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2.
Int Arch Allergy Immunol ; 181(2): 136-140, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31794965

RESUMO

BACKGROUND: Accurate use of adrenaline auto-injectors (AAIs) for anaphylaxis is critical to decrease mortality and morbidity. OBJECTIVE: In this study, we aimed to assess user knowledge of AAIs and evaluate the factors that affect their correct use. METHODS: The study involved caregivers of pediatric patients diagnosed with anaphylaxis who were trained with trainer injectors up to 24 months ago. The demographics of the caregivers, anaphylaxis history of the patients, usage of AAIs in the case of anaphylaxis, and the reasons for not using AAIs in anaphylaxis were evaluated. Users were asked to demonstrate the use of Penepin® with a trainer injector. RESULTS: Fifty-nine caregivers were enrolled in the study. Forty-seven (79.7%) users stated that they always carry AAIs with them. Forty-one (69.5%) of the users demonstrated all steps of the use of AAIs. The time from the last AAI training was the most significant parameter affecting the ability to use AAIs correctly (OR 0.678, 95% CI 0.546-0.841, p < 0.0001). AAI training every 6 months results in the proper usage of AAIs, with 96% probability. Thirty (50.8%) caregivers stated that anaphylactic reactions occurred in their children after the last AAI training. Of these, 16 (53.3%) users stated that they did not use an AAI for the anaphylactic reaction. The most common reason (50%) was not carrying an AAI on their person. CONCLUSION: Training users at least every 6 months is associated with the proper application of AAIs. Although regular training increases the frequency of AAI use in anaphylaxis, awareness of carrying AAIs is the most important factor for usage of AAI in anaphylaxis.


Assuntos
Anafilaxia/tratamento farmacológico , Epinefrina/administração & dosagem , Criança , Pré-Escolar , Feminino , Humanos , Injeções/métodos , Masculino , Autoadministração/métodos
3.
Medicine (Baltimore) ; 98(52): e18564, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876758

RESUMO

BACKGROUND: This study was designed to systematically evaluate the clinical efficacy and safety of ultrasound-guided intrathyroidal injection of glucocorticoids (GCs) versus routine oral administration of GCs for subacute thyroiditis (SAT) and to help seek evidence of evidence-based medicine (EBM) for ultrasound-guided intrathyroidal injection of GCs in the treatment of SAT. METHODS: Seven Chinese and English databases, including Chinese National Knowledge Infrastructure, Wanfang Data, VIP Information China Science and Technology Journal Database, SinoMed, PubMed, Cochrane Library, and Embase, were searched to collect randomized control trials on ultrasound-guided intrathyroidal injection of GCs in the treatment of SAT, which were published up to July 1, 2019. According to the method as described in Cochrane Reviewers' Handbook 5.1.0, the Cochrane Collaboration's tool for assessing risk of bias was employed to evaluate the quality of the literatures included. Statistical analysis was made by using Stata 12.0. The "metanif" command was used for sensitivity analysis to assess the stability of the results. Funnel diagram method, Egger linear regression method, and clipping complement method were used to evaluate publication bias. RESULTS: This study was carried out in strict accordance with the standard procedures for meta-analysis in the Cochrane Reviewers' Handbook 5.1.0. Critical data about the primary and secondary outcome measures were obtained by statistical analysis. CONCLUSION: This study would draw a definite conclusion about whether ultrasound-guided intrathyroidal injection of GCs is effective and safe in the treatment of SAT on the basis of EBM. This conclusion would provide scientific evidence for the clinical treatment of SAT.


Assuntos
Glucocorticoides/administração & dosagem , Tireoidite Subaguda/tratamento farmacológico , Ultrassonografia de Intervenção , Administração Oral , Glucocorticoides/uso terapêutico , Humanos , Injeções/efeitos adversos , Injeções/métodos , Glândula Tireoide/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia de Intervenção/efeitos adversos , Ultrassonografia de Intervenção/métodos
4.
BMJ ; 367: l6132, 2019 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-31748208

