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1.
Eur J Anaesthesiol ; 37(1): 14-24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31464712

RESUMO

BACKGROUND: Postoperative delirium (POD) has been confirmed as an important complication after major surgery. However, neurosurgical patients have usually been excluded in previous studies. To date, data on POD and risk factors in patients after intracranial surgery are scarce. OBJECTIVES: To determine the incidence and risk factors of POD in patients after intracranial surgery. DESIGN: Prospective cohort study. SETTING: A neurosurgical ICU of a university-affiliated hospital, Beijing, China. INTERVENTIONS: Adult patients admitted to the ICU after elective intracranial surgery under general anaesthesia were consecutively enrolled between 1 March 2017 and 2 February 2018. Delirium was assessed using the Confusion Assessment Method for the ICU. POD was diagnosed as Confusion Assessment Method for the ICU positive on either postoperative day 1 or day 3. Patients were classified into groups with or without POD. Data were collected for univariate and multivariate analyses to determine the risk factors for POD. RESULTS: A total of 800 patients were included. POD was diagnosed in 157 patients (19.6%, 95% confidence interval 16.9 to 22.4%). Independent risk factors for POD included age, nature of intracranial lesion, frontal approach craniotomy, duration of surgery, presence of an episode of low pulse oxygenation at ICU admission, presence of inadequate emergence and emergence delirium, postoperative pain and presence of immobilising events. POD was associated with adverse outcomes and high costs. CONCLUSION: POD is prevalent in patients after elective intracranial surgery. The identified risk factors for and the potential association of POD with adverse outcomes suggest that a comprehensive strategy involving screening for predisposing factors and early prevention of modifiable factors should be established in this population. TRIAL REGISTRATION: ClinicalTrials.gov NCT03087838.

2.
Sci Rep ; 9(1): 14542, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601935

RESUMO

The standard high-flow tracheal (HFT) interface was modified by adding a 5-cm H2O/L/s resistor to the expiratory port. First, in a test lung simulating spontaneous breathing, we found that the modified HFT caused an elevation in airway pressure as a power function of flow. Then, three tracheal oxygen treatments (T-piece oxygen at 10 L/min, HFT and modified HFT at 40 L/min) were delivered in a random crossover fashion to six tracheostomized pigs before and after the induction of lung injury. The modified HFT induced a significantly higher airway pressure compared with that in either T-piece or HFT (p < 0.001). Expiratory resistance significantly increased during modified HFT (p < 0.05) to a mean value of 4.9 to 6.7 cm H2O/L/s. The modified HFT induced significant augmentation in end-expiratory lung volume (p < 0.05) and improved oxygenation for lung injury model (p = 0.038) compared with the HFT and T-piece. There was no significant difference in esophageal pressure swings, transpulmonary driving pressure or pressure time product among the three treatments (p > 0.05). In conclusion, the modified HFT with additional expiratory resistance generated a clinically relevant elevation in airway pressure and lung volume. Although expiratory resistance increased, inspiratory effort, lung stress and work of breathing remained within an acceptable range.

3.
J Int Med Res ; 47(6): 2615-2625, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31099288

RESUMO

OBJECTIVE: To study the epidemiological characteristics of hand, foot and mouth disease (HFMD) in Tongzhou District, Beijing between 2013 and 2017. METHODS: Data on HFMD infections from 1 January 2013 to 31 December 2017 were collected from the Notifiable Infectious Diseases Reporting Information System and analysed. Serotyping of enteroviruses from samples from patients with HFMD was undertaken using reverse transcription-polymerase chain reaction. RESULTS: A total of 15 341 patients with HFMD were reported and 32 patients (0.2%) were classified as having severe HFMD. The annual mean incidence rate of HFMD was 219.3/100 000 of the general population. The incidence and case-severity rates of HFMD generally decreased between 2013 and 2017. In the floating migrant population, the incidence and cases-severity rates of HFMD were significantly higher than in the local population. The peak incidence and severity-case rates were at 2 years of age and > 90% of patients were ≤5 years. Enterovirus A71 and Coxsackievirus A16 were the predominant pathogens in 2013-2017. CONCLUSIONS: During the 5-year period 2013-2017, the incidence rate and case-severity rate of HFMD generally decreased in Tongzhou District, Beijing. The floating migrant population and children ≤5 years of age were at the highest risk of HFMD.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Doença de Mão, Pé e Boca/epidemiologia , Adolescente , Fatores Etários , Pequim/epidemiologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Tempo
4.
PLoS One ; 13(7): e0201064, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30024979

