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2.
Medicine (Baltimore) ; 99(9): e19323, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118762

RESUMO

BACKGROUND: Low intra-abdominal pressure (IAP) and deep neuromuscular blockade (NMB) are frequently used in laparoscopic abdominal surgery to improve surgical space conditions and decrease postoperative pain. The evidence supporting operations using low IAP and deep NMB is open to debate. METHODS: The feasibility of the routine use of low IAP +deep NMB during laparoscopic surgery was examined. A meta-analysis is conducted with randomized controlled trials (RCTs) to compare the influence of low IAP + deep NMB vs. low IAP + moderate NMB, standard IAP +deep NMB, and standard IAP + moderate NMB during laparoscopic procedures on surgical space conditions, the duration of surgery and postoperative pain. RCTs were identified using the Cochrane, Embase, PubMed, and Web of Science databases from initiation to June 2019. Our search identified 9 eligible studies on the use of low IAP + deep NMB and surgical space conditions. RESULTS: Low IAP + deep NMB during laparoscopic surgery did not improve the surgical space conditions when compared with the use of moderate NMB, with a mean difference (MD) of -0.09 (95% confidence interval (CI): -0.55-0.37). Subgroup analyses showed improved surgical space conditions with the use of low IAP + deep NMB compared with low IAP + moderate NMB, (MD = 0.63 [95% CI:0.06-1.19]), and slightly worse conditions compared with the use of standard IAP + deep NMB and standard IAP + moderate NMB, with MDs of -1.13(95% CI:-1.47 to 0.79) and -0.87(95% CI:-1.30 to 0.43), respectively. The duration of surgery did not improve with low IAP + deep NMB, (MD = 1.72 [95% CI: -1.69 to 5.14]), and no significant reduction in early postoperative pain was found in the deep-NMB group (MD = -0.14 [95% CI: -0.51 to 0.23]). CONCLUSION: Low IAP +deep NMB is not significantly more effective than other IAP +NMB combinations for optimizing surgical space conditions, duration of surgery, or postoperative pain in this meta-analysis. Whether the use of low IAP + deep NMB results in fewer intraoperative complications, enhanced quality of recovery or both after laparoscopic surgery should be studied in the future.


Assuntos
Cavidade Abdominal/fisiopatologia , Bloqueio Neuromuscular/efeitos adversos , Pressão/efeitos adversos , Cavidade Abdominal/irrigação sanguínea , Humanos , Complicações Intraoperatórias , Laparoscopia/métodos , Bloqueio Neuromuscular/métodos
3.
PLoS One ; 15(2): e0228536, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32049971

RESUMO

Recent literature emphasizes the importance of comfort in the design of exosuits and other assistive devices that physically augment humans; however, there is little quantitative data to aid designers in determining what level of force makes users uncomfortable. To help close this knowledge gap, we characterized human comfort limits when applying forces to the shoulders, thigh and shank. Our objectives were: (i) characterize the comfort limits for multiple healthy participants, (ii) characterize comfort limits across days, and (iii) determine if comfort limits change when forces are applied at higher vs. lower rates. We performed an experiment (N = 10) to quantify maximum tolerable force pulling down on the shoulders, and axially along the thigh and shank; we termed this force the comfort limit. We applied a series of forces of increasing magnitude, using a robotic actuator, to soft sleeves around their thigh and shank, and to a harness on their shoulders. Participants were instructed to press an off-switch, immediately removing the force, when they felt uncomfortable such that they did not want to feel a higher level of force. On average, participants exhibited comfort limits of ~0.9-1.3 times body weight on each segment: 621±245 N (shoulders), 867±296 N (thigh), 702±220 N (shank), which were above force levels applied by exosuits in prior literature. However, individual participant comfort limits varied greatly (~250-1200 N). Average comfort limits increased over multiple days (p<3e-5), as users habituated, from ~550-700 N on the first day to ~650-950 N on the fourth. Specifically, comfort limits increased 20%, 35% and 22% for the shoulders, thigh and shank, respectively. Finally, participants generally tolerated higher force when it was applied more rapidly. These results provide initial benchmarks for exosuit designers and end-users, and pave the way for exploring comfort limits over larger time scales, within larger samples and in different populations.