RESUMO

OBJECTIVE: To determine whether an injection of platelet rich plasma improves outcomes after acute Achilles tendon rupture. DESIGN: Randomised, placebo controlled, two arm, parallel group, participant and assessor masked, superiority trial. SETTING: Secondary care trauma units across 19 hospitals in the United Kingdom's health service. PARTICIPANTS: Recruitment commenced in July 2015 and follow-up was completed in March 2018. 230 adults aged 18 years and over were included, with acute Achilles tendon rupture presenting within 12 days of injury and managed with non-surgical treatment. Exclusions were injury at the insertion or musculotendinous junction, major leg injury or deformity, diabetes mellitus, platelet or haematological disorder, systemic corticosteroids, anticoagulation treatment, and other contraindicating conditions. INTERVENTIONS: Participants were randomised 1:1 to platelet rich plasma (n=114) or placebo (dry needle; n=116) injection. All participants received standard rehabilitation care (ankle immobilisation followed by physiotherapy). MAIN OUTCOMES AND MEASURES: Primary outcome was muscle tendon function at 24 weeks, measured objectively with the limb symmetry index (injured/uninjured×100) in maximal work done during the heel rise endurance test (an instrumented measure of repeated single leg heel rises until fatigue). Secondary outcomes included patient reported function (Achilles tendon rupture score), quality of life (short form 12 version 2®), pain (visual analogue scale), goal attainment (patient specific functional scale), and adverse events. A central laboratory analysed the quality and content of platelet rich plasma. Analyses were by modified intention to treat. RESULTS: Participants were 46 years old on average, and 57 (25%) of 230 were female. At 24 weeks, 202 (88%) participants completed the heel rise endurance test and 216 (94%) the patient reported outcomes. The platelet rich plasma was of good quality, with expected growth factor content. No difference was detected in muscle tendon function between participants receiving platelet rich plasma injections and those receiving placebo injections (limb symmetry index, mean 34.7% (standard deviation 17.7%) v 38.5% (22.8%); adjusted mean difference -3.9% (95% confidence interval -10.5% to 2.7%)) or in any secondary outcomes or adverse event rates. Complier average causal effect analyses gave similar findings. CONCLUSIONS: There is no evidence to indicate that injections of platelet rich plasma can improve objective muscle tendon function, patient reported function, or quality of life after acute Achilles tendon rupture compared with placebo, or that they offer any patient benefit. TRIAL REGISTRATION: ISRCTN54992179.


Assuntos
Tendão do Calcâneo/lesões , Tratamento Conservador/métodos , Plasma Rico em Plaquetas , Qualidade de Vida , Traumatismos dos Tendões/terapia , Adulto , Feminino , Humanos , Injeções/métodos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Recuperação de Função Fisiológica , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/fisiopatologia , Traumatismos dos Tendões/psicologia , Resultado do Tratamento , Reino Unido
5.
J Dairy Sci ; 102(11): 10573-10586, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31521364

RESUMO

Prostaglandin (PG) F2α and its analogs (aPGF2α) are used to induce regression of the corpus luteum (CL); their administration during the middle stage of the estrous cycle causes luteolysis in cattle. However, the bovine CL is resistant to the luteolytic actions of aPGF2α in the early stage of the estrous cycle. The mechanisms underlying this differential luteal sensitivity, as well as acquisition of luteolytic sensitivity by the CL, are still not fully understood. Therefore, to characterize possible differences in response to aPGF2α administration, we aimed to determine changes in expression of genes related to (1) angiogenesis-fibroblast growth factor 2 (FGF2), fibroblast growth factor receptor 1 (FGFR1), fibroblast growth factor receptor 2 (FGFR2), vascular endothelial growth factor A (VEGFA), vascular endothelial growth factor receptor 1 (VEGFR1), vascular endothelial growth factor receptor 2 (VEGFR2); and (2) steroidogenesis-steroidogenic acute regulatory protein (STAR), cytochrome P450 family 11 subfamily A member 1 (P450scc), and hydroxy-delta-5-steroid dehydrogenase, 3 ß- and steroid delta-isomerase 1 (HSD3B) in early- and middle-stage CL that accompany local (intra-CL) versus systemic (i.m.) aPGF2α injection. Cows at d 4 (early stage) or d 10 (middle stage) of the estrous cycle were treated as follows: (1) systemic saline injection, (2) systemic aPGF2α injection (25 mg), (3) local saline injection, and (4) local aPGF2α injection (2.5 mg). Progesterone (P4) concentration was measured in jugular vein blood samples during the entire set of experiments. After 4 h of treatment, CL were collected by ovariectomy, and mRNA and protein expression levels were determined by reverse transcription quantitative-PCR and Western blotting, respectively. Local and systemic aPGF2α injections upregulated FGF2 expression but decreased expression of VEGFA in both CL stages. Both aPGF2α injections increased the expression of STAR in early-stage CL, but downregulated it in middle-stage CL. In the early-stage CL, local administration of aPGF2α upregulated HSD3B, whereas systemic injection decreased its mRNA expression in early- and middle-stage CL. Moreover, we observed a decrease in the P4 level earlier after local aPGF2α injection than after systemic administration. These results indicate that aPGF2α acting locally may play a luteotrophic role in early-stage CL. The systemic effect of aPGF2α on the mRNA expression of genes participating in steroidogenesis seems to be more substantial than its local effect in middle-stage CL.