RESUMO

Postoperative agitation frequently occurs after general anesthesia and may be associated with serious consequences. However, studies in neurosurgical patients have been inadequate. We aimed to investigate the incidence and risk factors for early postoperative agitation in patients after craniotomy, specifically focusing on the association between postoperative pneumocephalus and agitation. Adult intensive care unit admitted patients after elective craniotomy under general anesthesia were consecutively enrolled. Patients were assessed using the Sedation-Agitation Scale during the first 24 hours after operation. The patients were divided into two groups based on their maximal Sedation-Agitation Scale: the agitation (Sedation-Agitation Scale ≥ 5) and non-agitation groups (Sedation-Agitation Scale ≤ 4). Preoperative baseline data, intraoperative and intensive care unit admission data were recorded and analyzed. Each patient's computed tomography scan obtained within six hours after operation was retrospectively reviewed. Modified Rankin Scale and hospital length of stay after the surgery were also collected. Of the 400 enrolled patients, agitation occurred in 13.0% (95% confidential interval: 9.7-16.3%). Body mass index, total intravenous anesthesia, intraoperative fluid intake, intraoperative bleeding and transfusion, consciousness after operation, endotracheal intubation kept at intensive care unit admission and mechanical ventilation, hyperglycemia without a history of diabetes, self-reported pain and postoperative bi-frontal pneumocephalus were used to build a multivariable model. Bi-frontal pneumocephalus and delayed extubation after the operation were identified as independent risk factors for postoperative agitation. After adjustment for confounding, postoperative agitation was independently associated with worse neurologic outcome (odd ratio: 5.4, 95% confidential interval: 1.1-28.9, P = 0.048). Our results showed that early postoperative agitation was prevalent among post-craniotomy patients and was associated with adverse outcomes. Improvements in clinical strategies relevant to bi-frontal pneumocephalus should be considered. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02318199).


Assuntos
Neoplasias Encefálicas/cirurgia , Craniotomia/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Unidades de Terapia Intensiva/estatística & dados numéricos , Pneumocefalia/etiologia , Complicações Pós-Operatórias/etiologia , Adulto , China/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumocefalia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco
5.
Respir Care ; 63(9): 1094-1101, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29945907

RESUMO

BACKGROUND: Stress index provides a noninvasive approach to detect injurious ventilation patterns and to personalize ventilator settings. Obtaining the stress index (SI), however, requires quantitatively analyzing the shape of pressure-time curve with dedicated instruments or a specific ventilator, which may encumber its clinical implementation. We hypothesized that the SI could be qualitatively determined through a visual inspection of ventilator waveforms. METHODS: Thirty-six adult subjects undergoing volume controlled ventilation without spontaneous breathing were enrolled. For each subject, 2 trained clinicians visually inspected the pressure-time curve directly from the ventilator screen. They then qualitatively categorized the shape of pressure-time curve as linear, a downward concavity, or an upward concavity at the bedside. We simultaneously recorded airway pressure and flow signals using a dedicated instrument. A quantitative off-line analysis was performed to calculate the SI using specific research software. This quantitative analysis of the SI served as the reference method for classifying the shape of the pressure-time curve (ie, linear, a downward concavity, or an upward concavity). We compared the SI categorized by visual inspection with that by the reference. RESULTS: We obtained 200 SI assessments of pressure-time curves, among which 125 (63%) were linear, 55 (27%) were a downward concavity, and 20 (10%) were an upward concavity as determined by the reference method. The overall accuracy of visual inspection and weighted kappa statistic (95% CI) was 93% (88-96%) and 0.88 (0.82-0.94), respectively. The sensitivity and specificity to distinguish a downward concavity from a linear shape were 91% and 98%, respectively. The respective sensitivity and specificity to distinguish an upward concavity from a linear shape were 95% and 95%. CONCLUSIONS: Visual inspection of the pressure-time curve on the ventilator screen is a simple and reliable approach to assess SI at the bedside. This simplification may facilitate the implementation of SI in clinical practice to personalize mechanical ventilation. (ClinicalTrials.gov registration NCT03096106.).