Assuntos
Desenho de Equipamento , Exoesqueleto Energizado , Perna (Membro)/fisiologia , Mialgia/prevenção & controle , Conforto do Paciente , Pressão/efeitos adversos , Ombro/fisiologia , Adulto , Tornozelo/fisiologia , Fenômenos Biomecânicos , Desenho de Equipamento/efeitos adversos , Desenho de Equipamento/métodos , Exoesqueleto Energizado/efeitos adversos , Feminino , Marcha/fisiologia , Humanos , Masculino , Mialgia/etiologia , Conforto do Paciente/métodos , Robótica/instrumentação , Robótica/métodos , Estresse Mecânico , Coxa da Perna/fisiologia , Adulto Jovem
4.
J Surg Res ; 246: 190-199, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31600648

RESUMO

BACKGROUND: Current guidelines support intraosseous access for trauma resuscitation when intravenous access is not readily available. However, safety of intraosseous blood transfusions with varying degrees of infusion pressure has not been previously characterized. MATERIALS AND METHODS: Adult female Yorkshire swine (Sus scrofa; n = 36; mean (M): 80 kg, 95% CI: 78-82 kg) were cannulated and then bled approximately 30% total blood volume. Swine were randomly assigned to proximal humerus intraosseous blood infusion with either Rapid Infuser, or Pressure Bag, or Push-Pull methods (n = 12 each). Flow rates, infusion pressures, vitals, biochemical variables, and pulmonary and renal tissue pathology were contrasted between groups. RESULTS: Flow rates were greater for the Push-Pull strategy than Pressure Bag (96.5 mL/min versus 72.6 mL/min, P = 0.02) or Rapid Infuser (96.5 mL/min versus 60 mL/min, P = 0.002) strategies. The pressures generated during the Push-Pull transfusion (3058 mmHg) were greater than the other strategies (≤360 mmHg). After the observation period, plasma-free hemoglobin levels were higher in the Push-Pull strategy than in the Rapid Infuser (40 mg/dL versus 12 mg/dL, P = 0.02) or Pressure Bag (40 mg/dL versus 12 mg/dL, P = 0.01). Groups did not significantly differ in vitals, biochemical variables, or tissue pathology. CONCLUSIONS: Push-Pull conferred the highest flow rates, but with higher infusion pressures and evidence of intravascular hemolysis. Rapid Infuser and Pressure Bag infusions had no increase from baseline in plasma-free hemoglobin. Pressure Bag infusion was noted to confer an advantage in flow rates over Rapid Infuser. Intraosseous blood transfusion with pressure bags can safely bridge toward central access in the early phases of trauma resuscitation.


Assuntos
Transfusão de Sangue/métodos , Hemólise , Infusões Intraósseas/efeitos adversos , Ressuscitação/efeitos adversos , Choque Hemorrágico/terapia , Adulto , Animais , Modelos Animais de Doenças , Feminino , Hemoglobinas/análise , Humanos , Úmero , Infusões Intraósseas/métodos , Pressão/efeitos adversos , Distribuição Aleatória , Ressuscitação/métodos , Choque Hemorrágico/sangue , Sus scrofa , Fatores de Tempo , Resultado do Tratamento
5.
Undersea Hyperb Med ; 46(4): 421-427, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509898

RESUMO

Introduction: About 26% of diving-related fatalities are caused by cardiac disease, part of which might be associated with fatal arrhythmias. This raises the question as to whether fatal arrhythmias are being provoked by hyperbaric conditions themselves or if exercise or stress provokes the fatal arrhythmias in cases of underlying (ischemic) cardiac disease. Objective: To measure the influence of hyperbaric conditions (50 msw) on cardiac conduction and arrhythmias in professional divers by means of ECG. Methods: This is a prospective study on military divers in a hyperbaric chamber with continuous ECG monitoring using Holter registrations. Supraventricular and ventricular ectopy was registered during hyperbaric conditions. RR, PR, QRS, QT and QTc intervals were calculated at 50 msw and compared with ECGs at rest. Results: Included were 17 male military divers who made 20 dives. A total of 10 PVCs, 45 PACs, four atrial runs and four atrial pairs were seen. Significant prolongation of the PR interval was seen and a decrease of in QRS duration at 50 msw. There was no significant change in the RR, QT and QTc intervals. Conclusion: In these divers, no clinically relevant arrhythmias were observed during wet dives in a recompression chamber at 50 msw. We observed a small prolongation of PR interval that is probably not clinically relevant in divers without any known conduction disorders.