Assuntos
Indutores da Angiogênese/farmacologia , Corpo Lúteo/efeitos dos fármacos , Dinoprosta/farmacologia , Esteroides/biossíntese , Indutores da Angiogênese/administração & dosagem , Animais , Bovinos , Dinoprosta/administração & dosagem , Vias de Administração de Medicamentos/veterinária , Ciclo Estral , Feminino , Expressão Gênica/efeitos dos fármacos , Injeções/métodos , Injeções/veterinária , Peptídeos e Proteínas de Sinalização Intercelular/genética , Luteólise/efeitos dos fármacos , Fosfoproteínas , Progesterona/sangue
6.
J Physiol Pharmacol ; 70(3)2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31539887

RESUMO

Prilocaine is widely used for spinal anesthesia. Its intermediate effect makes it a valuable choice for one-day surgery. The duration of the motor blockade (DMB) may have an impact on the length of stay. The goal of this study was to establish a correlation between the DMB and different parameters (hyperbaric prilocaine dose, puncture level, surgical position, age, patient weight, and patient height). We prospectively enrolled adult patients scheduled for ambulatory surgery (n = 384). Univariate and multivariate regressions (backward stepwise) were applied. A P value lower than 0.05 was considered significant. We performed first analyzes on the entire population. We achieved same on a subgroup only composed of patients who received 60 mg of hyperbaric prilocaine between L4 and L5 and staying on dorsal position during surgery. The univariate analyses of the entire population demonstrate a significant correlation between DMB and 1) the prilocaine dose (P < 0.001), and 2) the BMI (P = 0.011). On the same population, the multivariate analyses confirm these two independent parameters correlated to the DMB: the patient height (P = 0.03) and the hyperbaric prilocaine dose (P < 0.001). The second analyses performed on the subgroup (n = 65), demonstrate a wide variability in the DBM (mean ± SD): 90.12 ± 30.36 minutes. For this concern, univariate analyses illustrate that only the patient height was significantly correlated to the DMB (P = 0.005). The multivariate analyses confirm that patient height could be considered as an independent parameter of DBM (P = 0.005). Within our entire population, there exists a considerable variation in the duration of the motor block after a unique injection of hyperbaric prilocaine. The prilocaine dose and the patient height were the only independent factors of the extension of the DMB. However, this relation is extremely weak and only allows explaining the variability of the DMB in a minority of the patients. This unknown pharmacological property of hyperbaric prilocaine could restrict its use for day-care surgery.


Assuntos
Prilocaína/uso terapêutico , Procedimentos Cirúrgicos Ambulatórios/métodos , Raquianestesia/métodos , Feminino , Humanos , Injeções/métodos , Injeções Espinhais/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
7.
Curr Opin Anaesthesiol ; 32(5): 638-642, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31415044

RESUMO

PURPOSE OF REVIEW: Summarize the current thinking concerning the clinically relevant aspects of nerve anatomy and best injection sites for nerve blocks. RECENT FINDINGS: The widespread use of ultrasound in regional anesthesia has changed the practice of regional anesthesia and created new possibilities. Among them is the ability to identify fascial planes, and this has become the basis for a new group of blocks, the fascial plane blocks. In this kind of blocks, the target for injection is the plane itself and not a nerve in particular. transversus abdominis plane, pectoralis muscles, erector spinae plane blocks are some examples of fascial blocks. Because injecting into a fascial plane is not controversial, these blocks are not included in our discussion of optimal placement of the needle.To determine optimal needle placement, it is important to have a clear definition of what constitutes intraneural. Although, there is almost universal agreement that the violation of the epineurium defines the intraneural concept, the literature include several studies where this assessment is erroneous.Although intentional intraneural injection is still considered objectionable, some literature suggests that injecting intraneurally, especially if extrafascicular, may be benign. This evidence is limited and anecdotal. SUMMARY: It is necessary to have a better understanding of what intraneural injection is when dealing with any type of nerve blocks, be that single nerve, plexuses, or the sciatic nerve. Perineural injections provide successful anesthesia without putting the nerve integrity at risk. That practice is supported by years of experience and common sense. Currently, there is no evidence to support any kind of intraneural injections, intrafascicular or extrafascicular.