Assuntos
Testes Imediatos , Respiração Artificial/instrumentação , Testes de Função Respiratória/métodos , Ventiladores Mecânicos/estatística & dados numéricos , Adulto , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pressão , Estudos Prospectivos , Reprodutibilidade dos Testes , Respiração Artificial/métodos , Sensibilidade e Especificidade , Fatores de Tempo
6.
Medicine (Baltimore) ; 97(22): e10985, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29851854

RESUMO

The assessment of pain in patients with brain injury is challenging due to impaired ability to communicate. We aimed to test the reliability and validity of the critical-care pain observation tool (CPOT) and the bispectral index (BIS) for pain detection in critically brain-injured patients.This prospective observational study was conducted in a neurosurgical intensive care unit in a University-Affiliated Hospital. Adult brain-injured patients undergoing mechanical ventilation were enrolled. Nociceptive (endotracheal suctioning) and non-nociceptive (gentle touching) procedures were performed in a random crossover fashion. Before and immediately after the procedure, CPOT was evaluated by 2 residents and 2 chief nurses, and BIS was documented. The ability to self-report pain was also assessed. The inter-observer reliability of CPOT was analyzed. The criterion and discriminant validities of the CPOT and the BIS were tested.During the study, we enrolled 400 brain-injured patients. The ability to self-report pain was maintained in 214 (54%) and 218 (55%) patients during suctioning and gentle touching, respectively. The intraclass correlation coefficients (95% confidence interval) for inter-observer reliability of CPOT ranged from 0.86 (0.83-0.89) to 0.93 (0.91-0.94). Using self-reported pain as the reference, the area under the receiver operating characteristic curve (95% confidence interval) was 0.84 (0.80-0.88) for CPOT and 0.76 (0.72-0.81) for BIS. When the 2 instruments were combined as either CPOT ≥2 or BIS ≥88 after the procedure, the sensitivity and specificity were 0.90 (0.85-0.93) and 0.59 (0.52-0.66), respectively; and when the 2 instruments were combined as both CPOT ≥2 and BIS ≥88, the sensitivity and specificity were 0.62 (0.55-0.68) and 0.89 (0.83-0.93). Both CPOT and BIS increased significantly after suctioning (all P < .001) but remained unchanged after gentle touching (P ranging from .06 to .14).Our criterion and discriminant validity results supported the use of CPOT and BIS to detect pain in critically brain-injured patients. Combining use of CPOT and BIS in different ways might provide comprehensive pain assessment for different purposes.


Assuntos
Lesões Encefálicas/diagnóstico , Monitores de Consciência/estatística & dados numéricos , Cuidados Críticos/métodos , Medição da Dor/métodos , Dor/diagnóstico , Adulto , Lesões Encefálicas/terapia , Estado Terminal , Estudos Cross-Over , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Reprodutibilidade dos Testes , Respiração Artificial , Autorrelato , Sensibilidade e Especificidade
7.
BMC Anesthesiol ; 18(1): 21, 2018 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-29444644

RESUMO

BACKGROUND: Accurate measurement of esophageal pressure (Pes) depends on proper filling of the balloon. Esophageal wall elastance (Ees) may also influence the measurement. We examined the estimation of balloon-surrounding elastance in a bench model and investigated a simplified calibrating procedure of Pes in a balloon with relatively small volume. METHODS: The Cooper balloon catheter (geometric volume of 2.8 ml) was used in the present study. The balloon was progressively inflated in different gas-tight glass chambers with different inner volumes. Chamber elastance was measured by the fitting of chamber pressure and balloon volume. Balloon pressure-volume (P-V) curves were obtained, and the slope of the intermediate linear section was defined as the estimated chamber elastance. Balloon volume tests were also performed in 40 patients under controlled ventilation. The slope of the intermediate linear section on the end-expiratory esophageal P-V curve was calculated as the Ees. The balloon volume with the largest Pes tidal swing was defined as the best volume. Pressure generated by the esophageal wall during balloon inflation (Pew) was estimated as the product of Ees and best volume. Because the clinical intermediate linear section enclosed filling volume of 0.6 to 1.4 ml in each of the patient, we simplified the estimation of Ees by only using parameters at these two filling volumes. RESULTS: In the bench experiment, bias (lower and upper limits of agreement) was 0.5 (0.2 to 0.8) cmH2O/ml between the estimated and measured chamber elastance. The intermediate linear section on the clinical and bench P-V curves resembled each other. Median (interquartile range) Ees was 3.3 (2.5-4.1) cmH2O/ml. Clinical best volume was 1.0 (0.8-1.2) ml and ranged from 0.6 to 1.4 ml. Estimated Pew at the best volume was 2.8 (2.5-3.5) cmH2O with a maximum value of 5.2 cmH2O. Compared with the conventional method, bias (lower and upper limits of agreement) of Ees estimated by the simple method was - 0.1 (- 0.7 to 0.6) cmH2O/ml. CONCLUSIONS: The slope of the intermediate linear section on the balloon P-V curve correlated with the balloon-surrounding elastance. The estimation of Ees and calibration of Pes were feasible for a small-volume-balloon. TRIAL REGISTRATION: Identifier NCT02976844 . Retrospectively registered on 29 November 2016.


