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1.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 14-17, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31072967

RESUMO

OBJECTIVE: To assess whether oxytocin administered before clamping the umbilical cord modifies the volume of placental transfusion. DESIGN: Randomised controlled trial. METHODS: Mothers of term infants born vigorous by vaginal delivery with informed consent provided in early labour were randomly assigned to oxytocin (10 IU) given intravenously within 15 s of birth (group 1) or after clamping the umbilical cord 3 min after delivery (group 2). Soon after birth, all infants were weighed using a 1 g precision scale and subsequently placed on the mother's abdomen or chest. At 3 min, in both groups, the cord was clamped and cut, and the weight was again obtained. The primary outcome (volume of placental transfusion) was estimated by the difference in weights. RESULTS: 144 patients were included. There were no differences in the primary outcome: infants in group 1 (n=70) gained a mean weight of 85.9 g (SD 48.3), and in group 2 (n=74) 86.7 g (SD 49.6) (p=0.92). No differences were found in secondary outcomes, including newborns' haematocrit and bilirubin concentrations and severe maternal postpartum haemorrhage. On the advice of the Data and Safety Monitoring Committee, the trial was stopped due to futility at 25% of the planned sample size. CONCLUSIONS: When umbilical cord clamping is delayed for 3 min, term newborn infants born vigorous receive a clinically significant placental transfusion which is not modified by the administration of intravenous oxytocin immediately after birth. TRIAL REGISTRATION NUMBER: NCT02618499.


Assuntos
Constrição , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Circulação Placentária , Período Pós-Parto , Cordão Umbilical , Adulto , Bilirrubina/sangue , Peso ao Nascer , Parto Obstétrico , Feminino , Hematócrito , Maternidades , Humanos , Recém-Nascido , Injeções Intravenosas , Masculino , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Fatores de Tempo , Ganho de Peso
2.
Medicine (Baltimore) ; 98(50): e18366, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852142

RESUMO

We aimed to compare the impact on survival among albumin-bilirubin (ALBI) grade, modified ALBI (mALBI) and our proposed combined ALBI grade and Mac-2 binding protein glycosylation isomer (M2BPGi) or FIB4 index grading system in chronic hepatitis C (CHC) related compensated liver cirrhosis (n = 165, 93 men and 72 women, median age = 67 years). Patients with ALBI grade 1, 2, and 3 were allocated a score of 1, 2, and 3 points, respectively. Patients with mALBI grade 1, 2A, and 2B were allocated a score of 1, 2, and 3 points, respectively. Patients with a high or low M2BPGi were allocated a score of 1 and 0 point. Patients with a high or low FIB4 index were allocated a score of 1 and 0 point. Sum of the point of ALBI (1, 2, or 3) and M2BPGi (0 or 1) or FIB4 index (0 or 1) was defined as ALBI-M2BPGi grade or ALBI-FIB4 grade. Prognostic accuracy was compared using the Akaike information criterion (AIC) value and time dependent receiver operating characteristics (ROC) curve analysis. The median follow-up duration was 5.422 years. AIC value for survival by ALBI-M2BPGi grade was the lowest among 4 prognostic models (AIC: 205.731 in ALBI grade, 200.913 in mALBI grade, 189.816 in ALBI-M2BPGi grade, and 204.671 in ALBI-FIB4 grade). All area under the ROC curves of ALBI-M2BPGi grade in each time point were higher than those of ALBI grade, mALBI grade, and ALBI-FIB4 grade. In conclusion, our proposed ALBI-M2BPGi grading system seems to be helpful for estimating prognosis in patients with CHC related compensated LC.


Assuntos
Bilirrubina/genética , Cirrose Hepática/genética , Albumina Sérica Humana/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígenos de Neoplasias/sangue , Antígenos de Neoplasias/genética , Bilirrubina/sangue , Bilirrubina/metabolismo , Feminino , Marcadores Genéticos , Humanos , Cirrose Hepática/mortalidade , Masculino , Glicoproteínas de Membrana/sangue , Glicoproteínas de Membrana/genética , Pessoa de Meia-Idade , Estudos Retrospectivos , Albumina Sérica Humana/metabolismo
3.
Bratisl Lek Listy ; 120(11): 860-863, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31747768

RESUMO

AIM: We intended to investigate the association of bilirubin with total mortality in patients with chronic total coronary occlusion (CTO). METHODS: We included 172 patients who underwent coronary angiography due to stable angina pectoris and had CTO. We checked the viability of patients after 9 years of follow-up. RESULTS: Direct bilirubin levels were significantly lower in the non-viable group. We revealed age (OR = 1.045, 95% C.I: 1.009‒1.083; p = 0.015) and direct bilirubin concentrations (OR = 0.029, 95% C.I: 0.002‒0.435; p = 0.029) as independent predictors of mortality. Direct bilirubin value of > 0.2 mg/dL was associated with decreased mortality with a sensitivity of 85 %, and a specificity of 46 %. CONCLUSION: Serum direct bilirubin concentrations independently predict total mortality in patients with chronic total occlusion over 9 years of follow-up (Tab. 1, Fig. 2, Ref. 23).