Assuntos
Agulhas/efeitos adversos , Bloqueio Nervoso/métodos , Traumatismos dos Nervos Periféricos/prevenção & controle , Nervos Periféricos/anatomia & histologia , Humanos , Injeções/efeitos adversos , Injeções/instrumentação , Injeções/métodos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/instrumentação , Traumatismos dos Nervos Periféricos/etiologia , Nervos Periféricos/diagnóstico por imagem , Ultrassonografia de Intervenção
8.
BMC Musculoskelet Disord ; 20(1): 351, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31366332

RESUMO

BACKGROUND: In the treatment of Lateral Epicondylitis (LE) no single intervention concerning injection therapies has been proven to be the most effective with regard to pain reduction. In this trial 3 injection therapies (perforation with application of autologous blood, perforation with application of dextrose and perforation only) will be compared in a standardized and ultrasound guided way. The objective is to assess the effectiveness of these 3 injection therapies on pain, quality of life and functional recovery. By conducting this study, we hope to make a statement on the effectiveness of injection therapy in the treatment of LE. Hereby, unnecessary treatments can be avoided, a more universal method of treatment can be established and the quality of the treatment can be improved. METHODS/DESIGN: A multicenter, randomized controlled trial with a superiority design and 12 months follow-up will be conducted in four Dutch hospitals. One hundred sixty five patients will be recruited in the age of 18 to 65 years, with chronic symptomatic lateral epicondylitis lasting longer than 6 weeks, which have concordant pain during physical examination. Patients will be randomized by block randomization to one of the three treatment arms. The treatment will be blinded for patients and outcome assessors. The following three injection therapies are compared: perforation with application of autologous blood, perforation with application of dextrose and perforation only. Injections will be performed ultrasound guided in a standardized and automated way. The primary endpoint is: pain (change in 'Visual Analogue Scale'). Secondary endpoints are quality of life and functional recovery. These measurements are collected at baseline, 8 weeks, 5 months and 1 year after treatment. DISCUSSION: When completed, this trial will provide evidence on the effectiveness of injection therapy in the treatment of lateral epicondylitis on pain, quality of life and functional recovery. In current literature proper comparison of the effectiveness of injectables for LE is questionable, due to the lack of standardization of the treatment. This study will overcome bias due to manually performed injection therapy. TRIAL REGISTRATION: This study is registered in the Trial Register ( www.trialregister.nl ) of the Dutch Cochrane centre. Trial ID; NTR4569. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4569.


Assuntos
Transfusão de Sangue Autóloga/métodos , Glucose/administração & dosagem , Dor Musculoesquelética/terapia , Manejo da Dor/métodos , Cotovelo de Tenista/terapia , Adolescente , Adulto , Idoso , Estudos de Equivalência como Asunto , Feminino , Humanos , Injeções/instrumentação , Injeções/métodos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Cotovelo de Tenista/complicações , Cotovelo de Tenista/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia de Intervenção , Adulto Jovem
9.
J Opioid Manag ; 15(2): 169-175, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31343718

RESUMO

OBJECTIVE: Efforts to achieve balance between effective pain management and opioid-related adverse events (ORAEs) have led to multimodal analgesia regimens. This study compared opioids delivered via patient-controlled analgesia (PCA) plus liposomal bupivacaine, a long-acting local anesthetic with potential to be an effective component of such regimens, to opioids delivered through PCA alone or PCA plus subcutaneous bupivacaine infusion (ONQ), following laparotomy. DESIGN: Prospective, randomized controlled trial. SETTING: Single, tertiary-care institution. PATIENTS: One hundred patients undergoing nonemergent laparotomy. INTERVENTIONS: Patients were randomly assigned to one of three study treatments: PCA only (PCAO), PCA with ONQ, or PCA with injectable liposomal bupivacaine suspension (EXP). MAIN OUTCOME MEASURES: Cumulative opioid use, daily mean patient-reported pain scores, and ORAEs through 72 hours postoperatively. RESULTS: On average, the EXP (n = 31) group exhibited less than 50 percent of the total opioid consumption of the PCAO (n = 36) group, and less than 60 percent of that for the ONQ (n = 33) group. Postoperative days 1 and 3 pain scores were significantly lower for the EXP group as compared to the ONQ and PCAO groups (p ≤ 0.005). Fewer patients in the EXP group (19.4 percent) experienced ORAEs compared to the PCAO (41.1 percent) and ONQ (45.5 percent) groups (p = 0.002). CONCLUSIONS: Laparotomy patients treated with liposomal bupivacaine as part of a multimodal regimen consumed less opioids, had lower pain scores, and had fewer ORAEs. The role of liposomal bupivacaine in the postoperative care of laparotomy patients merits further study.