Assuntos
Arritmias Cardíacas/diagnóstico , Mergulho/efeitos adversos , Pressão/efeitos adversos , Adulto , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Descompressão , Mergulho/fisiologia , Eletrocardiografia Ambulatorial/instrumentação , Eletrocardiografia Ambulatorial/métodos , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Militares , Estudos Prospectivos , Água do Mar , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/etiologia , Taquicardia Supraventricular/fisiopatologia , Fatores de Tempo , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/etiologia , Complexos Ventriculares Prematuros/fisiopatologia
6.
Molecules ; 24(18)2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31505731

RESUMO

To expand the utilization of oyster protein (OP), the effects of high pressure (100 to 500 MPa) on chemical forces, structure, microstructure, and digestibility properties were investigated. High pressure (HP) treatment enhanced the electrostatic repulsion (from -13.3Control to -27.8HP200 mV) between protein molecules and avoided or retarded the formation of protein aggregates. In addition, the HP treated samples showed uniform distribution and small particle size. The changes in electrostatic interaction and particle size contributed to the improvement of solubility (from 10.53%Control to 19.92%HP500 at pH 7). The stretching and unfolding of protein were modified by HP treatment, and some internal hydrophobic groups and -SH groups were exposed. HP treatment modified the secondary structure of OP. The treated samples contained less α-helix and ß-sheet structures, whereas the proportions of ß-sheet and random coil structures were increased. The treated samples have high digestibility in the stomach (from 26.3%Control to 39.5%HP500) and in the total digestive process (from 62.1%Control to 83.7%HP500). In addition, the total digestive production showed higher percentages of small peptides (<1 kDa) after HP treatment. The protein solubility and digestibility were increased after HP treatment, and high solubility and high digestibility might increase the chance that OP become a kind of protein supplement.


Assuntos
Ostreidae/química , Pressão/efeitos adversos , Agregados Proteicos , Proteínas/química , Animais , Interações Hidrofóbicas e Hidrofílicas , Tamanho da Partícula , Peptídeos/química , Peptídeos/metabolismo , Conformação Proteica em alfa-Hélice , Conformação Proteica em Folha beta , Estrutura Secundária de Proteína , Proteínas/metabolismo , Solubilidade , Estômago/química
7.
Urologe A ; 58(11): 1289-1297, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31501985

RESUMO

Ureterorenoscopy and percutaneous nephrolitholapaxy are minimally invasive procedures and are the standard procedures for the treatment of kidney stones and ureteral calculi. To achieve an adequate view, in both methods an optimal and sufficient irrigation flow is necessary. The intrarenal pressure is influenced by the irrigation pressure and irrigation volume and has to be controlled. Pathologically elevated intrarenal pressure can lead to irreversible damage of the kidneys. Lasers are frequently used for stone fragmentation. It has been shown in studies that the laser energy can lead to an increase in the temperature and that thermal effects can also damage the kidneys. This article provides the surgeon with an overview about the effects of temperature and pressure changes during ureterorenoscopy and percutaneous nephrolitholapaxy and how damages can be avoided.


Assuntos
Temperatura Alta/efeitos adversos , Cálculos Renais/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Nefrostomia Percutânea/métodos , Pressão/efeitos adversos , Cálculos Ureterais/cirurgia , Ureteroscopia/métodos , Humanos , Cálculos Renais/diagnóstico , Resultado do Tratamento , Cálculos Ureterais/diagnóstico
8.
Forensic Sci Int ; 302: 109888, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31400617