Assuntos
Recuperação Demorada da Anestesia/fisiopatologia , Esôfago/fisiopatologia , Respiração Artificial , Mecânica Respiratória/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pressão , Testes de Função Respiratória/métodos
8.
Respir Care ; 63(2): 169-176, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29066585

RESUMO

BACKGROUND: The dynamic occlusion test is used to guide balloon catheter placement during esophageal pressure (Pes) monitoring. We introduced a cardiac cycle locating method to attenuate the influence of cardiac artifacts on Pes measurement. The aim was to provide a reliable analytic algorithm for the occlusion test. METHODS: Esophageal balloon catheters were placed in subjects receiving pressure support ventilation. During balloon position adjustment, end-expiratory occlusion was performed to induce 3 consecutive inspiratory efforts. Pes and airway pressure (Paw) data were collected for off-line analysis. For each occluded inspiratory effort, the change in Pes (ΔPes) was plotted against the change in Paw (ΔPaw), and the slope of the regression line was calculated. The ΔPes/ΔPaw ratio was also measured with the cardiac cycle locating method and peak-to-peak method. Bland-Altman analysis was used to assess the agreement between the ΔPes/ΔPaw ratio and the slope. We defined the occlusion test with all fitted slopes for the 3 inspiratory efforts within 0.8 to 1.2 to indicate optimal balloon position; otherwise, the position was deemed non-optimal. Using the slope as the reference, the diagnostic accuracy of the ΔPes/ΔPaw ratio in distinguishing the optimal and the non-optimal balloon position was analyzed. RESULTS: A total of 86 occlusion tests containing 258 inspiratory efforts were collected from 15 subjects. The median (interquartile range) slope of ΔPes versus ΔPaw plot was 0.85 (0.76, 0.91). Bias (lower and upper limit of agreement) of ΔPes/ΔPaw ratio measured by the cardiac cycle locating method and the peak-to-peak method was 0.02 (-0.13 to 0.16) and 0.06 (-0.18 to 0.31), respectively. Forty-five (52.3%) occlusion tests indicated optimal balloon positions. Compared to the peak-to-peak method, the cardiac cycle locating method was more specific in detecting the non-optimal position. CONCLUSIONS: The cardiac cycle locating method provided reliable and precise measurement for the occlusion test. This method can accurately detect non-optimal balloon position during catheter adjustment.


Assuntos
Cateterismo/métodos , Manometria/métodos , Respiração com Pressão Positiva/métodos , Testes de Função Respiratória/métodos , Adulto , Idoso , Algoritmos , Artefatos , Fenômenos Fisiológicos Cardiovasculares , Cateterismo/instrumentação , Esôfago/fisiopatologia , Feminino , Humanos , Inalação , Masculino , Manometria/instrumentação , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Pressão , Testes de Função Respiratória/instrumentação
9.
J Intensive Care Med ; 33(11): 609-623, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28429603