Assuntos
Analgesia Controlada pelo Paciente , Bupivacaína , Dor Pós-Operatória/prevenção & controle , Analgésicos Opioides/administração & dosagem , Anestésicos Locais , Bupivacaína/administração & dosagem , Humanos , Injeções/métodos , Laparotomia , Lipossomos , Medição da Dor , Estudos Prospectivos
10.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(7): 694-696, 2019 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-31302972

RESUMO

Special diseases with hemorrhoid hemorrhage are intractable cases in clinical practice. Surgery may result in serious trauma and high risk, such as higher morbidity of postoperative complication, delayed hospital stay, and even death. These patients usually underwent conservative therapy or injection therapy. In 2017, our Professional Committee standardized the procedure of Shaobei injection and established the clinical guideline, but still lacked guidance for special diseases with hemorrhoid hemorrhage. In view of this, based on current medical conditions, combined with years of clinical practice, after repeated discussions, comprehensive multidisciplinary perspectives on patients with special diseases such as coagulopathy, hypertension, diabetes, portal hypertension, renal dysfunction, immunodeficiency, and antithrombotic therapy, the experts of this guideline-writing committee formulate the corresponding clinical management strategies, mainly emphasizing on preoperative management of underlying disease, choice of anesthesia methods, and precautions during surgery.


Assuntos
Hemorragia Gastrointestinal/terapia , Hemorroidas/terapia , Injeções/efeitos adversos , Tratamento Conservador , Hemorragia Gastrointestinal/etiologia , Hemorroidas/complicações , Humanos , Injeções/métodos , Guias de Prática Clínica como Assunto
11.
Medicine (Baltimore) ; 98(25): e16127, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232963

RESUMO

BACKGROUND: Chronic urticaria (CU) is a common and easily recurring skin disease in the world. Many trials have shown that autologous whole-blood or autologous serum acupoint injection therapy is effective in treating CU. There is currently no systematic review of this therapy. The program aims to evaluate the effectiveness and safety of this therapy in patients with CU. METHODS: Literature search will be conducted at Medline, PubMed, Excerpt Medica Database, Springer, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journal Database, and other databases. The search date is until May 2019. We will search for popular terms including CU and this therapy. Import the literature electronically. Duplicate documents will be deleted. The primary outcome is the urticaria activity score or other validated scales. Secondary outcomes included response rate, quality of life scale, recurrence rate, and adverse events. A systematic review and search for a randomized controlled trial of this therapy for CU. Implement the Cochrane RevMan V5.3 bias assessment tool to assess bias assessment risk, data integration risk, meta-analysis risk, and subgroup analysis risk (if conditions are met). The mean difference, standard MD, and binary data will be used to represent continuous results. RESULTS: This study will provide a comprehensive review of the available evidence for the treatment of CU with this therapy. CONCLUSION: This study will provide new evidence for assessing the effectiveness and side effects of this therapy for CU. Since the data is not individualized, there is no need for formal ethical approval. PROSPERO REGISTRATION NUMBER: CRD42019128364.


Assuntos
Pontos de Acupuntura , Autoenxertos , Urticária/tratamento farmacológico , China , Doença Crônica/tratamento farmacológico , Protocolos Clínicos , Humanos , Injeções/métodos , Medicina Tradicional Chinesa/métodos , Medicina Tradicional Chinesa/normas , Inquéritos e Questionários , Resultado do Tratamento
12.
Muscle Nerve ; 60(1): 1-6, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31054148

RESUMO

High frequency ultrasound is a valuable tool for assessing soft tissue injuries about the shoulder. It has advantages over other imaging modalities including relatively low cost, portability, and dynamic real-time visualization. It has a high sensitivity for identifying tendon degeneration, bursitis, and rotator cuff tears. Ultrasound is also an excellent modality for diagnostic and therapeutic needle-guided procedures. A detailed knowledge of shoulder anatomy and transducer positioning is required for obtaining adequate diagnostic value from ultrasound. This Monograph is designed to help develop scanning protocols for optimizing image acquisition for musculoskeletal assessment of the shoulder. Muscle Nerve, 2019.


Assuntos
Bursite/diagnóstico por imagem , Lesões do Manguito Rotador/diagnóstico por imagem , Manguito Rotador/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Ombro/diagnóstico por imagem , Articulação Acromioclavicular/diagnóstico por imagem , Bursite/terapia , Humanos , Biópsia Guiada por Imagem/métodos , Injeções/métodos , Injeções Intra-Articulares/métodos , Doenças Musculoesqueléticas/diagnóstico por imagem , Doenças Musculoesqueléticas/patologia , Doenças Musculoesqueléticas/terapia , Lesões do Manguito Rotador/terapia , Ultrassonografia
13.
Eur Arch Otorhinolaryngol ; 276(7): 2007-2013, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31134359