RESUMO

INTRODUCTION: Pregnant women often suffer from negative fetal outcomes, despite wearing a seatbelt correctly. When restrained vehicle passengers are involved in a frontal collision without suffering from any injuries, the forces they experience are particularly concentrated in the chest because of the seatbelt. We analyzed the biomechanics of chest injuries sustained by restrained pregnant drivers and possible effects of these injuries on the fetus. MATERIAL AND METHODS: The Maternal Anthropometric Measurement Apparatus dummy, version 2B, representing a pregnant woman at 30 weeks of gestation, was used. Sled tests were performed for recreating frontal impact situations with vector velocity changes at impact speeds of 13, 26, and 40km/h. Overall kinematics of the dummy were examined using high-speed video imaging. Quantitative dummy responses, such as time course of acceleration of the sled and chest, pressure of the belt, and deflection of the chest (right and left) during impact were also measured. RESULTS: Although collision velocities were different, the distances of forward movement of the dummy were similar (121-129mm) owing to the safety devices. However, maximum deflection of the chest (35.4mm to the left and 15.7mm to the right) was obtained at a 26-km/h collision. Additionally, maximum deflection of 28.7mm to the left and 10.9mm to the right of the chest were obtained at 40km/h. CONCLUSIONS: Because the uterus enlarges and the fundus reaches the lower part of the rib cage during late pregnancy, we consider that the reason for negative fetal outcomes is partly owing to chest compression and subsequent applied forces on the uterus, even in minor to moderate frontal collisions. This knowledge may be useful for forensic scientists who determine the causes and mechanisms of a fetal death or the offenders' responsibilities for both maternal and fetal outcomes when the mother is involved in a frontal vehicle collision.


Assuntos
Acidentes de Trânsito , Cintos de Segurança/efeitos adversos , Traumatismos Torácicos/etiologia , Air Bags , Fenômenos Biomecânicos , Feminino , Morte Fetal , Humanos , Manequins , Gravidez , Pressão/efeitos adversos
9.
World J Gastroenterol ; 25(30): 4213-4221, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31435174

RESUMO

BACKGROUND: Clinically, tracheoesophageal fistula (TEF) is lack of effective surgical strategies. One reason is due to the lack of appropriate animal models of acquired TEF, which is usually complex and difficult. Recently, the magnetic compression technique has been applied for digestive tract anastomosis or vascular anastomosis in animals. In this study, an animal model of TEF in dogs was developed by using the magnetic compression technique, hoping to provide a new method for mimicking TEF. AIM: To establish a TEF model in dogs by using the magnetic compression technique. METHODS: Six male beagles were used as models with two Nd-Fe-B permanent magnets for TEF. The parent magnet and the daughter magnet were placed in the cervical esophagus and trachea, respectively. The anterior wall of the esophagus and the posterior wall of the trachea were compressed when the two magnets coupled. After 4-6 d, the necrotic tissue between the two magnets fell off and the parent and daughter magnets disengaged from the target location, leaving a fistula. Gastroscopy/bronchoscopy, upper gastrointestinal contrast study, and histological analysis were performed. RESULTS: The establishment of the TEF model in all six beagles was successful. The average time of magnet placement was 4.33 ± 1.11 min (range, 3-7 min). Mean time for the magnets to disengage from the target location was 4.67 ± 0.75 d (range, 4-6 d). TEFs were observed by gastroscopy/bronchoscopy and esophageal angiography. The gross anatomical structure of the esophagus and the trachea was in good condition. There was no esophageal mucosa or pseudostratified ciliated columnar epithelium at the site of the fistula according to histological analysis. CONCLUSION: It is simple, feasible, and minimally invasive to use the magnetic compression technique for the establishment of the TEF model in dogs.


Assuntos
Modelos Animais de Doenças , Esôfago/patologia , Traqueia/patologia , Fístula Traqueoesofágica/patologia , Animais , Cães , Esôfago/cirurgia , Humanos , Imãs , Masculino , Pressão/efeitos adversos , Traqueia/cirurgia , Fístula Traqueoesofágica/etiologia , Fístula Traqueoesofágica/cirurgia , Resultado do Tratamento
11.
Zhongguo Ying Yong Sheng Li Xue Za Zhi ; 35(3): 199-203, 2019 May 28.
Artigo em Chinês | MEDLINE | ID: mdl-31257798