Assuntos
Bilirrubina/sangue , Oclusão Coronária/mortalidade , Doença Crônica , Angiografia Coronária , Humanos , Fatores de Risco
4.
Arq Gastroenterol ; 56(4): 333-338, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31721967

RESUMO

BACKGROUND: Indigofera suffruticosa Mill (Fabaceae) is abundant in northeastern Brazil and popularly used in the treatment of infectious and inflammatory processes. Several biological properties, such as anti-inflammatory, anticancer, antitumor, hepatoprotective and low toxicity, are reported for this plant. OBJECTIVE: This study investigated hepatoprotective activity and the antioxidant effect of methanolic extract of I. suffruticosa leaves (MEIS) on Swiss albino mice submitted to experimental models of acetaminophen-induced liver injury. METHODS: MEIS (50 mg/kg; p.o.) was standardized according to the LD50 and its hepatoprotective property on Swiss albino mice evaluated during a 7-day period. On the eighth day, the acetaminophen-induced hepatic injury was performed. Histomorphometric analysis of liver tissue, antioxidant activity and serum levels of alanine aminotransferase (AST), aspartate aminotransferase (ALT) and bilirubin were measured. RESULTS: MEIS (50 mg/kg; p.o.) restored serum enzyme levels and results were close to those of positive control (silymarin) when compared to the negative control. Histopathological and histomorphometric analyzes confirmed MEIS hepatoprotective activity, showing reorganization of structural units of cells, nuclei and sinusoidal capillaries of hepatocytes, reducing the damage on liver tissue and increasing organ regeneration rate. MEIS showed high antioxidant potential at concentrations of 1000 and 500 µg/mL. CONCLUSION: This study suggests that MEIS has hepatoprotective activity and high antioxidant potential.


Assuntos
Acetaminofen/toxicidade , Analgésicos não Entorpecentes/toxicidade , Doença Hepática Induzida por Substâncias e Drogas/prevenção & controle , Indigofera/química , Extratos Vegetais/administração & dosagem , Substâncias Protetoras/administração & dosagem , Alanina Transaminase/sangue , Animais , Aspartato Aminotransferases/sangue , Bilirrubina/sangue , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Masculino , Camundongos
5.
Zhonghua Gan Zang Bing Za Zhi ; 27(10): 772-776, 2019 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-31734991

RESUMO

Objective: To investigate the prognostic value of albumin-to-bilirubin scores in the assessment of autoimmune hepatitis-related cirrhosis. Methods: The receiver operating characteristic curve was used to evaluate the accuracy of ALBI, Child-Pugh and model for end-stage liver disease (MELD) for prognosis prediction. Survival analysis was performed according to the ALBI classification. Spearman correlation analysis was performed on the ALBI score and the Child-Pugh score. Survival curves were plotted by Kaplan-Meier method, and Log-rank method was used to compare the survival difference curves between different groups. Results: 149 patients were recruited in the study. The ROC analysis showed that the ALBI scores (0.861, 0.826, 0.779, 0.744)was superior to Child-Pugh scores(0.703, P = 0.006; 0.672, P < 0.001; 0.613, P < 0.001; 0.583, P < 0.001)and MELD score(0.774, P = 0.031; 0.731, P = 0.007; 0.669, P < 0.001; 0.631, P < 0.001) for predicting 6, 12, 24, and 36 months mortality. Patients with ALBI grade 3 had a significantly lower survival rate than those with ALBI grade1 and grade 2. Conclusion: ALBI score may be useful to evaluate the long-term prognosis of patients with autoimmune hepatitis-related cirrhosis.