RESUMO

PURPOSE: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of high-flow nasal cannula (HFNC) on reintubation in adult patients. PROCEDURES: Ovid Medline, Embase, and Cochrane Database of Systematic Reviews were searched up to November 1, 2016, for RCTs comparing HFNC versus conventional oxygen therapy (COT) or noninvasive ventilation (NIV) in adult patients after extubation. The primary outcome was reintubation rate, and the secondary outcomes included complications, tolerance and comfort, time to reintubation, length of stay, and mortality. Dichotomous outcomes were presented as risk ratio (RR) with 95% confidence intervals (CIs) and continuous outcomes as weighted mean difference and 95% CIs. The random effects model was used for data pooling. FINDINGS: Seven RCTs involving 2781 patients were included in the analysis. The HFNC had a similar reintubation rate compared to either COT (RR, 0.58; 95% CI, 0.21-1.60; P = .29; 5 RCTs, n = 1347) or NIV (RR, 1.11; 95% CI, 0.88-1.40; P = .37; 2 RCTs, n = 1434). In subgroup of critically ill patients, the HFNC group had a significantly lower reintubation rate compared to the COT group (RR, 0.35; 95% CI, 0.19-0.64; P = .0007; 2 RCTs, n = 632; interaction P = .07 compared to postoperative subgroup). Qualitative analysis suggested that HFNC might be associated with less complications and improved patient's tolerance and comfort. The HFNC might not delay reintubation. Trial sequential analysis on the primary outcome showed that required information size was not reached. CONCLUSION: The evidence suggests that COT may still be the first-line therapy in postoperative patients without acute respiratory failure. However, in critically ill patients, HFNC may be a potential alternative respiratory support to COT and NIV, with the latter often associating with patient intolerance and requiring a monitored setting. Because required information size was not reached, further high-quality studies are required to confirm these results.


Assuntos
Extubação , Ventilação não Invasiva , Oxigenoterapia/métodos , Doença Aguda , Adulto , Cânula , Cuidados Críticos/métodos , Humanos , Tempo de Internação , Oxigenoterapia/efeitos adversos , Oxigenoterapia/estatística & dados numéricos , Cooperação do Paciente , Cuidados Pós-Operatórios/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Insuficiência Respiratória/terapia , Fatores de Tempo
11.
Intensive Care Med Exp ; 5(1): 35, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28770541

RESUMO

BACKGROUND: Esophageal pressure, used as a surrogate for pleural pressure, is commonly measured by air-filled balloon, and the accuracy of measurement depends on the proper balloon volume. It has been found that larger filling volume is required at higher surrounding pressure. In the present study, we determined the balloon pressure-volume relationship in a bench model simulating the pleural cavity during controlled ventilation. The aim was to confirm whether an optimal balloon volume range existed that could provide accurate measurement at both end-expiration and end-inspiration. METHODS: We investigated three esophageal balloons with different dimensions and materials: Cooper, SmartCath-G, and Microtek catheters. The balloon was introduced into a glass chamber simulating the pleural cavity and volume-controlled ventilation was initiated. The ventilator was set to obtain respective chamber pressures of 5 and 20 cmH2O during end-expiratory and end-inspiratory occlusion. Balloon was progressively inflated, and balloon pressure and chamber pressure were measured. Balloon transmural pressure was defined as the difference between balloon and chamber pressure. The balloon pressure-volume curve was fitted by sigmoid regression, and the minimal and maximal balloon volume accurately reflecting the surrounding pressure was estimated using the lower and upper inflection point of the fitted sigmoid curve. Balloon volumes at end-expiratory and end-inspiratory occlusion were explored, and the balloon volume range that provided accurate measurement at both phases was defined as the optimal filling volume. RESULTS: Sigmoid regression of the balloon pressure-volume curve was justified by the dimensionless variable fitting and residual distribution analysis. All balloon transmural pressures were within ±1.0 cmH2O at the minimal and maximal balloon volumes. The minimal and maximal balloon volumes during end-inspiratory occlusion were significantly larger than those during end-expiratory occlusion, except for the minimal volume in Cooper catheter. Mean (±standard deviation) of optimal filling volume both suitable for end-expiratory and end-inspiratory measurement ranged 0.7 ± 0.0 to 1.7 ± 0.2 ml in Cooper, 1.9 ± 0.2 to 3.6 ± 0.3 ml in SmartCath-G, and 2.2 ± 0.2 to 4.6 ± 0.1 ml in Microtek catheter. CONCLUSIONS: In each of the tested balloon, an optimal filling volume range was found that provided accurate measurement during both end-expiratory and end-inspiratory occlusion.