RESUMO

PURPOSE: To evaluate voice outcome after bilateral vocal fold injection with autologous fat in patients with non-paralytic glottic insufficiency due to vocal fold atrophy with or without sulcus. METHODS: This is a retrospective cohort study from September 2012 to December 2017 including 23 patients undergoing bilateral vocal fold injection with autologous fat (24 procedures) for vocal fold atrophy (15 procedures) or atrophy with sulcus (Ford type II or III) (9 procedures). Voice data were collected and analyzed for the preoperative and the 3- and 12-month postoperative time points according to a standardized protocol, including Voice Handicap Index (VHI)-30 and perceptive, acoustic and aerodynamic parameters. Failure rate was defined as non-relevant improvement (< 10 points) in VHI-30 at 12 months and number of revisions within 12 months. RESULTS: There was a clinically relevant (≥ 15 points) and statistically significant improvement in the VHI-30 (preoperative: 49.1 points; postoperative at 12 months: 29.7 points). Change in dynamic range was also statistically significant over time (p = 0.028). There were no differences in voice parameters between patients with atrophy only and atrophy with sulcus, although grade tended to be lower in patients with atrophy only over all time points. CONCLUSION: This study shows that bilateral vocal fold injection with autologous fat is a beneficial treatment not only for patients with atrophy but also for patients with sulcus. A comparison of the results with those reported from other forms of sulcus surgery confirmed this finding. However, there is a need for further prospective studies comparing the short- and long-term effects of different techniques.


Assuntos
Gordura Abdominal/transplante , Doenças da Laringe , Prega Vocal , Qualidade da Voz , Adulto , Atrofia , Feminino , Humanos , Injeções/métodos , Doenças da Laringe/patologia , Doenças da Laringe/fisiopatologia , Doenças da Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Países Baixos , Assistência Perioperatória/métodos , Estudos Retrospectivos , Resultado do Tratamento , Prega Vocal/patologia , Prega Vocal/fisiopatologia , Prega Vocal/cirurgia
14.
Muscle Nerve ; 60(3): 222-231, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31093989

RESUMO

The advent of high-resolution neuromuscular ultrasound (US) has provided a useful tool for conservative treatment of peripheral entrapment mononeuropathies. US-guided interventions require careful coordination of transducer and needle movement along with a detailed understanding of sonoanatomy. Preprocedural planning and positioning can be helpful in performing these interventions. Corticosteroid injections, aspiration of ganglia, hydrodissection, and minimally invasive procedures can be useful nonsurgical treatments for mononeuropathies refractory to conservative care. Technical aspects as well as the current understanding of the indications and efficacy of these procedures for common entrapment mononeuropathies are reviewed in this study. Muscle Nerve, 2019.


Assuntos
Mononeuropatias/cirurgia , Ultrassonografia de Intervenção , Ultrassonografia , Humanos , Injeções/métodos , Agulhas , Resultado do Tratamento , Ultrassonografia/métodos , Ultrassonografia de Intervenção/métodos
15.
Vet Comp Oncol ; 17(3): 407-412, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31020761

RESUMO

MicroRNAs (miRNA) are small, noncoding RNA molecules consisting of 18 to 25 nucleotides. Malignant melanomas (MMs) are one of the most common malignancies in both dogs and humans. We previously reported that chemically modified synthetic miRNA-205 (miR-205BP/S3) inhibits melanoma growth in vitro and in vivo. The present study aimed to evaluate the efficacy of intratumoral administration of synthetic miR-205 for spontaneous CMMs and to evaluate its potential as systemic therapy. Ten dogs with various stages of MM were treated with miR-205BP/S3 injected into tumours. Adverse effects (AEs) were assessed in accordance with the Veterinary Cooperative Oncology Group-Common Terminology Criteria for Adverse Events (VCOG-CTCAE) v1.1 guidelines. Five cases attained complete remission (CR), three attained stable disease (SD), and two cases displayed characteristics of progressive disease (PD). In all cases, no changes were observed in the blood parameters upon miRNA administration, and miR-205BP/S3 administration did not yield any side effects. The present results suggest that intratumoral administration of miR-205BP/S3 is a potentially applicable treatment for canine melanoma.