Assuntos
Albuminas/administração & dosagem , Bilirrubina/sangue , Hepatite Autoimune/diagnóstico , Cirrose Hepática/diagnóstico , Hepatite Autoimune/sangue , Humanos , Cirrose Hepática/sangue , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
6.
Medicine (Baltimore) ; 98(45): e17673, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702620

RESUMO

The effect of non-jaundice stage at diagnosis on clinicopathological features and prognosis of patients with periampullary carcinomas (PACs) remains uncertain.The 504 patients who were pathologically diagnosed with PACs between 2012 and 2017 were retrospective analyzed. Kaplan-Meier method was used to estimate survival and log-rank tests were used for comparisons between groups.Patients were divided into the non-jaundice group and the jaundice group according to serum total bilirubin (3 mg/dL) at diagnosis. By comparison with the jaundice group, more patients of the non-jaundice group manifested abdominal pain with longer duration. The degree of deterioration of complete blood count, liver function and CA19-9 in the non-jaundice group was significantly lower (P < .001). The non-jaundice group had larger tumor size (P = .001), more duodenal carcinoma and pancreatic carcinoma (P < .001), lower resection rate (P = .001) and less pancreatic and perineural invasion (P = .017, P = .002). The I stage was significantly more common in the non-jaundice group (P < .001). The cumulative 5-year survival of the non-jaundice group was significantly higher (P = .032). Multivariate analysis for all patients demonstrated that CEA level, cell differentiation, chemotherapy, and recurrence were independent prognostic factors.Patients with PACs in a non-jaundice stage at diagnosis showed more favorable clinicopathological features and long-term survival than such patients with jaundice.


Assuntos
Neoplasias dos Ductos Biliares/patologia , Colangiocarcinoma/patologia , Neoplasias Duodenais/patologia , Neoplasias Pancreáticas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/metabolismo , Bilirrubina/sangue , Colangiocarcinoma/metabolismo , Neoplasias Duodenais/metabolismo , Feminino , Humanos , Icterícia/sangue , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/metabolismo , Estudos Retrospectivos , Análise de Sobrevida , Carga Tumoral , Adulto Jovem
7.
Rev Saude Publica ; 53: 89, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644770

RESUMO

OBJECTIVE: Describe the clinical and epidemiological profile of confirmed cases of yellow fever whose patients were hospitalized in a general hospital for infectious diseases in the State of Rio de Janeiro, Brazil, from March 11, 2017 to June 15, 2018, during a recent outbreak and factors associated with death. METHODS: This is a retrospective observational study with analysis of secondary databases of local epidemiological surveillance system, and complementary data collection from epidemiological investigation records and clinical records. Study variables included demographic, epidemiological, clinical, and laboratory data. A descriptive statistical analysis and a bivariate and multivariate analysis by logistic regression were performed to analyze factors associated with death. RESULTS: Fifty-two patients diagnosed with yellow fever were hospitalized, 86.5% male patients, median age 49.5 years, 40.4% rural workers. The most frequent signs and symptoms were fever (90.4%), jaundice (86.5%), nausea and/or vomiting (69.2%), changes in renal excretion (53.8%), bleeding (50%), and abdominal pain (48.1%), with comorbidity in 38.5% of all cases. The lethality rate was 40.4%. Factors significantly associated with a higher chance of death in the bivariate analysis were: bleeding, changes in renal excretion, and maximum values of direct bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine. In the multivariate analysis by logistic regression, only changes in renal excretion and ALT remained significant predictors of higher chance of death. A threshold effect was also observed for AST. The cutoff points identified as high risk for death were ALT > 4,000 U/L and AST > 6,000 U/L. CONCLUSIONS: This study contributed to the knowledge on the profile of confirmed cases of high severity yellow fever. The main factors associated with death were changes in renal excretion and elevated serum transaminases, especially ALT. High lethality emphasizes the need for early diagnosis and treatment, and the importance of increasing vaccination coverage.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Mortalidade Hospitalar , Febre Amarela/mortalidade , Adolescente , Adulto , Idoso , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Bilirrubina/sangue , Brasil/epidemiologia , Creatinina/sangue , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo , Ureia/sangue , Febre Amarela/sangue , Adulto Jovem
8.
Medicine (Baltimore) ; 98(43): e17394, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651841

RESUMO

Child-Pugh (CP) grade A patients with early stage hepatocellular carcinoma (HCC) are candidates for curative surgery, while some patients still have a poor outcome. The aim of this study was to investigate the prognostic values of 2 new evaluation models for liver function, named albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grades, in CP grade A patients with HCC.In this retrospective cohort study, we reviewed 134 cases of CP grade A patients with hepatitis B-associated HCC who underwent radical surgery. ALBI and PALBI grades were calculated based on preoperative serologic examinations. Overall survival (OS) and recurrence-free survival (RFS) were estimated by Kaplan-Meier curve and Cox regression. The prognostic performances of the models were estimated by using the concordance index (C-index).During a median follow-up time of 27 months, 27.6% (37/134) of patients died and 26.1% (35/134) experienced recurrence. Kaplan-Meier analyses showed that ALBI and PALBI grades were significantly associated with OS and RFS. Multivariate analyses further revealed that both ALBI and PALBI grades were independent predictors for survival. Furthermore, the prognostic values of the combination of tumor size with ALBI (C-index = 0.754, 95% confidence interval [CI]: 0.675-0.849) or with PALBI (C-index = 0.762, 95% CI: 0.664-0.844) may be comparable with both Barcelona Clinic Liver Cancer and Cancer of Liver Italian Program staging systems.The ALBI and PALBI grades, in particular the combination with tumor size, are effective models for discriminating survival in CP grade A patients with HCC.


