humanos , Inquéritos e Questionários
17.
Otolaryngol Head Neck Surg ; 158(1): 43-53, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28949804

RESUMO

Objectives Dexmedetomidine has sympatholytic, sedative, anesthetic, and analgesic effects, as well as vasoconstrictive effects, which may help prevent hypotension under general anesthesia. This meta-analysis aimed to perform a systematic review of the literature and investigate the effect of dexmedetomidine on perioperative morbidity following nasal surgery and its adverse effects. Data Sources MEDLINE, SCOPUS, and the Cochrane database. Review Methods Two authors independently searched the databases from their inception to March 2017. Studies were selected that compared perioperative dexmedetomidine administration (dexmedetomidine groups) with a placebo or remifentanil (control groups) with regard to intraoperative morbidity, including surgical time, bleeding amount, hypotension, and bradycardia during operation, and postoperative morbidity, such as emergence agitation, nausea and vomiting, and sedation after operation. Results Surgical time, intraoperative blood loss, dose of inhaled anesthetic gas, dose of fentanyl, postoperative pain, and incidence of emergence agitation were significantly lower in the dexmedetomidine group versus the placebo group. In contrast, there were no significant differences in intraoperative hemodynamic stability and postoperative residual sedation and nausea and vomiting between groups. Additionally, compared with remifentanil (a currently widely used agent), dexmedetomidine was superior in view of postoperative pain and intraoperative blood pressure control. Conclusion This meta-analysis shows that the systemic administration of dexmedetomidine can decrease surgical time, intraoperative blood loss, and doses of intraoperative inhaled anesthetic gas and fentanyl as compared with placebo. It can also decrease postoperative pain and incidence of the emergence agitation. Due to the small number of studies, further clinical trials are needed to confirm these results.


Assuntos
Anestesia Geral , Dexmedetomidina/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Procedimentos Cirúrgicos Nasais , Complicações Pós-Operatórias/prevenção & controle , Humanos
18.
Laryngoscope ; 128(3): 573-580, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28944481

RESUMO

OBJECTIVES: The goal of this meta-analysis was to perform a systematic review of the literature on the effect of dexmedetomidine on perioperative morbidity following nasal surgery and on the adverse effects of dexmedetomidine. DATA SOURCES: MEDLINE, Scopus, and Cochrane Database of Systematic Reviews. REVIEW METHODS: Two authors independently searched scientific and medical databases from their inception of article collection to March 2017. Studies that compared perioperative dexmedetomidine administration (dexmedetomidine group) with another agent under monitored anesthesia care (MAC) or general anesthesia (control group) with outcomes of interest that were perioperative pain intensity; rescue analgesic consumption; or adverse effects such as hemodynamic instability, nausea, and vomiting (PONV), and operative bleeding were included in the analysis. RESULTS: Perioperative pain scores and postoperative need for analgesics were significantly decreased in the dexmedetomidine group versus control group (other agent or general anesthesia). In subgroup analysis according to anesthesia type (general anesthesia and other sedatives in MAC), dexmedetomidine showed a similar effect on bradycardia, hypotension, and desaturation with general anesthesia, but it reduced PONV effectively compared with general anesthesia. Additionally, dexmedetomidine satisfied patient significantly. By contrast, compared with other sedative under MAC, it provoked bradycardia significantly. CONCLUSION: This meta-analysis showed that systemic administration of dexmedetomidine efficiently can decrease intraoperative and postoperative pain without adverse effects such as nausea, vomiting, and respiratory depression. Dexmedetomidine also can decrease analgesic consumption. However, clinicians should be aware of the potential for intraoperative bradycardia; patients also should be educated regarding these possibilities. LEVEL OF EVIDENCE: NA. Laryngoscope, 128:573-580, 2018.


Assuntos
Analgésicos não Narcóticos/administração & dosagem , Dexmedetomidina/administração & dosagem , Procedimentos Cirúrgicos Nasais/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Assistência Perioperatória/métodos , Analgésicos/uso terapêutico , Anestesia/métodos , Humanos , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Resultado do Tratamento
19.
Eur Arch Otorhinolaryngol ; 274(7): 2685-2694, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28314960

RESUMO

Rhinoplasty is the most common facial plastic surgical procedure, and the occurrence of periorbital edema and ecchymosis is normal after rhinoplasty. The goal of this study was to perform a systematic review with meta-analysis of the efficacy of postoperative care of edema and ecchymosis following rhinoplasty. Two authors independently searched the databases (PubMed, SCOPUS, Embase, Web of Science, and the Cochrane database) from inception to September 2016. We included studies that compared postoperative care methods (intervention groups) with no treatment (control group) where the outcomes of interest were edema, ecchymosis, and satisfaction rate of patients on postoperative days. Sufficient data for meta-analysis were retrieved for 11 trials with a total of 627 patients. Eyelid edema and ecchymosis during the first 7 days postoperatively were statistically decreased in the arnica administration groups versus the control group. Eyelid edema and ecchymosis during the first 24 h postoperatively were statistically decreased in the cold compression group versus the control group. The ratio of patient satisfaction was statistically higher in the tapping application group than in the control group. However, the analysis indicated that surgeons had a significant tendency to decrease intranasal packing. The administration of arnica, cold compression, and tape could reduce eyelid edema and ecchymosis. Intranasal packing was associated with more adverse effects in terms of postoperative ecchymosis compared to non-packing. However, additional trials with thorough research methodologies should be conducted to confirm the results of this study.


Assuntos
Arnica , Crioterapia , Equimose/terapia , Edema/terapia , Extratos Vegetais/uso terapêutico , Complicações Pós-Operatórias/terapia , Rinoplastia/efeitos adversos , Equimose/etiologia , Edema/etiologia , Humanos , Satisfação do Paciente , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/etiologia
20.
Clin Exp Otorhinolaryngol ; 9(2): 89-97, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27090283

RESUMO

Despite widespread use of antibiotics and surgical procedures for treating peritonsillar abscess (PTA), symptoms of severe inflammation such as pain and trismus during treatment result in patient dissatisfaction. The goal of this study was to perform a systematic review and meta-analysis of the efficacy of systemic steroids on the clinical course of PTA. Two reviewers independently searched the databases (MEDLINE, Scopus, and the Cochrane Database) from inception to December 2014. Studies comparing systemic administration of steroids (steroid group) with placebo (placebo group), where the outcomes of interest were pain, body temperature, hospitalization, and oral intake during the posttreatment period, were included. Baseline study characteristics, study quality data, numbers of patients in the steroid and control groups, and outcomes were extracted. Sufficient data for meta-analysis were retrieved for 3 trials with a total of 153 patients. Pain-related parameters (patient-reported scores and trismus), body temperature, and dysphagia during the first 24 hours after treatment were significantly improved in the steroid group compared with placebo group. The discharge rate during the first 5 days of the posttreatment period was significantly higher in the steroid group than the control group. However, although more patients in the steroid group returned to normal activities and dietary intake at 24 hours after treatment, the differences between the groups were not significant and disappeared after 48 hours. In the treatment of PTA, systemic administration of steroids with antibiotics could reduce pain-related symptoms, as well as provide a benefit with respect to the clinical course. However, further trials with well-designed research methodologies should be conducted to confirm our results.

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