RESUMO

OBJECTIVE: To analyze the expression and relationship of hypoxia-inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF) and kinase insert domain receptor (KDR) in local skin tissues of pressure injury and investigate the possible mechanism of stage 3 pressure injury refractory wound. METHODS: Forty male SD rats were randomly divided into normal control group, compressed 3 d, 5 d, 7 d, and 9 d groups. Stage 3 pressure injury animal model were established by magnet compression. The morphology of skin was observed by HE staining. The expression of VEGF was detected by immunohistochemistry. The expression levels of HIF-1α, VEGF and KDR protein in skin tissue were detected by Western blot. One-way analysis of variance and LSD test were performed on the data. RESULTS: ①The HE results showed that compared with the normal control group, the epidermis of the compressed group was gradually thickened, the number of blood vessels was decreased, the collagen arrangement disordered and inflammatory cells infiltration were increased. ②Immunohistochemical results showed that the expression of VEGF protein in the 3 d group was significantly higher than that in the normal control group (P<0.01). The expression of VEGF protein in the skin tissue of 5 d, 7 d and 9 d groups was lower than that in normal control group (P<0.05). WB results were consistent with immunohistochemistry results. ③WB results showed that the expression of HIF-1α in the skin tissues of the rats in 3 d, 5 d and 7 d groups was higher than that in the normal control group (P<0.01 or P<0.05). The expression of KDR protein was lower than that of the normal control group (P<0.05 or P<0.01). CONCLUSION: HIF-1α mediated reduction of VEGF and KDR protein expression and decreased tissue angiogenesis may be one of the important causes of chronic dysfunction of stage 3 pressure injury.


Assuntos
Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Pressão/efeitos adversos , Pele/lesões , Fator A de Crescimento do Endotélio Vascular/metabolismo , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/metabolismo , Animais , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Masculino , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Fator A de Crescimento do Endotélio Vascular/genética , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/genética
12.
13.
Best Pract Res Clin Anaesthesiol ; 33(1): 47-56, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31272653

RESUMO

Nerve injury is a relatively rare but devastating complication of peripheral nerve blockade (PNB). Monitoring injection pressure during PNB is one method advocated to prevent injury by detecting needle tip placement in a noncompliant position (intraneural or abutting the epineurium). Animal studies show that gross neural damage and clinical injury are associated with injection pressures exceeding 15-20 psi. In contrast, pressures <15 psi are associated with an extraneural needle tip position and no histologic or clinical injury. Injection pressure monitoring has been shown to prevent injection against the brachial plexus roots or femoral nerve during peripheral nerve block. Multiple methods are available to monitor injection pressure, and most of them are inexpensive and easy to use. Large-scale registry database or pragmatic trials are indicated to show that injection pressure monitoring reduces injury in a patient setting.


Assuntos
Reação no Local da Injeção/patologia , Monitorização Intraoperatória/métodos , Bloqueio Nervoso/efeitos adversos , Traumatismos dos Nervos Periféricos/patologia , Humanos , Reação no Local da Injeção/etiologia , Reação no Local da Injeção/prevenção & controle , Injeções/efeitos adversos , Bloqueio Nervoso/instrumentação , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Pressão/efeitos adversos , Ultrassonografia de Intervenção/efeitos adversos , Ultrassonografia de Intervenção/métodos
14.
Medicina (Kaunas) ; 55(8)2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31357513

RESUMO

Background and objectives: Doppler ultrasound of umbilical and fetal vessels is useful for monitoring fetal well-being, fetal anemia, intrauterine growth retardation, and other perinatal outcomes. The adverse perinatal outcome and circulatory changes can be reflected in fetal Doppler studies. The aim of this study was to evaluate the effect of increased pressure exerted on the maternal abdominal wall during routine ultrasound on the middle cerebral artery (MCA), resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV). Materials and Methods: A prospective study was conducted, in which we included 40 pregnant women between 24 + 0 and 41 + 3 gestational weeks (GW), with singleton pregnancies, without any associated pathologies, undergoing routine US examination. We recorded the flow velocity waveforms in the MCA, and we measured the RI, PI, PSV, and the applied pressure on to the maternal abdominal wall-needed for a proper evaluation of MCA. We then repeated the same measurements at two different higher pressure levels, at the same time having a proper image of the targeted vessel. Results: We found significant differences for the PI and RI levels with an increase in abdominal pressure (median PI 1.46, 1.58, and 1.92, respectively; median RI 0.74, 0.78, and 0.85, respectively; p < 0.05), for both PI and RI. At the same time, we found no significant differences for PSV in the studied group in relationship with increase in abdominal pressure (median PSV 39.56, 40.10, and 39.70, respectively; p > 0.05). Conclusions: The applied abdominal pressure by the examiner's hand, during routine US scan in pregnancy, can modify the MCA parameters of blood flow resistance (PI and RI) when measured by Doppler US, thus influencing the diagnostic accuracy in a series of pregnancy associated pathologies, such as chronic fetal distress (CFD) or intrauterine growth restriction (IUGR).