Assuntos
Bilirrubina/sangue , Plaquetas/metabolismo , Carcinoma Hepatocelular/mortalidade , Hepatectomia/mortalidade , Neoplasias Hepáticas/mortalidade , Albumina Sérica/análise , Adulto , Biomarcadores Tumorais/sangue , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/virologia , Feminino , Hepatite B/complicações , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/virologia , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(43): e17693, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651899

RESUMO

This study sought to assess the hypothesis that anemia is associated with diabetic retinopathy in type 2 diabetes mellitus (DM) and investigate the factors mediating the relationship between anemia and diabetic retinopathy.In total, 1637 individuals with type 2 DM were examined in a cross-sectional study. Anemia was defined as hemoglobin level <120 g/L in women and <130 g/L in men. A logistic regression model was used to determine the association between anemia and diabetic retinopathy.Anemia was more prevalent in individuals with diabetic retinopathy. Logistic regression analysis found a statistically significant association between anemia and diabetic retinopathy after adjustment for traditional risk factors (odds ratio, 1.44; 95% confidence interval, 1.10-1.89, P = .009). Further adjustment for serum bilirubin levels removed the statistically significant association.In individuals with type 2 DM, anemia is related to diabetic retinopathy, and its association may be mediated by a correlated change in serum bilirubin levels.


Assuntos
Anemia/sangue , Bilirrubina/sangue , Diabetes Mellitus Tipo 2/sangue , Retinopatia Diabética/sangue , Biomarcadores/sangue , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Fatores de Risco
10.
Can J Vet Res ; 83(4): 285-290, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31571729

RESUMO

Analysis of hematologic and biochemical values in pigs is an important basis for biomedical research and veterinary clinical diagnosis. Reference values for specific-pathogen-free (SPF) 1-month-old Yorkshire (Y) pigs and Yorkshire-Landrace crossbred (YL) pigs are limited. The present research aimed to describe and compare the reference values for hematologic and biochemical parameters in such pigs. Blood samples were obtained from 90 Y pigs (52 males and 38 females) and 88 YL pigs (55 males and 33 females), all 1 month old and bred in an SPF environment. Among the 16 hematologic and 15 serum biochemical parameters tested, no significant differences between the Y and YL pigs were found except in the concentration of triglyceride (P < 0.05), and heterosis was not observed. Thus, the values determined in this study can be used as basic reference values for 1-month-old Y and YL pigs and will contribute to the use of SPF pigs in biomedical research.


Assuntos
Alanina Transaminase/sangue , Fosfatase Alcalina/sangue , Aspartato Aminotransferases/sangue , Bilirrubina/sangue , Suínos/sangue , Animais , Contagem de Células Sanguíneas/veterinária , Glicemia , Cruzamento , Colesterol/sangue , Creatinina/sangue , Feminino , Hemoglobinas/análise , Masculino , Valores de Referência , Albumina Sérica , Organismos Livres de Patógenos Específicos , Suínos/genética , Triglicerídeos/sangue
11.
Acta Gastroenterol Belg ; 82(3): 389-395, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31566326

RESUMO

BACKGROUND AND AIM: Preoperative biliary drainage (PBD) in patients with pancreatic cancer remains debatable. The aim of this study was to analyse the indications for PBD in patients performing pancreaticoduodenectomy (PD) and to evaluate the impact of this procedure on postoperative outcome. METHODS: Observational retrospective cohort study of patients undergoing PD for pancreatic cancer. Clinical data and postoperative outcome, namely complications and 90-day mortality, were prospectively collected and compared between patients performing PBD or direct surgery (DS). RESULTS: Eighty-two patients were included: 40 underwent PBD and 42 performed DS. Major complications (27.5% vs 33.3%, P=0.156) and 90-day mortality (10% vs 16.7%, P=0.376) were similar between the two groups. There was a trend for higher mean total bilirubin in patients with PBD (P=0.073). The indication for PBD was suspicion of cholangitis/choledocholithiasis or need to perform neoadjuvant chemotherapy in 24 (60%) patients. In the remaining, elevated bilirubin was probably the only reason to perform PBD. Length of hospital stay was longer in PBD group (P=0.003). On multiple logistic regression, 90-day mortality was not related with preoperative bilirubin levels, biliary drainage or its indication, but solely with age (OR 1.15, 95%CI 1.05-1.31, P=0.008). CONCLUSIONS: PBD is often performed in patients undergoing PD without a formal indication, mainly due to high bilirubin levels. No increased morbidity/mortality was observed but length of hospital stay was prolonged in patients performing PBD.