Assuntos
Doenças do Cão/terapia , Melanoma/veterinária , MicroRNAs/uso terapêutico , Animais , Cães , Feminino , Injeções/métodos , Injeções/veterinária , Masculino , Melanoma/terapia , MicroRNAs/efeitos adversos , MicroRNAs/síntese química
16.
J Acquir Immune Defic Syndr ; 81(4): e127-e134, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31021987

RESUMO

BACKGROUND: London, Canada, experienced an HIV outbreak among persons who inject drugs despite widespread distribution of harm reduction equipment. Hydromorphone controlled-release (HMC) is the local opioid of choice. Injection drug preparation equipment (IDPE; ie, cookers and filters) is often shared and reused because of the perception that there is residual HMC in the IDPE after use. The purpose of this study was to investigate the mechanisms of HIV transmission in this context. METHODS: Residual hydromorphone, (controlled-release or immediate-release), remaining in the IDPE, was measured with liquid chromatography-tandem mass spectrometry, in conditions replicating persons who inject drug use. HIV was added to IDPE in the presence HMC, hydromorphone immediate-release, or microcrystalline cellulose (an HMC drug excipient). HIV viral persistence was measured by reverse transcriptase activity and infectivity of indicator Tzm-bl cells. RESULTS: Forty-five percent of HMC remained in the IDPE after the first aspiration of solution, with no change after heating. HIV persistence and infectivity were preserved in the presence of HMC, and less so with microcrystalline cellulose. Heating the IDPE rapidly inactivated HIV. CONCLUSIONS: Sharing of IDPE is a potential means of HIV transmission. HMC encourages IDPE sharing because of the residual drug in the IDPE, and the HMC excipients preserve HIV viability. Heating IDPE before aspiration of the opioid may be a harm reduction strategy.


Assuntos
Composição de Medicamentos , Infecções por HIV/transmissão , Calefação , Injeções/métodos , Analgésicos Opioides/uso terapêutico , Canadá , Humanos , Hidromorfona/química , Londres , Saúde Pública , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/complicações
17.
Complement Ther Med ; 43: 140-147, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30935521

RESUMO

OBJECTIVE: To evaluate the clinical efficacy of Shengmai injection for the treatment of chronic obstructive pulmonary disease (COPD) through an evidence-based approach. METHODS: Randomized controlled trials (RCTs) investigating the effect of Shengmai injection on COPD were included in this study. Seven electronic databases were searched to obtain eligible studies. The quality of the included RCTs was evaluated according to the Cochrane Risk of Bias Assessment Tool. When appropriate, meta-analysis of the data was conducted by RevMan 5.3 software and Stata 13.0 software. The relative risk (RR) or mean difference (MD) and 95% confidence interval (CIs) were reported for dichotomous or continuous outcomes, respectively. Sensitivity analysis was performed to verify the independence of the results. Funnel plots and the Begg and Egger tests were implemented to determine the potential publication bias. RESULTS: Ultimately, 23 RCTs were included, involving 1804 participants. Meta-analysis showed that the combination of Shengmai injection and western medicine (WM) could achieve a better effect than WM alone in terms of improving the clinical total effective rate (RR = 1.20, 95% CIs: 1.15-1.24), pulmonary function (FEV1(L): MD = 0.41, 95% CIs 0.32 to 0.49; FEV1(%): MD = 6.21, 95% CIs: 2.72-9.71), blood gas index (PaO2: MD = 6.13, 95% CIs: 2.93-9.32; PaCO2: MD=-6.2, 95% CIs: -11.63 to -0.77), immunoglobulin levels (IgG: MD = 3.55, 95% CIs: 3.10-3.99; IgA: MD = 0.34, 95% CIs: 0.31to 0.38; IgM: MD = 0.35, 95% CIs: 0.27 to 0.42), C-reactive protein levels (MD = -8.05, 95% CIs: -10.11 to -6.00) and the lung rale disappearance time (MD = -2.57, 95% CIs: -3.19 to -1.95). Additionally, the CAT score, mMRC and average hospitalization time were also reduced significantly by Shengmai injection plus WM. Among 11 RCTs that mentioned safety issues, 6 RCTs found no adverse events, and the other 5 RCTs reported the details of adverse events. CONCLUSION: Shengmai injection may positively influence COPD in combination with WM. However, firm conclusions could not be draw due to the low quality of the evidence. Further high-quality studies are still required to test the efficacy of Shengmai injection for this condition.


Assuntos
Medicamentos de Ervas Chinesas/administração & dosagem , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Terapia Combinada/métodos , Humanos , Injeções/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
18.
Gastrointest Endosc ; 90(2): 302-306, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30980796