12.
Perit Dial Int ; 37(1): 14-20, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28153965

RESUMO

♦ BACKGROUND: Cognitive impairment (CI) is a common phenomenon and predictive of high mortality in peritoneal dialysis (PD) patients. This study aimed to analyze the association of social support and family environment with cognitive function in PD patients. ♦ METHODS: This is a cross-sectional study of PD patients from Peking University First Hospital and the Second Affiliated Hospital of Harbin Medical University. Global cognitive function was measured using the Modified Mini-Mental State Examination (3MS), executive function was measured by the A and B trail-making tests, and other cognitive functions were measured by the Repeatable Battery for the Assessment of Neuropsychological Status. Social support was measured with the Social Support Scale developed by Xiaoshuiyuan and family environment was measured with the Chinese Version of the Family Environment Scale (FES-CV). ♦ RESULTS: The prevalence of CI and executive dysfunction among the 173 patients in the study was, respectively, 16.8% and 26.3%. Logistic regression found that higher global social support (odds ratio [OR] = 1.09, 1.01 - 1.17, p = 0.027) and subjective social support predicted higher prevalence of CI (OR = 1.13, 1.02 - 1.25, p = 0.022), adjusting for covariates. Analyses of the FES-CV dimensions found that greater independence was significantly associated with better immediate memory and delayed memory. Moreover, higher scores on achievement orientation were significantly associated with poorer language skills. ♦ CONCLUSIONS: Our findings indicate that social support is negatively associated with the cognitive function of PD patients and that some dimensions of the family environment are significantly associated with several domains of cognitive function.


Assuntos
Transtornos Cognitivos/epidemiologia , Função Executiva , Relações Familiares , Diálise Peritoneal/psicologia , Apoio Social , Adulto , Fatores Etários , Idoso , China , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Estudos Transversais , Feminino , Hospitais Universitários , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/terapia , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Diálise Peritoneal/efeitos adversos , Valor Preditivo dos Testes , Prevalência , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais
13.
J Int Med Res ; 45(1): 320-331, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28222644

RESUMO

Objective To investigate the clinical feasibility of the injection test for balloon placement during oesophageal pressure measurement in patients without spontaneous breathing. Methods The injection test was performed in 12 mechanically ventilated patients under deep sedation and paralysis. During withdrawal of the balloon from the stomach and air injection into the gastric lumen of the catheter, the presence of the injection test wave in the balloon pressure tracing indicated that the whole balloon was positioned above the lower oesophageal sphincter (LES). The positive pressure occlusion test was performed at different balloon positions. Results In each patient, the injection test wave appeared at a distinct balloon depth, with a mean ± standard deviation of 41.9 ± 3.3 cm and range from 37 cm to 47 cm. The optimal ratio of changes in the balloon and airway pressure (0.8-1.2) during the positive pressure occlusion test was obtained when the balloon was located 5 cm and 10 cm above the LES in nine (75%) and three (25%) patients, respectively. Conclusions The injection test is feasible for identification of the whole balloon position above the LES during passive ventilation. The middle third of the oesophagus might be the optimal balloon position.


Assuntos
Balão Gástrico , Intubação Gastrointestinal/métodos , Intubação Intratraqueal/métodos , Respiração com Pressão Positiva/instrumentação , Paralisia Respiratória/terapia , Adulto , Idoso , Anestesia Geral , Esfíncter Esofágico Inferior , Feminino , Humanos , Intubação Gastrointestinal/instrumentação , Intubação Intratraqueal/instrumentação , Masculino , Pessoa de Meia-Idade , Respiração com Pressão Positiva/métodos , Pressão , Estudos Prospectivos , Paralisia Respiratória/fisiopatologia , Estômago
14.
J Neurosurg Anesthesiol ; 29(3): 281-290, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27152427

RESUMO

BACKGROUND: Endotracheal extubation is a painful and stressful procedure. The authors hypothesized that the prophylactic use of remifentanil would attenuate the pain intensity and stress responses resulting from extubation in neurosurgical patients. MATERIALS AND METHODS: In this prospective, randomized, double-blinded, controlled trial, 160 patients with planned delay extubation after elective intracranial operation were randomized 1:1 to receive either remifentanil or normal saline (control) before their extubation. The dose regime of remifentanil was a bolus of 0.5 µg/kg over 1 minute, followed by a continuous infusion of 0.05 µg/kg/min for 20 minutes. The primary outcome was the incidence of severe pain during the periextubation period. Secondary outcomes included changes in the pain intensity and vital signs, failing to pass an extubation evaluation after the study drug infusion, severe adverse events, postextubation complications, and clinical outcomes. RESULTS: Two patients in the remifentanil group did not pass the extubation evaluation. The incidence of severe pain during the periextubation period was significantly lower in the remifentanil group compared with the control group (25.0% vs. 41.3%, P=0.029). Compared with the control group, the visual analog scale in the remifentanil group was significantly lower after the bolus of remifentanil (12±18 vs. 25±27, P=0.001) and immediately after extubation (19±25 vs. 34±30, P=0.001). There were no significant differences in the vital signs immediately after extubation between the 2 groups (P>0.05). CONCLUSIONS: The prophylactic use of remifentanil decreases the incidence of severe pain. Our preliminary findings merit a larger trial to clarify the effect of the prophylactic use of remifentanil on clinical outcomes and adverse events.