Assuntos
Drenagem/efeitos adversos , Pancreaticoduodenectomia/métodos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Bilirrubina/sangue , Drenagem/métodos , Humanos , Pancreaticoduodenectomia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
12.
Medicine (Baltimore) ; 98(42): e17544, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626117

RESUMO

The protective role of serum total bilirubin, a widely recognized antioxidant, has been approved by numerous updating studies. However, regarding the effect of high serum total bilirubin level (STBL) in arteriosclerotic cardiovascular disease (ASCVD) are conflicting in different sources of data. We, therefore, performed this meta-analysis to evaluate the influence of STBL on risk of ASCVD.Four databases were used to identify the literature with a date of search of January, 2019. Finally, a total of 20 studies had been adopted. ASCVD was defined as acute coronary syndrome, stable angina, coronary revascularization, atherosclerotic stroke or transient ischemic attack, and peripheral arterial disease (PAD). All relevant data were collected from studies meeting the inclusion criteria.A total of 20 published studies (323,891 cases) met the inclusion criteria. The meta-analysis revealed that, in studies excluding heterogeneity, STBL was significantly positively related to in-hospital cardiovascular mortality (odds ratio [OR] 2.82, 95% confidence interval [CI] 1.83-4.36, Z = 4.69, P < .001) and major adverse cardiac events (OR 1.88, 95% CI 1.414-2.491, Z = 4.36, P < .001), also negatively associated with prognosis of acute myocardial infarction, pooled hazard ratio (HR) = 0.804 (95% CI 0.700-0.923, Z = 3.08, P = .002). The correlation similarity was also reflected in terms of patients with stroke (HR 0.78, 95% CI 0.70-0.88, Z = 4.24, P = .003). Combined analysis revealed that lower STBL was significantly associated with PAD, pooled OR = 0.91 (95% CI 0.85-0.98, Z = 2.39, P = .017). In general analysis, a conclusion can be drawn, that higher STBL was significantly negative correlated with cardiovascular disease, pooled HR = 0.83 (95% CI 0.73-0.94, Z = 3.02, P = .003).Higher STBL significantly improved the prognosis of ASCVD; furthermore, STBL was an important factor in the long-term prognosis of vascular-related disease prevention and can be used as a predictor in vascular-related disease risk prediction.


Assuntos
Aterosclerose/sangue , Bilirrubina/sangue , Doenças Cardiovasculares/sangue , Adulto , Idoso , Aterosclerose/mortalidade , Doenças Cardiovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Valor Preditivo dos Testes , Prognóstico , Medição de Risco/métodos , Fatores de Risco
13.
Pediatr Surg Int ; 35(11): 1223-1229, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31535197

RESUMO

PURPOSE: Kasai portoenterostomy (KP) is the primary procedure for biliary atresia (BA). However, due to reports of poor outcomes of KP, primary liver transplantation (LT) is preferred in selected cases. In Japan, primary LT is limited with no study reports details, particularly regarding the indications. We conducted the first nationwide survey to assess the status of primary LT in Japan. METHODS: Questionnaires were sent to institutions where procedures other than KP were performed as the initial procedure for BA and registered to the Japan Biliary Atresia Registry. Parameters related to procedure selection were analyzed. RESULTS: Of 2895 patients registered (1989-2013), primary LT (n = 15) or exploratory laparotomy (EL) followed by LT (n = 9) without KP was performed in 24 cases (0.8%). The main reason for primary LT was late diagnosis, and for EL followed by LT, lack of fibrous tissue at the porta hepatis (ο-type). The prognoses of LT without KP was good. CONCLUSION: Non-KP initial procedures were limited. Clear criteria regarding the timing of diagnosis or patient condition could not be determined. Reasons for not initially selecting KP varied, but late diagnosis was predominant. Further study is needed to create guidelines for the initial treatment of BA patients.