Assuntos
Parede Abdominal/fisiologia , Indicadores Básicos de Saúde , Artéria Cerebral Média/fisiologia , Pressão/efeitos adversos , Ultrassonografia Pré-Natal/efeitos adversos , Parede Abdominal/diagnóstico por imagem , Adulto , Análise de Variância , Velocidade do Fluxo Sanguíneo/fisiologia , Feminino , Monitorização Fetal/efeitos adversos , Monitorização Fetal/métodos , Idade Gestacional , Humanos , Gravidez , Estudos Prospectivos , Romênia , Ultrassonografia Pré-Natal/métodos
15.
Crit Care ; 23(Suppl 1): 114, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200734

RESUMO

Our current understanding of protective measures for avoiding ventilator-induced lung injury (VILI) has evolved from targeting low tidal volumes to lowering plateau and driving pressure. Even when pressures across the lung are reliably estimated, however, pressures alone cannot accurately gauge the injury risk; apart from flow rate, inspired oxygen fraction, and currently unmeasurable features of the mechanical microenvironment such as geometry, structural fragility, and vascular perfusion, the frequency with which high-risk tidal cycles are applied must help determine the intensity of potentially damaging energy application. Recognition of a strain threshold for damage by transpulmonary pressure, coupled with considerations of total energy load and strain intensity, has helped shape the unifying concept of VILI generation dependent upon the power transferred from the ventilator to the injured lungs. Currently, under-recognized contributors to the injury process must be addressed to minimize the risk imposed by ventilatory support.


Assuntos
Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Humanos , Pulmão/anatomia & histologia , Pulmão/fisiopatologia , Pressão/efeitos adversos , Respiração Artificial/tendências , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Volume de Ventilação Pulmonar/fisiologia , Lesão Pulmonar Induzida por Ventilação Mecânica/prevenção & controle
16.
BMC Musculoskelet Disord ; 20(1): 275, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31159799

RESUMO

BACKGROUND: Higher tourniquet pressures may be associated with an increased risk of complications. We aimed to determine (1) whether a lower tourniquet pressure [systolic blood pressure (SBP) + 120 mmHg] is as effective as conventional tourniquet pressure (SBP + 150 mmHg) in providing a bloodless surgical field and decreasing blood loss, and (2) whether lowering the tourniquet pressure decreases tourniquet-related complications compared to conventional inflation pressure. METHODS: One hundred and sixty knees in 124 patients undergoing total knee arthroplasty (TKA) were randomly allocated to either conventional (n = 80) or lower inflation pressure group (n = 80). The quality of the initial surgical field and occurrence of intraoperative blood oozing, hemoglobin drop, drained volume and calculated blood loss were assessed as efficacy variables. Safety outcome variables included post-operative pain, tourniquet site skin problems (ecchymosis, bullae, skin necrosis), and other tourniquet-related complications such as nerve palsy, venous thromboembolism, and delayed rehabilitation. RESULTS: A comparable bloodless surgical field was successfully provided in both groups (100% vs. 99%, p = 1.000). One case in the conventional pressure group and two cases in the lower pressure group showed intraoperative blood oozing (p = 1.000), which was successfully controlled after an increase of 30 mmHg in the tourniquet inflation pressure. There was no difference in the hemoglobin drop, drained volume, and calculated blood loss. The two groups did not differ in any safety outcomes such as post-operative pain, thigh complications, and other tourniquet related complications. CONCLUSION: This study demonstrates that a tourniquet inflation pressure of 120 mmHg above the SBP is effective method during TKA. TRIAL REGISTRATION: The trial was with ClinicalTrials.gov ( NCT01993758 ) on November 25, 2013.