Assuntos
Extubação/efeitos adversos , Analgésicos Opioides/uso terapêutico , Craniotomia/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Piperidinas/uso terapêutico , Adulto , Idoso , Extubação/métodos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Encéfalo/cirurgia , Craniotomia/métodos , Método Duplo-Cego , Feminino , Humanos , Incidência , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Medição da Dor/efeitos dos fármacos , Piperidinas/administração & dosagem , Piperidinas/efeitos adversos , Estudos Prospectivos , Remifentanil , Resultado do Tratamento
15.
Huan Jing Ke Xue ; 37(10): 3899-3905, 2016 Oct 08.
Artigo em Chinês | MEDLINE | ID: mdl-29964425

RESUMO

The dissolved organic matters from 2-buternal manufacture wastewater were fractionated into seven fractions by ultra-filtration membrane separation. The amounts and structural compositions of organic compounds in different molecular weight ranges were characterized by dissolved organic carbon (DOC), ultraviolet spectrum (UV), Fourier transform infrared spectrometer (FT-IR) and gas chromatography with mass spectrometry (GC-MS). The results showed that the fraction of molecular weight less than 1×103 had the largest proportion in the wastewater, and occupied 88.57% of the DOC. There were 27 kinds of compounds qualitatively analyzed by GC-MS, mainly including aldehyde, ketone, ester, alcohol, phenol, organic acid, alkane and other heterocyclic compounds. The proportions of compounds of peak area accounting for total peak area of organic matters were 6.9%, 5.3%, 35.4%, 13.2%, 4.6%, 0.4%, 1.7% and 16.8% respectively, adding up to 84%. The analysis of UV and FT-IR demonstrated that the spectral absorptive characteristics of organic compounds from different fractions were not significantly different. The fractions contained carbonyls, hydroxys and aromatic compounds, which was consistent with the qualitative analysis of GC-MS. The results of this study provide an important guidance for the development and optimization of 2-buternal manufacture wastewater treatment process.

16.
Artigo em Chinês | MEDLINE | ID: mdl-30148291

RESUMO

Objective: To investigate the transportation of intracellular and extracellular K(+), Ca(2+), Na(+) and Mg(2+) under the function of Cryptosporidium andersoni ATP-binding cassette (CaABC) 1 gene. Methods: CaABC1 gene was amplified by PCR using specifically designed primers. The eukaryotic expression plasmid pEGFP-C1-CaABC1 was constructed, and transfected into mouse intestinal epithelial cells via liposome transfection. The blank (with no transfection) and control groups (transfected with empty plasmid pEGFP-C1) were also set. Changes in intracellular and extracellular K(+), Ca(2+), Na(+) and Mg(2+) concentrations were examined by the ion concentration assay kit. Results: PCR amplification resulted in a 544 bp product. The recombinant plasmid pEGFP-C1-CaABC1 was successfully constructed. Green fluorescence was seen in the control and transfected groups, but not in the blank group. The concentrations of K(+), Ca(2+), Na(+) and Mg(2+) in intracellular fluid were (5.51 ± 0.51), (1.98 ± 0.06), (108.33 ± 1.33) and (0.93 ± 0.03) mmol/L in the blank group; (6.25 ± 0.70), (1.90 ± 0.13), (107.73 ± 1.79) and (0.87 ± 0.05) mmol/L in the control group; and (14.84 ± 0.90), (3.40 ± 0.14), (127.64 ± 1.49) and (1.72 ± 0.20) mmol/L in the transfected group. The concentrations of K+, Ca2+, Na+ and Mg2+ in extracellular fluid were (12.72 ± 0.83), (3.72 ± 0.03), (116.83 ± 1.04) and (2.02 ± 0.18) mmol/L in the blank group; (10.11 ± 0.90), (3.58 ± 0.06), (115.89 ± 1.86) and (1.71 ± 0.41) mmol/L in the control group; and (5.77 ± 0.21), (1.29 ± 0.18), (96.21 ± 1.19) and (0.64 ± 0.02) mmol/L in the transfected group. There were significant differences in K+, Ca2+ and Mg2+ concentrations between the transfected group and the control group. Conclusion: CaABC1 participates in the transportation of K+, Ca2+ and Mg2+.