Assuntos
Atresia Biliar/cirurgia , Transplante de Fígado/estatística & dados numéricos , Bilirrubina/sangue , Feminino , Humanos , Lactente , Japão , Laparotomia/estatística & dados numéricos , Masculino , Portoenterostomia Hepática , Sistema de Registros , Índice de Gravidade de Doença , Inquéritos e Questionários
14.
Vet J ; 251: 105350, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31492387

RESUMO

Gallbladder mucocele (GBM) is a common extra-hepatic biliary syndrome in dogs with death rates ranging from 7 to 45%. Therefore, the aim of this study was to identify the association of survival with variables that could be utilized to improve clinical decisions. A total of 1194 dogs with a gross and histopathological diagnosis of GBM were included from 41 veterinary referral hospitals in this retrospective study. Dogs with GBM that demonstrated abnormal clinical signs had significantly greater odds of death than subclinical dogs in a univariable analysis (OR, 4.2; 95% CI, 2.14-8.23; P<0.001). The multivariable model indicated that categorical variables including owner recognition of jaundice (OR, 2.12; 95% CI, 1.19-3.77; P=0.011), concurrent hyperadrenocorticism (OR 1.94; 95% CI, 1.08-3.47; P=0.026), and Pomeranian breed (OR, 2.46; 95% CI 1.10-5.50; P=0.029) were associated with increased odds of death, and vomiting was associated with decreased odds of death (OR, 0.48; 95% CI, 0.30-0.72; P=0.001). Continuous variables in the multivariable model, total serum/plasma bilirubin concentration (OR, 1.03; 95% CI, 1.01-1.04; P<0.001) and age (OR, 1.17; 95% CI, 1.08-1.26; P<0.001), were associated with increased odds of death. The clinical utility of total serum/plasma bilirubin concentration as a biomarker to predict death was poor with a sensitivity of 0.61 (95% CI, 0.54-0.69) and a specificity of 0.63 (95% CI, 0.59-0.66). This study identified several prognostic variables in dogs with GBM including total serum/plasma bilirubin concentration, age, clinical signs, concurrent hyperadrenocorticism, and the Pomeranian breed. The presence of hypothyroidism or diabetes mellitus did not impact outcome in this study.


Assuntos
Doenças do Cão/diagnóstico , Doenças da Vesícula Biliar/veterinária , Hiperbilirrubinemia/veterinária , Mucocele/veterinária , Hiperfunção Adrenocortical/veterinária , Animais , Bilirrubina/sangue , Biomarcadores , Doenças do Cão/mortalidade , Doenças do Cão/cirurgia , Cães , Doenças da Vesícula Biliar/diagnóstico , Doenças da Vesícula Biliar/mortalidade , Doenças da Vesícula Biliar/cirurgia , Predisposição Genética para Doença , Hiperlipidemias/veterinária , Mucocele/diagnóstico , Mucocele/mortalidade , Mucocele/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
15.
Medicine (Baltimore) ; 98(33): e16867, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415421

RESUMO

Acute kidney injury (AKI) is a complex syndrome with a variety of possible etiologies and symptoms. It is characterized by high mortality and poor recovery of renal function. The incidence and mortality rates of patients with AKI in intensive care units are extremely high. It is generally accepted that early identification and prompt treatment of AKI are essential to improve outcomes. This study aimed to develop a model based on risk stratification to identify and diagnose early stage AKI for improved prognosis in critically ill patients.This was a single-center, retrospective, observational study. Based on relevant literature, we selected 13 risk factors (age, sex, hypertension, diabetes, coronary heart disease, chronic kidney disease, total bilirubin, emergency surgery, mechanical ventilation, sepsis, heart failure, cancer, and hypoalbuminemia) for AKI assessment using the Kidney Disease Improving Global Outcomes (KDIGO) diagnostic criteria. Univariate and multivariate analyses were used to determine risk factors for eventual entry into the predictive model. The AKI predictive model was established using binary logistic regression, and the area under the receiver operating characteristic curve (AUROC or AUC) was used to evaluate the predictive ability of the model and to determine critical values.The AKI predictive model was established using binary logistic regression. The AUROC of the predictive model was 0.81, with a sensitivity of 69.8%, specificity of 83.4%, and positive likelihood ratio of 4.2.A predictive model for AKI in critically ill patients was established using 5 related risk factors: heart failure, chronic kidney disease, emergency surgery, sepsis, and total bilirubin; however, the predictive ability requires validation.


Assuntos
Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Estatísticos , Lesão Renal Aguda/diagnóstico , Adulto , Idoso , Bilirrubina/sangue , Comorbidade , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Sepse/epidemiologia
16.
Transplant Proc ; 51(7): 2420-2424, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31405742