Assuntos
Artroplastia do Joelho/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Osteoartrite do Joelho/cirurgia , Pressão/efeitos adversos , Torniquetes/efeitos adversos , Idoso , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/instrumentação , Pressão Sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Projetos Piloto , Estudos Prospectivos , Falha de Tratamento
17.
Undersea Hyperb Med ; 46(1): 17-33, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31154682

RESUMO

Crew survival in a distressed submarine (DISSUB) scenario may be enhanced by the knowledge of the risks of different types of decompression sickness (DCS) should the crew attempt tower escape. Four models were generated through calibration against DCS outcome data from 3,919 pressure exposures, each for the prediction of one of four categories of DCS: neurological, limb pain, respiratory and cutaneous. The calibration data contained details of human, goat, sheep and pig exposures to raised pressure while breathing air or oxygen/nitrogen mixtures. No exposures had substantial staged decompression or cases of suspected pulmonary barotrauma. DCS risk was scaled between species and with body mass. A parameter was introduced to account for the possibility of the occurrence of some symptom types masking others. The calibrated models were used to estimate likelihood of DCS occurrence for each symptom category following submarine tower escape. Escape depth was found to have a marked effect only on predicted rates of neurological DCS. Saturation at raised internal DISSUB pressure prior to escape was found to affect predicted rates of all symptom types. The iso-risk curves presented are offered as guidance to submarine crews and rescue forces in preparation for, or in the event of, a DISSUB scenario.


Assuntos
Doença da Descompressão/diagnóstico , Modelos Teóricos , Medicina Submarina , Avaliação de Sintomas , Animais , Calibragem , Cabras , Humanos , Militares , Modelos Animais , Pressão/efeitos adversos , Medição de Risco/métodos , Ovinos , Especificidade da Espécie , Suínos
18.
Aerosp Med Hum Perform ; 90(7): 655-659, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31227042

RESUMO

BACKGROUND: The evaluation of how air rarefaction can affect a loudspeaker performance at altitude implies the need for characterization of earphones during hypobaric conditions. The aim of this study was phonometric analysis at different altitudes of the acoustic output of a widely used earphone model, along with its consequences on audiological investigations conducted under such environmental conditions.METHODS: The transfer function of a TDH-39P earphone was analyzed with an artificial ear under nine different altitude levels, from sea level up to 35,000 ft, inside a hypobaric chamber. A specific phonometric system not sensitive to environmental pressure changes was used. Other potentially confounding factors, such as environmental temperature and humidity, were continuously monitored.RESULTS: No relevant temperature or humidity changes were detected. The sound pressure level generated by the earphone under hypobaric conditions was found considerably affected by air density changes. These data produced a correction table aiming at recalibrating the earphone's output at each audiometric octave test frequency within the 250-8000 Hz range. Quite different characteristics of response were observed at different audiometric frequencies. Such findings were particularly evident for altitudes exceeding 12,000 ft.DISCUSSION: The development of a frequency-selective and altitude-related correction factor for acoustic stimuli is an essential aspect when hearing threshold measurements in hypobaric environments are performed.Lucertini M, Botti T, Sanjust F, Cerini L, Autore A, Lucertini L, Sisto R. High altitude performance of loudspeakers and potential impact on audiometric findings. Aerosp Med Hum Perform. 2019; 90(7):655-659.


Assuntos
Medicina Aeroespacial/métodos , Audiometria/métodos , Limiar Auditivo/fisiologia , Hipóxia/fisiopatologia , Pressão/efeitos adversos , Estimulação Acústica , Medicina Aeroespacial/instrumentação , Altitude , Audiometria/instrumentação , Aviação , Humanos , Umidade , Temperatura
19.
J Tissue Viability ; 28(3): 125-132, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31174961