Assuntos
Cryptosporidium , Transfecção , Transportador 1 de Cassete de Ligação de ATP , Trifosfato de Adenosina , Animais , Citoplasma , Células Epiteliais , Camundongos , Plasmídeos
17.
Oncol Lett ; 10(4): 1979-1984, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26622783

RESUMO

The inhibition of apoptosis in cancer cells is the major pathological feature of hepatic carcinoma. Rosiglitazone (RGZ), a ligand for peroxisome proliferator-activated receptor γ (PPAR-γ), has been shown to induce apoptosis in hepatic carcinoma cells. However, the mechanism underlying this effect remains to be elucidated. The present study aimed to investigate the effect of RGZ on cell viability and apoptosis, and its mechanisms in cultured HepG2 cells using MTT assay, flow cytometry and western blotting. The results revealed that treatment with RGZ may attenuate HepG2 cell viability and induce the apoptosis of the cells. The mechanism of RGZ-induced apoptosis involves an increase in the level of activated PPAR-γ (p-PPAR-γ) and a decrease in p85 and Akt expression. In addition, the PPAR-γ antagonist GW9662 suppressed the effect of RGZ in the HepG2 cells. Taken together, the results suggest that RGZ induces the apoptosis of HepG2 cells through the activation of PPAR-γ, suppressing the activation of the PI3K/Akt signaling pathway. Such mechanisms may contribute to the favorable effects of treatment using RGZ in HepG2 cells.

19.
Cancer Biol Med ; 9(4): 248-53, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23691485

RESUMO

OBJECTIVE: To investigate the role of tyrosine 23 (Tyr23) phosphorylation of Annexin A2 (Anxa2) in regulating the proliferation and invasion of human breast cancer SK-BR-3 cells. METHODS: A panel of lentivirus plasmids expressing Anxa2-wide type (Ana2-WT), Anxa2-Y23A, and Anxa2-Y23D was generated and infected with SK-BR-3 cells. The monoclonal strains were screened. The expression of Anxa2-WT, Anxa2-Y23A, and Anxa2-Y23D was determined by Western blot analysis. The ability of the cells to proliferate was detected through an MTT [3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] test. Boyden chamber assays were employed to examine migration and invasion abilities. The interaction between Anxa2 and Stat3 was analyzed by immunoprecipitation analyses. Nucleoprotein and cytosolic protein were extracted from SK-BR-3, Anxa2-WT, Anxa2-Y23A, and Anxa2-Y23D cells to analyze the expression and localization of Stat3 phosphorylation. RESULTS: The monoclonal strains constitutively expressing Anxa2-WT, Anxa2-Y23A, and Anxa2-Y23D were screened. Both Anxa2-WT and Anxa2-Y23D enhanced the proliferation, migration and invasion abilities of SK-BR-3 cells (P<0.05). Immunoprecipitation analysis revealed that Anxa2 and Stat3 interacted with each other, and the expression of Stat3 phosphorylation in the nucleus was enhanced by Anxa2-Y23D. CONCLUSIONS: Tyr23 phosphorylation of Anxa2 promotes the proliferation and invasion of human breast cancer SK-BR-3 cells and the phosphorylation of Stat3 in the nucleus.

20.
J Tradit Chin Med ; 29(2): 141-5, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19663103

RESUMO

OBJECTIVE: To explore the analgesic and anti-inflammatory effects of lappaconitine gelata (LA). METHODS: The writhing response induced by acetic acid, the pain response induced by formaldehyde and hot plate method in the mouse, and the paw edema induced by egg albumen in the rat and the ear edema induced by xylene in the mouse were used for investigation on the analgesic and anti-inflammatory effects of LA. RESULTS: The writhing response induced by acetic acid, the pain response induced by formaldehyde and hot plate methods was significantly inhibited by LA. In addition, the paw edema induced by egg albumen in the rat and the ear edema induced by xylene in the mouse were all significantly suppressed by LA. CONCLUSION: LA has the analgesic and anti-inflammatory effects.


Assuntos
Aconitina/análogos & derivados , Analgésicos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Medicamentos de Ervas Chinesas/uso terapêutico , Edema/tratamento farmacológico , Aconitina/uso terapêutico , Animais , Edema/induzido quimicamente , Camundongos , Dor/induzido quimicamente , Dor/tratamento farmacológico , Ratos , Ratos Wistar
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