RESUMO

Sepsis causes life-threatening organ dysfunction and is the leading cause of morbidity and mortality in critically ill patients worldwide. Mortality rate of sepsis is close to 30% to 50% despite better understanding of the pathophysiology of sepsis, and advances in antimicrobial therapy, resuscitation strategies, and mechanical ventilation. Liver failure is characterized by accumulation of potentially toxic substances in the systemic circulation of the patient. Toxic effects of these molecules can induce cellular injuries leading to multiorgan dysfunction. Hydrophobic unconjugated bilirubin and bile acids, hydrophilic conjugated bilirubin, and ammonium are the main toxins accumulated in liver failure. We carried out cytokine adsorbtion (CytoSorb) procedure with continuous venovenous hemodialysis in 12-hour sessions. The biochemical values of the patients before and after the use of the filter were recorded. The parameters compared were as follows: total bilirubin, direct bilirubin, C-reactive protein, leukocyte, neutrophil, alanine aminotransferase, aspartate aminotransferase, creatinine, colloid oncotic pressure, ammonia, gamma-glutamyl transferase, alkaline phosphatase, procalcitonin, hematocrit, hemoglobin, pH, albumin, international normalized ratio, fibrinogen, lactate dehydrogenase, platelet, temperature, changes in vasoactive medication requirement, temperature. According to these results, cytokine adsorption systems can be considered as an option to lower bilirubin levels in cases of liver failure. Its inability to lower ammonia level is considered a disadvantage compared with other bilirubin-lowering methods. Although further studies are needed to compare different methods, cytokine adsorption systems may be considered in treatment planning as it contributes to the treatment of sepsis and hyperbilirubinemia in liver failure patients with sepsis.


Assuntos
/métodos , Citocinas/sangue , Hiperbilirrubinemia/sangue , Falência Hepática/terapia , Sepse/sangue , Adsorção , Amônia/sangue , Bilirrubina/sangue , Feminino , Humanos , Hiperbilirrubinemia/complicações , Falência Hepática/sangue , Falência Hepática/etiologia , Testes de Função Hepática/métodos , Masculino , Pessoa de Meia-Idade , Sepse/complicações , Resultado do Tratamento
17.
Artigo em Chinês | MEDLINE | ID: mdl-31446720

RESUMO

Objective:The aim of this study was to investigate the association between serum bilirubin levels and the severity of bilateral sudden sensorineural hearing loss (BSSHL). Method:A total of 113 patients with bilateral axillary sputum were enrolled, and the relationship between serum bilirubin levels and initial hearing levels was explored using a univariate and multivariate linear regression model. Result:Compared with the group with moderate and below hearing loss (≤70 dB HL), patients with severe profound HL(>70 dB HL) were more likely to have lower levels of total and indirect bilirubin level, magnesium and relative hearing gain, higher levels of final hearing, white blood counts, neutrophil, platelet and alkaline phosphatase. After adjusting for possible confounders, only serum indirect bilirubin levels were significantly negatively correlated with initial hearing loss in patients with bilateral axillary sputum. 1 µmol/L increase of IBIL was associated with 1.1 dB (95%CI: -2.2, 0.0) reduction in initial hearing loss. Conclusion:Within the normal or mildly elevated range, higher levels of IBIL are independently and significantly associated with less severe hearing loss in BSSHL. It suggested a beneficial effect of bilirubin on auditory system.


Assuntos
Bilirrubina/sangue , Perda Auditiva Bilateral/sangue , Perda Auditiva Súbita/sangue , Humanos , Estudos Retrospectivos
18.
Nat Commun ; 10(1): 3741, 2019 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-31431616

RESUMO

Clinical experience suggests increased incidences of neonatal jaundice when air quality worsens, yet no studies have quantified this relationship. Here we reports investigations in 25,782 newborns showing an increase in newborn's bilirubin levels, the indicator of neonatal jaundice risk, by 0.076 (95% CI: 0.027-0.125), 0.029 (0.014-0.044) and 0.009 (95% CI: 0.002-0.016) mg/dL per µg/m3 for PM2.5 exposure in the concentration ranges of 10-35, 35-75 and 75-200 µg/m3, respectively. The response is 0.094 (0.077-0.111) and 0.161 (0.07-0.252) mg/dL per µg/m3 for SO2 exposure at 10-15 and above 15 µg/m3, respectively, and 0.351 (0.314-0.388) mg/dL per mg/m3 for CO exposure. Bilirubin levels increase linearly with exposure time between 0 and 48 h. Positive relationship between maternal exposure and newborn bilirubin level is also quantitated. The jaundice-pollution relationship is not affected by top-of-atmosphere incident solar irradiance and atmospheric visibility. Improving air quality may therefore be key to lowering the neonatal jaundice risk.