RESUMO

AIM: Prolonged mechanical loading on soft tissues adjacent to bony prominences can lead to pressure ulcers. The presence of moisture at the skin interface will lower the tolerance to load. Absorbent pads manage moisture in individuals with incontinence, although their role in maintaining skin health is unknown. The present study investigated the effects of moist incontinence pads on skin physiology after periods of mechanical loading. MATERIAL AND METHODS: Twelve healthy participants were recruited to evaluate a single incontinence pad design under three moisture conditions: 0% (dry), 50% and 100% fluid capacity. For each pad condition, pressure (9 kPa) or pressure in combination with shear (3 N) was applied to the sacrum, followed by a period of off-loading. Measures included trans-epidermal water loss (TEWL) and inflammatory biomarkers sampled at the skin interface. RESULTS: Results revealed no change in TEWL in the loaded dry pad condition. By contrast, when the pads contained moisture, significant increases in TEWL were observed. These increases were reversed during off-loading. Inflammatory biomarkers, specifically IL-1α/total protein ratio, were up-regulated during dry pad loading, which recovered during off-loading. Loaded moist pads caused a significant increase in biomarkers, which remained elevated throughout the test period. CONCLUSION: The study revealed a marked compromise to stratum corneum integrity when the skin was exposed to moist incontinence pads in combination with mechanical loads. These physiological changes were largely reversed during off-loading. Incontinence pads provided some protection in the dry state, although more research is required to determine optimal clinical guidance for their use.


Assuntos
Umidade/efeitos adversos , Tampões Absorventes para a Incontinência Urinária/normas , Pele/lesões , Adulto , Biomarcadores/análise , Biomarcadores/sangue , Inglaterra , Desenho de Equipamento/normas , Feminino , Voluntários Saudáveis/estatística & dados numéricos , Humanos , Umidade/prevenção & controle , Inflamação/sangue , Inflamação/diagnóstico , Interleucina-1alfa/análise , Interleucina-1alfa/sangue , Masculino , Pessoa de Meia-Idade , Pressão/efeitos adversos , Lesão por Pressão/fisiopatologia , Lesão por Pressão/prevenção & controle , Proteínas/análise , Pele/irrigação sanguínea , Pele/fisiopatologia , Higiene da Pele/métodos
20.
J Wound Ostomy Continence Nurs ; 46(3): 194-200, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31083062

RESUMO

PURPOSE: The purpose of this study was to compare the effect of pressure injuries on mortality, hospital length of stay, healthcare costs, and readmission rates in hospitalized patients. DESIGN: A case-control study. SUBJECTS AND SETTING: The sample comprised 5000 patients admitted to a tertiary hospital located in Seoul Korea; 1000 patients with pressure injuries (cases) were compared to 4000 patients who acted as controls. METHODS: We retrospectively extracted clinical data from electronic health records. Study outcomes were mortality, hospital length of stay, healthcare costs, and readmission rates. The impact of pressure injuries on death and readmission was analyzed via multiple logistic regression, hospital deaths within 30 days were analyzed using the survival analysis and Cox proportional hazards regression, and impact on the length of hospitalization and medical costs were analyzed through a multiple linear regression. RESULTS: Developing a pressure injury was significantly associated with an increased risk of in-hospital mortality (odds ratio [OR], 3.94; 95% confidence interval [CI], 2.91-5.33), 30-days in-hospital mortality (OR, 2.18; 95% CI, 1.59-3.00), and healthcare cost (ß = 11,937,333; P < .001). Pressure injuries were significantly associated with an extended length of hospitalization (ß = 20.84; P < .001) and length of intensive care unit (ICU) stay (ß = 8.16; P < .001). Having a pressure injury was significantly associated with an increased risk of not being discharged home (OR, 5.55; 95% CI, 4.35-7.08), along with increased risks of readmission (OR, 1.30; 95% CI, 1.05-1.62) and emergency department visits after discharge (OR, 1.70; 95% CI, 1.29-2.23). CONCLUSIONS: Development of pressure injuries influenced mortality, healthcare costs, ICU and hospital length of stay, and healthcare utilization following discharge (ie, readmission or emergency department visits). Hospital-level efforts and interdisciplinary approaches should be prioritized to develop interventions and protocols for pressure injury prevention.


Assuntos
Avaliação de Resultados da Assistência ao Paciente , Lesão por Pressão/complicações , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/organização & administração , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pressão/efeitos adversos , Lesão por Pressão/epidemiologia , Lesão por Pressão/mortalidade , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos
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