RESUMO

BACKGROUND AND AIMS: Small-bowel varices (SBVs) are an uncommon consequence of portal hypertension. Radiologic intervention is usually considered for first-line management. When radiologic intervention is not possible, management options become very limited. The aim of this study was to evaluate the usefulness of double-balloon enteroscopy (DBE)-facilitated cyanoacrylate-injection endotherapy of SBVs. METHODS: This was a retrospective review of DBE-facilitated cyanoacrylate-injection endotherapy of SBVs (December 2015 to October 2016). RESULTS: Ten DBEs were performed in 6 patients (4 women; median age, 68.5 years). No radiologic or surgical options were deemed feasible. Thirteen nests of SBVs were identified and injected with cyanoacrylate glue without hemorrhagic or embolic adverse events. At the 30-day follow-up after therapy, only 1 patient had experienced a mild recurrence of mid-gut bleeding; this was managed conservatively. One patient presented with acute GI bleeding 7 months later, and a repeat DBE with cyanoacrylate-injection endotherapy was successfully performed. One patient succumbed to his underlying advanced cholangiocarcinoma after 2 months. The remaining patients had a median follow-up of 12 months without any recurrent GI bleeding. CONCLUSIONS: DBE-facilitated cyanoacrylate-injection endotherapy of SBVs appears to be a safe and effective option when other first-line options are not feasible.


Assuntos
Cianoacrilatos/administração & dosagem , Enteroscopia de Duplo Balão , Intestino Delgado/irrigação sanguínea , Varizes/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Injeções/métodos , Cooperação Internacional , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária
19.
J Pharm Biomed Anal ; 170: 112-123, 2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-30921645

RESUMO

Irinotecan hydrochloride liposome injection (IHLI) is a formulation of anticancer drug irinotecan hydrochloride (CPT-11) entrapped in the aqueous core of liposomes. To understand the pharmacokinetic property and evaluate the relationship between pharmacokinetics and pharmacodynamics/toxicity of IHLI, it is of prime importance to determine the concentrations of free CPT-11, total CPT-11 and its main metabolites (SN-38 and SN-38 G) in human plasma. In this paper, we developed and validated a sensitive and reliable ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method to quantify the concentrations of these related substances in human plasma. Free CPT-11, SN-38 and SN-38 G in human plasma were simultaneously separated and extracted by 96-well solid phase extraction (SPE) plate, while total CPT-11 was extracted by protein precipitation (PP) method. The analytes were chromatographed on an Acquity UPLC BEH C18 column and then detected on a Xevo TQ-S tandem mass spectrometer in multiple reactions monitoring (MRM) mode using positive electrospray ionization (ESI). The UPLC-MS/MS method combined with SPE and PP techniques were fully validated in line with existing guidelines issued by regulatory agencies. In brief, all the analytes achieved a satisfactory selectivity and sensitivity in this method. The calibration curves were proved to be linear over the concentration range of 10-10000 ng/mL for total CPT-11, 0.5-1000 ng/mL for free CPT-11, 0.5-200 ng/mL for SN-38 and SN-38 G, respectively. For all the analytes, the intra- and inter-run precisions were less than 11.4% and the accuracies (in terms of RE%) were within -7.7-7.3% except for accuracies of LLOQs were within -15.8 to 7.2%. Besides, carry-over, extraction recovery, matrix effect, dilution integrity, stability and special matrices were also assessed. Finally, the method was successfully applied to a phase I clinical pharmacokinetic study of IHLI in Chinese subjects with advanced solid tumors.


Assuntos
Cromatografia Líquida de Alta Pressão/métodos , Irinotecano/sangue , Plasma/química , Espectrometria de Massas em Tandem/métodos , Administração Intravenosa/métodos , Humanos , Injeções/métodos , Lipossomos/química , Reprodutibilidade dos Testes , Extração em Fase Sólida/métodos
20.
Minim Invasive Ther Allied Technol ; 28(4): 199-205, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30822190

RESUMO

Objective: Needle insertion is a common component of most diagnostic and therapeutic interventions. Needles with asymmetrically sharpened points such as the bevel point are ubiquitous. Their insertion path is typically curved due to the rudder effect at the point. However, the common planned path is straight, leading to targeting errors. We present a simple technique that may substantially reduce these errors. The method was inspired by practical experience, conceived mathematically, and refined experimentally. Methods: Targeting errors are reduced by flipping the bevel on the opposite side (rotating the needle 180° about its axis), at a certain depth during insertion. The ratio of the flip depth to the full depth of insertion is defined as the flip depth ratio (FDR). Based on a model, FDR is constant 0.3. Results: Experimentally, the ratio depends on the needle diameter, 0.35 for 20Ga and 0.45 for 18Ga needles. Thinner needles should be flipped a little shallower, but never less than 0.3. Conclusion: Practically, a physician may expect to reduce ∼80% of needle deflection errors by simply flipping the needle. The technique may be used by hand or with guidance devices.


Assuntos
Técnicas e Procedimentos Diagnósticos/instrumentação , Injeções/instrumentação , Injeções/métodos , Fenômenos Mecânicos , Agulhas , Punções/instrumentação , Punções/métodos , Humanos , Modelos Teóricos
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