Assuntos
Poluentes Atmosféricos/toxicidade , Poluição do Ar/análise , Icterícia Neonatal/induzido quimicamente , Exposição Materna/efeitos adversos , Material Particulado/toxicidade , Efeitos Tardios da Exposição Pré-Natal , Poluentes Atmosféricos/análise , Pequim , Bilirrubina/sangue , Feminino , Humanos , Recém-Nascido , Material Particulado/análise , Gravidez
19.
Ann Hematol ; 98(10): 2257-2265, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31440871

RESUMO

Vascular complications of sickle cell anemia (SCA) are influenced by many factors. Elevated plasma homocysteine (Hcy) is supposed to be an independent risk factor and is either genetic or nutritional origin. The present study evaluated the plasma Hcy level, MTHFR C677T gene polymorphism, effect of folic acid (FA) supplementation' and hemato-biochemical parameters in SCA and their effect on the vaso-occlusive crisis (VOC) in SCA patients of an Asian-Indian haplotype population. One hundred twenty cases of SCA (HbSS) and 50 controls with normal hemoglobin(HbAA) were studied. It was found that the plasma Hcy level is significantly higher (p < 0.0001) in patients with SCA (22.41 ± 7.8 µmol/L) compared to controls (13.2 ± 4.4 µmol/L). Moreover, patients without FA supplementation had a significantly (p < 0.001) higher Hcy level (27 ± 7 µmol/L) compared to those with supplementation (17.75 ± 5.7 µmol/L). Turkey-Kramer multiple comparison tests show that there is a significant difference (p < 0.05) in HbF percent, hemoglobin (Hb), platelet count, serum bilirubin (direct:Bil-D and total:Bil-T), aspartate transaminase (AST), lactate dehydrogenase (LDH), and plasma Hcy levels between mild and severe VOC. Between moderate VOC and severe VOC, there was a significant difference (p < 0.05) in HbF%, Bil-D, AST, Hcy. Pearson correlation revealed that plasma Hcy had a significantly (p < 0.05) positive correlation with AST, serum bilirubin (indirect and total), LDH, jaundice, stroke, VOC per year, and hospitalization per year whereas it was inversely correlated with HbF percentage, Hb level, and FA treatment. In the study population, increased plasma Hcy level, hemolysis, and platelet activation were found to influence VOC in SCA.


Assuntos
Anemia Falciforme , Homocisteína/sangue , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Polimorfismo Genético , Doenças Vasculares , Adolescente , Adulto , Anemia Falciforme/sangue , Anemia Falciforme/complicações , Anemia Falciforme/genética , Anemia Falciforme/fisiopatologia , Aspartato Aminotransferases/sangue , Bilirrubina/sangue , Plaquetas/metabolismo , Feminino , Hemoglobina Fetal/genética , Hemoglobina Fetal/metabolismo , Hemólise , Homocisteína/genética , Humanos , L-Lactato Desidrogenase/sangue , Masculino , Metilenotetra-Hidrofolato Redutase (NADPH2)/sangue , Pessoa de Meia-Idade , Ativação Plaquetária , Contagem de Plaquetas , Doenças Vasculares/sangue , Doenças Vasculares/etiologia , Doenças Vasculares/genética , Doenças Vasculares/fisiopatologia
20.
Int J Hyperthermia ; 36(1): 841-853, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31452408

RESUMO

Purpose: To compare the predictive value of albumin-bilirubin (ALBI) grade, platelet-ALBI (PALBI) grade and Child-Turcotte-Pugh (CTP) class in patients with large hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) combined with microwave ablation (TACE-MWA). Methods: A total of 349 consecutive HCC patients (89.1% male; mean [± SD] age 53.4 ± 12.27 years) from three medical centers, who underwent TACE-MWA for up to 3 HCCs with maximum diameters of 5.1-8.0 cm between January 2000 and June 2018, were investigated. Overall survival (OS) and progression-free survival (PFS) were analyzed. The prognostic performances of ALBI grade, PALBI grade and CTP class were compared. Results: TACE procedures were performed using lobaplatin (20-50 mg), epirubicin (30-60 mg), lipiodol (5-25 mL) and gelatin sponge particles (350-560 µm). The end point of the TACE procedure was stasis of blood flow in the feeder artery. The median follow-up duration was 28.0 months, the median OS was 28.0 months (95% confidence interval [CI] 23.55-32.45 months), and the median PFS was 4.8 months (95% CI 4.26-5.34 months). Patients with a ablation margin size of 11-15 mm experienced better PFS than those with a margin size of 6-10 or 0-5 mm (median, 6.5 versus [vs] 4.0 vs 2.3 months; p < .001). PALBI grade demonstrated significantly greater area under the curve values than ALBI grade or CTP class in predicting 1-, 3- and 5-year OS. Conclusions: PALBI grade provided better predictive value than ALBI grade or CTP class in patients with large HCCs after TACE-MWA.


Assuntos
Técnicas de Ablação , Bilirrubina/sangue , Plaquetas , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Neoplasias Hepáticas/terapia , Micro-Ondas/uso terapêutico , Albumina Sérica/análise , Índice de Gravidade de Doença , Adulto , Idoso , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/diagnóstico por imagem , Feminino , Humanos , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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